Clinical Presentation •
82-year-old male presents with a palpable mass at the medial aspect of the upper left arm
•
No history of malignancy
•
No history of recent trauma
Ultrasound of the Month – Case 31
1
Physical Examination •
A large palpable lesion is present at the medial upper arm
•
The mass is very firm but not painful to palpation
•
The mass is not pulsatile
•
Upper extremity neurologic examination is normal
Ultrasound of the Month – Case 31
2
Ultrasound examination was requested for further characterization of the mass
Ultrasound of the Month – Case 31
3
Ultrasound of the Month – Case 31
4
Ultrasound of the Month – Case 31
5
Ultrasound of the Month – Case 31
6
Diagnosis: •
Peripheral nerve sheath tumor of the ulnar nerve
Ultrasound of the Month – Case 31
7
Ultrasound of the Month – Case 31
8
Discussion •
Peripheral nerve sheath tumors (PNST) are neoplasms that arrive from the surface of peripheral nerves
•
These are most commonly Schwannomas or neurofibromas
•
These lesions may result in significant nerve-related symptoms such as pain or numbness or may be asymptomatic
•
The majority of these lesions are benign, but rarely may be malignant and as clinically indicated biopsy or excision may be necessary
•
There is an increased incidence of PNST in patients with Neurofibromatosis but the vast majority of these tumors are idiopathic
Ultrasound of the Month – Case 31
9