From numbness to diagnosis: a case of median nerve schwannoma

Nandu Krishnan; Jatinder Kumar Singla; Rajat Gupta; Vishal Gautam

doi:10.18203/issn.2455-4510.IntJResOrthop20243918

Authors

Nandu Krishnan Department of Orthopaedics, Indiana Hospital and Heart Institute, Mangalore, Karnataka, India
Jatinder Kumar Singla Department of Orthopaedics and Joint replacement, Arthroscopy and Sports Injury, Max Super Speciality hospital, Mohali, Punjab, India
Rajat Gupta Department of Orthopaedics and Orthopaedic Oncology, Fortis Hospital, Mohali, Punjab, India
Vishal Gautam Department of Orthopaedics and Hand Surgery, Fortis Hospital, Mohali, Punjab, India

DOI:

https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20243918

Keywords:

Median nerve schwannoma, Tinels sign, Antoni A area, Antoni B area, Verocay bodies

Abstract

Schwannomas are a common entity, but upper limb schwannomas are rarely encountered. Even in hand, ulnar nerve schwannomas are more commonly reported than median nerve schwannomas. Hence, we present a case report of median nerve schwannoma in a 54-year-old woman. She presented with a benign swelling of 3 cm associated with numbness and pain. On examination, Tinels sign was positive. MRI revealed a well-defined swelling that was hypointense on T1 and hyperintense on T2 STIR images. The swelling was marginally excised, and histopathology revealed the presence of Antoni A and B cells, consistent with Schwannoma. The patient was completely asymptomatic at 1-month follow-up. This case report stands as a testament to how early diagnosis and treatment can help in alleviating the physical as well as psychological stress in such patients.

Metrics

Metrics Loading ...

References

Artico M, Cervoni L, Wierzbicki V, D’Andrea V, Nucci F. Benign neural sheath tumours of major nerves: Characteristics in 119 surgical cases. Acta Neurochirurgica. 1997;139(12):1108–16.

Boufettal M, Azouz M, Rhanim A, Abouzahir M, Mahfoud M, Bardouni AE, et al. Schwannoma of the median nerve: diagnosis sometimes delayed. Clin Med Insigh Case Rep. 2014;7:16686–6.

3] Padasali PraveenS, Shankaregowda VS, Kshirsagar ShriramD. Median nerve schwannoma: A case and review of literature. Asian J Neurosurg. 2015;10(3):212.

Komurcu E, Kaymaz B, Adam G, Gokmen F, Murath A. A hybrid schwannoma of median nerve. Journal of the College of Physicians and Surgeons--Pakistan: JCPSP. 2014. Available at: pubmed.ncbi.nlm.nih. Accessed on 12 August 2024.

Harkin JC, Reed RS. Tumors of the Peripheral Nervous System. Washington DC: Armed Forces Institute of Pathol. 1968:110–6.

Aydin M, Kotan D, Keles M. Acute median nerve palsy due to hemorrhaged schwannoma: case report. J Brachial Plexus and Periph Nerve Inj. 2014;02(01):75–7.

Louis DS, Hankin FM. Benign nerve tumors of the upper extremity. Bulletin of the New York Academy of Med. 2023;61(7):45.

Knight DMA, Birch R, Pringle J. Benign solitary schwannomas. J Bone and Joint Surg. 2007;89(3):382–7.

Adani R, Baccarani A, Guidi E, Tarallo L. Schwannomas of the upper extremity: Diagnosis and treatment. La Chirurgia degli Organi di Movimento. 2008;92(2):85–8.

Ozdemir O, Kurt C, Coskunol E, Calli I, Ozsoy M. Schwannomas of the hand and wrist: long-term results and review of the literature. J Orthop Surg. 2005;13(3):267–72.

Sandberg K, Nilsson J, Nikoline Juul Nielsen, Dahlin LB. Tumours of peripheral nerves in the upper extremity: A 22-year epidemiological study. Scandinavian J Plas and Reconstruct Surg Hand Surg. 2009;43(1):43–9.

Kütahya H, Güleç A, Güzel Y, Kacira B, Toker S. Schwannoma of the median nerve at the wrist and palmar regions of the hand: a rare case report. Case Rep in Orthoped. 2013;2013:1–4.

Malizos KN, Ioannou M, Vasileios Kontogeorgakos. Ancient schwannoma involving the median nerve: a case report and review of the literature. Strategies in Trauma and Limb Reconstruction. 2013;8(1):63–6.

Eroglu U, Yakar F, Zaimoglu M, Ozgural O, Kahilogulları G. Median nerve schwannoma. ANZ J Surg. 2018;89(9):1158–9.