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Rigsby RK, Bhatt AA. Primary Pathology of the Parapharyngeal Space. Clin Neuroradiol 2023; 33:897-906. [PMID: 37380900 DOI: 10.1007/s00062-023-01316-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Accepted: 05/24/2023] [Indexed: 06/30/2023]
Abstract
The radiologically defined parapharyngeal space is a distinct location on cross-sectional imaging and is often described based on its displacement or invasion by tumors or other pathologies in adjacent spaces; however, there are multiple primary pathologic entities of the parapharyngeal space, which are often forgotten. Recognizing that a lesion is arising from the parapharyngeal space is important in generating an accurate differential diagnosis that will guide management.
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Affiliation(s)
- Ryan K Rigsby
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA.
| | - Alok A Bhatt
- Department of Radiology, Mayo Clinic, Jacksonville, FL, USA
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Loh J, Ong PY, Goh DLM, Puhaindran ME, Vellayappan BA, Ow SGW, Chan G, Lee SC. Clinical characteristics and genetic testing outcome of suspected hereditary peripheral nerve sheath tumours in a tertiary cancer institution in Singapore. Hered Cancer Clin Pract 2022; 20:23. [PMID: 35698239 PMCID: PMC9195433 DOI: 10.1186/s13053-022-00230-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 05/27/2022] [Indexed: 12/03/2022] Open
Abstract
Background Peripheral Nerve Sheath Tumors (PNST) are a diverse group of mostly benign tumours uncommon in the general population. About 5–10% of PNSTs are hereditary, predominantly arising from germline variants in NF1, NF2, SMARCB1, or LZTR1 gene. Methods We reviewed the clinical characteristics and genetic testing results of patients referred to the NCIS Adult Cancer Genetics Clinic for suspected hereditary PNST. Results 3,001 patients suspected to have various hereditary cancer syndromes were evaluated between year 2000 to March 2021. 13 (0.4%) were clinically diagnosed to have hereditary PNSTs. The majority were male (54%), with a median age at presentation to the genetics clinic of 29 years (range 19–48). 11/13 (85%) patients had multiple PNSTs, 12/13 (92%) had young onset PNSTs, 5/13 (38.5%) had personal and family history of PNST. 11/13 patients (85%) had clinical features of neurofibromatosis type 1 (NF1) including one patient who also fulfilled clinical criteria of neurofibromatosis type 2 (NF2); 2/13 (14%) had multiple schwannomas. Four patients underwent multi-gene panel testing, including one patient with clinical NF1, one patient who met both clinical NF1 and NF2 criteria, and two patients with multiple schwannomas. The patient with clinical features of NF1 was heterozygous for a pathogenic c. 2033dup variant in the NF1 gene. The patient with both NF1/NF2 features was heterozygous for a novel c.732 T > A nonsense variant in the NF2 gene. The two patients with multiple schwannomas were heterozygous for a pathogenic/likely pathogenic variant in the LZTR1 gene and are the first LZTR1-positive schwannomatosis patients reported in Asia. Conclusion Hereditary PNSTs are rare referrals to an adult cancer genetics clinic. NF1 is the most common PNST seen. LZTR1 variants may be the underlying cause in Asian patients with multiple schwannomatosis. Supplementary Information The online version contains supplementary material available at 10.1186/s13053-022-00230-4.
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Affiliation(s)
- Jerold Loh
- Department of Haematology-Oncology, NCIS, National University Cancer Institute, Singapore, National University Health System, Singapore, Singapore
| | - Pei Yi Ong
- Department of Haematology-Oncology, NCIS, National University Cancer Institute, Singapore, National University Health System, Singapore, Singapore
| | - Denise Li Meng Goh
- Division of Paediatric Genetics and Metabolism, Department of Paediatrics, Khoo Teck Puat - National University Children's Medical Institute, National University Hospital, Singapore, Singapore
| | - Mark E Puhaindran
- Department of Hand and Reconstructive Microsurgery, National University Hospital, Singapore, Singapore
| | | | - Samuel Guan Wei Ow
- Department of Haematology-Oncology, NCIS, National University Cancer Institute, Singapore, National University Health System, Singapore, Singapore
| | - Gloria Chan
- Department of Haematology-Oncology, NCIS, National University Cancer Institute, Singapore, National University Health System, Singapore, Singapore
| | - Soo-Chin Lee
- Department of Haematology-Oncology, NCIS, National University Cancer Institute, Singapore, National University Health System, Singapore, Singapore. .,Cancer Science Institute, Singapore, Singapore.
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Vetrano IG, Acerbi F, Falco J, D'Ammando A, Devigili G, Nazzi V. High-Definition 4K 3D Exoscope (ORBEYETM) in Peripheral Nerve Sheath Tumor Surgery: A Preliminary, Explorative, Pilot Study. Oper Neurosurg (Hagerstown) 2021; 19:480-488. [PMID: 32357216 DOI: 10.1093/ons/opaa090] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 02/10/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Surgery for peripheral nerve sheath tumors aims to preserve functional fascicles achieving gross-total resection. Increasing the visualization of anatomic details helps to identify the different layers and the tumor-nerve interface. The traditional microscope can present some limitations in this type of surgery, such as its physical obstruction. OBJECTIVE To present a proof-of-concept study about exoscope-guided surgery for schwannomas of the lower limbs, to analyze the advantages and disadvantages of the 4K, high-quality, 3-dimensional (3D) imaging. METHODS We analyzed 2 consecutive surgical cases of suspected schwannomas of the lower limbs using the ORBEYE™ exoscope (Olympus). A standard operative microscope was also available in the operating room. All procedures were performed with neurophysiological monitoring, to identify functioning nerves and to localize the tumor capsule safest entry point. The cases are reported according to the PROCESS guidelines. RESULTS In both cases, we achieved a gross total resection of the schwannomas; the exoscope provided an excellent view of the anatomic details at tumor-nerve interface, as visible in intraoperative images and in the 3D-4K video supporting these findings. The surgeon's position was comfortable in both cases, although if the co-surgeon positioned himself in front of the first surgeon, the comfort was slightly reduced. The 4K monitor allowed a realistic, nontiring 3D vision for all the team. CONCLUSION The ORBEYETM, after an adequate learning curve, can represent a feasible and comfortable instrument for nerve tumor surgery, which is usually performed in a single horizontal plane. Further and wider clinical series are necessary to confirm this first impression.
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Affiliation(s)
- Ignazio G Vetrano
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Francesco Acerbi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Jacopo Falco
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Antonio D'Ammando
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Grazia Devigili
- Neurological Unit 1, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Department of Neurosurgery, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
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Mansouri S, Suppiah S, Mamatjan Y, Paganini I, Liu JC, Karimi S, Patil V, Nassiri F, Singh O, Sundaravadanam Y, Rath P, Sestini R, Gensini F, Agnihotri S, Blakeley J, Ostrow K, Largaespada D, Plotkin SR, Stemmer-Rachamimov A, Ferrer MM, Pugh TJ, Aldape KD, Papi L, Zadeh G. Epigenomic, genomic, and transcriptomic landscape of schwannomatosis. Acta Neuropathol 2021; 141:101-116. [PMID: 33025139 PMCID: PMC7785562 DOI: 10.1007/s00401-020-02230-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/23/2020] [Accepted: 09/23/2020] [Indexed: 02/08/2023]
Abstract
Schwannomatosis (SWNTS) is a genetic cancer predisposition syndrome that manifests as multiple and often painful neuronal tumors called schwannomas (SWNs). While germline mutations in SMARCB1 or LZTR1, plus somatic mutations in NF2 and loss of heterozygosity in chromosome 22q have been identified in a subset of patients, little is known about the epigenomic and genomic alterations that drive SWNTS-related SWNs (SWNTS-SWNs) in a majority of the cases. We performed multiplatform genomic analysis and established the molecular signature of SWNTS-SWNs. We show that SWNTS-SWNs harbor distinct genomic features relative to the histologically identical non-syndromic sporadic SWNs (NS-SWNS). We demonstrate the existence of four distinct DNA methylation subgroups of SWNTS-SWNs that are associated with specific transcriptional programs and tumor location. We show several novel recurrent non-22q deletions and structural rearrangements. We detected the SH3PXD2A-HTRA1 gene fusion in SWNTS-SWNs, with predominance in LZTR1-mutant tumors. In addition, we identified specific genetic, epigenetic, and actionable transcriptional programs associated with painful SWNTS-SWNs including PIGF, VEGF, MEK, and MTOR pathways, which may be harnessed for management of this syndrome.
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Affiliation(s)
- Sheila Mansouri
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada
| | - Suganth Suppiah
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada
| | - Yasin Mamatjan
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada
| | - Irene Paganini
- The Department of Experimental and Clinical, Medical Genetics Unit, Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Jeffrey C Liu
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada
| | - Shirin Karimi
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada
| | - Vikas Patil
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada
| | - Farshad Nassiri
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada
| | - Olivia Singh
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada
| | | | - Prisni Rath
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Roberta Sestini
- The Department of Experimental and Clinical, Medical Genetics Unit, Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Francesca Gensini
- The Department of Experimental and Clinical, Medical Genetics Unit, Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Sameer Agnihotri
- Department of Neurological Surgery, Children's Hospital, University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Scott R Plotkin
- Department of Pathology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Marcela Maria Ferrer
- División de Neurocirugía and División Genética, Hospital de Clínicas "José de San Martín", Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Trevor J Pugh
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Kenneth D Aldape
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, Bethesda, MD, USA
| | - Laura Papi
- The Department of Experimental and Clinical, Medical Genetics Unit, Biomedical Sciences "Mario Serio", University of Florence, Florence, Italy
| | - Gelareh Zadeh
- Princess Margaret Cancer Center and MacFeeters-Hamilton Center for Neuro-Oncology Research, University Health Network, Wilkins Family Chair in Brain Tumor Research, 14-701 PMCRT, 101 College St, Toronto, ON, M5G 1L7, Canada.
- Division of Neurosurgery, Toronto Western Hospital, Toronto, Canada.
- Krembil Brain Institute, Toronto, Canada.
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Tarchouli M, Essarghini M, Qamouss O, El Kharras A, Bounaim A. Abdominal wall schwannoma: a case report. Gastroenterol Hepatol Bed Bench 2020; 13:95-100. [PMID: 32190231 PMCID: PMC7069535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Schwannomas or neurilemmomas are benign and slow-growing tumors that arise exclusively from Schwann cells in peripheral nerve sheaths. These neoplasms theoretically can occur anywhere in the body, but they most frequently affect extremities, as well as head and neck region. However, their presentation in the abdominal wall is extremely rare and only few cases have been reported in the literature. Subcutaneous lesions may be asymptomatic and only incidentally discovered upon physical examination or imaging. However, occasionally they induce mass effects on surrounding large nerves. We present the case of a 34-year-old man with abdominal wall pain localized in the right iliac fossa and palpable subcutaneous mass. Ultrasound and CT scan revealed a solid well-defined mass of the abdominal wall. Following surgical excision under general anesthesia, histological examination was consistent with the diagnosis of benign schwannoma.
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Affiliation(s)
- Mohamed Tarchouli
- Department of Surgery, First Medical and Surgical Center, Agadir, Morocco
| | - Mohamed Essarghini
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Ouadie Qamouss
- Department of Visceral Surgery, Mohammed V Military Teaching Hospital, Rabat, Morocco
| | | | - Ahmed Bounaim
- Faculty of Medicine and Pharmacy, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Kalamarides M, Bernat I, Peyre M. Extracapsular dissection in peripheral nerve schwannoma surgery using bright light and fluorescein sodium visualization: case series. Acta Neurochir (Wien) 2019; 161:2447-2452. [PMID: 31679103 DOI: 10.1007/s00701-019-04071-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 09/11/2019] [Indexed: 12/18/2022]
Abstract
BACKGROUND Schwannomas are the most frequent peripheral nerve sheath tumors and are treated by surgical resection when symptomatic. Tumor removal is performed by intraneural dissection and enucleation. In order to safely remove the tumor from the nerve, the use of sodium fluorescein has recently been proposed to distinguish the tumor from the adjacent normal nerve fibers, before incision of the tumor pseudocapsule and during intraneural tumor dissection. METHODS We report a consecutive case series of 5 peripheral nerve schwannomas operated in 4 patients, in which we evaluate the usefulness of sodium fluorescein compared to usual visual landmarks, at each step of the surgical procedure. RESULTS After exposition of the schwannoma, sodium fluorescein helped with the localization of intracapsular en passant nerve fascicles in only one case. Hence, the definition of a safe entry zone for capsular incision relied mainly on nerve monitoring and direct visualization of en passant nerve fascicles under microscope. During intraneural dissection, there was a sharp contrast between the fluorescent tumor and the non-fluorescent adjacent pseudocapsule in most cases but the colorimetric variation between tumor and normal tissue induced by fluorescence did not outperform the natural contrast between the yellow true capsule and the gray-red layers of the pseudocapsule. CONCLUSION Based on these results, we consider that the limited additional value of sodium fluorescein in primary peripheral nerve schwannoma surgery does not warrant its use in daily clinical practice. Additional studies are needed to assess its usefulness during the surgery of recurrences and tumors which are intertwined with several fascicles of origin such as neurofibromas.
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Nokes BT, Baumann CP, Cummings KW, Larsen BT, Cartin-Ceba R, Swanson KL. Intrathoracic ganglioneuroma presenting as an endobronchial mass. Respir Med Case Rep 2017; 22:209-211. [PMID: 28879079 PMCID: PMC5575446 DOI: 10.1016/j.rmcr.2017.08.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 08/07/2017] [Accepted: 08/22/2017] [Indexed: 01/19/2023] Open
Abstract
Peripheral nerve sheath tumors (PNST) are exceedingly rare, especially outside of the posterior mediastinum. These tumors represent less than 1% of pulmonary tumors. Very few pulmonary PNSTs are ganglioneuromas. We present a case of a ganglioneuroma presenting as an endobronchial mass. Case presentation An 80 year old male was seen in pulmonary clinic for routine cancer screening. He had a 60-pack year smoking history. CT evaluation noted a 1cm right lower lobe endobronchial lesion. This lesion was present since 2012 and had slightly increased in size since that time from 8mm (Figure 1). The lesion was further assessed using virtual bronchoscopy (Figure 2). Bronchoscopy revealed an obstructing lesion, which was completely excised with the snare (Figure 3). Pathology revealed well-circumscribed tumor consisting of nests and trabeculae of round/polygonal cells with granular eosinophilic and basophilic cytoplasm. The tumor was chromogranin, synaptophysin, S-100, pancytokeratin, SOX10, and TTF-1 positive, consistent with a ganglioneuroma. Discussion Aside from a solitary article regarding 75 patient samples (which included only one ganglioneuroma) only a small number of intrathoracic PNSTs have been reported. Only a single case report of an endobronchial ganglioneuroma has been reported. Each of these lesions were benign, and detected on routine imaging evaluations. Conclusions An intrapulmonary endobronchial location for a PNST is an exceedingly rare presentation of an already uncommon pathology.
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Affiliation(s)
- Brandon T Nokes
- The Department of Internal Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Coralie P Baumann
- The Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | | | - Brandon T Larsen
- The Department of Laboratory Medicine and Pathology, Mayo Clinic, Scottsdale, AZ, United States
| | - Rodrigo Cartin-Ceba
- The Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ, United States
| | - Karen L Swanson
- The Division of Pulmonary Medicine, Mayo Clinic, Scottsdale, AZ, United States
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Sung J, Kim JY. Fatty rind of intramuscular soft-tissue tumors of the extremity: is it different from the split fat sign? Skeletal Radiol 2017; 46:665-673. [PMID: 28255944 DOI: 10.1007/s00256-017-2598-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 12/31/2016] [Accepted: 02/08/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To analyze intramuscular soft-tissue tumors with fatty rind, and to evaluate the difference between fatty rind and split fat sign on magnetic resonance imaging (MRI). MATERIALS AND METHODS We retrospectively analyzed 50 pathologically confirmed intramuscular masses on MRI. We evaluated the distribution and shape of fatty rind and muscle atrophy. RESULTS Fatty rind was found more frequently in benign lesions (80% [36 out of 45]) compared with malignant lesions (25% [1 out of 5]; P = 0.013). Thirty-six benign lesions were peripheral nerve sheath tumors (PNSTs; n = 19), hemangiomas (n = 11), myxomas (n = 2), ganglion cysts (n = 2), giant cell tumor (n = 1), and leiomyoma (n = 1). One malignant lesion was a low-grade fibromyxoid sarcoma. In all masses with fatty rind, fat was confined to the proximal and the distal ends. In 12 cases, complete or partial circumferential fatty rind was also noted. Fatty rinds at both ends showed crescent, triangular, or combined shape. The prevalence of crescent-shaped fatty rind was significantly higher in benign PNST (17 out of 38) compared with the other tumors (1 out of 32; P < 0.001). Complete circumferential fat was noted only in hemangioma (n = 5). Triangular fatty rind was related to peripheral location of the mass or muscle atrophy. CONCLUSION Most intramuscular tumors with fatty rinds were benign, and PNST was the most common tumor type. Fatty rind could be caused by displaced neurovascular bundle fat, fatty atrophy of the muscle involved, or intermuscular or perimysial fat. Crescent-shaped fatty rind was noted more frequently in benign PNSTs.
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Affiliation(s)
- Jinkyeong Sung
- Departments of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon, Gyeonggi-do, 16247, South Korea
| | - Jee-Young Kim
- Departments of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 93, Jungbu-daero, Paldal-gu, Suwon, Gyeonggi-do, 16247, South Korea.
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Elsherif MA, Babovic-Vuksanovic D, Spinner RJ. An association of peripheral nerve sheath tumors and lipomas. Acta Neurochir (Wien) 2017; 159:185-90. [PMID: 27900489 DOI: 10.1007/s00701-016-3038-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/17/2016] [Indexed: 12/23/2022]
Abstract
BACKGROUND We noticed the coexistence of peripheral nerve sheath tumors (PNST) with lipomas within a subgroup of our patients. Given the prevalence of lipomas in the general population, we sought to investigate the extent of coexistence of the two entities aiming at uncovering any plausible association between both. METHODS A retrospective review of all peripheral nerve sheath tumors (sporadic and syndromic forms) treated by a single surgeon between January 2009 and August 2015 was done. We recorded demographics (i.e., gender, age at diagnosis, imaging information, time to diagnosis) in addition to the method of diagnosis, subtype, number and location of lipomas, if present. RESULTS Over 6 years, 309 patients with PNST were operated/evaluated. These included 141 sporadic (schwannomas, neurofibromas) and 168 syndromic (neurofibromatosis type 1 and 2 and schwannomatosis). We found 32 patients [10.3%, 95% confidence interval (CI) = 7.43%-14.3%] with coexistent lipomas, some of whom also had a family member with lipoma (n = 3). Of these 26 had schwannomas, 3 had neurofibromas and 3 lacked definitive PNST histopathological diagnosis. Fourteen percent of patients with schwannomas and 2.9% of patients with neurofibromas had coexisting lipomas. CONCLUSION We believe there is an increased association of peripheral nerve tumors and lipomas overall.
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Guraya SS, Prayson RA. Peripheral nerve sheath tumors arising in salivary glands: A clinicopathologic study. Ann Diagn Pathol 2016; 23:38-42. [PMID: 27402223 DOI: 10.1016/j.anndiagpath.2016.06.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 06/02/2016] [Indexed: 01/23/2023]
Abstract
Primary salivary gland peripheral nerve sheath tumors (PNST) are uncommon. This study is a retrospective, clinicopathologic review of 9 cases of PNST (5 neurofibromas, 3 schwannomas and 1 malignant peripheral nerve sheath tumor (MPNST)) arising from the salivary glands, encountered between 1990 and 2015. All patients with neurofibromas were male (ages 1-62 years) and had a single parotid lesion of which 2 were diffuse, 2 plexiform and one mixed diffuse/plexiform. Four had a history of neurofibromatosis I. Four of 5 presented with symptoms related to mass effect including facial swelling, facial drooping, and dysphagia. All underwent de-bulking surgery and recurred due to continued growth. Of the 3 patients with schwannomas, 1 was male and 2 were female (ages 19, 44 and 56 years). One tumor each arose in the sublingual, submandibular, and parotid glands. Two of 3 presented with soreness and swelling local to the affected gland, especially while chewing. There was no recurrence of these tumors after resection. An MPNST in a male presented as a tender mass in the patient's left parotid; the tumor was resected. There was no evidence of tumor elsewhere in the body. The tumor did not recur in 12 years of follow-up. The most common tumor type in the current series was neurofibroma; most arose in the background of neurofibromatosis type I and all of which recurred after initial subtotal resection. Most PNST arose in the parotid gland.
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Affiliation(s)
- Sahejmeet S Guraya
- Case Western Reserve University School of Medicine and Cleveland Clinic, Department of Anatomic Pathology, Cleveland, OH
| | - Richard A Prayson
- Case Western Reserve University School of Medicine and Cleveland Clinic, Department of Anatomic Pathology, Cleveland, OH.
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Elsherif MA, Spinner RJ, Miest RY. The coexistence of peripheral nerve sheath tumors and vitiligo: more than coincidence? Acta Neurochir (Wien) 2016; 158:95-9; discussion 99. [PMID: 26607956 DOI: 10.1007/s00701-015-2629-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Accepted: 10/28/2015] [Indexed: 10/22/2022]
Abstract
Neurocristopathies arise from abnormal migration, differentiation, or proliferation of neural crest derivatives, leading to diverse clinical and pathological features. They are classified into dysgenetic or neoplastic, and can affect single or multiple sites (simple versus complex). Examples include congenital melanocytic nevi, neuroblastoma, Hirshsprung's disease, Waardenburg's syndrome, neurofibromatosis (NF) 1 and multiple endocrine neoplasia (MEN) 2A and 2B. We report two cases of peripheral nerve sheath tumors associated with vitiligo and discuss the possible implicated embryologic, genetic and molecular mechanisms. To our knowledge, we also report the first case of de novo malignant peripheral nerve sheath tumor (MPNST) associated with vitiligo.
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Abstract
Superficial soft-tissue masses arising from skin appendages, metastasis, and inflammatory lesions have been widely reported. However, nerve-related superficial mass-like lesions other than peripheral nerve sheath tumors are less commonly described. High resolution magnetic resonance imaging (MRI) is an excellent non-invasive tool for the evaluation of such lesions. In this article, the authors discuss the entire spectrum of these lesions and also outline a systemic diagnostic approach.
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Affiliation(s)
- Vibhor Wadhwa
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Pearlene P Lee
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Kyung Jin Suh
- Dongguk University Gyungju Hospital College of Medicine, Dongguk University, Gyungju-Si, Republic of Korea
| | - John A Carrino
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Avneesh Chhabra
- The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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13
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Benevello C, Sommacale D, Palladino E, Bildea A, Tres I, Volpin E. A rare case of malignant schwannoma of the brachial plexus. World J Surg Proced 2013; 3:1-3. [DOI: 10.5412/wjsp.v3.i1.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We report a rare case of malignant schwannoma of the brachial plexus treated during a surgical campaign aimed at the poorest communities in the Cuzco region of Peru. A Peruvian 40-year-old-female from a mountain community presented with a mass on the lateral side of her left supraclavicular space. No imaging tools were available during this surgical campaign and so a biopsy of the tumor was carried out. Histopathological examination revealed it to be a low grade malignant schwannoma. A nerve enucleation of the tumor was chosen as neither chemotherapy nor radiotherapy was available. The tumour was a firm mass 4 cm x 3 cm x 2 cm in size. After excision of the lesion the patient presented neurological sequelae (deltoid, bicep, and tricep weakness) but her condition improved over the next 3 years. We report this case of malignant schwannoma of the brachial plexus as its incidence is very rare (the reported incidence is 0.001%) and because of its challenging treatment in poor healthcare conditions.
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