Subperiosteal Schwannoma: A Rare Cause of Unexplained Pain Around the Knee
Objectives: Bone surface is supplied with ample numbers of both sensory and sympathetic nerves, despite this a very few cases of Schwannoma had been reported to be originating from subperiosteal region. Our study aims at retrospectively analysing patients presenting with vague pain around the knee joint with inconclusive radiological features in whom subperiosteal Schwannoma was being considered as a differential diagnosis. Methods: Three patients presented with vague pain around knee joint to our OPD over a 10 years period. Two patients had a painful mass around knee. Pain was temporarily relieved with NSAIDs. Two patients had lesion in proximal tibia and one on distal femur. All patients were subjected to excisional biopsy and the results were analysed. Results: X ray was unremarkable in all three patients. Hypoechoic lesion was found on ultrasonography suspected to be benign neoplastic lesion. Histopathology study of all excisional biopsy specimens confirmed the diagnosis of schwannoma. All patients recovered uneventfully and had complete relief of pain post excision. There has not been any incidence of recurrence. Conclusion: In patients with diffused pain around knee, subperiosteal schwannoma should be kept as one of the differential diagnosis. USG can help in diagnosis subperiostel schwannoma.
1.Weiss SW, Goldblum JR, Enzinger FM. Benign tumours of the peripheral nerves. In: Weiss S, Goldblum JR, eds. Enzinger and Weiss’s soft tissue tumours. Fourth ed. St. Louis: Mosb 2001;1111–208.
2. Kim DH, Murovich JA, Tiel RL, Moes G, Kline DG. A series of 397 peripheral neural sheath tumors: 30-year experience at Louisiana State University Health Sciences Center. J Neurosurg 2005;102:246–55. [CrossRef]
3. Corfas G, Velardez MO, Ko CP, Ratner N, Peles E. Mechanisms and roles of axon–schwann cell interactions. Neurosci 2004;24:9250–60. [CrossRef]
4. Knight DMA, Birch R, Pringle J. Benign solitary schwannomas, review of 234 cases. J Bone Joint Surg [Br] 2007;89–B:382–7. 5. Baehring JM, Betensky RA, Batchelor TT. Malignant peripheral nerve sheath tumor: the clinical spectrum and outcome of treatment. Neurology 2003;61:696–8. [CrossRef]
6. Woodruff JM, Selig AM, Crowley K, Allen PW. Schwannoma (neurilemoma) with malignant transformation: a rare distinctive peripheral nerve tumour. Am J Surg Pathol 1994;18:882–95.
7. Ogose A, Hotta T, Morita T, Otsuka H, Hirata Y. Multiple schwannomas in the peripheral nerves. J Bone Joint Surg [Br] 1998;80–B:657–61. [CrossRef]
8. Ida CM, Scheithauer BW, Yapicier Ö, Carney JA, Wenger DE, Inwards CY et al. Primary schwannoma of the bone: A clinicopathologic and radiologic study of 17 cases. Am J SurgPathol 2011;35:989–97. [CrossRef]
9. Hilton DA and Hanemann CO. Schwannomas and their pathogenesis. Brain Pathol 2014;24:205–20. [CrossRef]
10. Salla JT, Johann ACBR, Garcia BG, Aguiar MCF, Mesquita RA. Retrospective analyses of oral peripheral nerves sheath tumors in Brazilians. Braz Oral Res 2009;23:43–8. [CrossRef]
11. Santos PPA, Freitas VS, Pinto LP, Freitas RA, Souza LB. Clinicopathologic analysis of 7 cases of oral schwannoma and review of the literature. Ann Diagn Pathol 2010;14:235–9. [CrossRef]
12. Igai H, Kamiyoshihara M, Kawatani N, Ibe T, Shimizu K. Sternal intraosseous schwannoma mimicking breast cancer metastasis. J. Cardiothorac Surg 2014;9:116. [CrossRef]
13. Samter TG, Vellios F, Shafer WG. Neurilemmona of bone. Report of 3 cases with a review of the literature. Radiology 1960;75:215–22. [CrossRef]
14. Kehoe NJ, Reid RP, Semple JC. Solitary benign peripheralnerve tumours. Review of 32 years' experience. J Bone Joint Surg Br 1995;77:497–500. [CrossRef]
15. Paksoy Y, Sahin M, Avunduk MC, Aksoy F, Odev K. Solitary juxtacortical neurofibroma of the humerus. Skeletal Radiol 2002;31:112–15. [CrossRef]
16. Verma RR, Khan MT, Davies AM, Mangham DC, Grimer RJ. subperiosteal schwannomas of the femur. Skeletal Radiol 2002;31:422–25. [CrossRef]
17. Lakhotia D, Jeph S and Sharma S. Subperiosteal schwannoma of pelvis- A rare case and review of literature. J Clin Diagn Res 2016;10:RD01–RD03. [CrossRef]
18. Albert P, Patel J, Badawy K, Weissinger W, et al. Peripheral nerve schwannoma: A review of varying clinical presentations and imaging findings. J Foot Ankle Surg 2017;56:1–6. [CrossRef]
19. Kransdorf MJ. Benign soft-tissue tumors in a large referral population: distribution of specific diagnoses by age, sex, and location. AJR 1995;164:395–402. [CrossRef]
20. Das Gupta TK, Brasfield RD, Strong EW, Hajdu SI. Benign solitary schwannomas (neurilemmomas). Cancer 1969;24:355–66.
21. Lhedan FA. Schwannoma of the femur: A rare case report. J Bone Oncol 2017;8:1–3. [CrossRef]
22. Singh V, Grimer R. Subperiostealschwannoma of the ulna. The IJOS 2005;3. [CrossRef]
23. Kenan S, Abdelwahab IF, Klein MJ, Hermann G, Lewis MM. Lesions of juxtacortical origin (surface lesions of bone). Skeletal Radiol 1994;22:337–357. [CrossRef]
24. Seeger LL, Lawrence Y, Eckardt JJ. Surface lesions of bone. Radiology 1998;206:17–33. [CrossRef]
25. Andrew SM, Freemont AJ. Juxtacortical malignant schwannoma with heterologous elements. Histopathology 1993;23:280–2. [CrossRef]
26. Reynolds DL Jr, Jacobson JA, Inampudi P, Jamadar DA, Ebrahim FS, Hayes CW. Sonographic characteristics of peripheral nerve sheath tumors. AJR Am J Roentgenol 2004;182:741–4.
27. Tsai W, Chiou H, Chou Y, Wang H, Chiou S and Chang C. Differentiation between schwannomas and neurofibromas in the extremities and superficial body. J Ultrasound Med 2008;27:161–6. [CrossRef]
28. Chee DW, Peh WC, Shek TW. Pictorial essay: Imaging of peripheral nerve sheath tumors. Can Assoc Radiol J 2011;62:176–82.
29. Kakkar C, Shetty CM, Koteshwara P, Bajpai S. Telltale signs of peripheral neurogenic tumors on magnetic resonance imaging. Indian J Radiol Imaging 2015;25:453–8. [CrossRef]
30. Zaidman CM, Seelig MJ, Baker JC, Mackinnon SE, Pestronk A. detection of peripheral nerve pathology: Comparison of ultrasound and MRI. Neurology 2013;80:1634–40. [CrossRef]
31. Rodriguez FJ, Folpe AL, Giannini C, Perry A. Pathology of peripheral nerve sheath tumors: Diagnostic overview and update on selected diagnostic problems. Acta Neuropathol 2012;123:295–319. [CrossRef]