Benign solitary schwannomas

Abstract

We reviewed 234 benign solitary schwannomas treated between 1984 and 2004. The mean age of the patients was 45.2 years (11 to 82). There were 170 tumours (73%) in the upper limb, of which 94 (40%) arose from the brachial plexus or other nerves within the posterior triangle of the neck. Six (2.6%) were located within muscle or bone. Four patients (1.7%) presented with tetraparesis due to an intraspinal extension. There were 198 primary referrals (19 of whom had a needle biopsy in the referring unit) and in these patients the tumour was excised. After having surgery or an open biopsy at another hospital, a further 36 patients were seen because of increased neurological deficit, pain or incomplete excision. In these, a nerve repair was performed in 18 and treatment for pain or paralysis was offered to another 14. A tender mass was found in 194 (98%) of the primary referrals. A Tinel-like sign was recorded in 155 (81%). Persistent spontaneous pain occurred in 60 (31%) of the 194 with tender mass, impairment of cutaneous sensibility in 39 (20%), and muscle weakness in 24 (12%). After apparently adequate excision, two tumours recurred. No case of malignant transformation was seen.

Schwannoma of the Lower Leg with Malignant Transformation. A Case Report

“…She did not return for check-ups in our department, nor did she ever present to the oncology department requesting treatment. [4,5] . They usually grow slowly and eccentrically to the nerve fibre, and are thus encapsulated by the perineurium [4] .…”

“…They usually grow slowly and eccentrically to the nerve fibre, and are thus encapsulated by the perineurium [4] . Most cases develop between 20 and 50 years of age, with equal sex distribution, the most affected sites being the head and neck and the flexor surface of the extremities [4,5] . Macroscopically, schwannomas are well circumscribed, round or oval whitish solid tumours, while microscopically they present a biphasic pattern with areas of highly organized spindle cells (Antoni A area) and less organized, hypocellular areas where myxoid tissue predominates (Antoni B area), surrounded by a true capsule.…”

“…The originating nerve may be seen entrapped at the periphery of the tumour or along one border of the tumour. Immunohistochemistry shows expression of S-100 protein [3][4][5] . Malignant transformation of schwannomas is rare.…”

Giant schwannoma of the axilla: a case report

“…Schwannomas can occur in isolation or as part of syndromes such as neurofibromatosis I and neurofibromatosis II. In 73% of cases, solitary benign schwannomas affect the upper limbs [2]. They can also appear in other areas, for example, on the inner thoracic wall [3], the retroperitoneum [4], or the orbita [5].…”

Peripheral nerve injuries

“…Of the 24 patients with lower limb schwannomas only 3 developed a Grade 3 motor deficit. Knight et al [17] found 28 patients to have neurological deficit and/or pain after excision of schwannomas. Factors to try to reduce the neurological deficit include; avoiding unnecessary biopsy, air tourniquet use for good vision under microscope, intracapsular approach, limited incision of the epineurium, atraumatic dissection, no en bloc resection if traumatic, adequate drainage to prevent hematoma formation and to raise the affected limb.…”