History and Physical Examination

Because neurilemmomas (neurilemomas; also referred to as schwannomas) can present in many locations, the clinical presentation can be varied.^[5] Some may involve the spinal nerve roots and present with symptoms that mimic those of herniated disk disease of the spine.^{[6, 7]}

Tenderness to palpation is often present; secondary neurologic symptoms may occur if the tumor is large. When involving the C7 nerve root, neurilemmoma has been described as a cause of thoracic outlet syndrome. Lesions in the sciatic nerve can mimic diskogenic low-back pain.

In the extremities, neurilemmomas can present either as an asymptomatic mass (usually mobile in the transverse plane and tethered along the axis of the nerve from which it arises) or as mild, localized pain and paresthesia resulting from pressure on the nerve of origin. Masses are slow-growing and can exist for months to years without producing symptoms. The average time from onset of symptoms to diagnosis is 5.5 years.

Lesions in proximal nerves may cause distal symptoms. If these masses occur in well-defined compartments (eg, wrist or ankle), they can present as either carpal tunnel or tarsal tunnel syndrome.

Differential Diagnoses

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Media Gallery

The cell of origin for a neurilemmoma is the Schwann cell, which is derived from the neural crest. These cells line the peripheral nerve processes.
Neurilemmomas have very distinctive appearances on magnetic resonance images. Many investigators believe that the presence of a target sign on a peripheral nerve is diagnostic for a neurilemmoma.
Pathology specimen.

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Author

Ian D Dickey, MD, FRCSC, LMCC Orthopedic Surgeon, Colorado Limb Consultants, Denver Clinic for Extremities at Risk; Medical Director, Denver Sarah Cannon Sarcoma Network; Staff Surgeon, Department of Orthopedics, Presbyterian/St Luke’s Hospital; Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine

Ian D Dickey, MD, FRCSC, LMCC is a member of the following medical societies: Canadian Orthopaedic Association, Maine Society of Orthopaedic Surgeons, Mayo Clinic Alumni Association, Musculoskeletal Tumor Society, New England Orthopedic Society, Royal College of Surgeons of Canada

Disclosure: Received consulting fee from Stryker Orthopaedics for consulting; Received honoraria from Cadence for speaking and teaching; Received grant/research funds from Wright Medical for research; Received honoraria from Angiotech for speaking and teaching; Received honoraria from Ferring for speaking and teaching.

Coauthor(s)

James Gerald Floyd, MD Assistant Professor, Department of Surgery, Division of Orthopedic Surgery, University of Alabama at Birmingham School of Medicine

James Gerald Floyd, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Medical Association, American Orthopaedic Foot and Ankle Society, National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Chief Editor

Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, Arkansas Medical Society, Florida Medical Association, Florida Orthopaedic Society

Disclosure: Nothing to disclose.

Additional Contributors

Howard A Chansky, MD Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center

Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Neurilemmoma (Schwannoma) Clinical Presentation

History and Physical Examination

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