Skip to main content

Advertisement

SpringerLink
Log in

Rare malignant melanotic nerve sheath tumors of the upper limb nerves: utility of high-frequency ultrasonography in preoperative imaging

  • Case Report
  • Published:
Skeletal Radiology Aims and scope Submit manuscript

Abstract

Melanotic nerve sheath tumor (MNST) is a rare variant of schwannoma. Here, we report an unusual case of multiple MNST lesions located in the upper limb nerves. The patient presented with a mass on the left wrist in 2016 and another mass on the left thumb in 2017. In both instances, magnetic resonance imaging scans confirmed multiple giant-cell tumors of the tendon sheath. Persistent pain in the left upper limb and numbness in the ring finger and little finger recurred in 2021. High-frequency ultrasound (HFUS) showed that the left brachial plexus nerves (C5-8) were widened compared with those on the contralateral side; the neuroma formed at the lateral cord, and the median nerve was markedly thickened. The surgical findings were consistent with the ultrasound results. Pathology confirmed that the tumors were malignant MNSTs. HFUS is important for preoperative diagnosis and lesion localization, even identifying some lesions that are unrecognized on magnetic resonance imaging; thus, HFUS is crucial for improving surgical strategy and decision-making.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

We’re sorry, something doesn't seem to be working properly.

Please try refreshing the page. If that doesn't work, please contact support so we can address the problem.

References

  1. Alexiev BA, Chou PM, Jennings LJ. Pathology of melanotic schwannoma. Arch Pathol Lab Med. 2018;142(12):1517–23.

    Article  CAS  Google Scholar 

  2. El Benna N, Ouachtou K, Mahroug N, Abdelouafi A, Karkouri M. Melanocytic cervical schwannoma. J Neuroradiol. 2009;36(2):114–5.

    Article  Google Scholar 

  3. Torres-Mora J, Dry S, Li X, Binder S, Amin M, Folpe AL. Malignant melanotic schwannian tumor: a clinicopathologic, immunohistochemical, and gene expression profiling study of 40 cases, with a proposal for the reclassification of “Melanotic nerve sheath tumor.” Am J Surg Pathol. 2014;38(1):94–105.

    Article  Google Scholar 

  4. Jackson C, Linos K, Liu X. Malignant melanotic nerve sheath tumor in pleural effusion: deceitful cytology with significant repercussions. Diagn Cytopathol. 2022;50(3):76–80.

    Article  Google Scholar 

  5. Fletcher CD, Bridges AJ, Hogendoorn CW, et al. WHO classification of tumours of soft tissue and bone. 4th ed. Lyon: IARC Press; 2013.

    Google Scholar 

  6. Er U, Kazanci A, Eyriparmak T, Yigitkanli K, Senveli E. Melanotic schwannoma. J Clin Neurosci. 2007;14(7):676–8.

    Article  Google Scholar 

  7. Choi JH, Ro JY. The 2020 WHO classification of tumors of bone: an updated review. Adv Anat Pathol. 2020;28(3):119–38.

    Article  Google Scholar 

  8. Zheng M, Zhu Y, Zhou X, Chen S, Cong R, Chen D. Diagnosis of closed injury and neoplasm of the brachial plexus by ultrasonography. J Clin Ultrasound. 2014;42(7):417–22.

    Article  Google Scholar 

  9. Zhang HY, Yang GH, Chen HJ, Wei B, Ke Q, Guo H, Ye L, Bu H, Yang K, Zhang YH. Clinicopathological, immunohistochemical, and ultrastructural study of 13 cases of melanotic nerve sheath tumor. Chin Med J (Engl). 2005;118(17):1451–61.

    Google Scholar 

  10. Faria MH, Dória-Netto RH, Osugue GJ, Queiroz Lde S, Chaddad-Neto FE. Melanotic schwannoma of the cervical spine progressing with pulmonary metastasis: case report. Neurol Med Chir (Tokyo). 2013;53(10):712–6.

    Article  Google Scholar 

  11. Hems TE, Birch R, Carlstedt T. The role of magnetic resonance imaging in the management of traction injuries to the adult brachial plexus. J Hand Surg Br. 1999;24(5):550–5.

    Article  CAS  Google Scholar 

  12. Holzgrefe RE, Wagner ER, Singer AD, Daly CA. Imaging of the peripheral nerve: concepts and future direction of magnetic resonance neurography and ultrasound. J Hand Surg Am. 2019;44(12):1066–79.

    Article  Google Scholar 

  13. Gong W, Wang J, Huang L, Yang X, Chen D, Zheng M. Diagnosis of cervical plexus tumours by high-frequency ultrasonography. BMC Med Imaging. 2021;21(1):148.

    Article  Google Scholar 

  14. Chen D, Zheng M (2020) Ultrasonography diagnosis of peripheral nerves: cases and illustrations: Springer, Singapore

  15. Zhu YS, Mu NN, Zheng MJ, Zhang YC, Feng H, Cong R, Zhou XD, Chen DZ. High-resolution ultrasonography for the diagnosis of brachial plexus root lesions. Ultrasound Med Biol. 2014;40(7):1420–6.

    Article  Google Scholar 

Download references

Author information

Author notes

  1. Wenqing Gong and Jing Wang contributed equally to this work.

Authors and Affiliations

  1. Department of Ultrasound, Xijing Hospital, the Fourth Military Medical University, No. 127 Changle West Road, Xi’an, 710032, China

    Wenqing Gong, Jing Wang, Minjuan Zheng & Dingzhang Chen

  2. Department of Hand-Surgery, Xijing Hospital, the Fourth Military Medical University, Xi’an, China

    Rui Zhao

Authors
  1. Wenqing Gong
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jing Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rui Zhao
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Minjuan Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dingzhang Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding authors

Correspondence to Minjuan Zheng or Dingzhang Chen.

Ethics declarations

Ethics approval

Ethical approval to report this case was obtained from the Ethics Committee of Xijing Hospital (KY20162034-1).

Informed consent

Written informed consent was obtained from the patient for anonymized information to be published in this article.

Conflict of interest

The authors declare no competing interests.

Additional information

Publisher's note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gong, W., Wang, J., Zhao, R. et al. Rare malignant melanotic nerve sheath tumors of the upper limb nerves: utility of high-frequency ultrasonography in preoperative imaging. Skeletal Radiol 51, 2201–2204 (2022). https://doi.org/10.1007/s00256-022-04059-9

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-022-04059-9

Keywords

Search

Navigation