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

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.