gms | German Medical Science

Objectives/Interrogation: Schwannoma is a rare nerve benign tumour, caled by a German physiologist Theodor Schwann. Tumour develops from the Schwann cells of the nerve sheat. There is also a malignant form of the schwannoma, but it is very rare (about 1%). Schwannoma can occur anywhere, but the most often it affects the vestibular nerve. Different sizes of the peripheral nerves schwannoma are described. So, the aim of this report is to present relatively rare and large form of this tumour at the median nerve.

We present the case of a 46 years old male patient with subcutaneous visible tuberous tumour of the anterior region on the lower border of the distal third of left forearm, which existed about one year. Tumour was round, well-defined, soft, non-pulsatile, painful on palpation. Ultrasound and MRI examinations were done. Under the tournique control, extirpation of the tumour was done with complete preservation of the median nerve. Dimensions of the tumour were 5.1x4.8x3.8cm. Pathological examination, including immunohistochemistry, showed benign schwanoma. One year after the surgery, there were no signes of reccurence, and hand function was normal.

Methods: Case report

Results and Conclusions: Schwannoma, also known as neurilemmona, is the most common peripheral nerve tumour. This tumour is seen in all ages, both sexes, and in all regions of the body. This is a solid tumour. Growth of the schwannoma is slow, and often painless. Median nerve is described as one of the localization of the schwannoma. Other tumours of this nerve are also possible. The terme large tumour is usually used when it affects significant part of the organ or some region.

Every subcutaeus mass should be taken seriosly, especialy if it is long lasting, large, and located in some specific parts of the body. Besides careful physical examination, additional diagnostic procedures are sometimes necessary, such as ultrasound, CT and MRI. Distal forearm and hand are one of important regions because of the fact that many different structures are located on small areas. Proper diagnostic procedures, surgery under tourniquet control and trained surgeon for hand surgery, as well modern histopathological examination are mandatory. Despite the fact that many common subcutaneus masses in this regions, such as lipoma and ganglion are the more frequent, detailed examinaton should be done before surgery, as we can see from this relatively rare case.