Case Report on Removing Large Schwannoma in Axilla

Introduction Schwannomas can achieve huge sized masses along the cerebrospinal axis and peripheral nerves.

Aim The removal or total excision of a huge schwannoma growing among many neurovascular structures as in the axillary region is a quite big challenge for most of surgeons.

Material and Methods The case concerns a young female (25 years old) with formication and pain in the left hand as well as discomfort from palpable formation in the axilla since 5 years. There is no evidence of paresis or paralysis. MR and CT 3D in axilla show a formation with a smooth contour and well enclosed within capsules, located dorsally from a. and v. dorsalis sinistra. A. brachialis and a. brachialis profunda came into contact with the tumor and curved below it. The tumor surrounded the os humerus and passed behind it.

Results With transaxillary access, we removed the front part of a tumor and under optical zoom removed the arteries and veins from the capsule and reached the back part of tumor through foramen quadrilateral. With the help of transcutaneous compression, we totally removed a tumor without breaking the capsule and preserving the wholeness of vessels. The formation size was 90/41–48 mm and in it was entering the branch of a. axillaris. The total excision followed by cutting the nerve branch (n. cutaneous brachii lateralis superior). Histological result—schwannoma. Postoperative period: the patient was without additional neurological deficit.

Conclusion Usually peripheral nerve schwannomas are benign. The slow growth of the tumor determines the longer interval between first symptoms and diagnosis (7–8 years) and reaching greater size because of the nature of adjacent tissues. The close position/location of large arteries, veins, and nerves in the axilla predetermine surgical risk of injury. Good preoperative imaging, blunt dissection, and microdissection aimed at minimizing these risks.

Keywords schwannoma; peripheral nerve; axilla