Research Articles

Schwannoma of the Upper Extremity: A Clinical Series

Abstract

Background: Schwannoma, the most common primary neural tumor of the upper extremity, arises from Schwann cells of the nerve sheet. The tumor is usually painless and slow-growing. Symptomatic masses could be treated through intra- or extra-capsular excision. Herein, we aim to evaluate the long-term results of surgical treatment of 12 cases of upper extremity Schwannoma.
Methods: Twelve cases of confirmed Schwannoma who were treated in Imam Khomeini University Hospital, Tehran, Iran, from 2011 to 2022, were included in our case series. All operations were done using loupe magnification or under a microscope. Age, sex, location of the mass, size of the tumor, affected nerve, histological diagnosis, and clinical follow-up, including the neurological status of the patients, were documented.
Results: Twelve patients with a mean age of 44 years were included. Seven (58.3%) were men and five (41.66%) were women. The mean follow-up period was 45 months (range: 6-135). The hand was the most common location of involvement and the digital nerve was the most frequent origin of Schwannoma. Postoperative evaluation showed no tumor recurrence and pain resolved in all twelve patients (100%). Sensory dysfunction resolved completely in 5 out of 8 patients who reported sensory impairment preoperatively (62.5%) and no motor function improvement was seen in the patient with motor deficit.
Conclusion: Adequate operative techniques can lead to complete tumor removal without neurological loss or recurrence. Neural function improvement in most cases is achieved. New neurologic impairment after excision of Schwannoma is rare.

1. Holdsworth BJ. Nerve tumours in the upper limb. A clinical review. J Hand Surg Br. 1985;10(2):236-8. doi: 10.1016/0266- 7681(85)90026-9. [PubMed: 4031612].
2. Forthman CL, Blazar PE. Nerve tumors of the hand and upper extremity. Hand Clin. 2004;20(3):233-42. doi: 10.1016/j.hcl.2004.03.003. [PubMed: 15275682].
3. Takase K, Yamamoto K, Imakiire A. Clinical pathology and therapeutic results of neurilemmoma in the upper extremity. J Orthop Surg (Hong Kong). 2004;12(2):222-5. doi: 10.1177/230949900401200216. [PubMed: 15621911].
4. Kang HJ, Shin SJ, Kang ES. Schwannomas of the upper extremity. J Hand Surg Br. 2000;25(6):604-7. doi: 10.1054/jhsb.2000.0472. [PubMed: 11106529].
5. Artico M, Cervoni L, Wierzbicki V, D'Andrea V, Nucci F. Benign neural sheath tumours of major nerves: Characteristics in 119 surgical cases. Acta Neurochir (Wien). 1997;139(12):1108-16. doi: 10.1007/BF01410969. [PubMed: 9479416].
6. Peksa R, Izycka-Swieszewska E, Rzepko R, Szurowska E. Central and peripheral neural schwannomas – morphological and immunohistochemical study and analysis of the vascularization. Ann Acad Med Gedan. 2008;38:71-81.
7. Jerzy G, Roman R, Jerzy R. Peripheral nerve tumours in own material. Folia Neuropathol. 2004;42(4):203-7. [PubMed: 15679038].
8. Sa A, Nobre AL, Cunha L. Schwannoma of the upper extremity: Retrospective analysis of 17 cases. Acta Med Port. 2016; 29(9):519-24. [In Portuguese]. doi: 10.20344/amp.6906. [PubMed: 28060689].
9. Patel MR, Mody K, Moradia VJ. Multiple schwannomas of the ulnar nerve: A case report. J Hand Surg Am. 1996;21(5):875-6. doi: 10.1016/S0363-5023(96)80207-3. [PubMed: 8891988].
10. Gonzalvo A, Fowler A, Cook RJ, Little NS, Wheeler H, McDonald KL, et al. Schwannomatosis, sporadic schwannomatosis, and familial schwannomatosis: A surgical series with long-term follow-up. Clinical article. J Neurosurg. 2011;114(3):756-62. doi: 10.3171/2010.8.JNS091900. [PubMed: 20932094].
Miles SJ, Amirfeyz R, Bhatia R, Leslie I. (ii) Benign soft tissue tumours of the hand. Orthop Trauma. 2010;24(3):181-5. doi: https://doi.org/10.1016/j.mporth.2010.05.005.
Siqueira MG, Socolovsky M, Martins RS, Robla-Costales J, Di Masi G, Heise CO, et al. Surgical treatment of typical peripheral schwannomas: The risk of new postoperative deficits. Acta Neurochir (Wien). 2013;155(9):1745-9. doi: 10.1007/s00701-013- 1818-6. [PubMed: 23873125].
Date R, Muramatsu K, Ihara K, Taguchi T. Advantages of intra- capsular micro-enucleation of schwannoma arising from extremities. Acta Neurochir (Wien). 2012;154(1):173-8. doi: 10.1007/s00701-011-1213-0. [PubMed: 22072218].
Adani R, Baccarani A, Guidi E, Tarallo L. Schwannomas of the upper extremity: Diagnosis and treatment. Chir Organi Mov. 2008;92(2):85-8. doi: 10.1007/s12306-008-0049-0. [PubMed: 18612585].
Lee SH, Jung HG, Park YC, Kim HS. Results of neurilemoma treatment: A review of 78 cases. Orthopedics. 2001;24(10):977- 80. doi: 10.3928/0147-7447-20011001-18. [PubMed: 11688777].
Park MJ, Seo KN, Kang HJ. Neurological deficit after surgical enucleation of schwannomas of the upper limb. J Bone Joint Surg Br. 2009;91(11):1482-6. doi: 10.1302/0301-620X.91B11.22519. [PubMed: 19880894].
Sawada T, Sano M, Ogihara H, Omura T, Miura K, Nagano A. The relationship between pre-operative symptoms, operative findings and postoperative complications in schwannomas. J Hand Surg Br. 2006;31(6):629-34. doi: 10.1016/j.jhsb.2006.06.008. [PubMed: 16928412].
Kim SM, Seo SW, Lee JY, Sung KS. Surgical outcome of schwannomas arising from major peripheral nerves in the lower limb. Int Orthop. 2012;36(8):1721-5. doi: 10.1007/s00264-012- 1560-3. [PubMed: 22562391]. [PubMed Central: PMC3535020].
19.Tang CY, Fung B, Fok M, Zhu J. Schwannoma in the upper limbs. Biomed Res Int. 2013;2013:167196. doi: 10.1155/2013/167196. [PubMed: 24093090]. [PubMed Central: PMC3777180].
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IssueVol 10 No 1 (2024) QRcode
SectionResearch Articles
DOI https://doi.org/10.18502/jost.v10i1.14967
Keywords
Soft Tissue Neoplasms Neurilemmoma Schwann Cells Upper Extremity
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How to Cite
1.
Azaditalab H, Farzan A, Hamdollahzadeh H, Shayan Moghadam R, Soleymani M. Schwannoma of the Upper Extremity: A Clinical Series. J Orthop Spine Trauma. 2024;10(1):28-30.