[A possible cause of misdiagnosis in tumors of the axilla: schwannoma of the brachial plexus].

Università degli Studi di Roma La Sapienza, Facoltà di Medicina e Chirurgia, Italy.
Il Giornale di chirurgia 01/2008; 29(1-2):38-41.
Source: PubMed


The Authors report a rare case of a 57 years old man affected by a left radial nerve schwannoma that occurred as an asymptomatic lesion of the axilla. At clinical examination the lump was undistinguishable from the most common axillary lymphadenopathy. A lymphoadenopathy was erroneously diagnosed with ultrasonography (US). This mistake was due to the low specificity of the instrumental methodology and to the rarity of an asymptomatic schwannoma of the infraclavicular brachial plexus. The neoplasia was excised without using the microscope. In the early post-operative follow up, a "falling" attitude of the wrist, the hand and the fingers appeared, peculiar for a lesion of the radial nerve. Furthermore a hypoaesthesia of the skin of first finger and of the first interosseus space was associated. The sensitive and motor electromyography showed a radial nerve suffering. The "stupor" of the nerve trunk was treated with steroid therapy for 7 days and the patient underwent to some series of neuro-rehabilitative physical therapy for 12 weeks. The postoperative total body CT, showed that the lesion was unique: therefore it was possible to exclude the diagnosis of neurofibromatosis. After 28 months electromyography and axillary US were performed showing the complete resolution of the motor and sensitive deficit and the absence of local recurrence.

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    ABSTRACT: Background: The brachial plexus' neurilemmoma is an extremely rare neoplasia. Case Report: A 61 years old woman came to our hospital with a clinical history of serum-hematic secretion from the right nipple. The physical examination was otherwise unremarkable. She had a negative mammography, while in the right retro-areolar section the ultrasound examination showed an ipoechoic lesion, with well defined margins, consistent with a papilloma and/or an intracanalicular fibroadenoma. In the left axilla, a solid capsulated, homogeneous, vascularized nodule was detected, non-univocally interpretable, suspicious for malignancy. The fine needle aspiration biopsy was consistent with mesenchimal neoformation, uncertain whether benign or malignant. Conclusions: After surgical removal the pathological diagnosis was: neurilemmoma.
    Full-text · Article · Jan 2010 · American Journal of Case Reports
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    ABSTRACT: Schwanomas originating from the brachial plexus, although rare, may be mistaken for another type of tumour. A 40 year-old woman, who had been treated years earlier for a breast adenocarcinoma, showed in the 5-year follow-up magnetic resonance examination a localized lesion in the right brachial plexus. The presumptive radiological diagnosis was a metastasis from the primary adenocarcinoma. Following surgical access via the right axilla, a well-circumscribed mass in the brachial plexus was detected. Under intraoperative electrophysiological guidance, the lesion was observed to depend on the ulnar nerve and its complete resection was possible without compromising nerve function. Histological findings indicated a schwannoma thus ruling out the presence of metastasis. The postoperative development was uneventful and six years after surgery, the patient is to date tumour-free. To the best of our knowledge, this is the first report of a brachial plexus schwannoma arising from the ulnar branch. Intraoperative electrophysiological monitoring is essential for a good surgical outcome.
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    ABSTRACT: The radial nerve is a continuation of the posterior cord of the brachial plexus and one of the major nerves that provide motor and sensory innervations to the forearm. MR imaging evaluation of the radial nerve pathology has been described in scattered case reports. Current high-field MR scanners enable high resolution and high contrast imaging of the peripheral nerves. This article reviews the 3 Tesla magnetic resonance neurography imaging of radial nerve anatomy and various pathologies affecting it with relevant case examples.
    Full-text · Article · Jul 2011 · Journal of Neuroradiology
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