Brachial plexus schwannoma in early adolescence. Case report

Abstract

Introduction: Primary tumors arising from the peripheral nerves are a rare occurrence. In 90% they are benign, although in a small percentage there is a risk of neoplastic transformation. Schwannomas and neurofibromas are the leading etiologies. They are commonly found in the neck and large nerves of limbs and arms, with a preference for regions of the elbow, wrist, and knee. The most vulnerable group of patients are people aged 20 to 50 years. The occurrence of this type of tumors in children is sporadic, especially if the tumor includes the brachial plexus. Materials and Methods: The clinical case of a neurinoma in a supraclavicular region, affecting a 12-year-old girl. After a detailed diagnosis, the tumor finally came to be a schwannoma of a brachial plexus. Discussion: Brachial plexus schwannoma is a rare find, although it should be considered in the differential diagnosis. A detailed search for signs of neurofibromatosis (von Recklinghausen's disease) should also be performed. Initial diagnostic imaging of cervical mass includes mainly MRI, thanks to which the surgeon can suspend the tumor of nervous origin, assess the vicinity of important nerves, vessels, and cervical spinal cord, as well as qualify for the surgery. Surgical treatment should be carried out after assessing the benefits and risks associated with the procedure, including irreversible damage to the brachial plexus. To maintain safety during the operation, the use of microsurgical instruments, microscopes or endoscopes should be considered by an experienced surgeon. Preserving nerve continuity is the essential goal of the treatment, especially in young, and active patients. Finally, the long-term observation is necessary for the assessment of potential tumor neoplastic transformation, nerve function of the brachial plexus and possible symptoms of neurofibromatosis. Keywords: Brachial plexus tumor; Schwannoma in early adolescence; Neurofibromatosis; Supraclavicular swelling