Dr. Pankaj Kumar Pande
Sr. Consultant
Surgical Oncology
BLK Cancer Centre
BLK Super Speciality
Hospital, New Delhi
Dr. Sandeep Mehta
Assistant Director
Surgical Oncology
BLK Cancer Centre
BLK Super Speciality
Hospital, New Delhi
Successfully dealing with a case of Brachial
Plexus Tumour
Primary Tumours of the brachial plexus are relatively rare, accounting
for less than 5% of all Tumours in the arm. They are usually not
associated with a neurologic deficit. The complex location of these
Tumours surrounded by important vascular structures makes the
resection challenging for surgeons.
THE CASE
A 44-year old non diabetic school teacher from Ethiopia was brought
to BLK with progressively increasing pain over her right shoulder
and right arm. She had been experiencing the pain for the past three
years and it would intensify every time she raised her hand over her
head. There was no history of sensory-motor deficits. She even had
to give up her profession due to the pain. On examination, there was
no palpable lump felt in her breasts. A lump was felt in the apex of
right axilla. No sensorineural deficit was noted and her distal arterial
pulsations were normal and symmetrical.
No evidence of any suspicious malignant mass lesion / architectural
distortion was seen in her right breast during Mammography.
Ultrasound of axilla showed an oval shaped, heteroechoic with
central echogenicity measuring 5.33 x 4.95 x 4.04 cm in size in the
right axilla. MR neck and axilla also fibers revealed a well marginated oval
shaped heterogenously enhancing lesion along the course of right
brachial plexus in the axillary region measuring about 43 x 49 x 61
mm. The lesion was displacing the axillary artery and veins inferiorly.
Medially, the lesion was abutting the thoracic wall.
THE PROCEDURE
The patient underwent surgery of the right brachial plexus region with
excision of the mass arising from the lateral cord of brachial plexus
under general anaesthesia without a muscle relaxant. Solid mass
was seen arising from the lateral cord of brachial plexus measuring
about 5 x 4 cm, firm in consistency with nerve fibers splaying around
it without any gross invasion. The clavicle and muscles were divided,
proximal and distal control of axillary vessels was done. The muscles
were sutured back and clavicle plating was done after excision of
mass. The final HPE was Neurofibroma.
THE RESULT
The patient did not have any sensory deficit in her right upper
limb post-operative. She had normal palmar flexion movements
and pincer grasp with slight weakness in dorsiflexion at wrist and
metacarpophalangeal joints. The patient went home happily, pain-free
and ready to resume her teaching profession.