Arch Hand Microsurg.  2022 Mar;27(1):88-92. 10.12790/ahm.21.0136.

Multiple ancient schwannomas of the ulnar nerve at distant sites: a case report

• Yoon T
• Hong KY

• KMID: 2526655
• DOI: http://doi.org/10.12790/ahm.21.0136

Abstract

In rare cases, schwannoma—a benign peripheral nerve tumor—undergoes chronic degenerative changes and progresses to ancient schwannoma. Herein, we report the first case of ulnar nerve-derived multiple ancient schwannomas, which uncommonly developed in the extremities and major nerves. A 76-year-old female patient presented with tingling sensations in her left ring and small fingers. She had a gradually enlarging mass that had developed 40 years ago in the proximal upper arm and a new mass that had grown on the wrist for the past few years. Based on physical examination, ultrasonography, and magnetic resonance imaging, ancient schwannomas of the ulnar nerve were suspected. The older and larger mass in the upper arm was more entangled with nerve fascicles, having necrotic changes. Through meticulous dissection of the nerve fascicles, both masses were successfully enucleated, and pathological examination confirmed ancient schwannoma. As ancient schwannomas grow, they become more entangled with the nerves; thus, early surgical removal is recommended.

Keyword

Schwannoma; Ulnar nerve; Ulnar neuropathies

Figure

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  Fig. 1. Multiple masses presented in the posteromedial aspect of the patient’s left upper arm and wrist. A 4-cm firm, painless mass was palpated on the patient’s left upper arm (arrow). A 0.5-cm firm, painless mass was palpated on the patient’s wrist (dotted arrow).

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  Fig. 2. Ultrasound and magnetic resonance T1 imaging. On ultrasound imaging, well-circumscribed heterogeneous echoic masses with internal calcification and internal vascularity originating from the ulnar nerve are observed in the subcutaneous layer of the upper arm (A) and wrist (B). The hyaline degeneration, cystic change, calcification, and hemorrhage observed on a magnetic resonance image of the upper arm mass are typical characteristics of ancient schwannoma (C, D).

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  Fig. 3. Multiple ancient schwannomas of the upper arm (A and B) and wrist (C and D) from the ulnar nerve. (A, C) Ancient schwannomas originating from the ulnar nerve are surrounded by nerve fascicles. (B, D) The masses are resected from the upper arm and forearm with minimal nerve damage through meticulous dissection. (E, F) Multiple ancient schwannomas are enucleated from the ulnar nerve of the left arm.

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  Fig. 4. Enucleated ancient schwannomas, magnified image, and immunohistochemical staining. The upper arm mass had developed for a longer period than the wrist mass. Hence, it is larger (A) and more entangled with the nerve fascicles (B). (C) Immunohistochemical staining is positive for S-100, a typical feature of schwannoma (×40).

Reference

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