Multiple Schwannomas of the Median Nerve

Abstract

Schwannomas originating from the Schwann cells of the nerve sheath, typically manifest as solitary, encapsulated outgrowths. These types of benign tumors are found in the head and neck region, the upper and lower extremities. Schwannomas usually present as solitary peripheral nerve tumors but they can also occur as multiple contiguous lesions in conditions like neurofibromatosis type 2-related schwannomatosis. However, there are very few reports in the literature about the involvement of a single nerve by multiple schwannomas without having any systemic pathology. This case report discusses a rare instance of multiple schwannomas affecting the median nerve in a 30-year-old male. The patient presented with a 4-year history of a painful mass and intermittent paresthesia in his thumb, index, and middle fingers. Clinical examination revealed a lobulated mass along the median nerve, confirmed by magnetic resonance imaging (MRI), which showed multiple multilobulated lesions encasing the nerve. Microsurgical excision was performed, with histopathological analysis confirming the diagnosis. Postoperatively, the patient experienced complete symptom resolution, and no recurrence was noted at the 18-month follow-up. This case highlights the diagnostic and therapeutic challenges of managing multiple schwannomas in the absence of systemic pathology. It underscores the importance of considering such occurrences in patients with peripheral nerve tumors and demonstrates the value of MRI for preoperative assessment and planning..