J Korean Soc Surg Hand.  2015 Sep;20(3):133-137. 10.12790/jkssh.2015.20.3.133.

The Importance of Preoperative Imaging Study on a Solitary Neurofibroma Originated from the Digital Nerve

• Han HH
• Choi JY
• Moon SH

• KMID: 2068819
• DOI: http://doi.org/10.12790/jkssh.2015.20.3.133

Abstract

This case is about a rare type of a solitary neurofibroma that originated from the digital nerve between the proximal phalanx of a finger and the web space, which was first misdiagnosed as giant cell tumor, ganglionic cyst, or fibroma originating from the tendon before radiologic studies were done. The preoperative magnetic resonance imaging (MRI) showed a non-enhanced well-circumscribed mass and the digital nerve was deviated to the volar-medial side due to the mass effect. Since neurofibroma is difficult to differentiate from others by physical examination, crucial information such as the connection between the mass and the nerve or the deviation of the digital nerve can be obtained by MRI findings. And it is important to plan the surgery safely from this information.

Keyword

Digital nerve; Neurofibroma; Preoperative imaging

MeSH Terms

Fibroma
Fingers
Ganglion Cysts
Giant Cell Tumors
Magnetic Resonance Imaging
Neurofibroma*
Physical Examination
Tendons

Figure

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  Fig. 1. Preoperative photograph shows diffuse swelling (black arrow) of the middle finger, without overlying skin changes.

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  Fig. 2. (A) Neurofibroma which has a clear margin and connects to the radial digital nerve sheath with a low signal on T1-weighted images. (B) Neurofibroma with a non-enhanced high signal on T2-weighted images. Neurovascular bundle is deviated to the volar central portion.

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  Fig. 3. A diagram of a solitary neurofibroma and a digital nerve shows the radial digital nerve(a) deviated to the midvolar side by the neurofibroma(b) and the incision design(c). Approaching towards the volar side of the finger could increase the chance of the digital nerve injuries.

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  Fig. 4. Intraoperative photograph shows a neurofibroma attached to a digital nerve sheath by a stalk. Black arrow, radial digital nerve.

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  Fig. 5. (A) Irregular arranged spindle cells with enlongated and wavy nuclei in a myxoidstroma with thin collagen fibers scattered in between seen in H&E staining (×200). (B) Staining with S-100 protein helps detecting schwann cell origin tumors. Immunochemistry by S-100 shows deep brown colored cells (×200).

Reference

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