Schwannoma of the superficial peroneal nerve presenting as web space pain

doi:10.1016/S1067-2516(09)80072-0

The Journal of Foot and Ankle Surgery

Volume 34, Issue 6, November–December 1995, Pages 532-533

https://doi.org/10.1016/S1067-2516(09)80072-0 Get rights and content

A 55-year-old male presented complaining of pain at his right fourth toe and dorsal fourth web space. Physical examination findings pointed to a lesion affecting the superficial peroneal nerve. A schwannoma of the superficial peroneal nerve was subsequently excised, relieving the patient's symptoms. In the differential diagnosis of nontraumatic and/or nonarthritic toe and foot pain, benign tumors, including schwannomas of the tibial and peroneal nerves, should be considered.

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Cited by (16)

An unusual case of a giant schwannoma of the common peroneal nerve with duration of twenty years
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Citation Excerpt :
Schwannomas could be solitary or multiple [5]. They typically affect the brachial plexus and the sciatic nerve or, rarely, the common peroneal nerve (CPN) or nerves in the foot and ankle region [1,2,4,6]. An 81-year-old female presented with a complaint of a visible mass on the lateral side of the popliteal fossa that has been growing slowly over a period of more than 20 years and that had been gradually limiting knee flexion for several months.
Schwannomas are the most frequent benign tumors of the sheaths of peripheral nerves, they are usually benign or they could rarely undergo malignant transformation. However, reports regarding the common peroneal nerve are scarce in the literature. In this report, we describe a case of an 81-year-old female with a giant schwannoma of this nerve with duration of more than 20 years but with no neurological deficit. The tumor was excised with no recurrences within the next two years. We also make a brief literature review concerning this tumor, its diagnosis, imaging, pathological findings, and surgical treatment.
Ancient Schwannoma of superficial peroneal nerve presenting as intermittent leg pain: A case report
2015, International Journal of Surgery Case Reports
Schwannomas are benign, encapsulated, slow-growing and usually solitary tumors originating from Schwann cells of the peripheral nerve sheath. Schwannomas of the superficial peroneal nerves are very rare, and therefore scarcely documented in the literature. The authors report a case of a diagnosed superficial fibular nerve sheath tumor with an unreported clinical presentation.
A 52-year-old Caucasian female arrived to our Orthopedics Department complaining of pain and numbness of the lateral aspect of her left leg. These symptoms were present for a year and were more evident at the end of the day, or after a long time in the orthostatic position. No evidence of other medical illnesses was found. There was no record of prior traumatic events related to that limb. Diagnosis of a benign peripheral nerve tumor was achieved and the patient was treated by surgical excision of the lesion.
The intermittent symptomatology presentation on this case suggest a mechanical compression etiology, allied to classical pain and paresthesia often exhibited by this kind of the tumor. An intracompartimental pressure elevation could explain why the symptoms disclosed an episodic pattern, due to a constricted, inclosed nerve.
We describe a rare case of a patient with an unusual superficial peroneal nerve Schwannoma clinical presentation. Literature on this topic is scarce and, therefore, this case report intends to add further data about this kind of lesion.
Tarsal Tunnel Syndrome Secondary to Schwannoma of the Posterior Tibial Nerve
2014, Journal of Foot and Ankle Surgery
Schwannoma is a benign tumor that arises from the peripheral nerve sheath. It presents as a discrete, often tender, and palpable nodule associated with neurogenic pain or paresthesia when compressed or traumatized. The growth rate is usually slow, and these lesions seldom exceed 2 cm in diameter. We report the case of a large schwannoma arising from the posterior tibial nerve located in the posterior medial ankle. The core needle biopsy findings were suggestive of a schwannoma, with spindle cells strongly and uniformly immunostaining for S-100 protein. The mass was marginally excised. The surgical specimen consisted of a grossly encapsulated white-yellow mass with irregular contours, measuring 3.7 × 3.5 × 2.7 cm. The cut surface showed areas of pin-point hemorrhage. The patient did not encounter any motor deficits; however, early results showed some subjective numbness. Few reports have been published of schwannomas arising from the tibial nerve. Marginal excision appears to be the recommended therapy for this tumor, without any evidence of recurrence at 9 months of follow-up.
Schwannoma of the common peroneal nerve. A differential diagnosis versus rare popliteal cyst
2012, Neurologia i Neurochirurgia Polska
W pracy przedstawiono przypadek pacjenta z objawami neuralgii nerwu strzałkowego wspólnego i postępującym deficytem neurologicznym wywołanym przez międzypęczkowy wzrost guza o charakterze nerwiaka osłonkowego (schwannoma). W badaniu ultrasonograficznym zmianę określono jako torbiel podkolanową. W badaniu za pomocą rezonansu magnetycznego stwierdzono cechy nietypowego położenia torbieli. Podejrzewano też ganglion lub krwiak. Z uwagi na przebieg kliniczny zdecydowano o odbarczeniu pnia nerwu. Śródoperacyjnie stwierdzono guz międzypęczkowy. Metodą mikrochirurgiczną odpreparowano poszczególne pęczki nerwu i usunięto guz o morfologii nerwiaka osłonkowego.
W przebiegu pooperacyjnym stwierdzono ustąpienie neuralgii i poprawę funkcji nerwu strzałkowego. Omówiono diagnostykę różnicową procesów zlokalizowanych w obrębie dołu podkolanowego. Badania obrazowe wskazywały raczej na nietypowe położenie torbieli, a nie na lity morfologicznie guz, dlatego w określeniu charakteru zmiany istotny był przebieg kliniczny. Wykonywanie dekompresji nerwu strzałkowego wspólnego w technice mikrochirurgicznej pozwala przeciwdziałać dodatkowym objawom neurologicznym w przebiegu pooperacyjnym.
The presented case concerns a patient with neuralgia of the common peroneal nerve and progressive neurological deficit caused by interfascicular growth of schwannoma. The ultrasound diagnostics identified the lesion as a popliteal cyst. Magnetic resonance imaging revealed features of atypical cyst location. Due to the clinical course, it was decided to decompress the nerve trunk. An interfascicular tumor was identified intraoperatively. Particular nerve bundles were separated microsurgically and the tumor of schwannoma morphology was removed. The postoperative course brought resolution of neuralgia and improvement of peroneal nerve function. In the case in question attention was focused on the differential diagnostics of processes located in the popliteal fossa. Imaging examination indicated an atypical cyst location rather than a morphologically solid tumor. The clinical course is essential for determining the nature of the lesion. Decompressing the common peroneal nerve in microsurgical technique allows the prevention of further neurological symptoms in the postoperative course.
Sciatica in a patient with unusual peripheral nerve sheath tumors
2006, Surgical Neurology
Other causes such as peripheral schwannomas can mimic lumbar disk disease.
We present an unusual case of multiple nerve sheath tumors in a patient with left radicular leg pain accompanied by a Tinel sign. Initial lumbar MR imaging revealed a mass in the right lumbar plexus, side opposite the patient's symptoms. Magnetic resonance neurography subsequently revealed a compressive mass of the sciatic nerve proximal to the popliteal fossa, histologically identified as a schwannoma.
This case emphasizes the importance of continued investigation when the radiographic findings do not correlate with the patient's history in the presence of localizing signs on physical examination.
Diseases of the nerves in the pelvic girdle and lower limbs
2006, Handbook of Clinical Neurophysiology
This chapter discusses the clinical applications of the various electrophysiological tests for neuropathy in the pelvic girdle and lower limbs. The most common neuropathy in the lower extremities is peroneal neuropathy, followed by femoral, sciatic, and posterior tibial neuropathies, in that order. Technical details of the various electrophysiological techniques and normal values are discussed. Peroneal neuropathy (i.e., common peroneal neuropathy) is the most common compression neuropathy in the lower extremities. It is a common cause of foot drop and is usually caused by compression at the fibular head. Theoretically, it is clinically characterized by weakness of the anterior tibialis and peroneus muscles and sensory impairment in the territory of the superficial peroneal nerve (lower lateral aspect of the calf). Classically, the deep peroneal branch is more involved than the superficial branch in this neuropathy.

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¹: Department of Orthopaedic Surgery, The Medical College of Pennsylvania, and Hahnemann University, Philadelphia, PA.

²: Department of Chemical Engineering, Drexel University, Philadelphia, PA.

³: The Medical College of Pennsylvania, and Hahnemann University School of Medicine, Philadelphia, PA.

⁴: Department of Orthopaedic Surgery, Case Western Reserve University, Cleveland, OH.

⁵: Department of Orthopaedic Surgery, Beth Israel Hospital, Boston, MA.

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Schwannoma of the superficial peroneal nerve presenting as web space pain

Surg. Neurol.

A benign tumor of the sciatic nerve: case report and review of the literature

Acta Neurol. Belg.

Benign spinal nerve sheath tumors: their occurrence sporadically in neurofibromatosis types 1 and 2

J. Neurosurg.

Tarsal tunnel syndrome caused by sciatic nerve schwannoma

Ann. Plast. Surg.

Tarsal tunnel syndrome caused by neurilemoma of the medial plantar nerve

J. Bone Joint Surg.

Tarsal tunnel syndrome secondary to neurilemoma. A case report

J. A. P. A.