Ancient Schwannoma of Radial Nerve: A Rare Case Report

  • Nitika Chawla Department of Pathology, Bhagat Phool Singh, G.M.C. For Women, Khanpur Kalan, Sonepat, Haryana, India
  • Parul . Department of Pathology, Bhagat Phool Singh, G.M.C. For Women, Khanpur Kalan, Sonepat, Haryana, India
  • Pardeep . Department of Medicine, Pt B.D. Sharma PGIMS, Rohtak, Haryana, India
  • Kulwant Singh Department of Pathology, Bhagat Phool Singh, G.M.C. For Women, Khanpur Kalan, Sonepat, Haryana, India
  • Parveen Rana Department of Pathology, Bhagat Phool Singh, G.M.C. For Women, Khanpur Kalan, Sonepat, Haryana, India
  • Swaran Kaur Saluja Department of Pathology, Bhagat Phool Singh, G.M.C. For Women, Khanpur Kalan, Sonepat, Haryana, India
Keywords: Ancient schwannoma, neural tumor, radial nerve

Abstract

Introduction Schwannoma is a benign tumor of nerve sheath origin. Ancient schwannomas were first described by Ackerman and Taylor in 1951. In the upper limb, the ulnar and median nerves are the primary nerves of flexor surfaces where schwannomas typically arise. The radial nerve is involved in just 7% of peripheral schwannomas. Case Report A 25-year-old male presented to the surgery OPD with a history of forearm swelling for 5 years. On ultrasonography (USG), there was a hypoechoic lesion in the anterior aspect of the forearm. Based on the long duration, clinical examination, and imaging, a diagnosis of benign nerve sheath tumor was made. Excision biopsy was performed, and a globular grey-white tissue piece measuring 2.5x1.5 cm was received in the Department of Pathology. Sections from the globular mass revealed a well-circumscribed tumor with oval to spindle cells randomly arranged within myxoid stroma. There were areas of marked degenerative changes with occasional interspersed hypocellular areas. Immunohistochemistry (IHC) was applied to further confirm the origin of these cells. These cells were positive for vimentin and S-100. The final diagnosis, based on histomorphological features and IHC, was given as ancient schwannoma. Conclusion Ancient schwannomas involving the radial nerve are very rare. They can be confused with malignant peripheral nerve sheath tumors on imaging due to degenerative features and nuclear pleomorphism. Histopathological examination along with IHC is crucial in the diagnosis of these rare tumors. We report the fourth case of an ancient schwannoma in the upper extremity involving the radial nerve.

References

Zachariades N. Schwannoma of the oral cavity: review of the literature and report of a case. J Oral Med. 1984;39:41-3.

Adani R, Baccarani A, Guidi E, Tarallo L. Schwannomas of the upper extremity: diagnosis and treatment. Chir Organi Mov. 2008;92(2):85-8.

Bhat AK, Acharya AM, Narayanakurup JK, Shankar V. Ancient Schwannoma of Radial Nerve: A Report of Two Cases. J Hand Surg Asian-Pac Vol. 2017;22(4):526-30.

Moreno-García C, Pons-García MA, González-García R, Monje-Gil F. Schwannoma of tongue. J Maxillofac Oral Surg. 2014;13(2):217-21.

Rockwell GM, Thoma A, Salama S. Schwannoma of the hand and wrist. Plast Reconstr Surg. 2003;111(3):1227-32.

Takase K, Yamamoto K, Imakiire A. Clinical pathology and therapeutic results of neurilemmoma in the upper extremity. J Orthop Surg (Hong Kong). 2004;12(2):222-5.

Ogose A, Hotta T, Morita T, Yamamura S, Hosaka N, Kobayashi H, Hirata Y. Tumors of peripheral nerves: correlation of symptoms, clinical signs, imaging features, and histologic diagnosis. Skeletal Radiol. 1999;28(4):183-8.

Weiss SW, Goldblum JR, Enzinger FM. Benign tumours of the peripheral nerves. In: Weiss S, Goldblum JR, Enzinger and Weiss’s soft tissue tumours. 4th ed. St. Louis: Mosby; 2001. p. 1111-208.

Forthman CL, Blazar PE. Nerve tumors of the hand and upper extremity. Hand Clin. 2004;20(3):233-42.

Ackerman LV, Taylor FH. Neurogenous tumors within the thorax; a clinicopathological evaluation of forty-eight cases. Cancer. 1951;4(4):669-91.

Malizos K, Ioannou M, Kontogeorgakos V. Ancient schwannoma involving the median nerve: a case report and review of the literature. Strategies Trauma Limb Reconstr. 2013;8(1):63-6.

Phan D, Ton NTM, Bui THK, Tran HNA, Truong VT. Ancient Schwannoma of the Radial Nerve: A Case Report. Cureus. 2023;15(8)

Subhashraj K, Balanand S, Pajaniammalle S. Ancient schwannoma arising from mental nerve. A case report and review. Med Oral Patol Oral Cir Bucal. 2009;14(1)

Published
11-07-2024
Section
Case Report