A 27-year-old female patient referred with a soft tissue mass on the radial side of the right wrist, and local neuralgia.
A 27-year-old female patient referred with a soft tissue mass on the radial side of the right wrist, and local neuralgia. An MRI study of the right wrist was performed on a 1.5 T MR scanner, with T1, T2, fat-suppressed T2-weighted spin-echo sequences, and post-gadolinium T1-weighted spin-echo sequences on axial and coronal planes. A soft tissue mass with heterogeneous content and prominent gadolinium enhancement was detected. The mass was totally removed surgically, the histopathological diagnosis was schwannoma with predominantly high cellular content(Antoni A) areas
Benign peripheral nerve sheath tumors, thus neurofibroma and schwannoma are not common periarticular soft tissue masses. They are typically located along peripheral nerves, most commonly ulnar and peroneal nerves. Schwannomas, also known as neurilemoma or neurinoma, are encapsulated benign slowly growing neoplasms arising from Schwann cells. They are asymptomatic until large enough to compress adjacent nerves, causing neuralgia. Lesions are almost always solitary, except in cases associated with neurofibromatosis. Schwannomas are surrounded by a true capsule of epineurium, and they displace nerve fibers and can be dissected and removed from the adjacent nerve without resultant neurologic damage. This is in contradistinction to neurofibromas, in which the adjacent nerve infiltrates the nerve and cannot be dissected free. Schwannomas demonstrate a low to intermediate signal intensity on T1-weighted images and a heterogeneous hyperintense signal intensity on T2-weighted images on MRI. They show intense gadolinium enhancement. Atrophy may be seen along the long axis of the muscle adjacent to the lesion in approximately 25 % of the cases. Neurofibromas and ganglion cysts should be considered in differential diagnosis of schwannomas. Neurofibromas have a more defined geographic internal architecture, characterized by low signal central region surrounded by a higher signal periphery on T2-weighted MR images. Ganglion cysts do not reveal gadolinium enhancement, and have much brighter content on T2-weighted MR images.
Schwannoma of the wrist
According to the provided MRI images of the right wrist, there is a clearly defined, localized soft tissue mass within the radial soft tissue. On T1-weighted images (T1WI), the lesion shows low-to-intermediate signal intensity; on T2-weighted images (T2WI), it appears with high signal intensity, albeit somewhat heterogeneous. After contrast administration, the lesion demonstrates noticeably homogeneous enhancement. A small amount of surrounding soft tissue is compressed and displaced, but no obvious bony destruction or intra-articular involvement is observed. The nearby muscle signals appear generally normal, with no evident erosive changes.
Cause: A benign peripheral nerve sheath tumor derived from Schwann cells, typically characterized by slow growth, and sometimes causes pain or numbness along the distribution of the affected nerve. Imaging Features: Often presents as low-to-intermediate signal on T1WI and high signal on T2WI, with notable contrast enhancement, usually appearing as an encapsulated solitary lesion.
Cause: Associated with proliferation of nerve fibers, may also cause localized pain or sensory disturbances. Imaging Features: A “target sign” on T2WI (low signal centrally, with high signal peripherally) is more typical for neurofibromas. They often have closer relationships with surrounding nerve fiber structures. Distinguishing from Schwannoma: Schwannomas are more likely to be separable from the nerve fascicles, whereas neurofibromas often show a more infiltrative growth pattern.
Cause: Fluid-filled cysts arising from the synovium or tendon sheaths, commonly seen around the wrist. Imaging Features: Characteristically high signal on T2WI with no or minimal enhancement (often only cyst wall enhancement). The contents typically exhibit homogeneous fluid signal, clearly indicating a cystic lesion.
Given the patient’s age (27, female), the presence of a radial-side mass along with neuralgic symptoms, and MRI findings of a well-demarcated, T2 hyperintense lesion with pronounced enhancement, the most likely diagnosis is Schwannoma (Neurilemmoma). These tumors are typically well-encapsulated, allowing surgical separation from the nerve fascicles, and are generally benign with a favorable surgical outcome.
During postoperative or conservative management stages, gradual exercises can be implemented to promote local functional recovery and alleviate nerve-related symptoms. These exercises target the wrist and forearm to improve muscle strength and flexibility:
Throughout the rehabilitation process, closely monitor any changes in pain, swelling, or neurological symptoms. If significant worsening is observed, seek medical advice promptly and adjust the exercise plan. Patients with additional concerns such as bone or cardiopulmonary issues should undergo further individualized assessment to ensure exercise safety.
Disclaimer: This report is a reference analysis based on the provided medical imaging and information. It does not substitute for an in-person consultation or professional medical opinion. If you have any doubts or if your condition changes, please seek medical attention promptly.
Schwannoma of the wrist
