Segmental schwannomatosis of tibial nerve-A case report

Chia-Hung Liu ； Chih-Hwa Chen ； Jeffrey Chun-Ying Wu ； Chin-Chean Wong ； Yang-Hwei Tsuang

《Formosan Journal of Musculoskeletal Disorders》 預刊文章 Pp. 1-5

https://doi.org/10.6492/FJMD.201907/PP.0003

摘要

This article describes a rare case of segmental schwannomatosis in a 57-year-old woman presented to the out-patient clinic with a 4-year history of left knee popliteal mass but a recent onset episode of progressive lower leg painful numbness. Physical examination revealed two firm masses in her popliteal fossa. A light percussion over the masses induced tingling sensation radiating out into the lower leg. T2-weighted sequence magnetic resonance imaging (MRI) of the knee showed two separate but adjacent hyper-intense masses along the tract of tibial nerve. Surgical exploration revealed two well-defined mass lesions in the popliteal fossa that closely intertwined with tibial nerve. After marginal excision, the results of pathological testing demonstrated classical Antoni-A area with nuclei palisading and Antoni B hypocellular myxoid area, which were consistent with schwannoma. Due to the anatomically-limited schwannomas in one limb with no evidence of cranial nerve dysfunction nor dermatological manifestation, the patient was finally diagnosed with segmental schwannomatosis. After operation, she complained transient numbness over dorsum of the left foot and left ankle dorsiflexion weakness. At follow-up 4 months after operation, she had full recovery of neurological functions. The aim of this article is to emphasize the significance of MRI as diagnostic tool in patient with schwannoma. Moreover, we reviewed relevant literature of segmental schwannomatosis, with focus on clinical presentations, diagnosis, and postoperative surgical outcomes.

關鍵字

neurofibromatosis type 2 ； peripheral nerve tumors ； schwannomas ； schwannomatosis ； segmental schwannomatosis