1
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Mehta N, Sathyan A, Agarwal S, Bhari N. Multiple palisaded encapsulated neuromas presenting as cobblestoned plaques over palms and oral cavity. J Cutan Pathol 2024; 51:332-337. [PMID: 38246881 DOI: 10.1111/cup.14589] [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: 09/17/2023] [Revised: 12/23/2023] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
Palisaded encapsulated neuroma (PEN) is a benign circumscribed nerve sheath tumor usually seen as a solitary painless papule on the face in middle-aged adults. We report a 22-year-old male with multiple adolescent-onset PENs distributed extensively, including the oral cavity and palms, contrary to the typical presentations. The lesions formed cobblestoned plaques and were confirmed through a skin biopsy, showing characteristic nodules of wavy spindle cells forming interlacing fascicles with interspersed clefts, and positive staining for specific markers, including markers for axons and perineurium. Notably, this case deviates from the usual presentation, shedding light on atypical manifestations of PEN in a young individual without any features suggestive of a neurocutaneous syndrome or multiple endocrine neoplasia syndrome.
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Affiliation(s)
- Nikhil Mehta
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Athira Sathyan
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Neetu Bhari
- Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi, India
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2
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Dhandapani S, Gendle C. Endoscopy for T10 nerve sheath tumor. Neurosurg Focus Video 2024; 10:V9. [PMID: 38616904 PMCID: PMC11013351 DOI: 10.3171/2024.1.focvid23214] [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] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/30/2024] [Indexed: 04/16/2024]
Abstract
Minimally invasive surgery (MIS) is increasingly being adopted for spinal intradural tumors. Through the use of conventional microscopy or exoscopy for large lobulated nerve sheath tumors, the posterior root attachment is often visualized only after mobilizing the tumor. Here, the authors describe the utility of angled endoscopy with its panoramic view for a T10 nerve sheath tumor. Gross-total extracapsular excision was achieved utilizing a minimally invasive right paraspinous approach, fenestration, lateral durotomy, sliding delivery of the tumor, sharp dissection of radicular attachments under neuromonitoring, and dural closure with oblique clips. Angled endoscopes help visualize the attachments behind large multilobulated tumors and confirm the totality of excision. The video can be found here: https://stream.cadmore.media/r10.3171/2024.1.FOCVID23214.
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Affiliation(s)
- Sivashanmugam Dhandapani
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
| | - Chandrashekhar Gendle
- Department of Neurosurgery, Postgraduate Institute of Medical Education & Research (PGIMER), Chandigarh, India
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3
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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4
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Arena JD, Sinha S, Wathen C, Ghenbot Y, Zhang PJ, Welch WC. Primary intradural extraosseous Ewing's sarcoma of the L3 nerve root: illustrative case. J Neurosurg Case Lessons 2024; 7:CASE23459. [PMID: 38224583 DOI: 10.3171/case23459] [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] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 12/19/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Ewing's sarcoma is an uncommon, aggressive malignancy that typically presents as an osseous lesion, most commonly in children and adolescents. Very rarely Ewing's sarcoma can present as an intradural extramedullary mass mimicking more common tumors. OBSERVATIONS A 32-year-old female had a left L3 nerve root-associated lesion identified in the setting of recent-onset radiculopathy. Contrast-enhanced magnetic resonance imaging of the lumbar spine was favored to demonstrate a schwannoma or neurofibroma. Hemilaminectomy, facetectomy, and resection of the mass led to improved radiculopathy and a tissue diagnosis of Ewing's sarcoma. Immediate referral to medical oncology facilitated expeditious initiation of adjuvant chemotherapy and radiation. LESSONS The differential diagnosis for newly identified nerve root-associated tumors should remain broad, including common benign pathologies and rare malignant entities. Tissue remains the gold standard for diagnosis, as preoperative imaging suggested a nerve sheath tumor. Malignant pathologies such as Ewing's sarcoma must be considered, especially in the setting of rapidly progressive symptoms or interval growth on serial imaging. Early diagnosis allows for the timely initiation of comprehensive oncological care. Long-term multidisciplinary follow-up is necessary for the surveillance of disease progression.
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Affiliation(s)
| | | | | | | | - Paul J Zhang
- 2Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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Kotch C, Dombi E, Shah AC, Smith K, Brown S, Li Y, Widemann BC, Fisher MJ. Retrospective Cohort Analysis of the Impact of Puberty on Plexiform Neurofibroma Growth in Patients with Neurofibromatosis Type 1. J Pediatr 2023; 260:113513. [PMID: 37244583 PMCID: PMC10691506 DOI: 10.1016/j.jpeds.2023.113513] [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] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 04/07/2023] [Accepted: 05/21/2023] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To assess the hypothesis that plexiform neurofibroma (PN) growth rates increase during puberty. STUDY DESIGN PN growth rates before and during puberty were compared in a retrospective cohort of children with neurofibromatosis type 1 with puberty defined by Tanner staging. Of 33 potentially eligible patients, 25 had adequate quality magnetic resonance imaging for volumetric analysis and were included in ≥1 anchor cohort. Volumetric analysis was performed for all available imaging studies within the 4 years before and after puberty, and before and after 9- and 11-year-old anchor scans. Linear regression was performed to estimate the slope of change (PN growth rate); growth rates were compared with paired t test or Wilcoxon matched-pairs signed rank test. RESULTS There were no significant difference in rates of PN growth in milliliters per month or milliliters per kilogram per month in the prepubertal vs pubertal periods (mean, 1.33 ± 1.67 vs 1.15 ± 1.38 [P = .139] and -0.003 ± 0.015 vs -0.002 ± 0.02 [P = .568]). Percent increases of PN volumes from baseline per month were significantly higher prepubertally (1.8% vs 0.84%; P = .041) and seemed to be related inversely to advancing age. CONCLUSIONS Puberty and its associated hormonal changes do not seem to influence PN growth rate. These findings support those previously reported, but from a typical population of children with neurofibromatosis type 1 with puberty confirmed by Tanner staging.
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Affiliation(s)
- Chelsea Kotch
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
| | - Eva Dombi
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Amish C Shah
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Katherine Smith
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Symone Brown
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Yimei Li
- Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
| | - Brigitte C Widemann
- Pediatric Oncology Branch, Center for Cancer Research, National Cancer Institute, Bethesda, MD
| | - Michael J Fisher
- Division of Oncology, Children's Hospital of Philadelphia, Philadelphia, PA; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA
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6
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ANIČIĆ M, PEŠIĆ A, DOŠENOVIĆ M, NESTOROVIĆ I, VUČIĆEVIĆ I, MARINKOVIĆ D, VUČIĆEVIĆ M. A case of nerve sheath tumor followed by multicentric high-grade T-cell lymphoma in an African pygmy hedgehog (Atelerix albiventris). J Vet Med Sci 2023; 85:853-857. [PMID: 37344420 PMCID: PMC10466052 DOI: 10.1292/jvms.23-0070] [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: 02/08/2023] [Accepted: 06/06/2023] [Indexed: 06/23/2023] Open
Abstract
A 3-year-old intact male African pygmy hedgehog was presented at the Teaching Hospital of the Faculty of Veterinary Medicine, University of Belgrade, with a growth on the left side of its abdomen. After clinical examination, the mass was surgically removed, and histopathological findings indicated a nerve sheath tumor. The hedgehog fully recovered after surgery and was euthanized eight months later due to the appearance of multicentric changes in the internal organs. Further necropsy and macroscopic, cytologic, histopathologic, and immunohistochemical findings revealed that the tumor was a multicentric high-grade T-cell lymphoma. This is an unusual case of an African pygmy hedgehog with two different neoplasms-a nerve sheath tumor followed by lymphoma.
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Affiliation(s)
- Milan ANIČIĆ
- University of Belgrade, Faculty of Veterinary Medicine,
Department of Pathology, Belgrade, Serbia
| | - Ana PEŠIĆ
- University of Belgrade, Faculty of Veterinary Medicine,
Department of Equine, Small Animal, Poultry and Wild Animal Diseases, Belgrade,
Serbia
| | - Milan DOŠENOVIĆ
- University of Belgrade, Faculty of Veterinary Medicine,
Department of Equine, Small Animal, Poultry and Wild Animal Diseases, Belgrade,
Serbia
| | - Ivan NESTOROVIĆ
- University of Belgrade, Faculty of Veterinary Medicine,
Department of Reproduction, Fertility and Artificial Insemination, Belgrade, Serbia
| | - Ivana VUČIĆEVIĆ
- University of Belgrade, Faculty of Veterinary Medicine,
Department of Pathology, Belgrade, Serbia
| | - Darko MARINKOVIĆ
- University of Belgrade, Faculty of Veterinary Medicine,
Department of Pathology, Belgrade, Serbia
| | - Miloš VUČIĆEVIĆ
- University of Belgrade, Faculty of Veterinary Medicine,
Department of Equine, Small Animal, Poultry and Wild Animal Diseases, Belgrade,
Serbia
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Koueik J, Larson S, Ahmed A, Hanna AS. Large vertebral artery pseudoaneurysm masquerading as a schwannoma: illustrative case. J Neurosurg Case Lessons 2023; 6:CASE23168. [PMID: 37392763 PMCID: PMC10555631 DOI: 10.3171/case23168] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 05/30/2023] [Indexed: 07/03/2023]
Abstract
BACKGROUND Extracranial vertebral aneurysms or pseudoaneurysms are rare and result primarily from trauma. Large pseudoaneurysms can masquerade as mass lesions, making it challenging to identify the correct diagnosis. OBSERVATIONS This is a case report in which a large vertebral pseudoaneurysm posed as a schwannoma and biopsy was attempted. It was later identified as a vascular lesion and treated appropriately with no complications. LESSONS Vascular etiologies should always be included in the differential diagnosis of spine and nerve pathologies especially lesions that are in the vicinity of major vascular channels such as the transverse foramina of the cervical spine.
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Affiliation(s)
| | - Sarah Larson
- Department of Neurologic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Azam Ahmed
- Department of Neurologic Surgery, University of Wisconsin, Madison, Wisconsin
| | - Amgad S. Hanna
- Department of Neurologic Surgery, University of Wisconsin, Madison, Wisconsin
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Benato A, D'Alessandris QG, Murazio M, Pacelli F, Mattogno PP, Fernández E, Lauretti L. Integrated Neurosurgical Management of Retroperitoneal Benign Nerve Sheath Tumors. Cancers (Basel) 2023; 15:3138. [PMID: 37370749 DOI: 10.3390/cancers15123138] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 05/24/2023] [Accepted: 06/09/2023] [Indexed: 06/29/2023] Open
Abstract
Peripheral nerve sheath tumors (PNST) of the retroperitoneum are rare and are often treated by general surgeons dealing with retroperitoneal cancers. However, resection without the correct microsurgical technique can cause permanent neurological deficits and pain. Here, we discuss our interdisciplinary approach based on the integration of expertise from neurosurgery and abdominal surgery, allowing for both safe exposure and nerve-sparing microsurgical resection of these lesions. We present a series of 15 patients who underwent resection of benign retroperitoneal or pelvic PNST at our institution. The mean age of patients was 48.4 years; 67% were female. Tumors were 14 schwannomas and 1 neurofibroma. Eight patients (53%) reported neurologic symptoms preoperatively. The rate of complete resection was 87% (n = 13); all symptomatic patients showed improvement of their preoperative symptoms. There were no postoperative motor deficits; one patient (7%) developed a permanent sensory deficit. At a mean postoperative follow-up of 31 months, we observed no recurrences. To our best knowledge, this is the second-largest series of benign retroperitoneal PNST consistently managed with microsurgical techniques. Our experience confirms that interdisciplinary management allows for safe treatment of these tumors with good neurological and oncological outcomes.
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Affiliation(s)
- Alberto Benato
- Rome Campus, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | | | - Marino Murazio
- Rome Campus, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Fabio Pacelli
- Rome Campus, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Surgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Pier Paolo Mattogno
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Eduardo Fernández
- Rome Campus, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
| | - Liverana Lauretti
- Rome Campus, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
- Department of Neurosurgery, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, 00168 Rome, Italy
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9
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Porrello G, Cannella R, Randazzo A, Badalamenti G, Brancatelli G, Vernuccio F. CT and MR Imaging of Retroperitoneal Sarcomas: A Practical Guide for the Radiologist. Cancers (Basel) 2023; 15:cancers15112985. [PMID: 37296946 DOI: 10.3390/cancers15112985] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 05/21/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023] Open
Abstract
Primary retroperitoneal sarcomas (RPS) represent around 10-16% of all sarcomas, with liposarcomas and leiomyosarcomas being the most common subtypes. RPS have some peculiar characteristics, imaging appearances, worse prognosis, and complications compared to other locations of sarcoma. Commonly, RPS primarily present as large masses, progressively encasing adjacent structures, causing mass effect, and complications. RPS diagnosis is often challenging, and these tumors may be overlooked; however, failure to recognize RPS characteristics leads to a worse prognosis for the patients. Surgery is the only recognized curative treatment, but the anatomical constraints of the retroperitoneum limit the ability to achieve wide resection margins; therefore, these tumors have a high rate of recurrence, and require long-term follow-up. The radiologist has an important role in the diagnosis of RPS, the definition of their extent, and their follow-up. Specific knowledge of the main imaging findings is required to reach an early diagnosis, and, ultimately, to guarantee the best patient management. This article provides an overview of the current knowledge regarding cross-sectional imaging features of patients with retroperitoneal sarcomas, presenting tips and tricks to improve imaging diagnosis of RPS.
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Affiliation(s)
- Giorgia Porrello
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS ISMETT (Mediterranean Institute for Transplantation and Advanced Specialized Therapies), Via Tricomi 5, 90127 Palermo, Italy
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
| | - Angelo Randazzo
- Department of Radiology, Azienda Sanitaria Provinciale, 92100 Agrigento, Italy
| | - Giuseppe Badalamenti
- Section of Medical Oncology, Department of Surgical, Oncological and Oral Sciences (DICHIRONS), University of Palermo, 90127 Palermo, Italy
| | - Giuseppe Brancatelli
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnosis (Bi.N.D), University of Palermo, 90127 Palermo, Italy
| | - Federica Vernuccio
- Department of Radiology, University Hospital of Padova, 35128 Padova, Italy
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10
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Wakely PE. Benign peripheral nerve tumors: Analysis of 89 FNA cases emphasizing diagnostic accuracy and their morphologic spectrum. Cancer Cytopathol 2023; 131:300-312. [PMID: 36650522 DOI: 10.1002/cncy.22680] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/01/2022] [Accepted: 12/15/2022] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Benign peripheral nerve tumors (BPNTs) are a heterogenous group of soft tissue tumors that include a variety of nerve sheath tumors, granular cell tumor (GCT), and ganglioneuroma. Only a few large studies exist on cytopathology and diagnostic accuracy using fine-needle aspiration (FNA) biopsy for this set of neoplasms. MATERIALS AND METHODS Both surgical and cytopathology files were searched for cases of BPNT. FNA biopsy was performed using standard techniques. RESULTS Eighty-nine cases from 88 patients (male:female = 1:1; age range: 16-85 years, mean age, 51 years) met inclusion criteria. FNA sites included extremities (58, 65%), head/neck (14, 16%), deep (9, 10%), and trunk (8, 10%). Aspirates were from primary neoplasms in all but one instance. There were 65 schwannomas, seven neurofibromas, seven perineuriomas, seven GCTs, and three ganglioneuromas/neuromas. Aspirates of schwannoma, GCT, neurofibroma (NF), and perineurioma (PN) were correctly diagnosed in 86%, 100%, 29%, and 0% of cases, respectively. Five tumors (6%) were interpreted as either a specific sarcoma or suspicious for sarcoma. Remaining aspirates were classified as spindle cell neoplasm, salivary gland neoplasm, and nondiagnostic. Cytologic features for schwannoma, NF, PN, and ganglioneuroma showed spindle cell-dominant smears arranged mainly in syncytial clusters. GCT aspirates contained a population of epithelioid cells harboring coarsely granular cytoplasm and bare nuclei. Immunohistochemical (IHC) staining in 55 (62%) cases showed S-100 expression in 95%. CONCLUSION FNA biopsy coupled with IHC is reliable in correctly classifying schwannoma and GCT, but less so for NF. Perineurioma can be mistaken for sarcoma.
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Affiliation(s)
- Paul E Wakely
- Department of Pathology, The Ohio State University Wexner Medical Center, James Cancer Hospital and Solove Research Institute, Columbus, Ohio, USA
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11
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Miranda SP, Nguyen J, Gu BJ, Ali ZS, Zager EL. Allograft nerve repair to prevent sensorimotor loss after nerve sheath tumor resection. Neurosurg Focus Video 2023; 8:V16. [PMID: 36628089 PMCID: PMC9815229 DOI: 10.3171/2022.10.focvid22101] [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] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 10/12/2022] [Indexed: 01/02/2023]
Abstract
Acellularized nerve allografts (ANAs) have been developed as substitutes for nerve autograft to promote nerve regeneration after surgical repair. In this video, the authors demonstrate operative techniques for using ANAs to repair potentially functional nerve fascicles during tumor resection. A 67-year-old female with schwannomatosis requested resection of a painful enlarging mass of the left ulnar nerve proximal to the elbow. During surgery, neuromonitoring suggested that fascicles entering the tumor could be functional. Therefore, nerve allograft was used to repair the transected fascicles. The patient recovered with full strength and sensation in the ulnar distribution, with resolution of her preoperative symptoms. The video can be found here: https://stream.cadmore.media/r10.3171/2022.10.FOCVID22101.
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Affiliation(s)
- Stephen P. Miranda
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Jessica Nguyen
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ben J. Gu
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Zarina S. Ali
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eric L. Zager
- Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania
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12
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Muacevic A, Adler JR, Owais M, Haseeb M, Kharal F. Schwannoma of the Ascending Colon in a 22-Year-Old Male: A Case Report. Cureus 2022; 14:e31946. [PMID: 36582566 PMCID: PMC9795079 DOI: 10.7759/cureus.31946] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2022] [Indexed: 11/29/2022] Open
Abstract
Schwannoma of the ascending colon is an extremely rare neoplasm that is often discovered incidentally in the asymptomatic older population on surveillance colonoscopy. We present the case of a symptomatic 22-year-old male presenting with one month of discomfort in the right lower abdominal quadrant, abdominal bloating, and hematochezia. A sessile polyp measuring 0.5 cm was identified in the ascending colon on the colonoscopy. The polyp was completely resected using cold snare polypectomy. Histological examination of the resected polyp with hematoxylin-eosin staining revealed small nodules of bland spindle cells with focal nuclear condensation. The lesional cells tested positive for S-100 and SOX-10 on immunohistochemical analysis, establishing the diagnosis of benign schwannoma. Since this lesion was submucosal, its diagnosis required an endoscopic biopsy that could only be performed on the mucosa. It was difficult to distinguish it from other mesenchymal tumors (gastrointestinal stromal tumor or leiomyoma), and this makes the differential diagnosis exceedingly challenging. If the immunohistochemistry is positive for S-100 and negative for C-KIT, CD-34, actin, and desmin, it aids in diagnosis. These tumors have non-specific radiological features and are asymptomatic.
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13
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Mikula AL, Smith BW, Lakomkin N, Doan MK, Jack MM, Bydon M, Spinner RJ. A significant association between C5 nerve sheath tumors and new postoperative weakness. J Neurosurg Spine 2021:1-6. [PMID: 34359025 DOI: 10.3171/2021.2.spine202139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 12/08/2020] [Accepted: 02/01/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The objective of this study was to determine if patients with nerve sheath tumors affecting the C5 spinal nerve are at greater risk for postoperative weakness than those with similar tumors affecting other spinal nerves contributing to the brachial plexus. METHODS A retrospective chart review (1998-2020)identified patients with pathologically confirmed schwannomas or neurofibromas from the C5 to T1 nerves. Patients with plexiform nerve sheath tumors, tumors involving more than 1 nerve, and malignant peripheral nerve sheath tumors were excluded. Collected variables included basic demographics, tumor dimensions, its location relative to the dura, involved nerve level, surgical approach, extent of resection, presenting symptoms, postoperative neurological deficits, and recurrence rate. RESULTS Forty-six patients (23 men, 23 women) were identified for inclusion in the study with an average age of 47 ± 17 years, BMI of 28 ± 5 kg/m2, and follow-up of 32 ± 45 months. Thirty-nine patients (85%) had schwannomas and 7 (15%) had neurofibromas. Tumors involved the C5 (n = 12), C6 (n = 11), C7 (n = 14), C8 (n = 6), and T1 (n = 3) nerves. Multivariable logistic regression analysis with an area under the curve of 0.85 demonstrated C5 tumor level as an independent predictor of new postoperative weakness (odds ratio 7.4, p = 0.028). Of those patients with new postoperative weakness, 75% improved and 50% experienced complete resolution of their motor deficits. CONCLUSIONS Patients with C5 nerve sheath tumor resections are at higher odds of new postoperative weakness. This may be due to the predominant single innervation of shoulder muscle targets in contrast to other upper extremity muscles that receive input from 2 or more spinal nerves. These findings are important for clinical decision-making and preoperative patient counseling.
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Affiliation(s)
- Anthony L Mikula
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Brandon W Smith
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Nikita Lakomkin
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | | | - Megan M Jack
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Mohamad Bydon
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
| | - Robert J Spinner
- 1Department of Neurological Surgery, Mayo Clinic, Rochester, Minnesota; and
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14
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Wilson MP, Katlariwala P, Low G, Murad MH, McInnes MDF, Jacques L, Jack AS. Diagnostic Accuracy of MRI for the Detection of Malignant Peripheral Nerve Sheath Tumors: A Systematic Review and Meta-Analysis. AJR Am J Roentgenol 2021; 217:31-9. [PMID: 33909462 DOI: 10.2214/AJR.20.23403] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE. This systematic review and meta-analysis evaluates the diagnostic accuracy of MRI for differentiating malignant (MPNSTs) from benign peripheral nerve sheath tumors (BPNSTs). MATERIALS AND METHODS. A systematic review of MEDLINE, Embase, Scopus, the Cochrane Library, and the gray literature from inception to December 2019 was performed. Original articles that involved at least 10 patients and that evaluated the accuracy of MRI for detecting MPNSTs were included. Two reviewers independently extracted clinical and radiologic data from included articles to calculate sensitivity, specificity, PPV, NPV, and accuracy. A meta-analysis was performed using a bivariate mixed-effects regression model. Risk of bias was evaluated using QUADAS-2. RESULTS. Fifteen studies involving 798 lesions (252 MPNSTs and 546 BPNSTs) were included in the analysis. Pooled and weighted sensitivity, specificity, and AUC values for MRI in detecting MPNSTs were 68% (95% CI, 52-80%), 93% (95% CI, 85-97%), and 0.89 (95% CI, 0.86-0.92) when using feature combination and 88% (95% CI, 74-95%), 94% (95% CI, 89-96%), and 0.97 (95% CI, 0.95-0.98) using diffusion restriction with or without feature combination. Subgroup analysis, such as patients with neurofibromatosis type 1 (NF1) versus those without NF1, could not be performed because of insufficient data. Risk of bias was predominantly high or unclear for patient selection, mixed for index test, low for reference standard, and unclear for flow and timing. CONCLUSION. Combining features such as diffusion restriction optimizes the diagnostic accuracy of MRI for detecting MPNSTs. However, limitations in the literature, including variability and risk of bias, necessitate additional methodologically rigorous studies to allow subgroup analysis and further evaluate the combination of clinical and MRI features for MPNST diagnosis.
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15
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Wilson TJ, Hamrick F, Alzahrani S, Dibble CF, Koduri S, Pendleton C, Saleh S, Ali ZS, Mahan MA, Midha R, Ray WZ, Yang LJS, Zager EL, Spinner RJ. Analysis of the effect of intraoperative neuromonitoring during resection of benign nerve sheath tumors on gross-total resection and neurological complications. J Neurosurg 2021; 135:1231-1240. [PMID: 33578389 DOI: 10.3171/2020.8.jns202885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 07/25/2020] [Accepted: 08/26/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The aim of this study was to examine the role of intraoperative neuromonitoring (IONM) during resection of benign peripheral nerve sheath tumors in achieving gross-total resection (GTR) and in reducing postoperative neurological complications. METHODS Data from consecutive adult patients who underwent resection of a benign peripheral nerve sheath tumor at 7 participating institutions were combined. Propensity score matching was used to balance covariates. The primary outcomes of interest were the association between IONM and GTR and the association of IONM and the development of a permanent postoperative neurological complication. The secondary outcomes of interest were the association between IONM and GTR and the association between IONM and the development of a permanent postoperative neurological complication in the subgroup of patients with tumors involving a motor or mixed nerve. Univariate and multivariate logistic regression were then performed on the propensity score-matched samples to assess the ability of the independent variables to predict the outcomes of interest. RESULTS A total of 337 patients who underwent resection of benign nerve sheath tumors were included. In multivariate analysis, the use of IONM (OR 0.460, 95% CI 0.199-0.978; p = 0.047) was a significant negative predictor of GTR, whereas none of the variables, including IONM, were associated with the occurrence of a permanent postoperative neurological complication. Within the subgroup of motor/mixed nerve tumors, in the multivariate analysis, IONM (OR 0.263, 95% CI 0.096-0.723; p = 0.010) was a significant negative predictor of a GTR, whereas IONM (OR 3.800, 95% CI 1.925-7.502; p < 0.001) was a significant positive predictor of a permanent postoperative motor deficit. CONCLUSIONS Overall, 12% of the cohort had a permanent neurological complication, with new or worsened paresthesias most common, followed by pain and then weakness. The authors found that formal IONM was associated with a reduced likelihood of GTR and had no association with neurological complications. The authors believe that these data argue against IONM being considered standard of care but do not believe that these data should be used to universally argue against IONM during resection of benign nerve sheath tumors.
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Affiliation(s)
- Thomas J Wilson
- 1Department of Neurosurgery, Stanford University, Stanford, California
| | - Forrest Hamrick
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Saud Alzahrani
- 3Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | | | - Sravanthi Koduri
- 5Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | | | - Sara Saleh
- 5Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Zarina S Ali
- 7Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Mark A Mahan
- 2Department of Neurosurgery, University of Utah, Salt Lake City, Utah
| | - Rajiv Midha
- 3Department of Clinical Neurosciences, University of Calgary, Alberta, Canada
| | - Wilson Z Ray
- 4Department of Neurosurgery, Washington University in St. Louis, Missouri
| | - Lynda J S Yang
- 5Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Eric L Zager
- 7Department of Neurosurgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Robert J Spinner
- 6Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
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16
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Abstract
The peripheral nervous system (PNS) relays messages between the central nervous system (brain and spinal cord) and the body. Despite this critical role and widespread distribution, the PNS is often overlooked when investigating disease in diagnostic and experimental pathology. This review highlights key features of neuroanatomy and physiology of the somatic and autonomic PNS, and appropriate PNS sampling and processing techniques. The review considers major classes of PNS lesions including neuronopathy, axonopathy, and myelinopathy, and major categories of PNS disease including toxic, metabolic, and paraneoplastic neuropathies; infectious and inflammatory diseases; and neoplasms. This review describes a broad range of common PNS lesions and their diagnostic criteria and provides many useful references for pathologists who perform PNS evaluations as a regular or occasional task in their comparative pathology practice.
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17
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Pu F, Zhang Z, Chen Z, Cai K, Wang B, Wu Q, Shi D, Liu J, Shao Z. Application of the da Vinci surgical robot system in presacral nerve sheath tumor treatment. Oncol Lett 2020; 20:125. [PMID: 32934694 PMCID: PMC7471688 DOI: 10.3892/ol.2020.11984] [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: 03/25/2020] [Accepted: 07/08/2020] [Indexed: 11/05/2022] Open
Abstract
The aim of the present study was to investigate the feasibility of da Vinci robotic surgery in the treatment of presacral tumors, and to observe its efficacy and safety. Between March 2016 and April 2019, 12 patients with presacral nerve sheath tumors underwent da Vinci robotic surgery, and the integrity of the tumor resection, surgical duration, pre- and postoperative visual analog scale (VAS) score, intra- and postoperative blood losses, postoperative bedtime, hospital stay and complications were observed. The tumor was completely removed in all 12 patients, the surgical duration ranged between 76 and 245 min (mean, 106.08 min) and the intraoperative blood loss was 76-145 ml (mean, 101.67 ml). The average preoperative VAS score of the patients was 3.25, and the average VAS score at 1 week, 1 month and 3 months post operation were 1.08, 0.42 and 0.08, respectively. All patients were out of bed on the second day after surgery, and the postoperative drainage was 10-50 ml (mean, 33.50 ml). The patients were hospitalized for 3-5 days (mean, 3.92 days). No complications occurred peri- or postoperatively, and wound pain was the main source of postoperative discomfort. In conclusion, the da Vinci robot can be applied to presacral nerve sheath tumors with high surgical safety, low-level bleeding, a rapid recovery and a short hospital stay, making it worthy of further study.
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Affiliation(s)
- Feifei Pu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Zhicai Zhang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Zhaohui Chen
- Department of Urology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Kailin Cai
- Department of Gastrointestinal Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Baichuan Wang
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Qiang Wu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Deyao Shi
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Jianxiang Liu
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
| | - Zengwu Shao
- Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430022, P.R. China
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18
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Dai A, Cai JP. Intravascular schwannoma: A review of a rare diagnosis. J Cutan Pathol 2020; 48:314-317. [PMID: 32623758 DOI: 10.1111/cup.13797] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 05/05/2020] [Revised: 06/23/2020] [Accepted: 07/01/2020] [Indexed: 12/12/2022]
Abstract
While schwannoma is one of the most common types of benign peripheral nerve tumors in adults, a very unique and specific variant of schwannoma, the intravascular variant, is exceedingly rare. There have only been three previously published cases of intravascular schwannomas. Here we describe a fourth case of an intravascular schwannoma in a 47-year-old man with an enlarging subcutaneous nodule on his posterior calf. This is the second case of an intravascular schwannoma contained within a vein. Also included is an overview of intravascular schwannomas, including a description and discussion of the histopathological diagnosis, differential diagnoses, and schwannoma variants.
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Affiliation(s)
- Annie Dai
- School of Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Jian-Ping Cai
- Dermatopathology, Florida Division of Dianon Systems/LabCorp, Tampa, Florida, USA
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19
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Biju RD, Duignan M, Maharaj M, Ziad F, Hussain Z. A Rare Case of Hemorrhagic Melanotic Schwannoma in a 38-year-old Female. Asian J Neurosurg 2020; 15:709-712. [PMID: 33145235 PMCID: PMC7591217 DOI: 10.4103/ajns.ajns_142_20] [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: 04/07/2020] [Revised: 08/01/2020] [Accepted: 05/02/2020] [Indexed: 11/25/2022] Open
Abstract
Melanotic schwannoma is a rare form of nerve sheath tumor composed of melanin-producing neoplastic Schwann cells. Less than 200 cases have been reported worldwide. The entity has been associated with Carney complex, a rare genetic disorder characterized by multiple benign tumors. A 38-year-old female presented to our unit with sudden-onset lower back pain and radiculopathy triggered by a mechanical injury. Imaging demonstrated a lesion within the left L5/S1 neural exit foramen with remodeling of bony architecture typical of a chronic, benign process. She proceeded for resection and histology revealed a psammomatous melanotic schwannoma. The patient recovered well with improvement in symptomology. Due to the aggressive nature of the disease, she remains under surveillance for local recurrence and distant metastasis. Clinicians should be aware of this malignant entity, despite its possible presentation with radiological features of a chronic, benign process. Unusual characteristics such as hemorrhage should be treated with a high index of suspicion.
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Affiliation(s)
| | - Maria Duignan
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
| | - Monish Maharaj
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
| | - Fouzia Ziad
- Department of Pathology, Waikato Hospital, Hamilton, New Zealand
| | - Zakier Hussain
- Department of Neurosurgery, Waikato Hospital, Hamilton, New Zealand
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20
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Abstract
Orbital schwannomas are rare neoplasms of the orbit. The presenting symptoms are often nonspecific. Classic imaging characteristics seen on magnetic resonance imaging (MRI) and orbital ultrasound can be useful to help aid in the diagnosis of orbital schwannoma. When diagnosed, the goal of treatment is complete surgical excision. The location of the tumor within the orbit dictates which surgical approach would provide the best exposure. When complete excision is achieved, recurrence rates are very low. This article addresses the etiology, patient population, presentation, natural history, and differential diagnosis of orbital schwannomas. Imaging characteristics and histopathologic subtypes are reviewed. Treatment goals, approaches, and specialties involved in the management of these patients is discussed. Finally, a representative case is presented.
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Affiliation(s)
- Mark B Chaskes
- Department of Otolaryngology, Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, United States
| | - Mindy R Rabinowitz
- Department of Otolaryngology, Head and Neck Surgery, Thomas Jefferson University Hospital, Philadelphia, United States
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21
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Sode T, Kunzler E, Uzoma B, McCollough M, Hosler GA. A meissnerian neurofibroma: Case report of a rare neurofibroma variant. J Cutan Pathol 2020; 47:967-969. [PMID: 32447757 DOI: 10.1111/cup.13759] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/19/2020] [Accepted: 05/21/2020] [Indexed: 11/28/2022]
Abstract
Structures resembling Meissner corpuscles have been described in various nerve sheath tumors, including schwannomas and neurofibromas. When present, they are focal or scattered, and rarely a prominent feature of the lesion. Here, we report a case of a 39-year-old female who presented with an isolated lesion on her abdomen. Histopathologically, the tumor was almost exclusively composed of Meissner corpuscle-like structures (pseudo-meissnerian bodies). At a small edge of the tumor, there were features of a classic neurofibroma, with a mixture of Schwann cells, fibroblast-like cells, and interspersed mast cells. We propose the term "meissnerian neurofibroma" for this extremely rare variant of neurofibroma.
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Affiliation(s)
| | - Elaine Kunzler
- Univeristy of Texas Southwestern Medical Center, Department of Dermatology, Dallas, Texas, USA
| | - Bianca Uzoma
- University of Texas Medical Branch School of Medicine, Galveston, Texas, USA
| | | | - Gregory A Hosler
- ProPath Dermatopathology, Dallas, Texas, USA.,Univeristy of Texas Southwestern Medical Center, Department of Dermatology, Dallas, Texas, USA
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22
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Banerjee J, Allaway RJ, Taroni JN, Baker A, Zhang X, Moon CI, Pratilas CA, Blakeley JO, Guinney J, Hirbe A, Greene CS, Gosline SJC. Integrative Analysis Identifies Candidate Tumor Microenvironment and Intracellular Signaling Pathways that Define Tumor Heterogeneity in NF1. Genes (Basel) 2020; 11:E226. [PMID: 32098059 PMCID: PMC7073563 DOI: 10.3390/genes11020226] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 02/15/2020] [Accepted: 02/19/2020] [Indexed: 12/12/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a monogenic syndrome that gives rise to numerous symptoms including cognitive impairment, skeletal abnormalities, and growth of benign nerve sheath tumors. Nearly all NF1 patients develop cutaneous neurofibromas (cNFs), which occur on the skin surface, whereas 40-60% of patients develop plexiform neurofibromas (pNFs), which are deeply embedded in the peripheral nerves. Patients with pNFs have a ~10% lifetime chance of these tumors becoming malignant peripheral nerve sheath tumors (MPNSTs). These tumors have a severe prognosis and few treatment options other than surgery. Given the lack of therapeutic options available to patients with these tumors, identification of druggable pathways or other key molecular features could aid ongoing therapeutic discovery studies. In this work, we used statistical and machine learning methods to analyze 77 NF1 tumors with genomic data to characterize key signaling pathways that distinguish these tumors and identify candidates for drug development. We identified subsets of latent gene expression variables that may be important in the identification and etiology of cNFs, pNFs, other neurofibromas, and MPNSTs. Furthermore, we characterized the association between these latent variables and genetic variants, immune deconvolution predictions, and protein activity predictions.
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Affiliation(s)
- Jineta Banerjee
- Computational Oncology, Sage Bionetworks, Seattle, WA 98121, USA
| | - Robert J Allaway
- Computational Oncology, Sage Bionetworks, Seattle, WA 98121, USA
| | - Jaclyn N Taroni
- Childhood Cancer Data Lab, Alex’s Lemonade Stand Foundation, Philadelphia, PA 19102, USA
| | - Aaron Baker
- Computational Oncology, Sage Bionetworks, Seattle, WA 98121, USA
- Department of Computer Sciences, University of Wisconsin-Madison, Madison, WI 53715, USA
- Morgridge Institute for Research, Madison, WI 53715, USA
| | - Xiaochun Zhang
- Division of Oncology, Washington University Medical School, St. Louis, MO 63110, USA
| | - Chang In Moon
- Division of Oncology, Washington University Medical School, St. Louis, MO 63110, USA
| | - Christine A Pratilas
- Sidney Kimmel Comprehensive Cancer Center and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - Jaishri O Blakeley
- Sidney Kimmel Comprehensive Cancer Center and Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
- Neurology, Neurosurgery and Oncology, Johns Hopkins University, Baltimore, MD 21287, USA
| | - Justin Guinney
- Computational Oncology, Sage Bionetworks, Seattle, WA 98121, USA
| | - Angela Hirbe
- Division of Oncology, Washington University Medical School, St. Louis, MO 63110, USA
| | - Casey S Greene
- Childhood Cancer Data Lab, Alex’s Lemonade Stand Foundation, Philadelphia, PA 19102, USA
- Department of Systems Pharmacology and Translational Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Sara JC Gosline
- Computational Oncology, Sage Bionetworks, Seattle, WA 98121, USA
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23
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Gambarotta G, Raimondo S, Udina E, Phillips JB, Haastert-Talini K. Editorial: Peripheral Nerve Regeneration. Front Cell Neurosci 2019; 13:464. [PMID: 31680873 PMCID: PMC6803521 DOI: 10.3389/fncel.2019.00464] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 09/30/2019] [Indexed: 11/17/2022] Open
Affiliation(s)
- Giovanna Gambarotta
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Italy
| | - Stefania Raimondo
- Department of Clinical and Biological Sciences, University of Torino, Orbassano, Italy.,Neuroscience Institute of the "Cavalieri Ottolenghi" Foundation (NICO), University of Torino, Orbassano, Italy
| | - Esther Udina
- Department of Cell Biology, Physiology and Immunology, Centro de Investigación Biomédica en Red sobre Enfermedades Neurodegenerativas, Institute of Neurosciences, Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - James B Phillips
- Department of Pharmacology, UCL School of Pharmacy, University College London, London, United Kingdom.,UCL Centre for Nerve Engineering, University College London, London, United Kingdom
| | - Kirsten Haastert-Talini
- Institute of Neuroanatomy and Cell Biology, Hannover Medical School, Hanover, Germany.,Center for Systems Neuroscience (ZSN) Hannover, Hanover, Germany
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24
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Sandler ML, Sims JR, Sinclair C, Sharif KF, Ho R, Yue LE, Téllez MJ, Ulkatan S, Khorsandi AS, Brandwein-Weber M, Urken ML. Vagal schwannomas of the head and neck: A comprehensive review and a novel approach to preserving vocal cord innervation and function. Head Neck 2019; 41:2450-2466. [PMID: 30957342 DOI: 10.1002/hed.25758] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [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: 12/21/2018] [Revised: 02/25/2019] [Accepted: 03/18/2019] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Schwannomas, benign tumors arising from neurolemmocytes, are the most common type of peripheral nerve tumors. Extracranial schwannomas are most often found in the parapharyngeal space, commonly involving the vagus nerve to cervical sympathetic trunk. Vagal schwannomas present several unique clinical and therapeutic challenges. METHODS A comprehensive literature review was conducted on 197 articles reporting 235 cases of cervical vagal schwannomas. Presenting symptoms, treatment approach, and postoperative outcomes were recorded and analyzed. RESULTS Vagal schwannomas commonly present as asymptomatic neck masses. When they become symptomatic, surgical resection is the standard of care. Gross total resection is associated with higher postoperative morbidity compared to subtotal resection. Initial reports using intraoperative nerve monitoring have shown improved nerve preservation. Recurrence rates are low. CONCLUSION The combination of intermittent nerve mapping with novel continuous vagal nerve monitoring techniques may reduce postoperative morbidity and could represent the future standard of care for vagal schwannoma treatment.
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Affiliation(s)
- Mykayla L Sandler
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - John R Sims
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Catherine Sinclair
- Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Kayvon F Sharif
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Rebecca Ho
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Lauren E Yue
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York
| | - Maria J Téllez
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York
| | - Sedat Ulkatan
- Department of Intraoperative Neurophysiology, Mount Sinai West Hospital, New York, New York
| | - Azita S Khorsandi
- Department of Radiology, New York Eye & Ear Infirmary of Mount Sinai, New York, New York
| | | | - Mark L Urken
- THANC (Thyroid, Head and Neck Cancer) Foundation, New York, New York.,Department of Otolaryngology-Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York
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25
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Shaines MD, Arora S. Case Report: An incidental finding of an metastases noted in a "cancer to cancer adrenal tumor " from a large malignant nerve sheath tumor of the thigh. F1000Res 2018; 6:1964. [PMID: 29862013 PMCID: PMC5954341 DOI: 10.12688/f1000research.12647.2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/03/2018] [Indexed: 11/21/2022] Open
Abstract
Current guidelines are vague for the management of soft tissue sarcomas, specifically malignant peripheral nerve sheath tumors (MPNST), regarding staging the disease with the use of routine abdominal imaging. The most recent guidelines from the National Comprehensive Cancer Network (NCCN) recommends to “consider” abdominal/pelvic CT imaging for certain sub groups of sarcomas (e.g., myxoid/round cell liposarcoma, epithelial sarcoma, angiosarcoma, leiomyosarcoma), but provide no guidance on other sarcoma subtypes regardless of tumor size. We report a case of a very large large MPNST in a 40 year-old-female with neurofibromatosis type 1 who was incidentally found to have adrenal metastasis.
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Affiliation(s)
- Matthew D Shaines
- Department of Internal Medicine, Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
| | - Shitij Arora
- Department of Internal Medicine, Division of Hospital Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, New York City, NY, USA
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26
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Barber C, Fahrenkopf M, Adams N, Naum S. Multiple Peripheral Schwannomas. Eplasty 2018; 18:ic7. [PMID: 29623152 PMCID: PMC5865225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Cara M. Barber
- aMichigan State University College of Human Medicine, Grand Rapids
| | - Matthew P. Fahrenkopf
- aMichigan State University College of Human Medicine, Grand Rapids,bSpectrum Health/Michigan State University Plastic Surgery Residency, Grand Rapids,Correspondence:
| | - Nicholas S. Adams
- aMichigan State University College of Human Medicine, Grand Rapids,bSpectrum Health/Michigan State University Plastic Surgery Residency, Grand Rapids
| | - Steven C. Naum
- aMichigan State University College of Human Medicine, Grand Rapids,bSpectrum Health/Michigan State University Plastic Surgery Residency, Grand Rapids,cOrthopedic Associates of Michigan, Grand Rapids
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27
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Abstract
Schwannomas are nerve sheath tumors that occur in Schwann cells. They are usually benign, but malignant transformation can occur. Symptomatology depends on the involvement of the surrounding tissues or the mass effect of the tumor. We describe a case of a 28-year-old man who initially presented with right iliac fossa pain associated with radiating pain over the anterior and lateral aspect of his right knee. Following subsequent investigations, we found a retroperitoneal schwannoma of the right lateral femoral cutaneous nerve. The key to our diagnosis was the referred pain to his right knee, which gave us a clue of possible neuropathic pain. Our patient highlights the need to consider a unified diagnosis when faced with an incongruent set of symptoms. Magnetic resonance imaging is the diagnostic modality of choice for the diagnosis of schwannomas. Treatment is directed towards symptomatic control. Surgery, radiation, and, in rare instances, chemotherapy are the major treatment modalities employed.
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Affiliation(s)
- Ibrahim M Hanif
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth, Singapore
| | - Nilesh H Pawar
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth, Singapore
| | - Wing Yan Mok
- Department of Radiology, Sengkang General Hospital, Sengkang Health, Singhealth, Singapore
| | - Melvin Chua
- Department of General Medicine, Sengkang General Hospital, Sengkang Health, Singhealth, Singapore
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28
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Haldeman C, Hanna A. Neurofibroma of the peroneal nerve. Neurosurg Focus 2018; 44:V2. [PMID: 29291298 DOI: 10.3171/2018.1.focusvid.17546] [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] [Indexed: 11/06/2022]
Abstract
Neurofibromas are benign tumors composed of different cell types from the peripheral nervous system. Neurofibromas infiltrate between nerve fascicles and do not have a discrete capsule. On MRI, they are T1 hypointense or isointense, T2 hyperintense, often with a "target sign," and contrast enhancing. The video shows gross-total resection of a peroneal nerve neurofibroma presenting as a painful mass in the popliteal fossa. Incisions across a skin crease can be either oblique or zigzag, but never perpendicular to it. It is also key to expose normal nerve proximal and distal to the tumor. The patient had a good functional outcome. The video can be found here: https://youtu.be/G74Zoa1Y2JM .
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Chachan S, Bin Abd Razak HR, Loo WL, Tan CS, Dinesh SK. Extradural hemangioma mimicking a dumbbell nerve sheath tumor in the thoracolumbar spine: Case report. Surg Neurol Int 2017; 8:244. [PMID: 29119042 PMCID: PMC5655760 DOI: 10.4103/sni.sni_120_17] [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: 04/05/2017] [Accepted: 05/17/2017] [Indexed: 11/16/2022] Open
Abstract
Background: Extradural hemangiomas are rare, have varied and challenging clinical presentations, and require special considerations from the management point of view. Case Description: A 70-year-old female presented with back pain that was ultimately attributed to a thoracolumbar extra-dural “dumbbell” hemangioma. Following surgical resection, the patient did well. Conclusion: Extradural hemangiomas may present as spinal extradural soft tissue masses that must be differentiated from dumbbell neurofibroma.
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Affiliation(s)
- Sourabh Chachan
- Department of Orthopaedics, Changi General Hospital, Singapore
| | | | - W Lim Loo
- Department of Orthopaedics, Changi General Hospital, Singapore
| | - C Sheng Tan
- Department of Pathology, Changi General Hospital, Singapore
| | - S K Dinesh
- Department of Orthopaedics, Changi General Hospital, Singapore
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Sharma A, Kamble PC, Singh V. A Rare Case of Intraneural Neurothekeoma of Median Nerve Mimicking Carpal Tunnel Syndrome. J Orthop Case Rep 2017; 7:73-75. [PMID: 29600216 PMCID: PMC5868890 DOI: 10.13107/jocr.2250-0685.956] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Neurothekeomas are uncommon benign soft tissue tumors of the peripheral nerves. It is commonly found in the upper extremities and in the head and the neck region as a small, asymptomatic, and superficial nodule. CASE REPORT We report a rare case of intraneural neurothekeoma (2.8 χ 2.4 x 1.8 cm) of the median nerve at the wrist in a 56-year-old female, which presented with clinical features of carpal tunnel syndrome. CONCLUSION Carpal tunnel syndrome caused by intraneural neurothekeoma has been rarely reported. Clinicians should be aware of this rare cause of carpal tunnel syndrome.
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Affiliation(s)
- Ayush Sharma
- Department of Orthopedic and Spine Surgeries Dr. B R Ambedkar Central Railway Hospital, Byculla [East], Mumbai. Maharashtra, India
| | | | - Vijay Singh
- Department of Orthopedic and Spine Surgeries Dr. B R Ambedkar Central Railway Hospital, Byculla [East], Mumbai. Maharashtra, India
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31
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R DeWall M, Montgomery CO, Gardner JM. Bilateral multifocal upper extremity atypical granular cell tumors presenting as long-standing right wrist and left hand masses in a 15-year-old African-American female. J Cutan Pathol 2017; 44:401-404. [PMID: 28075051 DOI: 10.1111/cup.12898] [Citation(s) in RCA: 4] [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: 10/10/2016] [Revised: 01/04/2017] [Accepted: 01/09/2017] [Indexed: 12/14/2022]
Abstract
Granular cell tumor (GrCT) is a benign nerve sheath tumor. Atypical and malignant variants of GrCT are rare but have been well described. We report a case of multifocal symmetric atypical GrCT in the bilateral hand/wrists of a 15-year-old African-American female. The initial clinical impression for both masses was favored to be ganglion cysts. Ultrasound findings of both masses revealed hypoechoic soft tissue lesions with some internal echogenicity favoring complex cysts. On excision, both masses were histologically circumscribed, lobulated and attached to tendon. Large epithelioid cells with abundant granular eosinophilic cytoplasm arranged in syncytial cords and trabeculae percolated through collagen. Many cells had pleomorphism and/or prominent nucleoli. Mitotic figures, spindling, high nuclear-to-cytoplasmic ratio and necrosis were absent. Both masses showed diffuse S100 protein but negative desmin and pancytokeratin expression. Ki-67 index was 1% to 2%. p53 was positive in 5% to 10% of nuclei. Both masses met criteria for atypical (but not malignant) GrCT. Our case shows that atypical GrCT may be not only multifocal but also symmetric. We speculate that migration of defective neural crest stem cells along both upper limb buds during embryogenesis may have allowed these essentially identical tumors to arise in similar locations bilaterally simultaneously.
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Affiliation(s)
- Michael R DeWall
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Corey O Montgomery
- Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jerad M Gardner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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R DeWall M, Montgomery CO, Gardner JM. Bilateral multifocal upper extremity atypical granular cell tumors presenting as long-standing right wrist and left hand masses in a 15-year-old African-American female. J Cutan Pathol 2017. [PMID: 28075051 DOI: 10.1111/cup.12898.] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Granular cell tumor (GrCT) is a benign nerve sheath tumor. Atypical and malignant variants of GrCT are rare but have been well described. We report a case of multifocal symmetric atypical GrCT in the bilateral hand/wrists of a 15-year-old African-American female. The initial clinical impression for both masses was favored to be ganglion cysts. Ultrasound findings of both masses revealed hypoechoic soft tissue lesions with some internal echogenicity favoring complex cysts. On excision, both masses were histologically circumscribed, lobulated and attached to tendon. Large epithelioid cells with abundant granular eosinophilic cytoplasm arranged in syncytial cords and trabeculae percolated through collagen. Many cells had pleomorphism and/or prominent nucleoli. Mitotic figures, spindling, high nuclear-to-cytoplasmic ratio and necrosis were absent. Both masses showed diffuse S100 protein but negative desmin and pancytokeratin expression. Ki-67 index was 1% to 2%. p53 was positive in 5% to 10% of nuclei. Both masses met criteria for atypical (but not malignant) GrCT. Our case shows that atypical GrCT may be not only multifocal but also symmetric. We speculate that migration of defective neural crest stem cells along both upper limb buds during embryogenesis may have allowed these essentially identical tumors to arise in similar locations bilaterally simultaneously.
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Affiliation(s)
- Michael R DeWall
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Corey O Montgomery
- Department of Orthopedic Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Jerad M Gardner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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Parmar V, Haldeman C, Amaefuna S, Hanna AS. A Vascular Malformation Presenting as a Peripheral Nerve Sheath Tumor. J Brachial Plex Peripher Nerve Inj 2016; 11:e38-e41. [PMID: 28077959 DOI: 10.1055/s-0036-1593442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 04/08/2016] [Accepted: 08/14/2016] [Indexed: 10/20/2022] Open
Abstract
We present the case of a venous malformation (VM) masquerading as a schwannoma. VMs are thin-walled vascular dilations of various sizes that typically present as soft, compressible, blue masses that are associated with pain or dysesthesia. VMs are commonly found in the head and neck as well as the distal extremities. Notably, slow-flow VMs are hypointense on T1-weighted imaging, hyperintense on T2-weighted imaging, and enhance markedly with contrast. However, VMs tend to be poorly circumscribed and fraught with venous lakes and phleboliths. Conservative therapy and sclerotherapy are the primary treatment options. In this case report, we present a VM presenting near the neurovascular bundle of the upper extremity axilla. Our case is unique in that the patient presented with symptoms and imaging qualities characteristic for a peripheral nerve schwannoma.
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Affiliation(s)
- Vikas Parmar
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, United States
| | - Clayton Haldeman
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, United States
| | - Steve Amaefuna
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, United States
| | - Amgad S Hanna
- Department of Neurological Surgery, University of Wisconsin, Madison, Wisconsin, United States
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Wali AR, Santiago-Dieppa DR, Steinberg JA, Alattar A, Cheung VJ, Modir R, Khalessi AA, Pannell JS. Hypoplastic Internal Carotid Artery Co-Presenting with Neurofibromatosis and Intracranial Masses. Cureus 2016; 8:e750. [PMID: 27688987 PMCID: PMC5037063 DOI: 10.7759/cureus.750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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] [Indexed: 11/05/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is associated with systemic vascular disease, and it can also affect intracranial vasculature in a small percentage of patients. Very rarely, NF1 may co-present with hypoplasia of the internal carotid artery (ICA). Prior reports have documented NF1 with bilateral optic gliomas and a unilateral hypoplastic internal carotid artery; however, we report a case with the aforementioned findings in addition to a right-sided lentiform mass. This case report further suggests a common congenital pathway related to neurofibromin loss of function resulting in both nerve sheath tumors and cerebrovascular anomalies.
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Affiliation(s)
- Arvin R Wali
- Department of Neurosurgery, University of California, San Diego
| | | | | | - Ali Alattar
- School of Medicine, University of California, San Diego
| | | | - Royya Modir
- Department of Neurosurgery, University of California, San Diego
| | | | - J Scott Pannell
- Department of Neurosurgery, University of California, San Diego
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Abstract
OBJECTIVE Resection significantly improves the clinical symptoms and functional outcomes of patients with intradural extramedullary tumors. However, patient quality of life following resection has not been adequately investigated. The aim in this retrospective analysis of prospectively collected quality of life outcomes is to analyze the efficacy of resection of intradural extramedullary spinal tumors in terms of quality of life markers. METHODS A retrospective review of a single institutional neurosurgical administrative database was conducted to analyze clinical data. The Oswestry Disability Index (ODI), visual analog scale (VAS) for pain, and the EQ-5D-3 L descriptive system were used to analyze quality of life preoperatively, less than 1 month postoperatively, 1-3 months postoperatively, 3-12 months postoperatively, and more than 12 months postoperatively. RESULTS The ODI scores increased perioperatively at the < 1-month follow-up from 36 preoperatively to 47. Relative to preoperative values, the ODI score decreased significantly at 1-3, 3-12, and > 12 months to 23, 17, and 20, respectively. VAS scores significantly decreased from 6.1 to 3.5, 2.4, 2.0, and 2.9 at the < 1-month, 1- to 3-, 3- to 12-, and > 12-month follow-ups, respectively. EQ-5D mobility significantly worsened at the < 1-month follow-up but improved at the 3- to 12-and > 12-month follow-ups. EQ-5D self-care significantly worsened at the < 1-month follow-up but significantly improved by the 3- to 12-month follow-up. EQ-5D usual activities improved at the 1- to 3-, 3- to 12-, and > 12-month follow-ups. EQ-5D pain and discomfort significantly improved at all follow-up points. EQ-5D anxiety and depression significantly improved at 1- to 3-month and 3- to 12-month follow-ups. CONCLUSIONS Resection of intradural extramedullary spine tumors appears to significantly improve patient quality of life by decreasing patient disability and pain and by improving each of the EQ-5D domains.
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Affiliation(s)
- Matthew J Viereck
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - George M Ghobrial
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - Sara Beygi
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
| | - James S Harrop
- Department of Neurosurgery, Thomas Jefferson University and Jefferson Hospital for Neuroscience, Philadelphia, Pennsylvania
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Krisht KM, Karsy M, Shah LM, Schmidt MH, Dailey AT. Unusual brachial plexus lesion: Hematoma masquerading as a peripheral nerve sheath tumor. Surg Neurol Int 2016; 7:S64-6. [PMID: 26904368 PMCID: PMC4743268 DOI: 10.4103/2152-7806.174889] [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: 02/27/2015] [Accepted: 09/01/2015] [Indexed: 12/21/2022] Open
Abstract
Background: Malignant peripheral nerve sheath tumors (MPNSTs) of the brachial plexus have unique radiographic and clinical findings. Patients often present with progressive upper extremity paresthesias, weakness, and pain. On magnetic resonance (MR) imaging, lesions are isointense on T1-weighted and hyperintense on T2-weighted sequences, while also demonstrating marked enhancement on MR studies with gadolinium diethylenetriamine pentaacetic acid. On the basis of their characteristic MR imaging features and rapid clinical progression, two brachial plexus lesions proved to be organizing hematomas rather than MPNST. Methods: A 51-year-old male and a 31-year-old female were both assessed for persistent and worsened left-sided upper extremity pain, paresthesias, and weakness. In both cases, the MR imaging of the brachial plexus demonstrated an extraspinal enhancing lesion located within the left C7–T1 neuroforamina. Results: Although the clinical and radiographic MR features for these 2 patients were consistent with MPNSTs, both lesions proved to be benign organizing hematomas. Conclusions: These two case studies emphasize that brachial plexus hematomas may mimic MPNSTs on MR studies. Accurate diagnosis of these lesions is critical for determining the appropriate management options and treatment plans. Delaying the treatment of a highly aggressive nerve sheath tumor can have devastating consequences, whereas many hematomas resolve without surgery. Therefore, if the patient has stable findings on neurological examination and a history of trauma, surgical intervention may be delayed in favor of repeat MR imaging in 2–3 months to re-evaluate the size of the mass.
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Affiliation(s)
- Khaled M Krisht
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - Michael Karsy
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - Lubdha M Shah
- Department of Radiology, University of Utah, Salt Lake City, Utah 84132, USA
| | - Meic H Schmidt
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
| | - Andrew T Dailey
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah 84132, USA
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Gupta S, Gupta R, Sodhani P. Spindle cell lipoma with predominant nerve sheath tumor-like areas: A potential diagnostic pitfall on aspiration cytology. Diagn Cytopathol 2015; 43:1017-9. [PMID: 26457887 DOI: 10.1002/dc.23377] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [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: 06/12/2015] [Revised: 09/07/2015] [Accepted: 09/24/2015] [Indexed: 11/08/2022]
Abstract
Spindle cell lipoma (SCL) is an uncommon variant of lipoma that usually is present in subcutaneous fat of adult men. This tumor has a low rate of local recurrence and no risk of malignant behavior. Although histological features of SCL are well documented, cytological descriptions have been few. We present the case of a 41-year man with a right arm swelling, which on fine-needle aspiration cytology showed adipose tissue fragments, spindle cell areas mimicking benign nerve sheath tumor, and bundles of ropy collagen in a myxoid background, suggesting a diagnosis of SCL. SCL with predominant spindle cell component may mimic benign nerve sheath tumor on aspiration cytology. Subtle cytological features like presence of adipose tissue, ropy collagen, and mast cells help in accurate diagnosis.
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Affiliation(s)
| | - Ruchika Gupta
- Division of Cytopathology, Institute of Cytology and Preventive Oncology (ICMR), Noida, Uttar Pradesh, India
| | - Pushpa Sodhani
- Division of Cytopathology, Institute of Cytology and Preventive Oncology (ICMR), Noida, Uttar Pradesh, India
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King P, Khan S, Inamullah O. Astounding recovery after resection of an intradural nerve sheath tumor in an adult male from Vietnam. Surg Neurol Int 2015; 6:145. [PMID: 26425395 PMCID: PMC4571639 DOI: 10.4103/2152-7806.164694] [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: 03/03/2015] [Accepted: 07/08/2015] [Indexed: 11/18/2022] Open
Abstract
Background: Spinal cord tumors can be classified as intramedullary, intradural extramedullary, or extradural. The differential diagnosis of spinal cord tumors includes meningiomas, astrocytomas, ependymomas, metastasis, nerve sheath tumors such as schwannomas or neurofibromas, and multiple sclerosis plaques. Radiology can provide clues to the type of tumor, but a pathology evaluation of a specimen is necessary to provide an accurate diagnosis. These tumors can cause a variety of neurological symptoms from spinal cord compression including pain, weakness, and paresthesia. They are treated by surgical resection, with a variety of outcomes possible depending on the severity of the preoperative symptoms, location and extent of the tumor, and efficacy of the surgery performed. Case Description: A 59-year-old male from Vietnam came to the Atlanta Medical Center for evaluation of severe ride sided hemiparesis and paresthesias. He first noticed alterations in his handwriting and quickly deteriorated to the point of being unable to walk or move his right arm. A cervical spinal mass was identified and analyzed on magnetic resonance imaging. Surgical resection was performed under a microscope in a joint operation between an orthopedic surgeon and neurosurgeon. A specimen of the tumor was sent to pathology for further evaluation. Conclusion: The mass was determined to be an intradural extramedullary schwannoma. The severity of the patient's symptoms and the location and size of the tumor made full recovery unlikely and postoperative quadriplegia a real possibility. The tumor was surgically resected, which led surprisingly, however, to a full and prompt resolution of the patient's symptoms. Less than 2 weeks after surgery, the patient was able to walk and had almost fully regained use of his hands.
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Affiliation(s)
- Paul King
- Department of Neurosurgery, Atlanta Medical Center, Atlanta, GA, USA
| | - Saleen Khan
- Ross University School of Medicine, Banana Trail, Portsmouth, Dominica
| | - Ovais Inamullah
- Ross University School of Medicine, Banana Trail, Portsmouth, Dominica
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Herden J, Drebber U, Ural Y, Zimmer S, Wille S, Engelmann UH. Retroperitoneal schwannomas of renal and pararenal origin: presentation of two case reports. Rare Tumors 2015; 7:5616. [PMID: 25918605 PMCID: PMC4387351 DOI: 10.4081/rt.2015.5616] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [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: 08/27/2014] [Accepted: 11/11/2014] [Indexed: 12/05/2022] Open
Abstract
Retroperitoneal schwannomas are a rare entity. They originate from the Schwann cells of the nerve sheaths and may be of renal or pararenal origin. We report on two patients with retroperitoneal schwannomas, who received surgery under the suspicion of renal cell carcinoma.
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Affiliation(s)
- Jan Herden
- Department of Urology, University Hospital , Cologne, Germany
| | - Uta Drebber
- Institute of Pathology, University Hospital , Cologne, Germany
| | - Yasemin Ural
- Department of Urology, University Hospital , Cologne, Germany
| | - Sandra Zimmer
- Department of Urology, University Hospital , Cologne, Germany
| | - Sebastian Wille
- Department of Urology, University Hospital , Cologne, Germany
| | - Udo H Engelmann
- Department of Urology, University Hospital , Cologne, Germany
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Zhao M, Zhang B, Liang F, Zhang J. Primary spinal intradural extraskeletal Ewing sarcoma mimicking a giant nerve sheath tumor: case report and review of the literature. Int J Clin Exp Pathol 2014; 7:9081-9085. [PMID: 25674292 PMCID: PMC4314022] [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] [Subscribe] [Scholar Register] [Received: 10/18/2014] [Accepted: 12/01/2014] [Indexed: 06/04/2023]
Abstract
Primary intradural extraskeletal Ewing sarcoma is a very rare form of malignant neoplasm. Only few cases have been reported on the literature. Here, we report a case of a 14-year-old boy who had a chief complaint of pain and tingling in the right lower limb. The patient initially seemed to have a giant nerve sheath tumor but was eventually diagnosed with intradural extraskeletal Ewing sarcoma arising from the nerve roots of the cauda equine. The literature with regard to primary spinal intradural extraskeletal Ewing sarcoma is reviewed.
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Affiliation(s)
- Mingfei Zhao
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang 310009, China
| | - Buyi Zhang
- Department of Pathology, Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang 310009, China
| | - Feng Liang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang 310009, China
| | - Jianmin Zhang
- Department of Neurosurgery, Second Affiliated Hospital, School of Medicine, Zhejiang UniversityHangzhou, Zhejiang 310009, China
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Bernthal NM, Putnam A, Jones KB, Viskochil D, Randall RL. The effect of surgical margins on outcomes for low grade MPNSTs and atypical neurofibroma. J Surg Oncol 2014; 110:813-6. [PMID: 25111615 DOI: 10.1002/jso.23736] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [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: 01/13/2014] [Accepted: 07/07/2014] [Indexed: 01/14/2023]
Abstract
BACKGROUND AND OBJECTIVES While convention defines atypical neurofibroma as benign and low-grade malignant peripheral nerve sheath tumors (MPNSTs) as malignant, sparse outcomes data exist for these tumors. This study reviews clinical outcomes of surgically resected low-grade MPNST and atypical neurofibroma, focusing on the effect of surgical margins on outcome. METHODS This study is a retrospective review of 23 patients who underwent surgical resection of a low-grade MPNST or atypical neurofibroma. Treatment characteristics of adjuvant therapy and surgical margin were noted. Endpoints of local recurrence, presence of metastatic disease, disease-specific survival, and overall survival were reviewed. RESULTS Eighteen of 23 patients (78%) had microscopically positive margins on the resection. Disease-specific survival was 100% for both atypical neurofibroma patients and those with low-grade MPNST, regardless of surgical margin. Local recurrence in terms of recurrence of measureable disease occurred in 2/12 (16.7%) of LGMPNST patients and 1/11 (9.1%) of atypical NF patients, all of whom had microscopically positive surgical margins. CONCLUSIONS In a study dedicated exclusively to "intermediate" nerve sheath tumors, no patients developed metastatic disease nor died of disease despite a high rate of microscopically positive surgical margins (78%). While positive margins did lead to increased rates of local recurrence, these data suggest that surgeons potentially can temper their zeal for negative surgical margins in the setting of low-grade MPNST and atypical neurofibroma, as surgical morbidity may be more important than a presumed survival benefit of wide resection.
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Affiliation(s)
- Nicholas M Bernthal
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California
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42
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Jalali-Farahani S, Blakeley JO, Belzberg AJ, Carrino JA, Chhabra A. Plexiform nerve sheath tumor or vascular malformation--role of advanced MR neurography and diffusion tensor imaging. Skeletal Radiol 2013; 42:1007-10. [PMID: 23519761 PMCID: PMC3991119 DOI: 10.1007/s00256-013-1594-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [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: 12/06/2012] [Revised: 01/20/2013] [Accepted: 02/21/2013] [Indexed: 02/02/2023]
Abstract
The authors report a vascular malformation mimicking a plexiform peripheral nerve sheath tumor. Three Tesla magnetic resonance neurography with high-resolution anatomic and advanced functional diffusion tensor imaging was helpful in evaluating full extent of the lesion and characterizing its internal architecture.
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Affiliation(s)
- Sahar Jalali-Farahani
- Russell H Morgan Department of Radiology & Radiological Science, 601 N. Caroline St, JHOC 3262, Baltimore, MD 21287, USA
| | - Jaishri O. Blakeley
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Allan J. Belzberg
- Department of Neurosurgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - John A. Carrino
- Russell H Morgan Department of Radiology & Radiological Science, 601 N. Caroline St, JHOC 3262, Baltimore, MD 21287, USA
| | - Avneesh Chhabra
- Russell H Morgan Department of Radiology & Radiological Science, 601 N. Caroline St, JHOC 3262, Baltimore, MD 21287, USA, Department of Radiology, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Abstract
Till date, 85 cases of melanotic schwannoma and 11 cases of spinal root melanoma have been reported in literature. We are reporting a case of a 45-year-old lady who presented with primary low back pain, and magnetic resonance imaging of lumbo-sacral spine showed at left L5-S1 foraminal lesion extending to the para-spinal compartment. Hemi-laminectomy, facetectomy, and excision of the lesion were done. It was primarily a cystic lesion with attachment to the exiting spinal nerve root. Histopathology of the cyst wall showed a fibro-collagenous stroma with no specific cell lining containing melanin pigment suggestive of a melanotic cyst. The patient was completely relieved of the back pain, and had no recurrence over a follow-up period of one and half years. This case is probably the first reported predominantly cystic, pigmented lesion, affecting the spinal root.
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44
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Müller CSL, Tilgen W, Kutzner H, Pföhler C. Recurring mixed-type neurothekeoma of the face. Dermatoendocrinol 2010; 1:220-2. [PMID: 20592794 DOI: 10.4161/derm.1.4.9442] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2009] [Accepted: 07/07/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Neurothekeomas are rare, benign neoplasms, typically occurring in younger patients with a remarkable predilection for the female population. The nomenclature and derivation of these tumors is controversial. The rarity of this unusual skin tumor in daily routine histopathologic findings prompted the following report. OBSERVATION We report a 17-year-old girl with an asymptomatic nodule at the inner angle of the left eye with slow progression in size within 12 months to 1 cm in diameter. Multiple treatments with laser surgery were performed and yielded no persistent remission of the tumor. Histopathologic examination revealed a non-encapsulated dermal tumor, composed of multiple, closely situated medium-sized nodules, separated by a myxoid collagenrich stroma, without epidermal alteration. In summary, due to the histoarchitecture and immunoprofile of the tumor, a mixed-type cellular neurothekeoma was diagnosed. CONCLUSION We think that it is important to be aware of these uncommon soft tissue lesions and the pitfalls of mixed-type neurothekeomas that often cause diagnostic problems. The aim of this report is to help to avoid misdiagnoses of malignant mesenchymal tumors with serious consequences, including extensive surgical therapy or radiation.
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Ponce-Olivera RM, Tirado-Sanchez A, Peniche-Castellanos A, Peniche-Rosado J, Mercadillo-Perez P. Myxoid neurofibroma: an unusual presentation. Indian J Dermatol 2010; 53:35-6. [PMID: 19967019 PMCID: PMC2784586 DOI: 10.4103/0019-5154.39742] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Myxoid neurofibroma (MN) is a benign tumor of perineural cell origin, which is demonstrated with a positive immunohistochemical staining for S-100 protein. The most common locations of the MN are the face, shoulders, arms, periungual and in the feet. To our knowledge, this is the first time that a trunk location is reported. MN should be included in the differential diagnosis of tumors on this location.
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Abstract
Although the head and neck region is recognized as the most common location for peripheral nerve sheath tumors, central involvement, particularly in the jaw bones, is quite unusual. Neurofibroma is one of the most common nerve sheath tumors occurring in the soft tissue and generally appears in neurofibromatosis 1 (NF1 or von Recklinghausen's disease). Malignant peripheral nerve sheath tumors (MPNSTs) are uncommon sarcomas that almost always arise in the soft tissue. Here, we report four cases of intraosseous peripheral nerve sheath tumors occurring in the jaw bones and compare the clinical, radiologic, and pathologic findings in order to make a differential diagnosis.
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Affiliation(s)
- Zhongmin Che
- Department of Oral Pathology, College of Dentistry, Yonsei University, Seoul, Korea
| | - Woong Nam
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Won-Se Park
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyung-Jun Kim
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
| | - In-Ho Cha
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
- Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Hyun-Sil Kim
- Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jong-In Yook
- Department of Oral Pathology, College of Dentistry, Yonsei University, Seoul, Korea
- Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Jin Kim
- Department of Oral Pathology, College of Dentistry, Yonsei University, Seoul, Korea
- Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
| | - Sang-Hwy Lee
- Department of Oral and Maxillofacial Surgery, College of Dentistry, Yonsei University, Seoul, Korea
- Oral Science Research Center, College of Dentistry, Yonsei University, Seoul, Korea
- Oral Cancer Research Institute, College of Dentistry, Yonsei University, Seoul, Korea
- Medical Research Center, College of Dentistry, Yonsei University, Seoul, Korea
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Abstract
STUDY DESIGN Single case report and extensive literature review. OBJECTIVES To present the first such report of cervical cord contusion after the percutaneous placement of gold-seed fiducials. The pathomechanics and surgical recommendations are reviewed. BACKGROUND Spinal cord injuries are well documented in the medical literature. These injuries range from cord contusion to transection and result primarily from trauma. A single case report of a patient who was found to have a nonhemorrhagic cervical spinal cord contusion after percutaneous fiducial implantation is presented. METHODS Single case report. RESULTS The patient underwent percutaneous placement of fiducials for stereotactic radiosurgery for a nerve sheath tumor. Postoperatively she had primarily sensory complaints; no motor deficits were detected on neurological examination. Neuroimaging studies demonstrated nonhemorrhagic cervical cord contusion. She was treated conservatively and had complete resolution of her symptoms. CONCLUSIONS The likely mechanism for the contusion was neck hyperextension during thrusting maneuvers during fiducial implantation. This is yet another report of normal intraoperative-evoked potentials with postoperative neurological sequelae. A dedicated team approach involving ancillary staff, anesthesiologists, and surgeons should be utilized to avert this potentially devastating complication.
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Affiliation(s)
- Quails E Stevens
- Bromenn Regional Medical Center, Department of Surgery, Section of Neurosurgery, Normal, Illinois, USA.
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Goldfarb RS, Davidson BN. Hysteroscopic resection of cervical nerve sheath tumor. JSLS 1999; 3:145-7. [PMID: 10444016 PMCID: PMC3015326] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Isolated nerve sheath tumors of the uterine cervix are very rare entities. This is especially true for benign nerve sheath tumors. We present, to the best of our knowledge, the first case of a benign nerve sheath tumor resected hysteroscopically. Our patient is a 69 year-old white female with a history of post menopausal bleeding. Initial workup included an endometrial biopsy and an ultrasound. A 4 cm cervical mass was identified on that study. Further characterization of the mass was obtained with magnetic resonance imaging (MRI). Gynecologic-Oncology consultation was obtained, and the opinion was that this was a cervical myoma. The patient continued to have bleeding and was taken to the operating room for a hysteroscopy and dilatation and curettage. At surgery, a large cervical mass was resected hysteroscopically. Final pathology report showed this to be a benign nerve sheath tumor.
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Affiliation(s)
- R S Goldfarb
- Department of Obstetrics and Gynecology, Henry Ford Health System, Detroit, Michigan 48322, USA
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