Presentation
Right index MCP region volar nodule for the last 5 years. No pain.
Patient Data
The clinically visible and palpable nodule is a well-defined, bilobed, heterogeneous hypoechoic lesion without calcification/ cystic changes. The lesion shows continuity with a palmar nerve proximally as well as distally. The lesion is eccentric to the nerve. Few internal flow signals are present. Adjacent artery, muscle, tendon, and MCP joint are normal.
Both short-axis cine-loops run from the proximal to distal direction, showing nerve continuity.
The intra-operative photograph shows a bilobed lesion. Continuity with the nerve was present. It was eccentrically located in the nerve.
The second photo shows an arrow pointing to the lesion.
The third photo of the resected lesion.
Image credit: Dr Piyush Patel
Case Discussion
The palmar nodule is in continuity with the nerve-favoring nerve sheath tumor. Histopathology revealed ancient schwannoma.
Intraoperative and gross specimen photos courtesy of Dr Piyush Patel (operating surgeon).
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