MULTIFOCAL ANCIENT NEURILEMOMA OF THE FEM ORAL NERVE IN CHRONIC MYELOBLASTIC DYSPLASIA

A large multiple lobulated painless mass in the inguinal fossa, was in vestigated and removed, in a 58 years old patient with undiagnosed chr onic myelodysplasia. The patient was initially refered to the urologic clinics for recurrent bleeding from the urinary tract, when the above mentioned and few smaller masses were palpated on the anterior aspect of the thigh. Clinical, laboratory and imaging investigation revealed enlargement of the spleen and the liver accompanied by relatively lar ge and well separated tumors under the inguinal ligament extending to the upper thigh. From clinical history the patient had recurrent episo des of spontaneous bleeding from the nose and the bladder. He underwen t open biopsy under general anesthesia where the inguinal tumor was fo und to be well encapsulated, firmly attached to a branch of the femora l nerve and loosely connected with the next mass that had similar char acteristics. Intraoperative decision was made to excise the entire les ion wich consisted of thirteen lobules of varying size, connected to e ach other as a chain. Histological examination revealed multifocal anc ient neurilemona from a sensory branch of the femoral nerve. Further i nvestigation of the patient for the episodes of hemorrage and the enla rgement of the spleen and the liver gave the diagnosis of chronic myel odysplasia. The patient was doing well one year after the excision of the tumor, and had an area with hypoesthesia above the knee. The concu rrence of the two distinct neoplasms is discussed.