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Corresponding Author

Hesham ElSobky, MD.

Subject Area

Oncology, Peripheral nerves

Document Type

Original Study

Abstract

Background Data: Peripheral nerve sheath tumors include a wide variety of pathologies; the most common types are schwannoma and neurofibroma. The comparative and analytic studies between them regarding clinical presentation, preoperative imaging, operative management, and postoperative follow-up are scarce.

Purpose: This study aims to provide a comparative analytic study of schwannoma, neurofibroma, and their mimics.

Study Design: This is a cross-sectional analytic study.

Patients and Methods: A total of 42 tumors in 36 patients have been excised by the same operator. The demographic data, primary signs, and symptoms have been analyzed. Pre- and postoperative clinical examination and follow-up clinical examination six months after surgery were our checkpoints. MRI was our main tool of investigation to determine the size, borders, extensions, and nature of the tumor.

Results: There was a statistical significance (p = 0.001) between schwannoma, neurofibroma, and tumor mimics regarding the tumor capsule appearance in MRI with positive capsule in 100%, 0%, and 44.4% in schwannoma, neurofibroma, and tumor mimics, respectively. Furthermore, there was a statistical difference between the three pathological groups regarding the tumor margins. Intraoperatively, the capsule was assessed and showed a statistical significance (p = 0.001) with percentages of tumors with a capsule of 100%, 0%, and 55.6% in schwannoma, neurofibroma, and tumor mimics, respectively. In the follow-up period after three months, no deficit was observed in 95.7%, 50%, 77.8%, mild deficit in 4.3%, 40%, and 22.2%, and improved deficit in 0%, 10%, and 0% in schwannoma, neurofibroma, and tumor mimics, respectively. However, there was no statistical significance (p = 0.06) between the three pathological groups.

Conclusion: Management of peripheral nerve sheath tumors is still a surgical dilemma, especially the plexiform type, which needs a multidisciplinary approach. Treating a single PNST differs from treating a syndromic patient with multiple lesions.

Keywords

peripheral nerve sheath tumors, nerve tumors, schwannoma, neurofibroma, tumor mimics

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