Atypical course of cutaneous schwannoma: a case report and literature review

Background. Schwannomas are benign (WHO Grade I) tumors of peripheral nerves arising from Schwann cells. Discrepancies between biological behavior and histological characteristics of tumor may exist. We consider it appropriate to describe such a case and compare it with literature data. Material and methods. A patient with subcutaneous schwannoma of the lower third of the right leg complicated by skin ulceration is presented. A review is devoted to data on atypical clinical course of schwannomas. Results and discussion. A 55-year-old man presented with tumor in the lower third of the right leg and skin ulceration 3.5×3 cm. The tumor appeared 10 months ago and significantly enlarged. Open biopsy revealed WHO Grade 1 schwannoma. Atypical course of disease required an extended resection of tumor and simultaneous skin defect closure with split-thickness thigh skin flap. Two months after surgery, the wound healed via primary intention. There were no signs of tumor recurrence, and Karnofsky score was 100. Conclusion. Atypical course of cutaneous schwannoma with ulcers complicates accurate and timely diagnosis, as well as complicates patient management, selection of primary specialist and surgical approach. Benign tumor verified by biopsy and clinical manifestations typical for soft tissue cancer can require early surgical intervention based on oncological principles.