[Malignant schwannoma of the median nerve]

The case of a 52-year old patient is described who was operated on for pronator-teres syndrome. Eight months postoperatively reoperation was necessary because of recurrent pain. The median nerve showed haemorrhagic necrosis in the region of the pronator teres muscle with an extensive intrafascicular swelling of the adjacent proximal and distal nerve segments. After resection of the median nerve, the histological examination revealed a benign schwannoma. Reconstruction of the median nerve was performed by interfascicular nerve grafting. Three months later severe pains recurred in the forearm which had to be opened in an emergency operation. Extensive haemorrhagic necrosis was evident. The histological diagnosis was now malignant schwannoma. Upper arm amputation was performed and later a functional prosthesis was fitted. Three years after the amputation multiple metastases occurred; the patient died within three months.