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Carone L, Messana G, Vanoli A, Pugliese L, Gallotti A, Preda L. Correlation between imaging and histology in benign solitary retroperitoneal nerve sheath tumors: a pictorial review. Insights Imaging 2024; 15:132. [PMID: 38816511 PMCID: PMC11139841 DOI: 10.1186/s13244-024-01709-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 04/26/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Benign nerve sheath tumors presenting as solitary retroperitoneal masses (RBNSTs) pose a complex diagnostic challenge for multidisciplinary teams regarding differential diagnosis, staging, and treatment planning. This article reviews the role played by different imaging techniques in assessing RBNSTs and elucidates their typical pathological features with a particular emphasis on the correlation between imaging and histological findings. Furthermore, some examples of retroperitoneal tumors that merit consideration in the process of differential diagnosis based on cross-sectional investigations (CSIs) are reported. The correlation between tissue architecture and appearance on imaging can help increase the accuracy of differential diagnosis with other retroperitoneal neoplasms at CSIs. CRITICAL RELEVANCE STATEMENT This educational review critically examines the correlation between imaging and histological features in solitary retroperitoneal benign nerve sheath tumors, offering valuable insights for improving the accuracy of differential diagnosis in clinical radiology. KEY POINTS RBNSTs are challenging to diagnose because they lack specific radiological features. Differential diagnosis of RBNSTs from other retroperitoneal neoplasms on imaging is complex. Surgical removal of RBNSTs is recommended for an accurate diagnosis.
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Affiliation(s)
- Luisa Carone
- Radiology 1 Unit, IRCCS San Matteo Hospital Foundation, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Gaia Messana
- Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Brambilla, 74, 27100, Pavia, Italy.
| | - Alessandro Vanoli
- Department of Molecular Medicine, University of Pavia, Viale Camillo Golgi, 19, 27100, Pavia, Italy
- Unit of Anatomic Pathology, IRCCS San Matteo Hospital Foundation, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Luigi Pugliese
- General Surgery 2 Unit, IRCCS San Matteo Hospital Foundation, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Anna Gallotti
- Radiology 1 Unit, IRCCS San Matteo Hospital Foundation, Viale Camillo Golgi, 19, 27100, Pavia, Italy
| | - Lorenzo Preda
- Radiology 1 Unit, IRCCS San Matteo Hospital Foundation, Viale Camillo Golgi, 19, 27100, Pavia, Italy
- Diagnostic Imaging and Radiotherapy Unit, Department of Clinical, Surgical, Diagnostic, and Pediatric Sciences, University of Pavia, Viale Brambilla, 74, 27100, Pavia, Italy
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2
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Karn M, Mahato BK, Ojha L, Thapa Y, Bhatta S, Sharma S, Chapagain S, Ranabhat S, Neupane BR, Shrestha DM. Low-grade malignant peripheral nerve sheath tumour presenting as retroperitoneal spindle cell neoplasm. J Int Med Res 2024; 52:3000605241255504. [PMID: 38759217 PMCID: PMC11107319 DOI: 10.1177/03000605241255504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 05/01/2024] [Indexed: 05/19/2024] Open
Abstract
Retroperitoneal spindle cell neoplasms are diagnostically challenging. Malignant peripheral nerve sheath tumours (MPNSTs) can sometimes present as sporadic primary retroperitoneal tumours. MPNSTs are usually high-grade and highly aggressive tumours and are associated with a poor prognosis. Low-grade MPNSTs are very rarely described. This current case report describes a case of sporadic primary low-grade MPNST presenting as retroperitoneal spindle cell neoplasm. The diagnosis, imaging and immunohistopathological findings, as well as its successful surgical management, are presented.
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Affiliation(s)
- Mitesh Karn
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Basant Kumar Mahato
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Liladhar Ojha
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Yeshika Thapa
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Suman Bhatta
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Sushil Sharma
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Sachita Chapagain
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Sunita Ranabhat
- Department of Pathology, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Bhoj Raj Neupane
- Department of Surgery, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
| | - Deependra Man Shrestha
- Department of Medicine, Gandaki Medical College Teaching Hospital and Research Centre, Pokhara, Gandaki Province, Nepal
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3
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Alqahtani MS, Alharbi SM, Alamri B, Alhefzi M, Alawwadh A. A Child Plexiform Neurofibroma of the Temple Region: A Case Report. Cureus 2024; 16:e60798. [PMID: 38903359 PMCID: PMC11189655 DOI: 10.7759/cureus.60798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Plexiform neurofibroma is a rare variant of neurofibromatosis type 1. Diagnosis is challenging due to the highly variable clinical presentation. Early diagnosis is essential for appropriate treatment and prevention of complications. This report describes a sporadic solitary plexiform neurofibroma in the temporal region of a seven-year-old girl. The growth of the mass began at birth and grew steadily over five years. Subsequently, the mass began to expand rapidly. The patient underwent complete surgical resection under general anesthesia. Histopathological examination revealed a plexiform neurofibroma. In conclusion, surgical excision is the gold standard for cases with symptomatic, visible, large superficial lesions.
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Affiliation(s)
- Mubarak S Alqahtani
- Department of Otorhinolaryngology-Head and Neck Surgery, Aseer Central Hospital, Abha, SAU
- Department of Otorhinolaryngology-Head and Neck Surgery, Abha Private Hospital, Abha, SAU
| | - Salmah M Alharbi
- Department of Otorhinolaryngology-Head and Neck Surgery, Aseer Central Hospital, Abha, SAU
| | - Bandar Alamri
- Department of Otorhinolaryngology-Head and Neck Surgery, Aseer Central Hospital, Abha, SAU
| | - Muayyad Alhefzi
- Department of Surgery, Faculty of Medicine, King Khalid University, Abha, SAU
| | - Adel Alawwadh
- Department of Pediatrics, Khamis Mushayt Maternity and Children Hospital, Khamis Mushayt, SAU
- Department of Pediatrics, Abha Private Hospital, Abha, SAU
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4
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Brambullo T, De Lazzari A, Franchi A, Trevisson E, Garau ML, Scarmozzino F, Vindigni V, Bassetto F. A Misdiagnosed Familiar Brooke-Spiegler Syndrome: Case Report and Review of the Literature. J Clin Med 2024; 13:2240. [PMID: 38673513 PMCID: PMC11050603 DOI: 10.3390/jcm13082240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/21/2024] [Accepted: 04/08/2024] [Indexed: 04/28/2024] Open
Abstract
Aim of the report: Brooke-Spiegler syndrome (BSS) is a rare autosomal dominant disease characterized by the growth of cylindromas, spiradenomas, trichoepitheliomas, or their combination. These neoplasms usually begin in the second decade and progressively increase in number and size over the years. Diagnosis necessitates consideration of family history, clinical examination, histological findings, and genetic analysis. The aim of this paper is to explore the clinical overlap between Brooke-Spiegler syndrome (BSS) and neurofibromatosis type 1 (NF1). We aim to highlight the challenges associated with their differential diagnosis and emphasize the lack of standardized diagnostic criteria and treatment approaches. Case presentation: Hereby, we introduce the case of a 28-year-old male referred for suspicion of neurofibromatosis type 1 (NF1) who initially declined the recommended surgical excision for a scalp mass. After four years, he returned with larger masses of the scalp, and underwent excision of multiple masses, revealing cylindromas, spiradenomas, and spiradenocylindromas. Family history reported similar tumors in his father, who was also diagnosed with NF1 for the presence of multiple subcutaneous lesions on the scalp. Clinical overlap led to a genetic consultation, but testing for CYLD mutations yielded no significant variations. Despite this, the strong family history and consistent findings led to a revised diagnosis of Brooke-Spiegler syndrome, correcting the initial misdiagnosis of NF1 syndrome. Conclusions: Thanks to the evolving landscape of BSS research over the past two decades, its molecular underpinnings, clinical presentation, and histopathological features are now clearer. However, a thorough family history assessment is mandatory when BSS is suspected. It is our belief that a multidisciplinary approach and cooperation between specialists are essential when dealing with BSS. By sharing this case, we hope to underscore the importance of considering BSS as a differential diagnosis, especially in cases with atypical presentations or overlapping features with other syndromes like NF1.
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Affiliation(s)
- Tito Brambullo
- Clinic of Plastic Surgery, Neurosciences Department, University of Padua, 35131 Padua, Italy; (T.B.); (A.D.L.); (A.F.); (V.V.)
| | - Alberto De Lazzari
- Clinic of Plastic Surgery, Neurosciences Department, University of Padua, 35131 Padua, Italy; (T.B.); (A.D.L.); (A.F.); (V.V.)
| | - Arianna Franchi
- Clinic of Plastic Surgery, Neurosciences Department, University of Padua, 35131 Padua, Italy; (T.B.); (A.D.L.); (A.F.); (V.V.)
| | - Eva Trevisson
- Clinical Genetics Unit, Department of Women and Children’s Health, University of Padova, 35131 Padua, Italy; (E.T.); (M.L.G.)
| | - Maria Luisa Garau
- Clinical Genetics Unit, Department of Women and Children’s Health, University of Padova, 35131 Padua, Italy; (E.T.); (M.L.G.)
| | - Federico Scarmozzino
- Surgical Pathology & Cytopathology Unit, Department of Medicine (DIMED), University of Padova, 35131 Padova, Italy;
| | - Vincenzo Vindigni
- Clinic of Plastic Surgery, Neurosciences Department, University of Padua, 35131 Padua, Italy; (T.B.); (A.D.L.); (A.F.); (V.V.)
| | - Franco Bassetto
- Clinic of Plastic Surgery, Neurosciences Department, University of Padua, 35131 Padua, Italy; (T.B.); (A.D.L.); (A.F.); (V.V.)
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5
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Srivastava S, Chaubey D, Rahul SK, Thakur VK, Ranjana R. Neonatal Paratesticular Scrotal Mass: A Rare Case of Atypical Neurofibromatous Neoplasm with Uncertain Biologic Potential. Afr J Paediatr Surg 2024; 21:148-150. [PMID: 38546256 PMCID: PMC11003578 DOI: 10.4103/ajps.ajps_17_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/27/2023] [Accepted: 04/06/2023] [Indexed: 04/04/2024] Open
Abstract
ABSTRACT Atypical neurofibromatous neoplasm with uncertain biologic potential presenting as a paratesticular scrotal mass in a neonate with congenital giant melanocytic nevus is rare. Only one such case of neonatal scrotal neurofibroma has been reported earlier. We report an additional case and its management.
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Affiliation(s)
- Saurav Srivastava
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Digamber Chaubey
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Sandip Kumar Rahul
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Vinit Kumar Thakur
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Rashmi Ranjana
- Department of Paediatric Surgery, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
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6
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Creus‐Bachiller E, Fernández‐Rodríguez J, Magallón‐Lorenz M, Ortega‐Bertran S, Navas‐Rutete S, Romagosa C, Silva TM, Pané M, Estival A, Perez Sidelnikova D, Morell M, Mazuelas H, Carrió M, Lausová T, Reuss D, Gel B, Villanueva A, Serra E, Lázaro C. Expanding a precision medicine platform for malignant peripheral nerve sheath tumors: New patient-derived orthotopic xenografts, cell lines and tumor entities. Mol Oncol 2024; 18:895-917. [PMID: 37798904 PMCID: PMC10994238 DOI: 10.1002/1878-0261.13534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 08/07/2023] [Accepted: 10/04/2023] [Indexed: 10/07/2023] Open
Abstract
Malignant peripheral nerve sheath tumors (MPNSTs) are aggressive soft-tissue sarcomas with a poor survival rate, presenting either sporadically or in the context of neurofibromatosis type 1 (NF1). The histological diagnosis of MPNSTs can be challenging, with different tumors exhibiting great histological and marker expression overlap. This heterogeneity could be partly responsible for the observed disparity in treatment response due to the inherent diversity of the preclinical models used. For several years, our group has been generating a large patient-derived orthotopic xenograft (PDOX) MPNST platform for identifying new precision medicine treatments. Herein, we describe the expansion of this platform using six primary tumors clinically diagnosed as MPNSTs, from which we obtained six additional PDOX mouse models and three cell lines, thus generating three pairs of in vitro-in vivo models. We extensively characterized these tumors and derived preclinical models, including genomic, epigenomic, and histological analyses. Tumors were reclassified after these analyses: three remained as MPNSTs (two being classic MPNSTs), one was a melanoma, another was a neurotrophic tyrosine receptor kinase (NTRK)-rearranged spindle cell neoplasm, and, finally, the last was an unclassifiable tumor bearing neurofibromin-2 (NF2) inactivation, a neuroblastoma RAS viral oncogene homolog (NRAS) oncogenic mutation, and a SWI/SNF-related matrix-associated actin-dependent regulator of chromatin (SMARCA4) heterozygous truncated variant. New cell lines and PDOXs faithfully recapitulated histology, marker expression, and genomic characteristics of the primary tumors. The diversity in tumor identity and their specific associated genomic alterations impacted treatment responses obtained when we used the new cell lines for testing compounds against known altered pathways in MPNSTs. In summary, we present here an extension of our MPNST precision medicine platform, with new PDOXs and cell lines, including tumor entities confounded as MPNSTs in a real clinical scenario. This platform may constitute a useful tool for obtaining correct preclinical information to guide MPNST clinical trials.
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Affiliation(s)
- Edgar Creus‐Bachiller
- Hereditary Cancer ProgramCatalan Institute of Oncology, ICO‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de LlobregatBarcelonaSpain
| | - Juana Fernández‐Rodríguez
- Hereditary Cancer ProgramCatalan Institute of Oncology, ICO‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Mouse Lab, IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
| | | | - Sara Ortega‐Bertran
- Hereditary Cancer ProgramCatalan Institute of Oncology, ICO‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de LlobregatBarcelonaSpain
| | - Susana Navas‐Rutete
- Hereditary Cancer ProgramCatalan Institute of Oncology, ICO‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
| | | | - Tulio M. Silva
- Department of PathologyHospital Vall d'HebronBarcelonaSpain
| | - Maria Pané
- Department of PathologyHUB‐IDIBELL, L'Hospitalet de LlobregatBarcelonaSpain
| | - Anna Estival
- Department of Medical OncologyCatalan Institute of OncologyBarcelonaSpain
| | | | - Mireia Morell
- Hereditary Cancer ProgramCatalan Institute of Oncology, ICO‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Mouse Lab, IDIBELL, Hospitalet de LlobregatBarcelonaSpain
| | - Helena Mazuelas
- Hereditary Cancer Group, Germans Trias i Pujol Research Institute (IGTP)BarcelonaSpain
| | - Meritxell Carrió
- Hereditary Cancer Group, Germans Trias i Pujol Research Institute (IGTP)BarcelonaSpain
| | - Tereza Lausová
- Department of NeuropathologyInstitute of Pathology, Heidelberg University HospitalHeidelbergGermany
- Clinical Cooperation Unit NeuropathologyGerman Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK)HeidelbergGermany
| | - David Reuss
- Department of NeuropathologyInstitute of Pathology, Heidelberg University HospitalHeidelbergGermany
- Clinical Cooperation Unit NeuropathologyGerman Cancer Research Center (DKFZ), German Consortium for Translational Cancer Research (DKTK)HeidelbergGermany
| | - Bernat Gel
- Hereditary Cancer Group, Germans Trias i Pujol Research Institute (IGTP)BarcelonaSpain
| | - Alberto Villanueva
- Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Procure ProgramCatalan Institute of OncologyBarcelonaSpain
| | - Eduard Serra
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
- Hereditary Cancer Group, Germans Trias i Pujol Research Institute (IGTP)BarcelonaSpain
| | - Conxi Lázaro
- Hereditary Cancer ProgramCatalan Institute of Oncology, ICO‐IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Program in Molecular Mechanisms and Experimental Therapy in Oncology (Oncobell), IDIBELL, Hospitalet de LlobregatBarcelonaSpain
- Centro de Investigación Biomédica en Red de Cáncer (CIBERONC)MadridSpain
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7
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Qi X, Tan Y, Feng Y, Ma D, Wang L, Pang H. Case report and literature review: plexiform schwannoma in the penile and inguinal region in a child. Front Oncol 2024; 14:1356000. [PMID: 38496758 PMCID: PMC10940339 DOI: 10.3389/fonc.2024.1356000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2023] [Accepted: 01/30/2024] [Indexed: 03/19/2024] Open
Abstract
Penile schwannoma is an uncommonly seen peripheral nerve tumor, of which penile plexiform schwannomas (PS) is extremely rare that has only been reported in several adults. We present a case of penile PS with a similar lesion in inguinal region in a 9-year-old child, which appeared as painless masses and rapidly growing within one year. Penile ultrasonography suggested well-defined lesions with limited vascularity. Both masses presented with low-to-intermediated signal intensity and no definite enhancement in computed tomography. The lesions were completely resected with minimal intraoperative bleeding, and a diagnose of benign PS was confirmed based on H&E staining and positive S-100 expression in immunohistochemistry. There was no evidence of tumor recurrence or metastasis after 6 months of follow-up. Only 6 cases of penile schwannoma in children were recorded, of which 5 were malignant, and none was PS. The malignancy rate of penile schwannoma in children may be overestimated due to delayed diagnose of benign ones. A rapidly growing penile mass with a suspected metastatic lesion in inguinal region could be easily misdiagnosed as malignant. This case report and literature review is expected to assist clinicians in getting a comprehensive understanding of children penile schwannomas and choosing the best management strategy when faced with this rare condition.
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Affiliation(s)
- Xiaoying Qi
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yifei Tan
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Yanru Feng
- Department of Thoracic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Dan Ma
- Department of Ultrasound, Meishan Women and Childrens’ Hospital, Alliance Hospital of West China Second University Hospital, Sichuan University, Meishan, Sichuan, China
| | - Ling Wang
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Houqing Pang
- Department of Ultrasound, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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8
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Kezar S, Fowlkes NW, Hensel ME. Nerve sheath tumor in the forearm of a common marmoset (Callithrix jacchus). J Med Primatol 2024; 53:e12659. [PMID: 37340582 DOI: 10.1111/jmp.12659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 05/17/2023] [Accepted: 06/05/2023] [Indexed: 06/22/2023]
Abstract
Tumors of the skin and subcutaneous tissues are uncommon in marmosets. In this report, we describe the gross, histopathology, and immunohistochemical findings of a nerve sheath tumor that arose in the left forearm of an adult female marmoset (Callthrix jacchus).
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Affiliation(s)
- Sarah Kezar
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, Bastrop, Texas, USA
| | - Natalie W Fowlkes
- The University of Texas MD Anderson Cancer Center, Veterinary and Comparative Pathology, Houston, Texas, USA
| | - Martha E Hensel
- The University of Texas MD Anderson Cancer Center, Michale E. Keeling Center for Comparative Medicine and Research, Bastrop, Texas, USA
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9
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Dengler NF, Pedro MT, Kolbenschlag J. [Interdisciplinary Treatment Of Tumorous And Tumour-Like Lesions Of Peripheral Nerves]. HANDCHIR MIKROCHIR P 2024; 56:11-20. [PMID: 38508203 DOI: 10.1055/a-2250-7772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
Tumorous or tumour-like lesions of peripheral nerves are generally rare, heterogeneous and challenging to diagnose and treat. They may become apparent by a palpable swelling (lump) near nerves, sensory and/or motor deficits, pain to touch or neuropathic pain. In 91% of cases, tumours are benign. The differentiation of entities and their characteristics as well as a function-preserving resection strategy are highly relevant. Misdiagnosis and inadequate treatment can lead to severe deficits and pain syndromes. Benign tumours include schwannomas and neurofibromas, which can occur sporadically but can also be associated with neurogenetic tumour disposition syndromes if they occur more frequently. Rarer benign nerve tumours include perineuriomas, lipomas, aggressive fibrosis (desmoid tumours), paragangliomas and haemangiomas. Ganglion cysts are described as tumour-like lesions. The association of nerve tumours with neurogenetic syndromes and the correct classification of potentially malignant lesions such as MPNST (malignant peripheral nerve sheath tumour) or intermediate stages such as ANNUBPs (atypical neurofibromatous neoplasms with unknown biological potential) pose particular challenges. Interdisciplinarity is highly relevant for clinical treatment and a correct diagnosis. The aim of our work is to provide an overview of the relevant entities, diagnostic evaluation and contemporary treatment strategies based on the current data situation and taking into account the recently published interdisciplinary AWMF S2k guideline "Diagnosis and Treatment of Peripheral Nerve Tumours".
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Affiliation(s)
- Nora Franziska Dengler
- Fakultät für Gesundheitswissenschaften Brandenburg, Medizinische Hochschule Theodor Fontane, Bad Saarow, Germany
- Klinik für Neurochirurgie, Helios Klinik Bad Saarow, Germany
| | - Maria Teresa Pedro
- Sektion für Periphere Nervenchirurgie, Klinik für Neurochirurgie, Univeristätsklinikum Ulm am BKH Günzburg, Ulm, Germany
| | - Jonas Kolbenschlag
- Universitätsklinik für Hand-, Plastische, Rekonstruktive und Verbrennungschirurgie, BG Klinik Tübingen, Tubingen, Germany
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10
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Le MA, Shi R, Geraghty J, Zayat V, Parikh J. A Rare Case of Hepatic Schwannoma in the Setting of Schwannomatosis. Cureus 2024; 16:e54705. [PMID: 38523988 PMCID: PMC10960616 DOI: 10.7759/cureus.54705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/22/2024] [Indexed: 03/26/2024] Open
Abstract
Schwannomas are benign nerve sheath tumors commonly found in the head, neck, vestibular system, and extremities. Primary hepatic schwannomas are exceptionally rare, with 34 cases reported to date according to our review of the literature. This case report describes a 79-year-old man with a medical history of skin and thyroid cancer, who presented with no clinical symptoms and underwent a follow-up MRI due to an initial scan indicating a suspicious hepatic mass resembling an atypical hemangioma. The MRI revealed a 3.6 cm left hepatic mass concerning for an intrahepatic cholangiocarcinoma. Histopathological and immunohistochemical studies of a biopsy of the liver mass confirmed the presence of a benign hepatic schwannoma. Further evaluation revealed multiple spinal schwannomas, leading to the diagnosis of schwannomatosis. The diagnosis of hepatic schwannomas poses challenges through imaging alone. This case underscores the importance of microscopic evaluation in accurately diagnosing hepatic masses. Additionally, the presence of concurrent schwannomas should be considered in patients initially diagnosed with isolated schwannomas.
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Affiliation(s)
- Minh-Anh Le
- Internal Medicine, University of Central Florida College of Medicine/HCA Healthcare Graduate Medical Education, Orlando, USA
| | - Rachel Shi
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Justin Geraghty
- Medical School, University of Central Florida College of Medicine, Orlando, USA
| | - Vania Zayat
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
- Pathology, University of Central Florida College of Medicine, Orlando, USA
| | - Jignesh Parikh
- Pathology, Orlando Veterans Affairs Medical Center, Orlando, USA
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11
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Hassan U, Saeed SM, Mushtaq S, Hussain M, Hameed M. The Expression of Mucin-4 (MUC4) in Sarcomas Apart From Sclerosing Epithelioid Fibrosarcoma and Low-Grade Fibromyxoid Sarcoma. Cureus 2023; 15:e49546. [PMID: 38156143 PMCID: PMC10753521 DOI: 10.7759/cureus.49546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2023] [Indexed: 12/30/2023] Open
Abstract
Background Low-grade fibromyxoid sarcoma (LGFMS) and sclerosing epithelioid fibrosarcoma (SEF) are two rare but aggressive soft tissue sarcomas that can be difficult to distinguish due to histopathological similarities. The present study examines the diagnostic capacities of mucin-4 (MUC4), a transmembrane mucin, in identifying different types of sarcomas and broadens its evaluation to include a wide range of sarcomas. Methods Immunohistochemical (IHC) examination of tissue samples from various sarcomas was performed using a mouse anti-MUC4 monoclonal antibody. IHC was conducted on 4-mm thick formalin-fixed paraffin-embedded tissue sections after pressure cooker antigen retrieval with a mouse anti-MUC4 monoclonal antibody. Results MUC4 was shown to be highly expressed in SEF (n=13) and LGFMS (n=10), while focal positivity in synovial sarcoma (n=1). Other sarcomas, such as malignant peripheral nerve sheath tumors, fibrosarcoma, leiomyosarcoma, liposarcoma, and myxofibrosarcoma, exhibited no expression (n=0). These findings are consistent with previous research and support MUC4 specificity as a SEF and LGFMS marker. This study provides information on the diagnostic efficacy of MUC4, particularly in the context of certain subtypes. It not only helps our understanding of these unique instances, but it also provides context for histopathological and IHC findings in soft tissue sarcoma. Furthermore, this study investigates the influence of age and gender on MUC4 expression in a range of sarcomas, which was typically understudied in the literature and found no relation with expression of MUC4. Conclusion In conclusion, this study adds to our understanding of soft tissue sarcomas by emphasizing the crucial role of MUC4 in certain sarcoma subtypes while acknowledging the complex variety of the sarcoma landscape. Further research is needed to understand the molecular mechanism that governs marker expression patterns, as well as the therapeutic implications.
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Affiliation(s)
- Usman Hassan
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Saad M Saeed
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Mushtaq
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mudassar Hussain
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Maryam Hameed
- Pathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Chen C, Cao J, Song L, Wang W, Guo D, Shi Q, Zhang Y, Chen Y, Liu C, Li F. Primary lipoblastic nerve sheath tumor in an inguinal lymph node mimicking metastatic tumor: a case report and literature review. Front Oncol 2023; 13:1258769. [PMID: 37965461 PMCID: PMC10642330 DOI: 10.3389/fonc.2023.1258769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/18/2023] [Indexed: 11/16/2023] Open
Abstract
Lipoblastic nerve sheath tumors of soft tissue are characterized as schwannoma tumors that exhibit adipose tissue and lipoblast-like cells with signet-ring morphology. They have been documented to arise in various anatomic locations, including the thigh, groin, shoulder, and retroperitoneum. However, to our knowledge, this tumor has not been previously reported as a lymph node primary. We present herein the first case of a benign primary lipoblastic nerve sheath tumor arising in an inguinal lymph node in a 69-year-old man. Microscopic examination revealed a multinodular tumor comprising fascicles of spindle cells, as well as adipocytic and lipoblast-like signet-ring cell component in the context of schwannoma. Despite the presence of some bizarre cells with nuclear atypia, no obvious mitotic activity or necrosis was observed. Immunohistochemical analysis showed strong and diffuse expression of S-100, SOX10, CD56, and NSE in the spindle cells as well as in the signet-ring lipoblast-like cells and the mature adipocytes. Sequencing analysis of the neoplasm identified six non-synonymous single nucleotide variant genes, specifically NF1, BRAF, ECE1, AMPD3, CRYAB, and NPHS1, as well as four nonsense mutation genes including MRE11A, CEP290, OTOA, and ALOXE3. The patient remained alive and well with no evidence of recurrence over a period of ten-year follow-up.
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Affiliation(s)
- Chengxin Chen
- Department of Pathology and Key Laboratory for Xinjiang Endemic & Ethnic Diseases, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
| | - Jiachen Cao
- Department of Pathology and Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Lingxie Song
- Department of Pathology and Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Wenjie Wang
- Department of Pathology and Key Laboratory for Xinjiang Endemic & Ethnic Diseases, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
| | - Dandan Guo
- Department of Pathology and Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Qi Shi
- Department of Pathology and Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Ying Zhang
- Department of Pathology and Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yunzhao Chen
- The People’s Hospital of Suzhou National Hi-Tech District, Suzhou, China
| | - Chunxia Liu
- Department of Pathology, The Second Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Feng Li
- Department of Pathology and Key Laboratory for Xinjiang Endemic & Ethnic Diseases, The First Affiliated Hospital, Shihezi University School of Medicine, Shihezi, China
- Department of Pathology and Medical Research Center, Beijing Institute of Respiratory Medicine and Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
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Plorina EV, Saulus K, Rudzitis A, Kiss N, Medvecz M, Linova T, Bliznuks D, Lihachev A, Lihacova I. Multispectral Imaging Analysis of Skin Lesions in Patients with Neurofibromatosis Type 1. J Clin Med 2023; 12:6746. [PMID: 37959212 PMCID: PMC10649204 DOI: 10.3390/jcm12216746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 10/11/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
Neurofibromatosis type 1 (NF1) is a rare disease, affecting around 1 in 3500 individuals in the general population. The rarity of the disease contributes to the scarcity of the available diagnostic and therapeutic approaches. Multispectral imaging is a non-invasive imaging method that shows promise in the diagnosis of various skin diseases. The device utilized for the present study consisted of four sets of narrow-band LEDs, including 526 nm, 663 nm, and 964 nm for diffuse reflectance imaging and 405 nm LEDs, filtered through a 515 nm long-pass filter, for autofluorescence imaging. RGB images were captured using a CMOS camera inside of the device. This paper presents the results of this multispectral skin imaging approach to distinguish the lesions in patients with NF1 from other more common benign skin lesions. The results show that the method provides a potential novel approach to distinguish NF1 lesions from other benign skin lesions.
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Affiliation(s)
- Emilija V. Plorina
- Institute of Atomic Physics and Spectroscopy, University of Latvia, LV-1586 Riga, Latvia; (K.S.); (A.L.); (I.L.)
- LTD Longenesis, Dzirnavu 41A-5, LV-1010 Riga, Latvia
| | - Kristine Saulus
- Institute of Atomic Physics and Spectroscopy, University of Latvia, LV-1586 Riga, Latvia; (K.S.); (A.L.); (I.L.)
| | - Ainars Rudzitis
- Pauls Stradins Clinical University Hospital, Pilsoņu 13, LV-1002 Riga, Latvia;
| | - Norbert Kiss
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Maria Str. 41, H-1085 Budapest, Hungary; (N.K.); (M.M.)
| | - Márta Medvecz
- Department of Dermatology, Venereology and Dermatooncology, Semmelweis University, Maria Str. 41, H-1085 Budapest, Hungary; (N.K.); (M.M.)
| | - Tatjana Linova
- Dermatology Clinic, Health Center 4, Skanstes 50, LV-1013 Riga, Latvia;
| | - Dmitrijs Bliznuks
- Institute of Smart Computing Technologies, Riga Technical University, Zunda Krastmala 10, LV-1658 Riga, Latvia;
| | - Alexey Lihachev
- Institute of Atomic Physics and Spectroscopy, University of Latvia, LV-1586 Riga, Latvia; (K.S.); (A.L.); (I.L.)
| | - Ilze Lihacova
- Institute of Atomic Physics and Spectroscopy, University of Latvia, LV-1586 Riga, Latvia; (K.S.); (A.L.); (I.L.)
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Hasnaoui A, Kacem S, Sassi I, Ben Abdallah F, El Guesmi S. MPNST of the abdominal wall in a patient with lynch syndrome: A case report of a rare presentation and unique association. Int J Surg Case Rep 2023; 110:108677. [PMID: 37603917 PMCID: PMC10445449 DOI: 10.1016/j.ijscr.2023.108677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/12/2023] [Accepted: 08/15/2023] [Indexed: 08/23/2023] Open
Abstract
INTRODUCTION The abdominal wall is an extremely rare location for malignant peripheral nerve sheath tumors (MPNSTs). Besides presenting a rare location of MPNST, the peculiarity of our case lies in its association with Lynch syndrome, which is to our knowledge the first reported case of its kind. PRESENTATION OF CASE We present a case report of a 39-year-old male with a personal history of colonic cancer. Genetic counseling revealed Lynch syndrome with a heterozygous germline mutation in MLH1. Nine years after the right hemicolectomy, the patient presented with an asymptomatic lump in the abdominal wall. CT imaging showed a 3 cm mass in the aponeurosis of the right external oblique muscle. The patient underwent successful resection of the parietal tumor. Pathological examination revealed an MPNST. No additional treatment was warranted, and the patient exhibited no signs of relapse during the six months following the surgery. DISCUSSION MPNSTs of the anterior abdominal wall are extremely rare and challenging. Some studies have investigated the presence of mismatch repair (MMR) deficiency in patients with sarcomas. Our case consolidates the hypothesis of an association between sarcomas and Lynch syndrome, which raises the question of the efficacy of immune checkpoint inhibitor therapy in these cases where treatment options remain limited. CONCLUSION It is essential to have a deep understanding of the growth patterns of MPNSTs in the context of syndromes that predispose individuals to tumors, like Lynch syndrome. This knowledge is crucial for accurately predicting patient outcomes and developing appropriate plans for monitoring and treatment.
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Affiliation(s)
- Anis Hasnaoui
- Faculty of Medicine of Tunis, Tunis El Manar University, Rue Djebal Lakhdar, 1006 Tunis, Tunisia; Department of General Surgery, Menzel Bourguiba Hospital, Tunisia.
| | - Salma Kacem
- Department of Oncologic Surgery, Salah Azaiez institute, Tunis, Tunisia
| | - Imen Sassi
- Department of Oncologic Surgery, Salah Azaiez institute, Tunis, Tunisia
| | | | - Sondes El Guesmi
- Department of Oncology, Menzel Bourguiba Hospital, Menzel Bourguiba, 7050 Bizerte, Tunisia
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Sharma AE, Kerr DA, Cipriani NA. Small biopsies in the head and neck: Bone and soft tissue. Semin Diagn Pathol 2023; 40:353-370. [PMID: 37453847 DOI: 10.1053/j.semdp.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 04/30/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
Bone and soft tissue lesions in the head and neck encompass not only a broad morphologic spectrum but also significant inherent clinicopathologic overlap. Epidemiology, radiology, and location - similar to the diagnostic assessment in other sites - are especially important considerations in the context of an established mesenchymal proliferation. Herein, the approach towards diagnosis is stratified by morphology (spindle, sarcomatoid, epithelioid, round cell), cellular lineage (fibroblastic, nerve sheath, rhabdomyogenic), and tumor grade (benign, low- to high-grade malignant) as the basis of further immunohistochemical or molecular investigation.
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Affiliation(s)
- Aarti E Sharma
- Hospital for Special Surgery, New York, NY, United States
| | - Darcy A Kerr
- Dartmouth Hitchcock Medical Center, Lebanon, NH, United States
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Pertea M, Grosu OM, Filip A, Moraru DC, Luca S, Fotea MC, Lunca S, Olinici D, Poroch V, Carp C, Veliceasa B. Rare Benign Tumors and Tumor-like Lesions of the Hand without Skin Damage-Clinical, Imagistic and Histopathological Diagnosis, Retrospective Study. Diagnostics (Basel) 2023; 13:diagnostics13061204. [PMID: 36980511 PMCID: PMC10046979 DOI: 10.3390/diagnostics13061204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The broad spectrum of diagnoses and clinical features of hand tumors and the absence of pathognomonic signs often lead to an inaccurate or delayed diagnosis. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study intends to highlight the clinical, imaging and histological characteristics of uncommon hand tumors or tumor-like lesions. METHODS In this retrospective study, we report a series of 80 patients diagnosed with rare hand tumors and tumor-like lesions without skin damage. Age, gender, tumor location, imaging examinations and clinical and laboratory findings were analyzed. The histopathological exam established the final diagnosis. Surgery was indicated and performed in all cases. RESULTS This study included: neurofibroma, glomus tumor, lipoma, schwannoma, epidermal inclusion cyst and idiopathic tenosynovitis with "rice bodies." We have described the clinical, imagistic and histopathological particularities of these tumors. Surgical management included the complete removal of tumors, with no recurrence recorded within two years and overall high patient satisfaction. The most common findings were lipomas and the rarest neurofibromas. CONCLUSIONS To optimize the care of hand tumors and reduce diagnostic and treatment errors, knowledge of hand tumor types and their clinical and laboratory characteristics is necessary for every surgeon.
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Affiliation(s)
- Mihaela Pertea
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Oxana Madalina Grosu
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandru Filip
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Dan Cristian Moraru
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Stefana Luca
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Madalina-Cristina Fotea
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Sorinel Lunca
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Second Surgical Clinic, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Doinita Olinici
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Dermatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Vladimir Poroch
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Palliative Care, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Claudiu Carp
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Bogdan Veliceasa
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
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Zhou H, Yao C, Dong Y, Alhaskawi A, Wang Z, Lai J, Ezzi SHA, Kota VG, Abdulla MHAH, Lu H. Clinical characteristics and management experience of schwannoma in extremities: Lessons learned from a 10-year retrospective study. Front Neurol 2022; 13:1083896. [PMID: 36588891 PMCID: PMC9797853 DOI: 10.3389/fneur.2022.1083896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Schwannomas are the most common neoplastic lesions of the peripheral nerves when growing on the extremities, they usually have adverse effects on patients due to the exposed and functional nature of the region. Methods In the present single-center retrospective study, we included all patients with pathologically confirmed schwannoma located in extremities between 2011 and 2021 totaling 183 patients. Data on gender, age, duration history, clinical presentation, occurrence region, nerve affiliation, imaging data, modus operation, mass volume, immunohistochemistry, postoperative neurological function, and recurrence were collected. Results As in previous studies, patients were predominantly middle-aged with a mean age of 49.5, without gender preference and a male-to-female ratio of 1.2:1. Most patients are first seen for this disease, and only five of them are recurrent. The majority presented with an isolated (91.26%), asymptomatic (37.7%) mass, with tenderness (34.97%) being the second frequent complaint. 60% of lesions occurred in the upper extremity, more commonly on the left side (55.26%) than the right. The average duration of onset was 47.50 months. MRI is more sensitive for neurogenic tumors than ultrasound, as it owns 78.93% correct. In immunohistochemistry, the top three markers for positive labeling schwannoma are S-100 (98.95%), Ki67 (98.68%) and β-Catenin. 98.36% of patients underwent complete resection of the lesion, of which 14.44% required partial sacrifice of the nerve fibers. Thanks to the application of intraoperative peripheral nerve microscopic operation, only 6 patients showed symptoms of postoperative nerve injury, and 3 of them received second surgery. Intraoperative microscopic manipulation, preservation of the main nerve, and the need for reconstruction of the affected nerve fibers are some of the points worth noting. Discussion In summary, the possibility of schwannoma should not be overlooked in the identification of masses that occur in the upper extremities of the middle-aged population. Preoperative ultrasound and MR are useful for determining the nature of the mass, and S100, Ki67, and β-Catenin are sensitive to it. Surgical resection can achieve satisfying functional results and a low risk of nerve injury.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengjun Yao
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zewei Wang
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingtian Lai
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Vishnu Goutham Kota
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou, China,*Correspondence: Hui Lu
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Thomas IN, Balasundaram A, James JJ, Shanmugam NP. Ankle Swelling in Patients With Type 1 Neurofibromatosis: A Report of Two Cases With Rare Presentation of Common Genodermatosis. Cureus 2022; 14:e28938. [PMID: 36237736 PMCID: PMC9547610 DOI: 10.7759/cureus.28938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2022] [Indexed: 11/20/2022] Open
Abstract
Neurofibromatosis type 1 is characterized by multiple cutaneous neurofibromas of varying sizes along with skeletal, neurologic, and ophthalmic features. Solitary swellings in neurofibromatosis type 1 are not commonly encountered except in the form of plexiform neurofibromas. We report two cases with neurofibromatosis type 1 presenting with solitary swelling in the ankles which were proven to be the diffuse type of neurofibroma, radiologically and histopathologically. Diffuse type neurofibroma presenting as ankle swelling in type 1 neurofibromatosis has not been reported before.
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