Sciatic Schwannoma Mimicking Musculoskeletal and Peripheral Nerve Pathologies: Chronic Diagnostic Challenges

Abstract

Sciatic schwannomas are rare peripheral nerve sheath tumors that often mimic more common conditions, such as lumbar radiculopathy or piriformis syndrome, leading to delayed diagnosis and inappropriate interventions. We report the case of a 35-year-old woman with right-sided hip and leg pain persisting for seven years following a Pilates session. Initially attributed to a soft tissue injury, her symptoms progressively worsened despite multiple treatments. An initial misdiagnosis of peroneal nerve entrapment led to unnecessary peroneal nerve decompression, which failed to relieve symptoms. A contrast-enhanced pelvic MRI ultimately revealed a sciatic nerve mass. Surgical excision confirmed a sciatic schwannoma, resulting in the complete resolution of symptoms. This case underscores the diagnostic challenges associated with sciatic schwannomas and highlights the value of pelvic MRI in persistent sciatic pain. Clinicians should consider pelvic MRI when conventional imaging is unremarkable and symptoms fail to improve with standard treatment to avoid unnecessary interventions and diagnostic delays. This case may represent the first reported sequential occurrence of an intracranial epidermoid tumor and a sciatic nerve schwannoma.