Case Report

We are presenting a case of a 21-year-old male who presented to the surgical outpatients' department, Lok Nayak Hospital, Delhi with a large neurofibroma (22 kg) over the left gluteal region in association with neurofibromatosis (Figure 1). The patient was having a lot of difficulty in walking because of such a huge growth. Intraoperatively, this growth was found to be highly vascular. It was resected successfully though there was high blood loss (approximately 1.8 litres). The postoperative result was very satisfying to the patient (Figure 2).

Figure 1

Figure 1: Preoperative image showing giant neurofibroma of the left gluteal region

Figure 2

Figure 2: Postoperative result after 2 weeks

Discussion

Neurofibromas (NFs) are benign nerve sheath tumors which were first described by Smith in 1849 and later by Von Recklinghausen in 1882₁. They are relatively common, slowly growing, and painless tumors. The majority of NFs are solitary lesions that occur in the dermis or subcutis ₂,₃.

Macroscopically, NFs are well circumscribed and if still confined by the epineurium they are encapsulated. Most of them are not encapsulated. They vary in size and shape but most of them are between 1cm and 2cm ₄. Histologically, NFs contain interlacing bundles of elongated cells with wavy, dark-staining nuclei and slender cytoplasmic processes ₂,₅. These cells are arranged closely and are separated by small amounts of mucoid material. NFs lack epithelial elements. They demonstrate S-100 positivity and typically in some but not all of their components spindle cells. In keeping with their benign behaviour they lack significant mitotic activity.

There is plenty of data about large neurofibromas of vulva ₆, retroperitoneum, chest wall₇, penis₈ etc. but very few case reports of such a giant NFs are available. Thus, this is an interesting case, which needs to be highlighted.

Correspondence to

Dr. Pankaj Kumar Garg C-13, Sector 52; Noida 201301 Uttar Pradesh India Email: dr.pankajgarg@mail.com Phone: +919999817562