Sciatic Nerve Schwannoma in the Gluteal Region Mimicking Sciatica

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Excerpt

Here, we present the case of a 27-year-old woman with a 4-year history of sharp pain and a palpable mass in the right gluteal region when sitting and with the pain worsening at night. Despite physiotherapy, the pain was not relieved. Upon physical examination, Tinel sign was positive in the right gluteal fold. Her skin sensation was normal, and no muscle weakness was apparent. Ultrasound scanning revealed a hypoechoic mass in the gluteal region (Fig. 1). Magnetic resonance imaging was then performed, which revealed an intrinsic sciatic nerve tumor (Fig. 2). The patient underwent a surgical enucleation (Fig. 3) with a histopathologic examination, and her condition was subsequently diagnosed as sciatic nerve schwannoma in the right gluteal region. Pain relief was achieved after surgery.
Peripheral nerve sheath tumors are indeed rare; benign schwannomas are the most common and are estimated to occur in six patients per 100,000.1 Sporadic schwannomas show no predilection toward sex or race, and they affect patients of all ages, but particularly patients between age 20 and 50.2 Schwannomas may occur anywhere in the peripheral nerve system (most commonly in the head and neck region). Schwannoma of the sciatic nerve is uncommon (with a frequency of <1%), and diagnosis might be challenging. Schwannomas are usually asymptomatic and benign.3 When symptoms like dysesthesia, pain, or weakness occur, surgical excision is suggested.4 The case of successfully treated sciatic nerve schwannoma presented here emphasizes the importance of considering sciatic nerve schwannoma in gluteal pain differential diagnosis.
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