Arch Hand Microsurg.  2024 Jun;29(2):105-109. 10.12790/ahm.24.0006.

Neglected very large ancient schwannoma of the distal wrist: a case report and literature review

• Lee HR
• Yun Y
• Kwak HJ
• Kang JH

• KMID: 2556360
• DOI: http://doi.org/10.12790/ahm.24.0006

Abstract

Ancient schwannoma is a variant of schwannoma characterized by slow progression, degenerative changes, and a higher incidence in older adults. There have been two prior reported cases of ancient schwannoma arising from the distal ulnar nerve at the wrist level, but neither were longstanding or very large. Herein, we report an ancient schwannoma found in the ulnar nerve of the distal forearm that was found to be clinically meaningful in size. A 61-year-old man presented with complaints of tingling sensation of the fourth and fifth fingers and bulging of the ulnar side of the wrist. The patient reported that the mass in his wrist had grown very slowly, starting about 10 years ago, and that he had started experiencing a tingling sensation in his fourth and fifth fingers about 3 years prior, which had become worse in the past year. Based on the results of the preoperative examination, a benign nerve sheath tumor was suspected. As it was thought that the possibility of malignancy was not high, we elected to perform a marginal excision. Pathological examination confirmed ancient schwannoma. At his most recent visit, 3 years after surgery, he reported no recurrence and that he felt better than before surgery, but some tingling sensations remained. As with small ancient schwannoma in the distal wrist, most cases of large ancient schwannoma can be treated without special complications based on an accurate preoperative diagnosis.

Keyword

Neurilemmoma; Schwannoma; Ulnar nerve

Figure

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  Fig. 1. T1-weighted imaging (T1WI) showing overall low signal intensity (A) and T2-weighted imaging (T2WI) showing a mix of high and low signal intensity (B). (C) Several areas inside the mass showed low signal intensity (degenerative areas) on both contrast-enhanced T1WI and T2WI.

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  Fig. 2. The mass was located in the ulnar nerve in an eccentric fashion and was removed with minimal damage to the nerve.

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  Fig. 3. (A) The tissue showing nodular cellularity with irregular vascular channels and fibrinodegenerative area (H&E, ×40). (B) Prominent streaming fascicles of spindle cells (Antoni A tissue) are noted (H&E, ×100).

Reference

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