Successful enucleation of large multinodular/plexiform schwannoma of the foot and ankle
Successful enucleation of large multinodular/plexiform schwannoma of the foot and ankle
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DOI：
10.1186/s40064-015-1087-3
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发表时间：
2015-06-17
期刊：
影响因子：
--
通讯作者：
Naito, Masatoshi
中科院分区：
文献类型：
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作者：
Nishio, Jun;Mori, Shun;Naito, Masatoshi
背景资料：它往往是具有挑战性的，以完全切除多结节/丛状神经鞘瘤涉及重要的深部nerves.Case描述：一个32岁的女性提出了一个缓慢增长的5年的历史，在内侧的右脚踝疼痛的质量。磁共振成像（MRI）显示多发结节性病变，T1加权序列上相对于骨骼肌呈等信号，T2加权序列上呈不均匀高信号。钆给药后发现轻度至中度增强。所有58个肿瘤均采用囊内技术完全摘除。组织学检查证实诊断为神经鞘瘤，主要由安东尼A区组成。术后烧灼感立即缓解。患者没有加重神经功能缺损，并非常满意的治疗结果，在最后follow-up.Discussion和评价：我们经历了一个非常罕见的情况下，一个大的多结节/丛状神经鞘瘤所产生的胫后神经及其较大的终端分支。我们的病例具有这种情况的特征性MRI特征。这是非常重要的，以区分多结节/丛状神经鞘瘤丛状神经纤维瘤和恶性周围神经鞘肿瘤，与完全手术摘除是cured.Conclusions：MRI是一个临床上有用的方式在评价和检测深层次的多结节/丛状神经鞘瘤。囊内摘除术似乎是一个可以接受的治疗这种特殊的肿瘤位于足部和踝关节。
Background: It is often challenging to completely resect multinodular/plexiform schwannomas involving important deep nerves using minimally invasive surgically techniques.Case description: A 32-year-old woman presented with a 5-year history of a slowly growing, painful mass in the medial aspect of the right ankle. Magnetic resonance imaging (MRI) demonstrated multiple nodular lesions with iso-signal intensity relative to skeletal muscle on T1-weighted sequences and heterogeneous high signal intensity on T2-weighted sequences. Mild to moderate enhancement was identified after gadolinium administration. All 58 tumors were completely enucleated using an intracapsular technique. Histological examination confirmed the diagnosis of schwannoma consisting mainly of Antoni A areas. The burning sensation was relieved immediately after surgery. The patient had no aggravated neurological deficit and was very satisfied with the outcome of the treatment at final follow-up.Discussion and evaluation: We experienced a very rare case of a large multinodular/plexiform schwannoma arising from the posterior tibial nerve and its larger terminal branch. Our case had the characteristic MRI features of this condition. It is extremely important to differentiate multinodular/plexiform schwannoma from plexiform neurofibroma and malignant peripheral nerve sheath tumor, with complete surgical enucleation being curative.Conclusions: MRI is a clinically useful modality in the evaluation and detection of deep-seated multinodular/plexiform schwannoma. Intracapsular enucleation seems to be an acceptable treatment for this peculiar tumor located in the foot and ankle.