Tibial Nerve Schwannoma: A Case Report and Review of the Literature

Abstract

 Introduction. Schwannomas are the most common benign tumors of peripheral nerve sheaths. They are typically slow-growing masses that often remain asymptomatic. Malignant transformation of schwannomas is especially rare, occurring in only 1% of patients. Imaging modalities such as MRI or ultrasound are used in the evaluation of peripheral nerve tumors. Biopsy is indicated only when the clinical diagnosis is unclear and is associated with poorer postoperative outcomes. When indicated, schwannomas are managed through complete surgical excision. Case presentation. This article presents the clinical case of a 36-year-old male diagnosed with a benign peripheral nerve schwannoma. The patient was initially examined by an orthopedic trauma surgeon, who ordered an MRI for diagnosis. Despite the suspicion of a schwannoma based on imaging, a biopsy was performed. After the patient was referred to a plastic and reconstructive surgery specialist due to a high risk of malignancy, a decision was made for the radical excision of the large tumor. Post-surgery, histopathological examination of the mass revealed that the suspected internal necrosis observed in the MRI was, in fact, a hematoma, likely secondary to the preceding biopsy. The patient did not develop any additional postoperative neurological deficit. Conclusions. In summary, schwannomas should be primarily diagnosed clinically and confirmed with diagnostic imaging, such as MRI or ultrasound. Biopsy is not recommended for diagnosis confirmation if a schwannoma is suspected on imaging. The first-line effective treatment is radical excision of the schwannoma. Radical surgical removal is indicated in the presence of neurological symptoms, pain, rapid tumor growth, or suspicion of malignant transformation.