Asian Journal of Case Reports in Surgery

Ulceration within a Neurofibromatous Nodule: A Case Report

Pradeoth Mukundan Korambayil *

Department of Plastic Surgery and Burns, Jubilee Mission Medical College and Research institute Thrissur, Kerala 680005, India.

Deepthy Vijayaraghavan

Department of Pathology, Jubilee Mission Medical College and Research Institute Thrissur, Kerala 680005, India.

Catherine Angel D Cunha

Department of Plastic Surgery and Burns, Jubilee Mission Medical College and Research institute Thrissur, Kerala 680005, India.

*Author to whom correspondence should be addressed.

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Abstract

Neurofibromatosis (NF1) is a genetic disorder characterized by the development of multiple benign nerve sheath tumors called neurofibromas. In approximately 8-12% of individuals with NF1, these neurofibromas can undergo malignant transformation into malignant peripheral nerve sheath tumors (MPNST). Here, we present the case of a 46-year-old male with known NF1, who presented with a large, progressively increasing neurofibromatous nodule in the occipital region that eventually ulcerated. The patient had a history of multiple neurofibromatous nodules covering his body since the age of 15. A team of expert plastic surgeons completely excised the tumor,  and histopathological examination revealed a high-grade MPNST. The patient was informed about the clinical implications and treatment options. Genetic testing was also considered to assess the  risk for relatives of the proband. This case underscores the importance of close monitoring and early detection of malignant transformation in patients with NF1. NF1 is associated with a wide range of clinical manifestations, including café-au-lait spots, Lisch nodules, and skeletal abnormalities. Regular clinical evaluations and imaging studies are crucial in patients with NF1 to detect any signs of malignant transformation early. Treatment options for MPNST include surgical resection, radiation therapy, and chemotherapy, but the prognosis remains poor, emphasizing the importance of early intervention and genetic counseling in affected individuals and their families.

Keywords: Neurofibromatosis [NF-1], malignant peripheral nerve sheath tumours, recurrent lesion, surgical excision

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