Schwannoma of the Hand: Importance of Differential Diagnosis & Microsurgical Dissection

PURPOSE: The schwannoma is a benign peripheral nerve tumor arising from the Schwann cell of the nerve sheath. Only 2-8% of schwannomas arise in the hand and wrist. Misdiagnosis is frequent such as ganglion and neurofibroma. This article documents and clarifies the clinical features of schwannomas arising in the hand and wrist, and emphasizes importance of differential diagnosis and meticulous surgical extirpation under magnification. METHODS: The author reviewed clinical features of 15 patients with pathologic final diagnosis of schwannoma developed in hand and wrist during the last 12 years from 1998 through 2009. The review included the sex, age of onset, duration, preoperative diagnosis, location, involved nerve, preoperative symptoms and. Postoperative sequelae after surgical extirpation of the lesion with magnification, or without magnification of the surgical fields. RESULTS: The chief complaints were slow growing firm mass in all patients, and followed by pain in 40%, and paresthesia in 40% respectively. The lesions were developed solitarily in 14 patients(93%). The postoperative pathologic diagnosis and preoperative diagnosis were coincided with only in 6 patients(40%). Other preoperative diagnosis were soft tissue tumor in 4 patient(26.6%), and ganglion in 3 patients(20%), and neurofibroma in 2 patients(13%). In all patients who were undergone surgical excision under the fields of magnification, all symptoms were subsided without any sequelae. Meanwhile muscle weakness, paresthesia, hypoesthesia and/or accidental nerve resection developed after surgical excision with naked eye. CONCLUSION: Schwannoma in hand most commonly appears as a slow growing solitary mass with pain or paresthesia. The chance of preoperative misdiagnosis was 60% in this series. To provide good prognosis and less sequelae, careful and elaborate diagnostic efforts and meticulous surgical excision under the magnification are necessary in management of schwannoma.

The Use of Hyalomatrix(R) in the Treatment of Difficult To Heal Wound

PURPOSE: Although traditional and current treatment strategies may demonstrate success, persistence or recurrence of difficult-to-heal wounds remain significant problems. A novel product, Hyalomatrix(R) (Fidia Advanced Biopolymer, Abano Terme, Italy) is a bilayer of an benzyl esterified hyaluronan scaffold beneath a silicone membrane. The scaffold delivers hyaluronan to the wound, and the silicone membrane acts as a temporary epidermal barrier. We present the results obtained with Hyalomatrix(R) in the treatment of difficult-to-heal wounds. METHODS: From November, 2008 to March, 2010, Hyalomatrix(R) has been used on total 10 patients with wounds that were expected difficult to heal with traditional and other current strategies. After average 37.4 days from development of wounds, Hyalomatrix(R) was applied after wound debridement. On the average, Hyalomatrix(R) application period was 17.6 days. After average 16.5 days from removal of Hyalomatrix(R) , skin grafts was performed. RESULTS: In all cases, regeneration of fibrous granulation tissues and edge re-epithelization were present after the application of the Hyalomatrix(R) . And all of the previous inflammatory signs were reduced. After skin grafts, no adverse reactions were recorded in 9 cases. But in one case, postoperative wound infection occured due to a lack of efficient fibrous tissues. In this model, the Hyalomatrix(R) acts as a hyaluronan delivery system and a barrier from the external environments. In tissue repair processes, the hyaluronan performs to facilitate the entry of a large number of cells into the wounds, to orientate the deposition of extracellular matrix fibrous components and to change the microenvironment of difficult-to-heal wounds. CONCLUSION: Our study suggests that Hyalomatrix(R) could be a good and feasible approach for difficult-to-heal wounds. The Hyalomatrix(R) improves microenvironments of difficult-to-heal wounds, reduces infection rates and physical stimulus despite of aggravating factors.

A Case Report of Isolated Inguinal Tuberculous Lymphadenitis

PURPOSE: Tuberculous lymphadenitis constitutes about 30% of all types of extrapulmonary tuberculosis. Cervical lymphadenitis is the commonest form (70%), followed by axillary and inguinal. But inguinal tuberculous lymphadenitis is rare form. Especially isolated inguinal tuberculous lymphadenitis was seldom reported. In Korea, that case was not reported. This case emphasizes the need for awareness of tuberculosis as a possible cause of isolated inguinal adenitis. METHODS: We experienced one case of isolated inguinal tuberculous lymphadenitis. We analyzed clinical features, preoperative assessments and method of treatments. RESULTS: A 37-year-old female patient presented with a painless swelling in the left inguinal region of 12 month's duration. There was no history of urethral discharge, dysuria, genital sores, unprotected sexual contacts or trauma. Examination revealed enlarged left inguinal lymph nodes, 2 x 1 cm, non-tender and firm mass. The external iliac, popliteal, right inguinal and other groups of lymph nodes were normal. Serologic tests, urinary tests and chest radiologic test were normal. The excision of mass was performed under the general anesthesia. A excisional biopsy showed chronic granulomatous inflammation with caseous necrosis, consistent with tuberculosis. After excision, the primary repair was done and completely healed on postoperative 25 days. CONCLUSION: The isolated inguinal tuberculous lymphadenitis was rare form of inguinal suppurative mass. Although medical management is the principal mode of therapy of tuberculous adenitis and surgery is rarely necessary, we didn't consider the possibility of tuberculous lymphadenitis in our case. A high index of suspicion is essential for a diagnosis of isolated inguinal tuberculous lymphadenitis. Our case emphasizes this importance and illustrates the need for awareness of tuberculosis as a possible cause of isolated inguinal adenitis.

A Case Report of Isolated Inguinal Tuberculous Lymphadenitis

PURPOSE: Tuberculous lymphadenitis constitutes about 30% of all types of extrapulmonary tuberculosis. Cervical lymphadenitis is the commonest form (70%), followed by axillary and inguinal. But inguinal tuberculous lymphadenitis is rare form. Especially isolated inguinal tuberculous lymphadenitis was seldom reported. In Korea, that case was not reported. This case emphasizes the need for awareness of tuberculosis as a possible cause of isolated inguinal adenitis. METHODS: We experienced one case of isolated inguinal tuberculous lymphadenitis. We analyzed clinical features, preoperative assessments and method of treatments. RESULTS: A 37-year-old female patient presented with a painless swelling in the left inguinal region of 12 month's duration. There was no history of urethral discharge, dysuria, genital sores, unprotected sexual contacts or trauma. Examination revealed enlarged left inguinal lymph nodes, 2 x 1 cm, non-tender and firm mass. The external iliac, popliteal, right inguinal and other groups of lymph nodes were normal. Serologic tests, urinary tests and chest radiologic test were normal. The excision of mass was performed under the general anesthesia. A excisional biopsy showed chronic granulomatous inflammation with caseous necrosis, consistent with tuberculosis. After excision, the primary repair was done and completely healed on postoperative 25 days. CONCLUSION: The isolated inguinal tuberculous lymphadenitis was rare form of inguinal suppurative mass. Although medical management is the principal mode of therapy of tuberculous adenitis and surgery is rarely necessary, we didn't consider the possibility of tuberculous lymphadenitis in our case. A high index of suspicion is essential for a diagnosis of isolated inguinal tuberculous lymphadenitis. Our case emphasizes this importance and illustrates the need for awareness of tuberculosis as a possible cause of isolated inguinal adenitis.