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Omar W, Ahmedou AB, Youssef O, Sami R, Abada R, Mohamed R, Mohamed M. Intermittent dysphagia revealing a lateropharyngeal neurofibroma in a child: Case report: A case report. Ann Med Surg (Lond) 2021; 67:102438. [PMID: 34168868 PMCID: PMC8209718 DOI: 10.1016/j.amsu.2021.102438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/18/2021] [Accepted: 05/23/2021] [Indexed: 11/05/2022] Open
Abstract
Introduction Neurofibromatosis type 1 (NF1) is an disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. Case presentation We present the case of a 12-year-old patient referred by his pediatrician for intermittent dysphagia and a sensation of food attachment, in whom several café-au-lait spots on the body had been found, and a case of type 1 neurofibromatosis in the patient's siblings. The decision was to closely follow-up the patient, the progression of his symptoms and the size of the cervical neurofibroma. The patient's current follow-up has been two years, with a minimal increase in the frequency of episodes of dysphagia, and with Ct-scan performed every year. No major growth of the cervical mass was noted. Discussion Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. Conclusion The treatment is not codified and abstention therapeutic may be a wise decision. NF1 shows an autosomal dominant pattern of inheritance and wide phenotypical variability. Neurofibromatosis type 1 is a neurogenetic disorder. The cervical soft tissues may also be the primary site for tumors. The treatment is not codified. Abstention therapeutic may be a wise decision.
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Affiliation(s)
- Wydadi Omar
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Ahmed Brahim Ahmedou
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Oukessou Youssef
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Rouadi Sami
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Redallah Abada
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Roubal Mohamed
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
| | - Mahtar Mohamed
- ENT, Head and Neck Surgery Department, Ibn Rochd UniversityHospital, Faculty of Medicine and Pharmacy, Hassan II, Casablanca, Morocco
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Pandey S, Singh K, Sharma V, Khan MT, Ghosh A, Santhosh D. Bilateral Mirror Image Cervical Neurofibroma in an Adult with Neurofibromatosis Type 1. Malays J Med Sci 2017; 24:117-120. [PMID: 28381935 DOI: 10.21315/mjms2017.24.1.13] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Accepted: 06/02/2016] [Indexed: 10/20/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is an autosomal dominant disorder characterised by various phenotypic features like hyperpigmented spots, neurofibromas, Lisch nodules, skeletal abnormalities and tendency to develop neoplasms. Only few cases of Non-Familial Spinal Neurofibromatosis-1 (Non-FSNF1) have been described in literature with tumors involving the spinal roots at every level being even rarer. We reported an interesting case of bilateral symmetrical cervical neurofibroma with multiple spinal neurofibromas appearing as mirror image on CT, associated with non familial NF-1 as a rare presentation in a 25-year-old adult male.
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Affiliation(s)
- Sharad Pandey
- Department of Neuro Surgery, Sir Sunder Lal Hospital, IMS (Institute of Medical Science), BHU(Banaras Hindu University), Varanasi, Uttar Pradesh-221005, India
| | - Kulwant Singh
- Department of Neuro Surgery, Sir Sunder Lal Hospital, IMS (Institute of Medical Science), BHU(Banaras Hindu University), Varanasi, Uttar Pradesh-221005, India
| | - Vivek Sharma
- Department of Neuro Surgery, Sir Sunder Lal Hospital, IMS (Institute of Medical Science), BHU(Banaras Hindu University), Varanasi, Uttar Pradesh-221005, India
| | - Mohammed Tabish Khan
- Department of Neuro Surgery, Sir Sunder Lal Hospital, IMS (Institute of Medical Science), BHU(Banaras Hindu University), Varanasi, Uttar Pradesh-221005, India
| | - Amrita Ghosh
- Department of Pathology, Sir Sunder Lal Hospital, IMS BHU, Varanasi, Uttar Pradesh-221005, India
| | - Deepa Santhosh
- Department of Pathology, Sir Sunder Lal Hospital, IMS BHU, Varanasi, Uttar Pradesh-221005, India
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3
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Abstract
The MR findings in 7 patients with neurofibromatosis involving the spine were evaluated. Six patients had paraspinal tumors at multiple levels. In 4 they were bilateral. Five patients had multiple intraspinal lesions, frequently with growth through the neural foramen. In one patient paraspinal tumors were found in the lumbar sacral plexus and in another bony dysplasia and meningoceles but no tumors were disclosed. In 2 patients the lesions were associated with bilateral acoustic neuromas and multiple intracranial meningeomas. In one of these a spinal meningeoma with signal characteristics close to spinal cord was found. The other tumors had a signal that was equal to or slightly lower than the spinal cord and slightly higher than muscle on T1-weighted images. On T2-weighted images the tumors had a markedly increased signal compared to surrounding tissue. In 3 patients with tumors larger than 4 cm the signal intensity was inhomogeneous with decreased signal in the center on T2-weighted images, indicating the presence of increased fibrous tissue. Gadolinium-DTPA was given to one patient with marked increase in intensity of small tumors on T1-weighted images. The study shows that MR imaging is the modality of choice for evaluating most aspects of spinal and paraspinal neurofibromatosis.
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Lacerda LDS, Alves ÚD, Zanier JFC, Machado DC, Camilo GB, Lopes AJ. Differential diagnoses of overgrowth syndromes: the most important clinical and radiological disease manifestations. Radiol Res Pract 2014; 2014:947451. [PMID: 25009745 PMCID: PMC4070411 DOI: 10.1155/2014/947451] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/19/2014] [Accepted: 05/27/2014] [Indexed: 12/25/2022] Open
Abstract
Overgrowth syndromes comprise a heterogeneous group of diseases that are characterized by excessive tissue development. Some of these syndromes may be associated with dysfunction in the receptor tyrosine kinase (RTK)/PI3K/AKT pathway, which results in an increased expression of the insulin receptor. In the current review, four overgrowth syndromes were characterized (Proteus syndrome, Klippel-Trenaunay-Weber syndrome, Madelung's disease, and neurofibromatosis type I) and illustrated using cases from our institution. Because these syndromes have overlapping clinical manifestations and have no established genetic tests for their diagnosis, radiological methods are important contributors to the diagnosis of many of these syndromes. The correlation of genetic discoveries and molecular pathways that may contribute to the phenotypic expression is also of interest, as this may lead to potential therapeutic interventions.
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Affiliation(s)
- Letícia da Silva Lacerda
- Department of Radiology, State University of Rio de Janeiro, 20551-030 Rio de Janeiro, RJ, Brazil
| | - Úrsula David Alves
- Department of Radiology, State University of Rio de Janeiro, 20551-030 Rio de Janeiro, RJ, Brazil
| | | | - Dequitier Carvalho Machado
- Department of Radiology, State University of Rio de Janeiro, 20551-030 Rio de Janeiro, RJ, Brazil
- Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, 20550-170 Rio de Janeiro, RJ, Brazil
| | - Gustavo Bittencourt Camilo
- Department of Radiology, State University of Rio de Janeiro, 20551-030 Rio de Janeiro, RJ, Brazil
- Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, 20550-170 Rio de Janeiro, RJ, Brazil
| | - Agnaldo José Lopes
- Postgraduate Programme in Medical Sciences, State University of Rio de Janeiro, 20550-170 Rio de Janeiro, RJ, Brazil
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Pascual-Castroviejo I, Pascual-Pascual SI, Viaño J, Velazquez-Fragua R, López-Gutierrez JC. Bilateral spinal neurofibromas in patients with neurofibromatosis 1. Brain Dev 2012; 34:563-9. [PMID: 21999966 DOI: 10.1016/j.braindev.2011.09.011] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2011] [Revised: 09/19/2011] [Accepted: 09/20/2011] [Indexed: 11/26/2022]
Abstract
Neurofibromatosis 1 (NF1) is a neurocutaneous syndrome that can be inherited as autosomal dominant or may appear due to a de novo mutation. We present 8 patients (5 M and 3 F) with sporadic or non-familial spinal neurofibromatosis 1 (non-FSNF1) associated with bilateral spinal neurofibromas involving all of the paraspinal nerves. To our knowledge, this is the first series of such association described in the literature. Their ages ranged from 6 months to 20 years (average 9.8 years) at the time of radiological diagnosis. This presentation appears to be earlier than in familial spinal neurofibromas in NF1 (FSNF1). Predisposition to malignancy probably is greater in the non-FSNF1 type. MRI studies were performed routinely in all patients with NF1 and these were complemented with MRI enhanced with gadolinium and repeated at different ages in cases with paraspinal tumors. Coronal views provided the best evidence for the presence of neurofibromas in every spinal nerve. The size of the tumors and the clinical complications increased with advancing age in most patients. Giant plexiform tumors were often seen in the cervico-thoracic region. Malignant peripheral nerve sheath tumors (MPNST) were found in one patient with a sciatic tumor and another patient died suddenly at home without necropsy or pathological study. Voluminous paraspinal neurofibromas can be at risk for malignancy. More frequent neuroimaging studies may be necessary for an earlier detection. Early surgical treatment to anticipate the occurrence of MPNST during surveillance could be an option. Bilateral spinal neurofibromas are found in both patients who inherited the NF1 and in those due to de novo mutations.
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6
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Chee DWY, Peh WCG, Shek TWH. Pictorial essay: imaging of peripheral nerve sheath tumours. Can Assoc Radiol J 2010; 62:176-82. [PMID: 20510574 DOI: 10.1016/j.carj.2010.04.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2009] [Revised: 04/11/2010] [Accepted: 04/13/2010] [Indexed: 02/07/2023] Open
Abstract
Peripheral nerve sheath tumours (PNST) may be benign or malignant. Benign PNSTs include neurofibroma and schwannoma. Neurogenic tumours share certain characteristic imaging features, suggested by a fusiform-shaped mass with tapered ends, the "split-fat" sign, atrophy of the muscles supplied by the involved nerve, the "fascicular sign," and the "target sign"; these imaging features are best demonstrated on magnetic resonance imaging. This pictorial essay emphasizes the characteristic signs and distinguishing features of PNSTs on imaging.
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Affiliation(s)
- Daniel W Y Chee
- Department of Diagnostic Radiology, Alexandra Hospital, Singapore, Republic of Singapore
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7
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Hillier JC, Moskovic E. The soft-tissue manifestations of neurofibromatosis type 1. Clin Radiol 2005; 60:960-7. [PMID: 16124977 DOI: 10.1016/j.crad.2005.02.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 01/28/2005] [Accepted: 02/08/2005] [Indexed: 11/21/2022]
Abstract
The radiological appearances of neurofibromatosis type 1 (NF-1) are numerous and variable, because of the widespread presence of peripheral nerves. Knowledge of this variability can prevent unnecessary intervention. For example, occasionally lesions can be misinterpreted and biopsies performed unnecessarily. Thus, familiarity with the manifestations of this disease and the spectrum of associated abnormalities is an important part of the radiologist's armamentarium. This paper explores the manifold radiological appearances of extracranial NF-1 as experienced by the Sarcoma and Soft Tissue Tumour Unit at the Royal Marsden Hospital.
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Affiliation(s)
- J C Hillier
- Department of Clinical Radiology, Chelsea and Westminster Hospital, London, UK.
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8
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Kalra N, Vijayanadh O, Lal A, Khandelwal N, Mukherjee KK, Suri S. Retroperitoneal plexiform neurofibroma mimicking psoas abscesses. ACTA ACUST UNITED AC 2005; 49:330-2. [PMID: 16026442 DOI: 10.1111/j.1440-1673.2005.01443.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Retroperitoneal plexiform neurofibroma is a rare finding in neurofibromatosis type I, or von Recklinghausen's disease. A case of retroperitoneal plexiform neurofibroma mimicking psoas abscesses is reported here with its CT and MRI findings.
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Affiliation(s)
- N Kalra
- Department of Radiodiagnosis, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
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9
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Zacharia TT, Jaramillo D, Poussaint TY, Korf B. MR imaging of abdominopelvic involvement in neurofibromatosis type 1: a review of 43 patients. Pediatr Radiol 2005; 35:317-22. [PMID: 15517232 DOI: 10.1007/s00247-004-1352-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2004] [Revised: 08/23/2004] [Accepted: 09/15/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND Plexiform neurofibromas are a frequent complication of neurofibromatosis type 1. This article discusses MR imaging findings and distribution of plexiform neurofibromas in the abdomen and pelvis. OBJECTIVE To define the most prevalent patterns of involvement and MR imaging findings in abdominopelvic neurofibromatosis type 1. MATERIALS AND METHODS We reviewed the MR appearance of abdominopelvic lesions in 23 male and 20 female patients (median age: 16 years) with type 1 neurofibromatosis. The patients were part of a multi-institutional study of 300 patients. Imaging included coronal or sagittal, and axial short tau inversion recovery images. RESULTS The most common abdominopelvic involvement was in the abdominopelvic wall (n=28, 65%) and lumbosacral plexus (n=27, 63%). Retroperitoneal involvement was frequent (n=15, 35%). Lesions were less often intraperitoneal (21%) (P=0.001). Pelvic disease (n=27, 63%), neural canal involvement (n=18, 42%), and hydronephrosis (n=4, 9%) were also noted. Target-like appearance of plexiform lesions was noted in more than half the patients. CONCLUSION Abdominopelvic involvement in neurofibromatosis type 1 is primarily extraperitoneal. Although lesions are most prevalent in the abdominopelvic wall and lumbosacral plexus, retroperitoneal and pelvic involvement is common and usually affects important organs. MR imaging added information in the initial and follow-up clinical evaluation of these patients.
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Affiliation(s)
- T Thomas Zacharia
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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10
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Abstract
We report a young man with asymptomatic neurofibromatosis type-1 initially diagnosed on CT. CT demonstrated the typical lesions of this disorder: extensive cervical, thoracic, abdominal and pelvic masses and spinal alterations. The symmetrical distribution and the location of the lesions as well as their attenuation are characteristic of NF-1 and may be considered diagnostic for this disease.
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Affiliation(s)
- Tal Arazi-Kleinmann
- Department of Diagnostic Imaging, Sheba Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Tel 52621, Hashomer, Israel.
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11
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Zuccoli G, Ferrozzi F, Tognini G, Troiso A. Enlarging tongue masses in neurofibromatosis type 1: MR findings of two cases. Clin Imaging 2001; 25:268-71. [PMID: 11566089 DOI: 10.1016/s0899-7071(01)00301-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Plexiform neurofibromas usually occur in the neck, pelvis, and extremities. Jaws and oral cavity plexiform neurofibromas have also been described. Magnetic resonance (MR) patterns for neurofibromas are typical. They include low-to-intermediate signal intensity on T1-weighted images, enhancement of the solid component of the tumor after contrast medium administration, heterogeneity on T2-weighted images, and in some cases, multiple target signs due to a collagen central area. We report MR findings of two neurofibromatosis type 1 (NF1) patients with enlarging tongue plexiform neurofibromas.
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Affiliation(s)
- G Zuccoli
- Radiology Department, Arcispedale Santa Maria Nuova, Viale Risorgimento 80, 42100, Reggio Emilia, Italy.
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12
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Abstract
Neurofibromatosis type 1 (NF1) is the most common of the phakomatoses and has a variety of localized or, more frequently, systemic manifestations throughout the thorax, abdomen, pelvis, and extremities. Classic computed tomographic (CT) findings in NF1 with thoracic involvement include small, well-defined subcutaneous neurofibromas, focal thoracic scoliosis, posterior vertebral scalloping, enlarged neural foramina, and characteristic rib abnormalities due to bone dysplasia or erosion from adjacent neurofibromas. However, more atypical manifestations are occasionally seen, and magnetic resonance (MR) imaging can be useful in equivocal cases. NF1 with abdominopelvic involvement tends to arise in the retroperitoneal, mesenteric, and paraspinal regions; it may be quite extensive and therefore difficult to distinguish from adenopathy at CT. The multiplanar capabilities of MR imaging, particularly with T2 weighting, make this modality helpful in evaluating affected patients and making the diagnosis. The classic peripheral manifestations of NF1 include limb hemihypertrophy, pseudarthrosis, peripheral nerve neurofibromas, and subcutaneous common and plexiform neurofibromas. In some cases of NF1, imaging findings are inconclusive, and biopsy and subsequent pathologic analysis are required. Familiarity with the various manifestations of NF1 in different anatomic locations is important in making the diagnosis and optimizing postdiagnostic treatment.
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Affiliation(s)
- B J Fortman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA
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Murphey MD, Smith WS, Smith SE, Kransdorf MJ, Temple HT. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors: radiologic-pathologic correlation. Radiographics 1999; 19:1253-80. [PMID: 10489179 DOI: 10.1148/radiographics.19.5.g99se101253] [Citation(s) in RCA: 349] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Numerous neurogenic tumors can affect the musculoskeletal system, including traumatic neuroma, Morton neuroma, neural fibrolipoma, nerve sheath ganglion, neurilemoma, neurofibroma, and malignant peripheral nerve sheath tumors (PNSTs). The diagnosis of neurogenic tumors can be suggested from their imaging appearances, including lesion shape and intrinsic imaging characteristics. It is also important to establish lesion location along a typical nerve distribution (eg, plantar digital nerve in Morton neuroma, median nerve in neural fibrolipoma, large nerve trunk in benign and malignant PNSTs). Traumatic and Morton neuromas are commonly related to an amputation stump or are located in the intermetatarsal space, respectively. Neural fibrolipomas show fat interspersed between nerve fascicles and are often associated with macrodactyly. Nerve sheath ganglion has a cystic appearance and commonly occurs about the knee. Radiologic characteristics of neurilemoma, neurofibroma, and malignant PNST at computed tomography (CT), ultrasonography, and magnetic resonance imaging include fusiform shape, identification of entering and exiting nerve, low attenuation at CT, target sign, fascicular sign, split-fat sign, and associated muscle atrophy. Although differentiation of neurilemoma from neurofibroma and of benign from malignant PNST is problematic, recognition of the radiologic appearances of neurogenic tumors often allows prospective diagnosis and improves clinical management of patients.
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Affiliation(s)
- M D Murphey
- Department of Radiologic Pathology, Armed Forces Institute of Pathology, Washington, DC 20306, USA
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14
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Suga K, Hirabayashi A, Kishimoto K, Kume N, Matsumoto T, Matsunaga N. Tc-99m DTPA used as reference imaging to evaluate the distribution of other tumor-seeking tracers in tumors associated with neurofibromatosis. Clin Nucl Med 1999; 24:435-9. [PMID: 10361941 DOI: 10.1097/00003072-199906000-00012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Two patients with multiple benign and malignant tumors associated with neurofibromatosis underwent radionuclide imaging with Tc-99m DTPA, Tl-201, and Ga-67. In these patients, Tc-99m DTPA accumulated intensively in both the benign and malignant tumors and localized and defined the extent of every tumor. In contrast, Ga-67 and Tl-201 uptake was seen only in focal areas of tumor where there was malignant transformation or at sites that showed progressive tumor growth. Tc-99m DTPA imaging accurately demonstrated areas of neoplastic involvement and identified the areas that would be seen with the other two tracers in individual tumors. Tc-99m DTPA may not always be used for the differential diagnosis of malignant and benign tumors of neurofibromatosis, but it can provide a reference pattern for imaging to evaluate accurately the distribution of Tl-201 and Ga-67 by mapping out the anatomic extent of these tumors.
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Affiliation(s)
- K Suga
- Department of Radiology, Yamaguchi University School of Medicine, Ube, Japan
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15
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Lee JY, Lee KS, Han J, Yoon HK, Kim TS, Han BK, Kim J, Shim YM. Spectrum of neurogenic tumors in the thorax: CT and pathologic findings. J Comput Assist Tomogr 1999; 23:399-406. [PMID: 10348446 DOI: 10.1097/00004728-199905000-00014] [Citation(s) in RCA: 44] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Neurilemomas and neurofibromas appear as round soft tissue masses at CT. Variable enhancement with either homogeneity or heterogeneity is seen in neurilemomas. Attenuation of the tumors on enhanced CT depends on histology: the extent of Antoni A or B tissue and the amount of myxoid or cystic degeneration or hemorrhage. Neurofibromas are usually homogeneous low attenuation lesions on unenhanced CT. They show homogeneous enhancement or early central blush on enhanced scan. The extent of enhancement depends on the proportions of tumor components: nerve sheath cells, collagen bundles, and areas of myxoid degeneration. Malignant nerve sheath tumors show variable attenuation. Bony destruction, pleural effusion, and metastatic pulmonary nodules may also occur. Ganglioneuromas appear as oblong homogeneous low attenuation lesions on both enhanced and unenhanced CT. This low attenuation is due to their pathologic components, with an abundant amount of myxoid matrices and a relatively small amount of ganglion cells. Neuroblastomas appear as aggressive soft tissue lesions with calcification. Ganglioneuroblastomas may appear with features in between those of ganglioneuromas and neuroblastomas. The typical location of the posterior mediastinum or the aortopulmonary window and high enhancement with administration of contrast medium at CT suggest the diagnosis of paragangliomas.
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Affiliation(s)
- J Y Lee
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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16
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Kuntz C, Blake L, Britz G, Filler A, Hayes CE, Goodkin R, Tsuruda J, Maravilla K, Kliot M. Magnetic resonance neurography of peripheral nerve lesions in the lower extremity. Neurosurgery 1996; 39:750-6; discussion 756-7. [PMID: 8880769 DOI: 10.1097/00006123-199610000-00021] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE We describe the clinical application and utility of high-resolution magnetic resonance neurography (MRN) techniques to image the normal fascicular structure of peripheral nerves and its distortion by mass lesions or trauma in the lower extremity. METHODS MRN images were obtained using a standard 1.5 Tesla magnet and custom built phased-array coils. Patients were imaged using T1-weighted spin echo without and with gadolinium, T2-weighted fast spin echo with fat peripheral nerve tumors (three neurofibromas and one schwannoma), two with intraneural cysts, and three with traumatic peripheral nerve lesions. Six patients with peripheral nerve mass lesions underwent surgery, thereby allowing MRN images to be correlated with intraoperative and pathological findings. RESULTS Preoperative MRN accurately imaged the normal fascicular anatomy of peripheral nerves and precisely depicted its relation to tumor and cystic lesions. Increased signal on T2-weighted fast spin-echo and short tau inversion recovery fast spin-echo pulse sequences was seen in the peripheral nerve fascicles of patients with clinical and electrodiagnostic evidence of nerve injury. CONCLUSION MRN proved useful in the preoperative evaluation and planning of surgery in patients with peripheral nerve lesions.
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Affiliation(s)
- C Kuntz
- Department of Neurological Surgery, University of Washington, Seattle, USA
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17
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Drevelengas A, Kalaitzoglou I. Giant lumbar meningocele in a patient with neurofibromatosis. Neuroradiology 1995; 37:195-7. [PMID: 7603594 DOI: 10.1007/bf01578257] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- A Drevelengas
- Department of Radiology, G. Papanikolaou General Hospital, Exohi, Thessaloniki, Greece
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18
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Abstract
Although the cutaneous, bony and retroperitoneal appearances of peripheral von Recklinghausen neurofibromatosis are well known, involvement of intra-abdominal organs and of the mediastinum is less well recognised. We present the case of a woman with peripheral neurofibromatosis who presented with loin pain. In addition to cutaneous neurofibromas, plexiform neurofibromas were present in the mediastinum, liver, mesentery and psoas muscles.
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Affiliation(s)
- K J Gossios
- Department of Diagnostic Radiology, Royal Marsden Hospital, Sutton, Surrey
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19
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Riccardi VM. Type 1 neurofibromatosis and the pediatric patient. CURRENT PROBLEMS IN PEDIATRICS 1992; 22:66-106; discussion 107. [PMID: 1576827 DOI: 10.1016/0045-9380(92)90053-2] [Citation(s) in RCA: 74] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- V M Riccardi
- Neurofibromatosis Institute, Pasadena, California
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20
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Abstract
We present a case of plexiform neurofibroma of the pelvis in a patient with neurofibromatosis using magnetic resonance imaging (MRI) with computed tomography (CT) correlation. We discovered an extensive pelvic mass with a slightly greater signal intensity than muscle in T1-weighted images and a marked increased signal intensity in T2-weighted images. Multiple hypointense septations were identified throughout the tumor, particularly in the T2-weighted images. The MR appearance of pelvic plexiform neurofibroma is identical to those found in spinal and paraspinal locations. In the presence of an extensive pelvic mass in a patient with neurofibromatosis, MRI is recommended in evaluating and diagnosing plexiform neurofibroma. Since the MRI appearance of this tumor is characteristic, other lesions can possibly be ruled out. In addition, MRI's multiplanar capability is ideally suited to demonstrate the extension of these large tumors.
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Affiliation(s)
- P R Ros
- Department of Radiology, University of Florida College of Medicine, Gainesville, 32610
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Vock P, Mattle H, Studer M, Mumenthaler M. Lumbosacral plexus lesions: correlation of clinical signs and computed tomography. J Neurol Neurosurg Psychiatry 1988; 51:72-9. [PMID: 3351532 PMCID: PMC1032716 DOI: 10.1136/jnnp.51.1.72] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Neurological signs and computed tomographic morphology were compared in 60 patients. The primary neurological deficit was most commonly located in the sacral (n = 31) or lumbar plexus (n = 23) and was most commonly caused by a neoplasm (n = 40). In 78% of the patients it correlated with the lesions detected by computed tomography (CT). CT reliably demonstrates extraspinal mass lesions, but only moderately well predicts functional signs.
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Affiliation(s)
- P Vock
- Department of Diagnostic Radiology, University of Bern, Switzerland
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Aughenbaugh GL. Thoracic Manifestations of Neurocutaneous Diseases. Radiol Clin North Am 1984. [DOI: 10.1016/s0033-8389(22)01187-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
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