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Case Report

REKHA and
10.1177/1534734604268094
SCIATIC
NERVE
RAVISCHWANNOMA
3
3

Sciatic Nerve Schwannoma


A. Rekha, MS, and A. Ravi, MS
Sri Ramachandra Medical College and Research Institute, Deemed University, Chennai-600116, India

Schwannomas are benign tumors of the nerve sheath, commonly seen in the vestibular nerve. Although they are common in the head and neck areas, their occurrence in extra-

cranial locations is rare. We report a case of a sciatic nerve


schwannoma and review the literature.
Key words: schwannoma, neurilemmoma, sciatic nerve

SCIATIC NERVE SCHWANNOMA


Schwannomas are tumors arising from the Schwann
cells of the neural sheath of motor and sensory nerves.
They are seen in all cranial nerves except optic and olfactory. They are also called neurilemmomas, neurinomas, and perineural fibroblastomas.1 They occur in
3 clinical settingslocalized schwannomas, in association with neurofibromas as a part of Von Recklinghausen syndrome, or as schwannomatosis.
CASE REPORT
A 60-year-old gentleman sought medical opinion for
a slow-growing painless swelling in the posterior
thigh. History revealed that the swelling had been there
for more than 10 years, during which time it had gradually increased in size. On examination there was a firm
swelling (15 10 cm) in the posterior thigh just proximal to the popliteal fossa that appeared well circumscribed. It was nontender and appeared to produce no
distal pressure effects. A diagnosis of a soft tissue tumor, possibly sarcoma, was made, and we ordered a
needle biopsy. The biopsy showed benign spindle
cells. Magnetic resonance imaging showed a welldefined swelling in the posterior compartment of the
thigh close to the sciatic nerve (see Fig. 1). The patient
Correspondence should be sent to: Dr A. Rekha, MS, Assistant Professor of Surgery, 4/27 Kambar Street, Alandur, Chennai 600016, India;
e-mail: rekha_a@yahoo.com.
Conflict of interest: None.
DOI: 10.1177/1534734604268094
2004 Sage Publications

was taken up for surgery where the schwannoma was


seen in relation to the sciatic nerve (see Fig. 2). The tumor was excised. The cut surface showed a focal area of
hemorrhage. The patient had transient neuropraxia
that recovered. The patient was well at the 1-year
follow-up.
DISCUSSION
Schwannomas occur in any age group; there is no
sex predilection. They arise focally from the sheath of
the nerve fascicle and present as well-defined eccentrically placed masses. This permits their dissection from
the underlying neural bundle.1
Schwannomas are seen in cranial nerves, especially
the eighth cranial nerve. When they occur in extracranial locations, they commonly involve the head and
the neck,2 for example, the tongue,3 the nasopharynx,
the parapharyngeal space,4 and the brachial plexus.5
The literature mentions schwannomas seen in the gastrointestinal tract,6,7 the psoas muscle,8,9 and the external genitalia10 occasionally.
If schwannomas occur in the lower limb, they are
found in association with either the sciatic nerve (1%)
or the posterior tibial nerve.11 There are reports of bifocal sciatic nerve schwannoma12 as well as schwannomatosis of the sciatic nerve.13
PATHOLOGY
Neurilemmomas are fusiform, round, or oval masses
that are sharply circumscribed and encapsulated. They
are usually less than 5 cm in diameter, but those in the
retroperitoneum and mediastinum may be larger.

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REKHA and RAVI

Fig. 3

Fig. 1
MRI showing the posterior compartment along with the
sciatic nerve.

Fig. 2

Sciatic nerve with schwannoma.

When large, neurilemomas are more likely to show secondary degeneration and hemorrhage.
Histologically, benign Schwannomas are composed
of an alternating pattern of Antoni A and B areas.
Antoni A area is a highly ordered cellular component
and consists of Schwann cells arranged in compact,
twisted bundles, associated with delicate reticulin fibers and spindle-shaped nuclei aligned in parallel
rows forming a typical palisading pattern (see Fig. 3).
Between the rows, there are fine cytoplasmic fibrils
with acellular, eosinophilic masses called Verocay

166

Histopathology showing the Antoni type A bodies.

bodies. Antoni B area is less cellular and is formed by


irregularly arranged masses of elongated cells and fibers, similar in appearance to the neurofibroma, with
areas of cystic degeneration and edema.
Immunohistochemically, schwannomas show an intense and relatively uniform staining for S-100 protein,
which is a marker for Schwann cells. The cells also express vimentin, Leu 7 antigen, and glial fibrillary acidic
proteins.
Malignant change is uncommon, though malignant
schwannomas have been reported in the literature. The
neoplastic cells of a malignant tumor usually exhibit
hyperchromasia and variations in the nuclear size and
shape with frequent mitotic figures. When a tumor contains epithelial glandular structures that may be well
differentiated, malignancy should be suspected.14
Special staining techniques should be applied to establish the pathological diagnosis. Immunostain for S100, vimentin, and leucine-7 will be positive while
epithelial membrane antigen and smooth muscle antibody (SMA), negative. Unlike benign schwannomas,
the pattern of staining for S-100 protein in malignant
forms is usually very faint and focal. Schwannoma lesions may usually be differentiated from other spindle
cell neoplasms such as fibrosarcoma, neurofibroma,
and leiomyosarcoma by immunohistochemical studies
and electron microcopy.15
TREATMENT
These benign tumors are excised surgically. There is
no need for local dissection or subsequent adjuvant
therapy in view of their extreme benign course.

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SCIATIC NERVE SCHWANNOMA

CONCLUSION
Benign nerve sheath tumors can occur in the lower
limb, albeit rarely. An awareness of the existence of sciatic nerve schwannomas is essential in differentiating
them from soft-tissue sarcoma. Schwannomas have
good prognosis, and patients recover from excision
with little neurological deficit.
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