Incidental diagnosis of vaginal schwannoma in a patient with thigh pain
A 43-year-old Korean woman (gravid 2, para 2) presented to an orthopedist with thigh pain and burning and tingling sensations in the medial aspect of the left thigh. The pain reported to be exacerbated by dorsiflexion of the ankle or prolonged activity. The patient's medical history was otherwise unremarkable, and her physical examination was normal. Ankle and toes had full range of motion and deep tendon reflexes were intact. Straight leg raising test was negative, but caused vague discomfort in the thigh. Plain radiograph AP and lateral views of the left thigh were normal. The patient was referred for MRI of the left thigh and images revealed a mass lesion of heterogeneous intensity 5.2×5.7 cm in the left vaginal wall (). During subsequent physical examination, a cystic, non-tender, swelling was palpated in the left vaginal wall.\nThe patient referred to a gynecologist and it was decided to excise the mass via per-vaginal approach. The solid mass was removed without any perioperative complications, and the patient made an uneventful recovery. Patient's thigh pain disappeared after surgery.\nMacroscopically, the tumor was a well-circumscribed, soft, solid mass measuring 5.3×4.3 cm. Tumor section revealed a yellow/gray heterogeneous appearance without apparent necrosis ().\nMicroscopic examination showed a fascicular arrangement of spindle cells without nuclear atypia. Mitosis was not observed in high-power fields. Immunohistochemically, tumor cells showed a positive reaction for S-100 protein. All of these features were in keeping with a diagnosis of schwannoma ().\nThe patient has been followed for 8 months since surgery without evidence of recurrence.