Multiple huge ancient neurilemmomas arising from superficial peroneal nerve: a case report

Abstract

Neurilemmomas, also known as schwannomas, present as encapsulated, slow-growing, solitary, smooth-surfaced, and usually asymptomatic mass arising from Schwann cells of the nerve sheath surrounding cranial or peripheral nerves. They represent the most prevalent benign peripheral nerve sheath tumours and the occurrence in the upper extremity accounts for 12 to 19% and in the lower extremity for 13.5 to 17.5% of all cases. Schwannomas of the superficial peroneal nerve are very rare, and one can find in the literature only a few cases in the last 20 years. The smallest reported spinal giant schwannoma was of size 3 cm × 2 cm × 3 cm while the largest size reported of the same was 10 cm × 10 cm × 12 cm. We present a case report of a 54-year-old male with multiple huge ancient neurilemmomas arising from superficial peroneal nerve of 17 years’ duration. As the ultrasonography reported a hypoechoic mass in the left leg, antero-lateral muscular compartment with increased vascularity and magnetic resonance imaging (MRI) suggested large elongated lesion with multiple areas of haemorrhages; the primary diagnosis was made as vascular malformation. It was only after surgical exploration, three tumour masses were found arising from superficial peroneal nerve of sizes 15 × 6 cm, 2 × 2 cm, and 1 × 1 cm. The tumour was completely removed with meticulous dissection. Even though few fascicles of superficial peroneal nerve had to be sacrificed during excision, the patient recovered well with no neurological deficit.

Level of evidence: Level V, therapeutic study.

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Authors

Contributions

The outline and intellectual content were described by RP and KM. The manuscript writing and literature review was done KM and SN. Final review and critical appraisal were done by RP. The approval for the final version to be published given by RP. KM is accountable for all aspects of the work. All the authors have seen and approve the final version of the manuscript for the publication.

Corresponding author

Correspondence to Kiran S. Mahapure.

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Conflict of interest

All authors Rajesh S Powar, Kiran S Mahapure, and Saipriya Natrajan declare that they have no conflict of interest.

Ethical approval

This is a case report. The Institutional Ethics Committee has confirmed that no ethical approval is required.

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Informed consent was obtained from the patient included in the study. The Patients signed informed consent regarding publishing their data and photographs without their name and identifying details.The participant has consented to the submission of the case report to the journal.

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Appropriate written and informed consent was obtained from the patient for publication of the clinical data after de-identification/removing the personal details.

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Prior presentation

The case report was presented as e-poster in 78th Annual Conference of the Association of Surgeons of India, ASICON 2018, Chennai.

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Powar, R.S., Mahapure, K.S. & Natrajan, S. Multiple huge ancient neurilemmomas arising from superficial peroneal nerve: a case report. Eur J Plast Surg (2021). https://doi.org/10.1007/s00238-020-01774-1

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Keywords

  • Neurilemmoma
  • Schwannoma
  • Superficial peroneal nerve sheath tumour