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LETTER TO EDITOR Table of Contents   
Year : 2009  |  Volume : 52  |  Issue : 2  |  Page : 286-288
Intraosseous schwannoma of head of first metatarsal: A rare entity


1 Department of Pathology, Jawaharlal Nehru Medical College, AMU, Aligarh, India
2 Department of Orthopedic Surgery, Jawaharlal Nehru Medical College, AMU, Aligarh, India

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How to cite this article:
Sufian Z, Mazhar A, Lateef JZ, Rana SK. Intraosseous schwannoma of head of first metatarsal: A rare entity. Indian J Pathol Microbiol 2009;52:286-8

How to cite this URL:
Sufian Z, Mazhar A, Lateef JZ, Rana SK. Intraosseous schwannoma of head of first metatarsal: A rare entity. Indian J Pathol Microbiol [serial online] 2009 [cited 2020 Apr 8];52:286-8. Available from: http://www.ijpmonline.org/text.asp?2009/52/2/286/48954


Sir,

Schwannomas are benign, slow growing neoplasms originating from the peripheral nerve sheath. The head and neck region is the most common site of benign schwannoma and the location in the bone is very rare. [1] Regarding bone, which has most commonly been reported in the intraosseous region of the jaw bone, its location in the intraosseous region of the head of the first metatarsal is a very rare presentation. [2]

A 40-year-old male presented with pain and swelling in the left foot after a trivial trauma. Examination revealed diffuse swelling at the angle of the left foot with poorly defined margins, firm in consistency, but the overlying skin was normal. X-ray of the left foot showed an osteolytic lesion of the first metatarsal with a pathological fracture [Figure 1]. The patient was operated upon and curetting was performed from the osteolytic lesion and the material was submitted for histopathological examination.

The specimen consisted of multiple creamish-white firm tissue piece aggregates measuring 5 × 4cm, which were firm in consistency [Figure 2]. Histopathological examination showed morphology consistent with classical schwannoma with predominantly Antoni A areas, showing interlacing bundles of spindle cells with fibrillary cytoplasmic processes arranged in cellular areas along with areas of loosely arranged spindle cells in a myxoid matrix with cystic degeneration (Antoni B areas) [Figure 3]. Nuclear palisading and Verocay bodies were numerous [Figure 4]. The patient was doing well after 9 months of follow-up, with no clinical or radiological signs of lesion recurrence.

Schwannoma is a slow growing, benign tumour derived from Schwann cells, which are sheath cells that cover the myelinated nerve fibers. Intraosseous schwannomas are rare benign neoplasms of the bone of which fewer than 200 cases have been described in the world literature. [3] In all of these intraosseous schwannomas, the mandible is the most commonly affected area, particularly the posterior segment of the body and the ramus. [2] Its presentation as involvement of the head of the metatarsal bone is very rare. Involvement of the metatarsal bone was found in only two cases in the English language medical literature to the best of our knowledge. [3]

Clinically, schwannoma is a slow growing, benign tumor that may be present for years before becoming symptomatic. Intraosseous schwannoma most commonly presents with complaints of swelling. [2] However, pain may be present in about 50% of the cases, [2] whereas no symptoms are present in about 25%. [2] In the case presented in this paper, the patient became aware of swelling after the incidence of a trivial trauma, before which he was asymptomatic.

The possibility of intraosseous schwannoma was not considered at first in our case because of the extreme rarity of this location. The histopathologic examination provided a definitive diagnosis for the case.

Intraosseous schwannoma radiographically is unilocular or multilocular and is usually associated with bone resorption and may be rarely associated with pathological fracture. [4]

There are three mechanisms by which schwannomas may involve a bone: [5]

  1. the tumor may arise centrally within a bone,
  2. the tumor may arise within a nutrient canal and produce canal enlargement or
  3. soft tissue or periosteal tumor may cause secondary erosion and penetration into a bone.


In our case the tumor was purely intraosseous and there was no evidence that there was involvement of the soft tissue/periosteal region. Therefore, the third mechanism can be excluded.

In conclusion, we present a neurilemmoma that developed in an intraosseous location within the head of the first metatarsal of the left foot. Although very rare, intraosseous neurilemmoma should be included in the differential diagnosis of painful, radiographically benign appearing, unilocular radioluscent lesions arising in bones.

 
   References Top

1.de Lacerda SA, Brentegani LG, Rosa AL, Vespúcio MV, Salata LA. ­Intraosseous schwannoma of mandibular symphysis: Case report. Braz Dent J 2006;17:255-8.  Back to cited text no. 1    
2.Chi AC, Carey J, Muller S. Intraosseous schwannoma of the mandible: A case report and review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003;96:54-65.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Meek RM, Sharma H, Jane MJ, Raby N, Macduff E, Reid R. Solitary intraosseous schwannoma of the metatarsal bone: A case report. Foot Ankle Int 2007;28:845-8.  Back to cited text no. 3  [PUBMED]  [FULLTEXT]
4.Mutema GK, Sorger J. Intraosseous schwannoma of the humerus. Skelet Radiol 2002;31:419-21.  Back to cited text no. 4    
5.Park Y, Kim YW, Yang MH, Kim EJ, Ryu DM. Neurilemmoma of the mandible. Skelet Radiol 1999;28:536-9.  Back to cited text no. 5    

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Correspondence Address:
Zaheer Sufian
4/1129, Sir Syed Nagar, Aligarh - 202 002, UP
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.48954

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]

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