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A Rare Case of Schwannoma of the Superficial Peroneal Nerve with Split Fat Sign

DOI : https://doi.org/10.36349/easms.2020.v03i11.002
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Abstract: Schwannoma of the superficial peroneal nerve is very rare, with only four cases reported till 2006. Unlike neurofibromas, schwannomas do not traverse through the nerve but remain in the sheath lying on top of the nerve. Here we present a rare case of Schwannoma of the superficial peroneal nerve with split fat sign. A 48 year old woman complained of a swelling in the lateral aspect of proximal 1/3rd of right leg below the knee joint for 2 weeks. The swelling was painless and very small to begin with but it gradually progressed to the current size of 4 x 2 cm and caused mild pain. On examination mild tenderness and increased local warmth was noted at the site of the swelling. Sensations were intact at the site of swelling. There was no history was trauma or co-morbidities. MRI findings revealed a well-defined ovoid lesion which shows isointensity to muscle in T1WI and hyperintensity in T2 STIR, arising from the nerve sheath in the subcutaneous plane lateral to the right fibular neck. Axial and Coronal T2 STIR MR image of right fibular neck shows an image of right fibular neck with a large ovoid lesion which has predominantly high signal and is eccentrically located in distribution of superficial peroneal nerve which has central region low signal intensity representing “target” sign, which is also known as split fat sign. Differential diagnosis considered were schwannoma and neurofibroma. Later bone curettage was performed and histopathology examination revealed findings consistent with schwannoma.

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Dr. Afroza Begum

Lecturer, Dept. of Pharmacology and Therapeutics, Shaheed Monsur Ali Medical College & Hospital, Uttara, Dhaka-1230, Bangladesh

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