Neurilemmoma (Schwannoma) Clinical Presentation

Updated: Oct 08, 2020
  • Author: Ian D Dickey, MD, FRCSC, LMCC; Chief Editor: Harris Gellman, MD  more...
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Presentation

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.