c l i n i c a l f o l i o s : d i s c u s s i o n




Related narratives: Schwannoma of the Brachial Plexus, Genitofemoral Schwannoma
Schwannoma of the Radial Nerve, Lumbar Plexus Schwannoma

Most peripheral nerve tumors arise from the Schwann cells of the nerve sheath which are of neural crest origin. Schwannomas are most often solitary and encapsulated. They displace nerve fibers and cause symptoms by compression. They are associated with type 2 neurofibromatosis. They are firm, slow growing and may exhibit xanthomatous change and areas of cystic degeneration. They can usually be shelled out without damage to the nerve. When located extradurally, they usually involve large nerves with mixed motor and sensory components. Schwannomas of the brachial plexus are very rare. Malignant degeneration in a Schwannoma is extremely rare.

Malignant Schwannoma is a separate entity arising from plexiform neuromas rather than malignant degeneration of a schwannoma. They are highly malignant sarcomas with aggressive local and eventual metastatic behavior. If the lesion in this case had evidenced signs of malignancy, the approach would have aimed at wide local excision including vascular resection and reconstruction.

Lesions near the superior thoracic aperture present technical difficulties for adequate exposure. A stage by stage approach allows progressive assessment of the exposure and safe resection with the least amount of morbidity. Further steps which could have been taken in this case include division of the anterior scalene, limited upper sternotomy, trap door incision and/or thoracotomy. There are rare case reports of intrathoracic extension of schwannomas of the superior aperture.


Canale: Campbells Operative Orthopedics, 9th ed, 1998: 751

Cotran: Robbins Pathologic Basis of Disease, 6th ed, 1999: 1352-1354

A case of schwannoma arising in the brachial plexus with intrathoracic extension Tokitsu K - Kyobu Geka - 1997 Jul; 50(7): 598-601

Cervical schwannoma: a case report and eight years review.
Ku HC - J Laryngol Otol - 2000 Jun; 114(6): 414-7

Neurinomas of the brachial plexus: case report.
Forte A - Eur Rev Med Pharmacol Sci - 1999 Jan-Feb; 3(1): 19-21

Axillary schwannoma masquerading as cervical radiculopathy.
Boutsen Y - Clin Rheumatol - 1999; 18(2): 174-6

Anterior cervical-transsternal approach for resection of benign tumors at the thoracic inlet Ladas G - Ann Thorac Surg - 1999 Mar; 67(3): 785-9

This page was last modified on 10-Jan-2001.