Neurofibroma of saphenous nerve mimicking thrombophlebitis
Young man (25 yrs) complained of persistent pain on the medial side of the lower part of the left thigh. A cord like structure with 3 small nodular thickenings was palpable parallel to the course of the great saphenous vein. Initially in a he was treated as case of superficial thrombophlebitis of the great saphenous vein in private clinic near his home. But when the pain persisted even after receiving local therapies and Injection Heparin (LMWH) he is referred to the vascular surgery unit in our hospital. Duplex scan of the thigh reported it as thrombophlebitis of a vein parallel to the great saphenous vein. We continued Injection Heparin and suspected thrombophilia. The pain persisted and on further detailed examination of swelling we noted nodular swellings over a cord like structure. He did not give history of risk factors for thrombophlebitis. We considered biopsy of the cord with nodules to confirm a diagnosis. The excised cord with nodular structure was sent to histological examination. It was confirmed as “Neurofibroma” of the saphenous nerve. Post operatively the pain subsided dramatically and patient was discharged with an advice to attend the follow-up clinic. Diagnosis of small tumors of peripheral nerve at this site can be mistaken as a case of thrombophlebitis and there may be undue delay in diagnosis as we do not perform biopsy for thrombophlebitis in routine clinical practice. Unusual pain, nodular feeling of the swelling in this case helped us to consider early biopsy and excision of the tumor.
