Giant forefoot schwannoma

case report

Abstract

Benign schwannoma/benign neurilemmoma is a solitary nerve sheath tumor that typically presents in adults between age 20 and 50. Schwannoma accounts for less 5% of benign soft tissue tumors. These tumors may arise in bone as well as in soft tissues. Most lesions are asymptomatic. Schwannoma is rarely found in the foot. The typical solitary tumor presents as a slow growing painless mass which may have been present for 1 to 2 years or more. There can be local bony impingement and bone remodeling because of pressure from the tumor, but these tumors do not invade bone. MRI scans show typical features for an indeterminate tumor, with low signal intensity on T1 and high signal intensity on T2 weighted sequences. Most lesions may be observed without surgery. Because of the indeterminate MRI appearance of this tumor, a complete evaluation and staged biopsy is recommended before definitive surgical removal is planned. Treatment is by excision with a marginal margin. Recurrence following resection is rare. Less than 10% of schwannomas occur in the foot. We report on the presentation and management of a very large schwannoma which caused extensive bone remodeling in the forefoot. Level of Clinical Evidence: 4