Submit Your Article CMED MEACR meeting
Home Print this page Email this page Users Online: 744
Home About us Editorial board Search Ahead of print Current issue Archives Submit article Instructions Subscribe Contacts Login 


 
 Table of Contents  
CASE REPORT
Year : 2015  |  Volume : 4  |  Issue : 6  |  Page : 720-722

Sciatic schwannoma: A rare entity


Department of Pathology, Pt. B.D. Sharma, PGIMS, Rohtak, Haryana, India

Date of Web Publication9-Nov-2015

Correspondence Address:
Megha Ralli
30/32 West Patel Nagar, New Delhi - 110 008
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2278-0513.169113

Rights and Permissions
  Abstract 

Schwannomas are one of few truly encapsulated neoplasms of human body. These are composed of Schwann cells. In general, schwannomas have a predilection for the head, neck, mediastinum, and retroperitoneal regions, sciatic nerve involvement is rare. The patient presents with pain in hip region radiating along the lateral side of leg, may be associated with other neurological signs and symptoms. Treatment of symptomatic schwannomas consists of marginal excisional resection with emphasis on identification of the nerve fascicles and excision of the tumor stalk. Here, we present a case of sciatic schwannoma in a young female, which was diagnosed on histopathology.

Keywords: Pelvic pain, schwannoma, sciatic


How to cite this article:
Kumar S, Ralli M, Sharma J, Sansanwal P, Singh G. Sciatic schwannoma: A rare entity. Clin Cancer Investig J 2015;4:720-2

How to cite this URL:
Kumar S, Ralli M, Sharma J, Sansanwal P, Singh G. Sciatic schwannoma: A rare entity. Clin Cancer Investig J [serial online] 2015 [cited 2020 Apr 7];4:720-2. Available from: http://www.ccij-online.org/text.asp?2015/4/6/720/169113


  Introduction Top


Schwannomas are the most common benign tumors of the peripheral nervous system, which are encapsulated and composed of Schwann cells. Involvement of the sciatic nerve is rare and represents less than one over 100 cases. The nerve might be affected by the tumor all along its course.[1] Schwannomas are most commonly occur in adults between 20 and 50 years of age. Their symptomatology usually mimics sciatic pain due to herniated disc.[2] Their diagnosis can be delayed for a long period of time, usually symptoms being attributed to lumbo-sacral degenerative pathology.[3] From all the benign sciatic tumors, 60% are represented by neurofibroma and 38% are schwannomas, rest having other histological types.[4] Unlike neurofibromas, schwannomas do not transverse through the nerve but remain in the sheath lying on the top of the nerve.[5] In general, schwannomas have a predilection for the head, neck, mediastinum, and retroperitoneal regions.[6] They are usually solitary lesions, but multiple lesions can be seen. Multiple schwannomas can be found in patients with neurofibromatosis type II. Here we present a case of sciatic schwannoma in a young female, which was diagnosed on histopathology.


  Case Report Top


A 23-year-old female presented in orthopedic outpatient department with posterior hip pain since 1 year. Her physical examination was within normal limits. Her ultrasonography revealed a large heteroechoic mass lesion of size 116 mm × 104 mm showing flow on color Doppler and a few cystic or necrotic areas seen in pelvic region and seemed to extend to pelvic bone. A contrast-enhanced magnetic resonance imaging (CEMRI) was advised for further evaluation. The CEMRI revealed a lesion involving sacrum with associated soft tissue mass which was hypointense on T1-weighted and heterogeneously hyperintense on T2-weighted images, showing multiple cystic lesions with fluid-fluid level. The soft tissue component was extending in presacral area and pushing rectum laterally. Radiologically and clinically, provisional diagnosis of chondrosarcoma giant cell tumor and aneurysmal bone cyst were made associated with sacral canal stenosis. Further, a biopsy was done to confirm the diagnosis.

On gross examination, we received multiple gray white soft tissue pieces measuring 1 cm × 0.8 cm × 0.6 cm. Microscopic examination of the lesion revealed densely packed spindle cells arranged in Antoni type A and Antoni type B areas [Figure 1]. The Antoni type A areas were composed of spindle cells arranged in palisading fashion or in organoid arrangement (Verocay bodies). The Antoni type B areas showed tumor cells separated by abundant edematous stroma [Figure 2]. Mitosis was < 2/10 hpf. On immunohistochemistry, these tumor cells were S-100 positive [Figure 3], thus confirming the neural origin of tumor. Hence, a final diagnosis of schwannoma was made.
Figure 1: Densely packed spindle cells showing hypercellular (Antoni A) and hypocellular (Antoni B) areas (H and E, ×40)

Click here to view
Figure 2: Antoni type B areas showed tumor cells separated by abundant edematous stroma with Verocay bodies (H and E, ×100)

Click here to view
Figure 3: S-100 positivity in spindle-shaped tumor cells (immunohistochemistry, ×100)

Click here to view


The patient underwent surgical excision and is on regular follow-up.


  Discussion Top


Schwannomas are one of the few truly encapsulated neoplasms of human body and is almost solitary (unless seen as a component of Recklinghausen disease type II).[7] They are also known as neurilemomas and are a benign peripheral nerve sheath tumor composed of well-differentiated Schwann cells.[8] One of the uncommon origins of the schwannomas is sciatic nerves, and they are more common at the females who are in the second to fifth decades.[9] Neoplastic involvement of the sciatic nerve has been reported in soft tissue malignancies, sarcoidosis, lymphoma, and infiltrating intermuscular lipoma, but sciatic schwannomas are rare.[10]

They generally arise in the sensory as opposed to the motor portion of nerves but can arise in association with any peripheral nerve and along the flexor surfaces of the extremities.[11] The nerve of origin can be demonstrated in the periphery, flattened along the capsule but not penetrating the substance of the tumor.[12] Treatment of symptomatic schwannomas consists of marginal excisional resection with emphasis on the identification of the nerve fascicles and the excision of the tumor stalk, thus preventing recurrence while preserving the parent nerve. Recurrence is rare, even when the excision is incomplete. Few studies mention recurrence following excisional resection.[8],[12] Since it is a benign neoplasm that only recurs locally, every attempt should be made to preserve the nerve.[12]

Clinically, the patient presents with pain in hip region radiating along the lateral side of leg may be associated with other neurological signs and symptoms.[7] Our patient presented with pelvic pain which is rare and can be easily misdiagnosed on physical examination. There were no features of neurofibromatosis II in our patient. Most common presentation is sciatica which was observed by Chavan and Kullolli and Naik et al.[2],[13] Rhanim et al. diagnosed sciatic schwannoma in patient presenting with right side lower leg and foot pain. The MRI findings in their case were similar to that in our case.[3] Ghaly reported a posterior tibial nerve schwannoma case who had been misdiagnosed as psychosomatic disorder for 10 years,[14] and also there are other case reports which exists mid-thigh sciatic nerve which mimics plantar neuropathy foot pain.[9]

Conventional schwannomas are composed of two organized cell patterns: Antoni A and Antoni B. These patterns are present in all the cases of conventional schwannoma in varying proportions. The Antoni A pattern is more organized with a palisaded appearance and an elongated, spindle-shaped cellular nucleus. A characteristic appearance in the Antoni A pattern is the Verocay body, which is a circular coalescence of elongated nuclei. The Antoni B pattern is characterized by a diffuse cellular structure with rounded nuclei.[7] This palisaded arrangement is not unique to schwannoma. It can also occur in leiomyoma, leiomyosarcoma, gastrointestinal stromal tumor, calcifying aponeurotic fibroma, and even in nonneoplastic smooth muscle. The rare occurrence of plexiform areas in schwannoma may cause them to be mistaken for neurofibroma. Most of these plexiform schwannomas are found superficially in the dermis or subcutaneous tissue, but they can also be deep seated.[15]


  Conclusion Top


Sciatic schwannoma, though rare, should be kept in mind while dealing with patients presenting with hip pain and pelvic mass. Schwannoma is a benign neoplasm and simple excision is the required treatment. Hence, thorough clinical, radiological, and histopathological examination should be done for making proper diagnosis and approaching to correct diagnosis would prevent unnecessary treatment options such as chemotherapy and radiotherapy.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Rekha A, Ravi A. Sciatic nerve schwannoma. Int J Low Extrem Wounds 2004;3:165-7.  Back to cited text no. 1
    
2.
Chavan D, Kullolli G. Sciatica secondary to sciatic nerve schwannoma – A rare case report. Int J Pharm Biol Sci 2014;5:653-7.  Back to cited text no. 2
    
3.
Rhanim A, Zanati R, Mahfaud M, Berrada MS, Yaacoubi ME. A rare cause of chronic sciatic pain: Schwannoma of the sciatic nerve. J Clin Orthop Trauma 2013;4:89-92.  Back to cited text no. 3
    
4.
Gorgan M, Sandu AM, Bucur N, Neacsu A, Pruna V, Voina A, et al. Sciatic Nerve schwannoma: A case report. Rom Neurosurg 2008;XV:27-31.  Back to cited text no. 4
    
5.
Haspolat Y, Ozkan FU, Turkmen I, Kemah B, Turhan Y, Sarar S, et al. Sciatica due to schwannoma at the sciatic notch. Case Rep Orthop 2013;2013:510901.  Back to cited text no. 5
    
6.
Linder J. Diseases of the skin and connective tissues. In: Damjanov I, editor. Anderson's Pathology. 10th ed. St. Louis: Mosby; 1996. p. 2508.  Back to cited text no. 6
    
7.
Çakmak G, Ulusal AE, Bilgiç S, Tuncay C. Sciatic schwannoma – Rare cause of sciatica: A case report. J Clin Anal Med 2015;6:525-7.  Back to cited text no. 7
    
8.
Wilson AG Jr, Hofmeister EP, Thompson M. Recurrent schwannoma with bony erosion of the distal middle finger. Am J Orthop (Belle Mead NJ) 2007;36:E37-9.  Back to cited text no. 8
    
9.
Kralick F, Koenigsberg R. Sciatica in a patient with unusual peripheral nerve sheath tumors. Surg Neurol 2006;66:634-7.  Back to cited text no. 9
    
10.
Feinberg J, Sethi S. Sciatic neuropathy: Case report and discussion of the literature on postoperative sciatic neuropathy and sciatic nerve tumors. HSS J 2006;2:181-7.  Back to cited text no. 10
    
11.
Graham DI, Lantos PL, editors. Tumours of the Nervous System: Greenfield's Neuropathology. London: Arnold; 2002. p. 898-9.  Back to cited text no. 11
    
12.
Strickland JW, Steichen JB. Nerve tumors of the hand and forearm. J Hand Surg Am 1977;2:285-91.  Back to cited text no. 12
    
13.
Naik T, Premkumar A, Naik CS, Hulegar AA. Rare case of sciatic schwannoma. Asian J Neurosurg 2015;10:234-5.  Back to cited text no. 13
  Medknow Journal  
14.
Ghaly RF. A posterior tibial nerve neurilemoma unrecognized for 10 years: Case report. Neurosurgery 2001;48:668-72.  Back to cited text no. 14
    
15.
Agaram NP, Prakash S, Antonescu CR. Deep-seated plexiform schwannoma: A pathologic study of 16 cases and comparative analysis with the superficial variety. Am J Surg Pathol 2005;29:1042-8.  Back to cited text no. 15
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]


This article has been cited by
1 A Case of Restless Legs Syndrome in Patient with Neurogenic Sciatic Nerve Tumor
Ji Hoon Lee,Kyoung Jin Hwang,Sung Sang Yoon,Key-Chung Park,Jin San Lee
Journal of Sleep Medicine. 2017; 14(2): 74
[Pubmed] | [DOI]
2 Case Report: Sciatic nerve schwannoma - a rare cause of sciatica
Sunil Munakomi,Pratyush Shrestha
F1000Research. 2017; 6: 267
[Pubmed] | [DOI]



 

Top
 
 
  Search
 
Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
Access Statistics
Email Alert *
Add to My List *
* Registration required (free)

 
  In this article
Abstract
Introduction
Case Report
Discussion
Conclusion
References
Article Figures

 Article Access Statistics
    Viewed1789    
    Printed22    
    Emailed0    
    PDF Downloaded18    
    Comments [Add]    
    Cited by others 2    

Recommend this journal