P28 Congenital Cellular Plexiform Schwannoma Masquerading as Infantile Haemangioma – A Case Report

Abstract

Abstract Introduction Schwannomas are tumours of the peripheral nerve sheath that rarely metastasize but are prone to recurrence. They sometimes occur in the context of syndromes such as neurofibromatosis type 2, Carney complex, and schwannomatosis. Congenital schwannomas appear as an erythematous patch that increases in size in the first few weeks and can be easily mistaken for infantile haemangioma (IH). Case A 3-month-old boy was referred to us for suspected IH on the dorsum of his right hand. At birth, he had a slightly erythematous patch but was rapidly increasing in size. Initial ultrasound done locally suggested it may be an IH based on the demonstration of arterial and venous flows. He was otherwise well, and there were no concerns about his growth or development. On examination, he had a firm mass, measuring 3 cm in diameter, that was not clinically in keeping with a vascular anomaly. Our repeated ultrasound showed a solid tumour, possibly fibrosarcoma or myofibroma. Biopsy confirmed cellular plexiform schwannoma and he underwent excision. The results of whole genome sequencing are pending (SMARC-1 and NF), and he remains under the care of the oncology team. Conclusion Clinicians assessing infants with “haemangiomas” have a difficult task of differentiating them from other soft tissue tumours. The clinical appearance of vascularity, along with high vascular flow seen on the imaging, cannot always rule out soft tissue tumours. Assessment of firmness can be somewhat subjective, but any vascular lesion that is very firm should be investigated further.