Axillary schwannoma, preoperative diagnosis on a tru-cut biopsy: Case report and literature review

Abstract

HighlightsAlthough Axillary Schwannoma is a rare condition, physicians should recognize it as a part of their differential diagnosis of an axillary swelling.Preoperative utilization of Tru-cut biopsy in diagnosing this condition will further help surgeons to plan proper surgical treatment.The author recommends utilizing an intraoperative nerve stimulator to facilitate nerve preservation during excision; aiming to provide optimal management and better outcome.

Two case reports: Breast schwannoma and a rare case of an axillary schwannoma imitating an axillary lymph node metastasis

“…Schwannomas are benign tumors of the peripheral nervous system which arise from Schwann cells and form the myelin sheath of the neuronal axons [1] . Only 2.6% of all Schwannomas are located intramammary and 5% in the axillary region [2 , 3 , [7] , [8] – 9] . Histologically they demonstrate spindle cells which are arranged in so called Antoni A and B tissue, areas with nuclear palisading (Verocay bodies) and strong expression of S100 [10 , 11] .…”

“…The location and the peripheral nerve stimulation during manipulation could have led to the differential diagnosis of an axillary Schwannoma, especially as a singular axillary lymph node metastasis in the presence of breast cancer is usually initially seen in the inferior lymph node group near the breast tail (level I). Cases of axillary Schwannomas imitating lymphadenopathy have been published, impeding the correct diagnosis, particularly if the patient has a simultaneous breast cancer or another malignancy potentially spreading into axillary lymph nodes, as for example a malignant melanoma [7 – 9 , 14 , 16] .…”

“…To improve diagnostic accuracy several specimens should be obtained from the target mass, which can be challenging for small masses in a “high risk” location. Sometimes even open biopsy or full extirpation is recommended [7 , 13 – 15 , 17] . Despite the central core needle position in the mass of our second case histology revealed scar tissue only and we could not determine the Schwannoma at the first histopathologic examination although the location was non–operated and non–inflamed.…”

“…They are more frequent in patients with neurofibromatosis but also occur as independent solitary tumors with the most common locations at the head, neck, and extremities [2 – 6] . Only 5% are located in the axillary region and intramammary schwannomas account for only 2.6% of all Schwannomas [2 , 3 , 7 – 9] . Here, we present a case of a breast Schwannoma and a Schwannoma in the axillary region, mimicking a lymph node metastasis.…”

Primitive neuroectodermal tumor of ulnar nerve: A rare case

“…The most probable sites of metastasis are the lungs, bone and bone marrow 11,24,26,27 . On the other hand a benign mass usually presents as a slow-growing mass taking several years to cause neurological symptoms 28,29 . In addition, the macroscopic features of pPNET seen during surgery were unlike those of schwannoma,lacking the well-formed capsule which is a very common and reassuring finding for the diagnosis 30 .…”