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Debs P, Luna R, Fayad LM, Ahlawat S. MRI features of benign peripheral nerve sheath tumors: how do sporadic and syndromic tumors differ? Skeletal Radiol 2024; 53:709-723. [PMID: 37845504 DOI: 10.1007/s00256-023-04479-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 09/20/2023] [Accepted: 10/06/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVES To compare MRI features of sporadic and neurofibromatosis syndrome-related localized schwannomas and neurofibromas. METHODS In this retrospective study, our pathology database was searched for "neurofibroma" or "schwannoma" from 2014 to 2019. Exclusion criteria were lack of available MRI and intradural or plexiform tumors. Qualitative and quantitative anatomic (location, size, relationship to nerve, signal, muscle denervation) and functional (arterial enhancement, apparent diffusion-weighted coefficient) MRI features of sporadic and syndrome-related tumors were compared. Statistical significance was assumed for p < 0.05. RESULTS A total of 80 patients with 64 schwannomas (sporadic: 42 (65.6%) v. syndrome-related: 22 (34.4%)) and 19 neurofibromas (sporadic: 7 (36.8%) v. syndrome-related: 12 (41.7%)) were included. Only signal heterogeneity (T2W p=0.001, post-contrast p=0.03) and a diffused-weighted imaging target sign (p=0.04) were more frequent with schwannomas than neurofibromas. Sporadic schwannomas were similar in size to syndrome-related schwannomas (2.9±1.2cm vs. 3.7±3.2 cm, p = 0.6), but with greater heterogeneity (T2W p = 0.02, post-contrast p = 0.01). Sporadic neurofibromas were larger (4.6±1.5cm vs. 3.4±2.4 cm, p = 0.03) than syndrome-related neurofibromas, also with greater heterogeneity (T2W p=0.03, post-contrast p=0.04). Additional tumors along an affected nerve were only observed with syndrome-related tumors). There was no difference in apparent diffusion coefficient values or presence of early perfusion between sporadic and syndrome-related tumors (p > 0.05). CONCLUSIONS Although syndrome-related and sporadic schwannomas and neurofibromas overlap in their anatomic, diffusion and perfusion features, signal heterogeneity and presence of multiple lesions along a nerve are differentiating characteristics of syndrome-related tumors.
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Affiliation(s)
- Patrick Debs
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
| | - Rodrigo Luna
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
- Division of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
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2
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Gowda S, Dhillon D, Khandwala A. A rare case of multifocal schwannomatosis with multiple lesions of the median nerve. Hand Surg Rehabil 2024; 43:101616. [PMID: 37951496 DOI: 10.1016/j.hansur.2023.11.001] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/14/2023]
Affiliation(s)
- Siri Gowda
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom.
| | - Dharminder Dhillon
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
| | - Asit Khandwala
- Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, United Kingdom
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3
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Guedes F, Henriques VM, Torrão FL, Haikal NP, Sanches GE, Barbosa DAN, Marsicano FG, Rosa LAN, Siquara AC, Malessy MJA. When biopsy goes wrong: a case series of misdiagnoses and complications from biopsies of masses of unknown origin potentially originating from a peripheral nerve. J Neurosurg 2024; 140:480-488. [PMID: 37877976 DOI: 10.3171/2023.5.jns23385] [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: 02/18/2023] [Accepted: 05/15/2023] [Indexed: 10/26/2023]
Abstract
OBJECTIVE Biopsies of peripheral nerve tumors (PNTs) are often used to plan an efficient treatment strategy. However, performing a biopsy is controversial when the mass is likely to be a benign PNT (BPNT). The aim of this study was to evaluate the side effects of biopsies in patients with potential PNTs. METHODS A retrospective and cross-sectional study was conducted on 24 patients who underwent biopsy of a mass of unknown origin potentially originating from a peripheral nerve (MUOPON), performed in nonspecialty services, and who were later referred to the authors' service for resection of their lesion between January 2005 and December 2022. The patients were evaluated for pain score, presence of a motor or sensory deficit, biopsy diagnosis, and definitive histopathological postsurgical diagnosis. RESULTS The location of the tumor was supraclavicular in 7 (29.2%) patients, in the axillary region in 3 (12.5%), in the upper limb in 7 (29.2%), and in the lower limb in 7 (29.2%). Twenty-one (87.5%) patients were evaluated by MRI before biopsy, and 3 (12.5%) underwent ultrasound. One patient did not have an examination before the procedure. Based on the biopsy findings, 12 (50%) analyses had an inconclusive histopathological result. The preexisting pain worsened, as measured 1 week after biopsy, in all patients and had remained unchanged at the first evaluation by the authors (median 3 months, range 2-4 months). In 1 case, the open biopsy had to be interrupted because the patient experienced excruciating pain. Four (16.7%) patients developed motor deficits. Subsequent surgery was hampered by scar formation and intratumoral hemorrhage in 5 (20.8%) patients. The initial diagnosis obtained by biopsy differed from the final histopathological diagnosis in all patients, of whom 21 (87.5%) had BPNTs, 2 (8.3%) malignant peripheral nerve sheath tumors, and 1 (4.2%) an ancient schwannoma. CONCLUSIONS Biopsies of PNTs are controversial and may result in misdiagnosis, neuropathic pain, or neurological deficit due to axonal damage, and they may also hinder microsurgical resection when if performed when not indicated. Indications for biopsy of an MUOPON must be carefully considered, especially if BPNT is a possible diagnosis.
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Affiliation(s)
- Fernando Guedes
- 1Department of Surgery, Neurosurgery Division, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
- 2Peripheral Nerves Unit, Division of Neurosurgery, Pedro Ernesto University Hospital (HUPE), University of the State of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Vinícius M Henriques
- 1Department of Surgery, Neurosurgery Division, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Francisco L Torrão
- 1Department of Surgery, Neurosurgery Division, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Neder P Haikal
- 2Peripheral Nerves Unit, Division of Neurosurgery, Pedro Ernesto University Hospital (HUPE), University of the State of Rio de Janeiro (UERJ), Rio de Janeiro, Brazil
| | - Gabriel E Sanches
- 1Department of Surgery, Neurosurgery Division, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Daniel A N Barbosa
- 3Department of Neurosurgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Felipe G Marsicano
- 1Department of Surgery, Neurosurgery Division, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Livia A N Rosa
- 1Department of Surgery, Neurosurgery Division, Gaffrée and Guinle University Hospital (HUGG), Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Ana C Siquara
- 4Pathology Division, Antônio Pedro University Hospital (HUAP), Federal Fluminense University (UFF), Niterói, Rio de Janeiro, Brazil; and
| | - Martijn J A Malessy
- 5Department of Nerve Surgery, Leiden University Medical Center, Leiden, The Netherlands
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Başak AM, Özçelik D, Turan G. Plexiform neurofibroma (Hamartoma) of the median nerve: A two-case report. Hand Surg Rehabil 2023; 42:541-546. [PMID: 37714515 DOI: 10.1016/j.hansur.2023.08.007] [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] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 08/18/2023] [Accepted: 08/19/2023] [Indexed: 09/17/2023]
Abstract
Plexiform neurofibroma is a benign peripheral nerve-sheath tumor, rarely involving major nerves of the extremities. In the literature, there are no clear treatment strategies for plexiform neurofibroma of major peripheral nerves. Our experience encountered two patients with plexiform neurofibroma of the median nerve, presenting with a palmar mass and symptoms of carpal tunnel compression. Preoperatively, plexiform neurofibroma was diagnosed on MRI and clinical examination. Both patients also experienced significant neurological deterioration, with finger numbness and increased nerve/tumor size. Potential malignant transformation was also considered. For these reasons, resection of the involved area of the nerve and repair were indicated. In both patients, intraoperative pathological diagnosis was plexiform neurofibroma. The 45-year-old male patient refused further surgery after carpal tunnel release, which was performed under axillary block. One year postoperatively, nerve compression symptoms decreased moderately. In the other patient, a 7-year-old boy, a significantly enlarged area of the median nerve was resected, and neurorrhaphy was performed. One year postoperatively, median nerve motor-sensory functions recovered completely. Four years postoperatively, no enlargement of the residual tumor was observed.
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Affiliation(s)
- Ali Murat Başak
- Department of Orthopaedics and Traumatology, Sakarya University Medical Faculty, Sakarya, Turkey; Department of Orthopaedics and Traumatology, Sağlık Bilimleri University Gülhane Research and Education Hospital, Ankara, Turkey.
| | - Derya Özçelik
- Department of Plastic Reconstructive and Aesthetic Surgery, Sakarya University Medical Faculty, Sakarya, Turkey; Plastic Reconstructive and Aesthetic Surgeon Private Practice, Poyracık Sokak 47/5 Nişantaşı Şişli, İstanbul, Turkey
| | - Gupse Turan
- Department of Pathology, Sakarya University Medical Faculty, Sakarya, Turkey
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Amrami KK, Chebrolu VV, Felmlee JP, Frick MA, Powell GM, Marek T, Howe BM, Fagan AJ, Kollasch PD, Spinner RJ. 7T for clinical imaging of benign peripheral nerve tumors: preliminary results. Acta Neurochir (Wien) 2023; 165:3549-3558. [PMID: 37464202 DOI: 10.1007/s00701-023-05724-1] [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: 05/15/2023] [Accepted: 07/07/2023] [Indexed: 07/20/2023]
Abstract
PURPOSE MRI has become an essential diagnostic imaging modality for peripheral nerve pathology. Early MR imaging for peripheral nerve depended on inferred nerve involvement by visualizing downstream effects such as denervation muscular atrophy; improvements in MRI technology have made possible direct visualization of the nerves. In this paper, we share our early clinical experience with 7T for benign neurogenic tumors. MATERIALS Patients with benign neurogenic tumors and 7T MRI examinations available were reviewed. Cases of individual benign peripheral nerve tumors were included to demonstrate 7T MRI imaging characteristics. All exams were performed on a 7T MRI MAGNETOM Terra using a 28-channel receive, single-channel transmit knee coil. RESULTS Five cases of four pathologies were selected from 38 patients to depict characteristic imaging features in different benign nerve tumors and lesions using 7T MRI. CONCLUSION The primary advantage of 7T over 3T is an increase in signal-to-noise ratio which allows higher in plane resolution so that the smallest neural structures can be seen and characterized. This improvement in MR imaging provides the opportunity for more accurate diagnosis and surgical planning in selected cases. As this technology continues to evolve for clinical purposes, we anticipate increasing applications and improved patient care using 7T MRI for the diagnosis of peripheral nerve masses.
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Affiliation(s)
- Kimberly K Amrami
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA.
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
| | - Venkata V Chebrolu
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
- Siemens Healthineers, Rochester, MN, USA
| | - Joel P Felmlee
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Matthew A Frick
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Garret M Powell
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Tomas Marek
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Andrew J Fagan
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
| | - Peter D Kollasch
- Department of Radiology, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, USA
- Siemens Healthineers, Rochester, MN, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
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6
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Lenartowicz KA, Smith BW, Jack MM, Wilson TJ, Klein CJ, Amrami KK, Spinner RJ. What is new in intraneural perineurioma? Acta Neurochir (Wien) 2023; 165:3539-3547. [PMID: 37684428 DOI: 10.1007/s00701-023-05765-6] [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: 06/12/2023] [Accepted: 08/18/2023] [Indexed: 09/10/2023]
Abstract
Since the initial description of intraneural (IN) perineurioma in 1964, advances in the understanding of the clinical presentation, diagnostic imaging, pathologic features, and genetic underpinnings have changed how this pathology is managed. IN perineuriomas are rare, benign peripheral nerve sheath tumors, most frequently coming to clinical attention when patients present with painless, progressive weakness or sensory loss in adolescence or young adulthood. The gold standard of diagnosis has traditionally been with targeted tissue biopsy demonstrating "pseudo-onion bulb" formation with positive epithelial membrane antigen (EMA) staining. However, modern magnetic resonance imaging is allowing some patients to forgo biopsy. Recent genetic studies of IN perineuriomas have demonstrated common TRAF7 point mutations and rare NF2 mutations, which may present targets for diagnosis or therapy in the future. Current advances have allowed for us to provide improved patient counseling with informed understanding for various clinical scenarios. With the workup and diagnosis now clearly defined, the next frontier is for improving the lives of patients with IN perineuriomas through the interaction between restoration of functional deficits and advances in our understanding of the genetics of this entity.
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Affiliation(s)
| | - Brandon W Smith
- Department of Neurosurgery, Duke University, Durham, NC, USA
| | - Megan M Jack
- Department of Neurosurgery, Cleveland Clinic, Cleveland, OH, USA
| | - Thomas J Wilson
- Department of Neurosurgery, Stanford University Medical Center, Stanford, CA, USA
| | | | | | - Robert J Spinner
- Departement of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA.
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7
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Istefan E, Belstock J, Dahlin LB, Nyman E. Surgery of Schwannoma in the upper limb - sensitivity and specificity of preoperative magnetic resonance imaging and relation between tumour size and symptoms. BMC Musculoskelet Disord 2023; 24:713. [PMID: 37679701 PMCID: PMC10483856 DOI: 10.1186/s12891-023-06838-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 08/27/2023] [Indexed: 09/09/2023] Open
Abstract
BACKGROUND Benign peripheral nerve tumours consist of different types, most commonly Schwannomas. Preoperative Magnetic Resonance Imaging (MRI) is commonly performed before surgery and Pathoanatomical Diagnosis (PAD) confirms the diagnosis. Our aims were to study the utility of MRI and the relation between tumour size and symptoms. METHODS Retrospectively, patients, surgically treated for benign nerve tumours between 2008 and 2019, were identified and preoperative MRI, with measurement of tumour size, PAD, symptoms, peroperative details, and symptomatic outcomes of surgery, were analysed. RESULTS The sensitivity and specificity to correctly identify Schwannomas with preoperative MRI were 85% and 50%, respectively, based on 30 Schwannomas and nine neurofibromas that were identified. Tumour size did not affect the presence of preoperative symptoms, but patients with sensory dysfunction at last follow-up had larger Schwannomas (p < 0.05). Symptoms as a palpable tumour, paraesthesia and pain improved by surgical excision (p < 0.001, p < 0.001 and p < 0.012, respectively), but sensory and motor dysfunction were common postoperatively. No malignant peripheral nerve sheath tumours (MPNST) were found. Using a surgical microscope, instead of only loop magnification, lowered the risk of perioperative nerve injuries (p < 0.05), but did not further diminish postoperative symptoms. CONCLUSIONS Early and accurate diagnosis of Schwannomas is valuable for adequate presurgical preparation and prompt surgical intervention. Preoperative examination with MRI has a high sensitivity, but low specificity; although recent advancement in MRI technology indicates improvement in diagnostic precision. Surgical excision is preferably performed early in conjunction with symptomatic debut to improve outcome.
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Affiliation(s)
- Emanuel Istefan
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 85, Sweden
| | - Johannes Belstock
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 85, Sweden
| | - Lars B Dahlin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 85, Sweden
- Department of Translational Medicine - Hand Surgery, Lund University, Malmö, 205 02, Sweden
- Department of Hand Surgery, Skåne University Hospital, Malmö, 205 02, Sweden
| | - Erika Nyman
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, 581 85, Sweden.
- Department of Hand Surgery, Plastic Surgery and Burns, Linköping University Hospital, Linköping, 581 85, Sweden.
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Nagaraj A, Jumah F, Raju B, Nanda A. Microsurgical Resection of a Paraganglioma of the Cauda Equina-A Technical Note: 2-Dimensional Operative Video. Oper Neurosurg (Hagerstown) 2022; 23:e63. [PMID: 35591779 DOI: 10.1227/ons.0000000000000210] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/26/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Anmol Nagaraj
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School & University Hospital, New Brunswick, New Jersey, USA
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9
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Berger MH, Haidar YM. Malignant Peripheral Nerve-Sheath Tumor. N Engl J Med 2021; 385:e23. [PMID: 34387968 DOI: 10.1056/nejmicm2033082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
| | - Yarah M Haidar
- University of California Irvine School of Medicine, Orange, CA
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10
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Abstract
Neoplasms of the peripheral nervous system represent a heterogenous group with a wide spectrum of morphological features and biological potential. They range from benign and curable by complete excision (schwannoma and soft tissue perineurioma) to benign but potentially aggressive at the local level (plexiform neurofibroma) to the highly malignant (malignant peripheral nerve sheath tumors [MPNST]). In this review, we discuss the diagnostic and pathologic features of common peripheral nerve sheath tumors, particularly those that may be encountered in the intracranial compartment or in the spine and paraspinal region. The discussion will cover schwannoma, neurofibroma, atypical neurofibromatous neoplasms of uncertain biological potential, intraneural and soft tissue perineurioma, hybrid nerve sheath tumors, MPNST, and the recently renamed enigmatic tumor, malignant melanotic nerve sheath tumor, formerly referred to as melanotic schwannoma. We also discuss the diagnostic relevance of these neoplasms to specific genetic and familial syndromes of nerve, including neurofibromatosis 1, neurofibromatosis 2, and schwannomatosis. In addition, we discuss updates in our understanding of the molecular alterations that represent key drivers of these neoplasms, including neurofibromatosis type 1 and type 2, SMARCB1, LZTR1, and PRKAR1A loss, as well as the acquisition of CDKN2A/B mutations and alterations in the polycomb repressor complex members (SUZ12 and EED) in the malignant progression to MPNST. In summary, this review covers practical aspects of pathologic diagnosis with updates relevant to neurosurgical practice.
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Affiliation(s)
- Sarra M Belakhoua
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- School of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Fausto J Rodriguez
- Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Sydney Kimmel Cancer Center, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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11
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Kravtsov MN, Mirzametov SD, Ivanov GM, Svistov DV. [Synchronous schwannoma and ependymoma of the cauda equina]. Zh Vopr Neirokhir Im N N Burdenko 2021; 85:75-79. [PMID: 33864671 DOI: 10.17116/neiro20218502175] [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] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The article presents a case of surgical treatment of primary multiple benign tumors of the cauda equine of different histological origin: spinal nerve root schwannoma and ependymoma of the filum terminale.
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Affiliation(s)
- M N Kravtsov
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, Saint Petersburg, Russia
| | - S D Mirzametov
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, Saint Petersburg, Russia
| | - G M Ivanov
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, Saint Petersburg, Russia
| | - D V Svistov
- Military Medical Academy named after S.M. Kirov of the Ministry of Defense of the Russian Federation, Saint Petersburg, Russia
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12
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Luna R, Fayad LM, Rodriguez FJ, Ahlawat S. Imaging of non-neurogenic peripheral nerve malignancy-a case series and systematic review. Skeletal Radiol 2021; 50:201-215. [PMID: 32699955 DOI: 10.1007/s00256-020-03556-z] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the frequency, clinico-pathologic and imaging features of malignant tumors in peripheral nerves which are of non-neurogenic origin (non-neurogenic peripheral nerve malignancy-PNM). MATERIALS AND METHODS We retrospectively reviewed our pathology database for malignant peripheral nerve tumors from 07/2014-07/2019 and performed a systematic review. Exclusion criteria were malignant peripheral nerve sheath tumor (MPNST). Clinico-pathologic and imaging features, apparent diffusion coefficient (ADCmin), and standard uptake values (SUVmax) are reported. RESULTS After exclusion of all neurogenic tumors (benign = 196, MPNST = 57), our search yielded 19 non-neurogenic PNMs (7%, n = 19/272), due to primary intraneural malignancy (16%, n = 3/19) and secondary perineural invasion from an adjacent malignancy (16%, n = 3/19) or metastatic disease (63%, n = 12/19). Non-neurogenic PNMs were located in the lumbosacral plexus/sciatic nerves (47%, n = 9/19), brachial plexus (32%, n = 6/19), femoral nerve (5%, n = 1/19), tibial nerve (5%, n = 1/19), ulnar nerve (5%, n = 1/19), and radial nerve (5%, n = 1/19). On MRI (n = 14/19), non-neurogenic PNM tended to be small (< 5 cm, n = 10/14), isointense to muscle on T1-W (n = 14/14), hyperintense on T2-WI (n = 12/14), with enhancement (n = 12/12), low ADCmin (0.5-0.7 × 10-3 mm2/s), and variable metabolic activity (SUVmax range 2.1-13.1). A target sign was absent (n = 14/14) and fascicular sign was rarely present (n = 3/14). Systematic review revealed 89 cases of non-neurogenic PNM. CONCLUSION Non-neurogenic PNMs account for 7% of PNT in our series and occur due to metastases and primary intraneural malignancy. Although non-neurogenic PNMs exhibit a non-specific MRI appearance, they lack typical signs of neurogenic tumors such as the target sign. Quantitative imaging features identified by DWI (low ADC) and F18-FDG PET/CT (high SUV) may be helpful clues to the diagnosis.
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Affiliation(s)
- Rodrigo Luna
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
| | - Laura M Fayad
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA
- Division of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fausto J Rodriguez
- Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Division of Pathology - Neuropathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Shivani Ahlawat
- The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA.
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13
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Sarikaya C, Varol E, Çakici YE, Naderİ S. Acute Neurologic Deterioration in Mobile Spinal Schwannoma. World Neurosurg 2020; 146:270-273. [PMID: 33212276 DOI: 10.1016/j.wneu.2020.10.142] [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: 07/25/2020] [Revised: 10/24/2020] [Accepted: 10/26/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Spinal schwannomas are commonly presented with minor symptoms, including radicular pain, sensory deficits, and minor neurologic deficit. Acute neurologic deterioration is uncommon. CASE DESCRIPTION In this study, a case of cauda equina schwannoma presented with acute neurologic deficit after movement of spinal schwannoma is presented. CONCLUSIONS It is noted that movement of spinal schwannoma and resultant acute neurologic deterioration should be considered during the follow-up.
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Affiliation(s)
- Caner Sarikaya
- Department of Neurosurgery, University of Health Sciences, Umraniye Teaching and Research Hospital, Istanbul, Turkey.
| | - Eyüp Varol
- Department of Neurosurgery, University of Health Sciences, Umraniye Teaching and Research Hospital, Istanbul, Turkey
| | - Yunus Emre Çakici
- Department of Neurosurgery, University of Health Sciences, Umraniye Teaching and Research Hospital, Istanbul, Turkey
| | - Sait Naderİ
- Department of Neurosurgery, University of Health Sciences, Umraniye Teaching and Research Hospital, Istanbul, Turkey
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Smeu B, Costache A, Dumbrava B, Codita I, Cristescu M, Copăescu C. Posterior Microscopic and Anterior Robotic Assisted STAGED Approach for Voluminous "Dumbbell" Ganglioneuroma - Surgical Technique and Literature Review. Chirurgia (Bucur) 2020; 115:656-664. [PMID: 33138903 DOI: 10.21614/chirurgia.115.5.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2020] [Indexed: 11/23/2022]
Abstract
Introduction: ganglioneuromas are benign tumors emerging from the sympathetic nervous system that could grow up to significant sizes before becoming symptomatic. Aim: to describe the surgical technique of the posterior microscopic and anterior robotic assisted staged approach for voluminous "dumbbell" ganglioneuroma. Besides this, a detailed report of the evolution of 9 years old female patient with such a tumor who underwent a staged bipolar approach, under direct neuromonitoring is presented. The literature has been reviewed on this topic. Methods: the neurosurgical approach consisted in S2-S3 laminectomy, resecting the intracanalar and intraforaminal S2 tumor, ligating and sectioning the S2 root, the surgical approach was minimally invasive using the DaVinci XI platform for excising the anterior retrorectal extension. Results: As for the posterior surgical stage, the neurosurgical operating time was 165 minutes with a five days hospital stay, and the second anterior surgical staged step took 660 minutes with five days hospital stay. There were no complications in both surgical stages, and the postoperative outcome was uneventful. The 6 months MRI evidenced no recurrency. Conclusions: the posterior microscopic and anterior robotic-assisted staged approach with continuous neuromonitoring for "dumbbell" ganglioneuroma has proven to be an efficient surgical strategy and technique. Further studies may support the effectiveness of this novel surgical approach and strategy.
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Klippel E, Moshagen V, Pietsch T, Heinen C. [Intraneural perineurioma of the radial nerve in the spiral canal as the cause of a 6-year progressive paresis of hand and finger extension]. Nervenarzt 2020; 91:952-954. [PMID: 32910223 DOI: 10.1007/s00115-020-00958-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Ekkehard Klippel
- Neurozentrum Schlosscarrée, Ritterbrunnen 7, 38100, Braunschweig, Deutschland.
| | - Volker Moshagen
- Neurozentrum Schlosscarrée, Ritterbrunnen 7, 38100, Braunschweig, Deutschland
| | - Torsten Pietsch
- Institut für Neuropathologie, DGNN Hirntumor-Referenzzentrum, Universitätsklinikum Bonn, Bonn, Deutschland
| | - Christian Heinen
- Universitätsklinik für Neurochirurgie, Evangelisches Krankenhaus Oldenburg, Oldenburg, Deutschland
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Kumaria A, Haider Z, Ali A, Pillai D, Bommireddy R, Bateman A, Gakhar H. Intracranial Mimics of Cauda Equina Syndrome: Heads or Tails? World Neurosurg 2020; 144:e643-e647. [PMID: 32916368 DOI: 10.1016/j.wneu.2020.09.014] [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: 07/30/2020] [Revised: 09/04/2020] [Accepted: 09/04/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND To report cases of extraspinal mimics of cauda equina syndrome (CES) to enable prompt diagnosis and treatment in the future. CES results from compression of spinal nerve roots. Current practice mandates lumbosacral magnetic resonance imaging (MRI) scanning to diagnose CES. However, it may not reveal compression or provide an explanation for the presentation. We present 3 cases of suspected CES who went on to have intracranial pathology. METHODS Retrospective review of all patients presenting with CES-type features who were subsequently found to have causative intracranial pathology over a 6-month period. RESULTS Three cases were found, and these are hereby presented. CASE PRESENTATION Case 1: A 57-year-old lady presented with urinary retention and bilateral leg weakness. She underwent an MRI spine which showed no evidence of CES. She was diagnosed with haemorrhagic intracranial metastases. Case 2: A 52-year-old lady presented with lower back and right buttock pain, with right-sided leg numbness, saddle hypoesthesia, and bowel and bladder incontinence. MRI spine showed no cauda equina compression. MRI neuraxis revealed a subdural haematoma. Case 3: A 69-year-old lady presented with a 6-day history of urinary incontinence, right foot drop, and leg weakness. MRI spine was negative for CES. She was diagnosed with an intraparenchymal haematoma of posterior left frontal lobe. CONCLUSIONS Negative lumbosacral MRI will not exclude extraspinal mimics of CES and, although rare, these cases should be considered.
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Affiliation(s)
- Ashwin Kumaria
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom.
| | - Zulfiqar Haider
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Arousa Ali
- Department of Neurosurgery, Queen's Medical Centre, Nottingham, United Kingdom
| | - Dilip Pillai
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Raj Bommireddy
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Antony Bateman
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
| | - Harinder Gakhar
- Department of Spinal Surgery, Royal Derby Hospital, Derby, United Kingdom
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Abstract
INTRODUCTION Leiomyoma of peripheral nerve is a rare condition characterized by neuropathy of affected nerve. We herein report a rare presentation of leiomyoma of radial nerve which presented with wrist drop. PATIENT CONCERNS A 37-year-old man visited our clinic with a history of sudden onset weakness of the wrist dorsiflexion/finger extension of the right side. DIAGNOSIS T2-weighted with fat saturation image of MRI demonstrated a well-defined, intra-neural, round mass of about 0.8 cm × 0.5 cm within the radial nerve. Excision of mass established the pathological diagnosis of intra-neural leiomyoma. INTERVENTIONS The patient underwent excision of mass and attached nerve tissue, followed his medial antebrachial nerve graft for repair of the defected radial nerve. OUTCOMES As of the 1-year follow-up, no symptoms of recurrence have been observed. Also, the strength of wrist dorsiflexion improved to grade 4/5 CONCLUSION:: This rare case demonstrates the importance of MR imaging to differentiate intra-neural leiomyomas from other benign peripheral nerve sheath tumors. Surgical treatment plays an important role in the treatment of patient with intraneural leiomyoma with neurologic deficits.
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Affiliation(s)
| | - Hyun Jin Kim
- Department of Pathology and Translational genomics
| | - Yoon La Choi
- Department of Pathology and Translational genomics
| | - Byung Joon Jeon
- Department of Plastic Surgery, Sungkyunkwan University School of Medicine, Samsung Medical Center, Seoul, Republic of Korea
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18
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Farschtschi SC, Mainka T, Glatzel M, Hannekum AL, Hauck M, Gelderblom M, Hagel C, Friedrich RE, Schuhmann MU, Schulz A, Morrison H, Kehrer-Sawatzki H, Luhmann J, Gerloff C, Bendszus M, Bäumer P, Mautner VF. C-Fiber Loss as a Possible Cause of Neuropathic Pain in Schwannomatosis. Int J Mol Sci 2020; 21:ijms21103569. [PMID: 32443592 PMCID: PMC7278954 DOI: 10.3390/ijms21103569] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 04/17/2020] [Revised: 05/09/2020] [Accepted: 05/15/2020] [Indexed: 01/22/2023] Open
Abstract
Schwannomatosis is the third form of neurofibromatosis and characterized by the occurrence of multiple schwannomas. The most prominent symptom is chronic pain. We aimed to test whether pain in schwannomatosis might be caused by small-fiber neuropathy. Twenty patients with schwannomatosis underwent neurological examination and nerve conduction studies. Levels of pain perception as well as anxiety and depression were assessed by established questionnaires. Quantitative sensory testing (QST) and laser-evoked potentials (LEP) were performed on patients and controls. Whole-body magnetic resonance imaging (wbMRI) and magnetic resonance neurography (MRN) were performed to quantify tumors and fascicular nerve lesions; skin biopsies were performed to determine intra-epidermal nerve fiber density (IENFD). All patients suffered from chronic pain without further neurological deficits. The questionnaires indicated neuropathic symptoms with significant impact on quality of life. Peripheral nerve tumors were detected in all patients by wbMRI. MRN showed additional multiple fascicular nerve lesions in 16/18 patients. LEP showed significant faster latencies compared to normal controls. Finally, IENFD was significantly reduced in 13/14 patients. Our study therefore indicates the presence of small-fiber neuropathy, predominantly of unmyelinated C-fibers. Fascicular nerve lesions are characteristic disease features that are associated with faster LEP latencies and decreased IENFD. Together these methods may facilitate differential diagnosis of schwannomatosis.
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Affiliation(s)
- Said C. Farschtschi
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
- Correspondence: ; Tel.: +49(0)407410-53869
| | - Tina Mainka
- Department of Neurology, Charité University Medicine, 10117 Berlin, Germany;
- Berlin Institute of Health, 10178 Berlin, Germany
| | - Markus Glatzel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.G.); (C.H.)
| | - Anna-Lena Hannekum
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Michael Hauck
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
- Department of Neurophysiology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| | - Mathias Gelderblom
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Christian Hagel
- Department of Neuropathology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (M.G.); (C.H.)
| | - Reinhard E. Friedrich
- Department of Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany;
| | - Martin U. Schuhmann
- Department of Neurosurgery, University Medical Center Tübingen, 72076 Tübingen, Germany;
| | - Alexander Schulz
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745 Jena, Germany; (A.S.); (H.M.)
- MVZ Human Genetics, 99084 Erfurt, Germany
| | - Helen Morrison
- Leibniz Institute on Aging, Fritz Lipmann Institute, 07745 Jena, Germany; (A.S.); (H.M.)
| | | | - Jan Luhmann
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Christian Gerloff
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
| | - Martin Bendszus
- Department of Neuroradiology, University Medical Center Heidelberg, 69120 Heidelberg, Germany; (M.B.); (P.B.)
| | - Philipp Bäumer
- Department of Neuroradiology, University Medical Center Heidelberg, 69120 Heidelberg, Germany; (M.B.); (P.B.)
- Department of Radiology, German Cancer Research Center, 69120 Heidelberg, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany; (A.-L.H.); (M.H.); (M.G.); (J.L.); (C.G.); (V.-F.M.)
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Chick G, Victor J, Hollevoet N. Clinical and radiological characteristics of 82 solitary benign peripheral nerve tumours. Acta Orthop Belg 2020; 86:151-161. [PMID: 32490787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Benign peripheral nerve tumours are rare lesions. The surgical treatment and clinical outcomes depend on the resectability. The aim of this retrospective study was to identify clinical or radiological features that may predict the surgical technique that should be used to improve clinical outcome. Eighty-two patients were diagnosed with solitary benign peripheral nerve tumours. Fifty-five tumours were surgically resectable, and 27 were nonresectable. Pre-operative magnetic resonance imaging and ultrasound were used, which were predictive of the neural origin of the tumours in 87% (39/45) of cases imaged. In 78% (50/64) of cases imaged, an origin from the nerve sheath (peripheral nerve sheath tumour), or from non-neural elements was possible. However, no imaging or clinical criteria were identified that could determine tumour resectability preoperatively. The diagnosis of solitary peripheral nerve tumour still relies on the macroscopic appearance and definitive histology after epineurotomy.
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20
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Ara R, Islam MS, Rashid MH, Khan MN, Chakraborty RK, Rima SZ, Nahar N, Khatun S, Dowel FA, Ara R, Mahmud MA. Brachial Plexus Schwannoma: A Case Report with Emphasis on Imaging. Mymensingh Med J 2019; 28:685-688. [PMID: 31391445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Brachial plexus tumors are rare. Schwannomas are benign nerve sheath tumors and only about 5% arise from brachial plexus. Diagnosis of these tumors are challenging for radiologists as well as clinicians as they are rare and the anatomy of the neck is complex. We report a case of a middle aged woman who was admitted in Mymensingh Medical College in Neurosurgery Department on 15th December 2017 with right supraclavicular swelling; based on the clinical findings was provisionally diagnosed as supraclavicular lymphadenopathy; Ultrasonography and Magnetic Resonance Imaging suggested schwannoma. Complete excision of the mass through supraclavicular approach showed the origin of it from the brachial plexus, which subsequently was confirmed to be a schwannoma with histopathology.
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Affiliation(s)
- R Ara
- Dr Rawshan Ara, Senior Medical Officer & Assistant professor, Institute of Nuclear Medicine & Allied Sciences (INMAS), Mymensingh, Bangladesh; E-mail:
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Iwanaga J, Puffer RC, Watanabe K, Spinner RJ, Tubbs RS. Division of Sacrospinous and Sacrotuberous Ligaments Expands Access Through Greater Sciatic Foramen: Anatomic Study with Application to Resection of Greater Sciatic Foramen Tumors. World Neurosurg 2019; 128:e970-e974. [PMID: 31100516 DOI: 10.1016/j.wneu.2019.05.045] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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: 02/15/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Tumors of the greater sciatic foramen remain difficult to treat. They often have both intrapelvic and extrapelvic components that may limit visualization and make safe resection of the tumor difficult. Therefore the goal of the present anatomic study was to quantitate how much additional surgical working space could be gained by transection of the sacrospinous and sacrotuberous ligaments. METHODS Sixteen sides from 9 fresh-frozen Caucasian cadaveric torsos underwent transgluteal dissection and exposure of the greater sciatic foramen and associated liagments. With the piriformis in place, the vertical and horizontal diameters of the greater sciatic foramen were measured. Next, the sacrotuberous and sacrospinous ligaments were cut at their ischial attachments. The vertical diameter of the now confluent greater and lesser sciatic foramina (V2) was measured. RESULTS The mean vertical diameter of the greater sciatic foramen (V1) was 54.8 ± 9.7 mm. The horizontal diameter of the greater sciatic foramen had a mean of 44.3 ± 6.1 mm with a range of 30-52 mm. After transection of the sacrotuberous and sacrospinous ligaments, the vertical distance of the greater and lesser sciatic foramina (V2) had a mean of 74.8 ± 6.8 mm with a range of 60.1-90 mm. The mean ratio of V2 to V1 was 1.40. CONCLUSIONS The vertical length of the greater sciatic foramen increased, on average, 40% after resection of the sacrotuberous and sacrospinous ligaments. The results of this study support an alternative technique for resecting large intrapelvic tumors via a transgluteal approach.
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Affiliation(s)
- Joe Iwanaga
- Seattle Science Foundation, Seattle, Washington, USA; Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan.
| | - Ross C Puffer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Koichi Watanabe
- Division of Gross and Clinical Anatomy, Department of Anatomy, Kurume University School of Medicine, Kurume, Fukuoka, Japan
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - R Shane Tubbs
- Seattle Science Foundation, Seattle, Washington, USA; Department of Anatomical Sciences, St. George's University, St. George's, Grenada
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Abstract
INTRODUCTION Running is one of the most common sports practices in the world due to the beneficial impact on the health, despite the relatively high risk of getting injuries. In fact, running is one of the most common sports capable to induce overuse injuries of the lower back and leg. In previous studies, the symptoms in the lower limb have been attributed to lumbosacral degenerative pathology. When the symptoms are unclear, they must be studied with great attention by carrying out an accurate process of screening and differential diagnosis. MATERIALS AND METHODS A 42-year-old non-competitive male runner who complained of left leg pain was referred to a physiotherapist. He reported a continuous, deep, sharp, shooting pain of the left leg. The symptoms began one year earlier. Symptoms worsened during prolonged driving and long distance running. The patient had been previously diagnosed with lumbar radicular irradiation in the leg by a general practitioner. Initial management, in another physical therapy outpatient setting, was without any improvement. RESULTS After surgical excision, symptoms gradually regressed shortly and the patient was referred to a physiotherapist in order to fully recover and restore work and running activities. CONCLUSION This case report describes the history, assessment and treatment of a runner with a rare cause of leg pain. After surgery excision, treatment focused on education and loading the tissues over many weeks through a graded program of loaded exercises and running retraining.
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Humhej I, Ibrahim I, Lodin J, Sameš M, Čižmář I. Image Possibilities of the Peripheral Nerve Tumor Using Magnetic Resonance Imaging - Case Report. Acta Chir Plast 2019; 60:9-13. [PMID: 30939878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Magnetic resonance imaging (MRI) plays a crucial role in the diagnosis and morphological analysis of peripheral nerve tumours (PNTs). In recent years, a number of novel MRI sequences such as MR neurography (MRN), diffusion tensor imaging (DTI) or MR tractography (MRT) have emerged extending the range of conventional MRI techniques. These advanced sequences are able to provide detailed information concerning PNTs structure, including the course and function of individual neural fascicles. This data can then be utilized in tailoring a suitable surgical procedure, reducing the risks of postoperative neurological deficit. The following case report of a median nerve tumour demonstrates the range and practicality of current MRI techniques. With continuing advancement and perfection of these MRI techniques, we can expect their integration into standard diagnostic protocols of PNTs.
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Abstract
RATIONALE Brachial plexus schwannomas are rare benign tumors that are derived from Schwann cells. Because they are rare, and because of the complexity of the anatomy of the neck, these tumors can be a challenge to diagnose for radiologists and clinicians. In the present study, we describe a clinical case of brachial plexus schwannoma detected on ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI), and presenting as a palpable neck mass. PATIENT CONCERNS A 49-year-old woman had a palpable mass in the right neck, which had been there for the last 1 year. Metastatic cervical lymphadenopathy was suspected in the primary health clinic; therefore, the patient was referred to our hospital. DIAGNOSES The right neck mass was a well-circumscribed oval soft tissue mass on US, CT, and MRI. US-guided core needle biopsy was performed and the mass was proved to be a schwannoma. INTERVENTIONS The patient did not undergo surgical excision because the brachial plexus schwannoma was small and there was no accompanying neurological symptom. OUTCOMES The patient is being followed up regularly at the outpatient department. LESSONS Brachial plexus schwannoma should be considered for a differential diagnosis in patients with a palpable neck mass, and imaging studies play an important role in diagnosing the brachial plexus schwannoma.
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Affiliation(s)
- Kyeong Hwa Ryu
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon
| | - Jin Il Moon
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon
| | - Hye Jin Baek
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon
- Gyeongsang National University School of Medicine, Jinju
| | - Soo Buem Cho
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon
| | - Bo Hwa Choi
- Department of Radiology, Gyeongsang National University Changwon Hospital, Changwon
| | - Hyo Jung An
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
| | - Dae Hyun Song
- Gyeongsang National University School of Medicine, Jinju
- Department of Pathology, Gyeongsang National University Changwon Hospital, Changwon, Republic of Korea
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Stone JJ, Boland JM, Spinner RJ. Analysis of Peripheral Nerve Schwannoma Pseudocapsule. World Neurosurg 2018; 119:e986-e990. [PMID: 30114537 DOI: 10.1016/j.wneu.2018.08.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [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: 06/17/2018] [Revised: 07/31/2018] [Accepted: 08/02/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Using proper surgical technique, schwannomas can be resected safely, with a low recurrence rate and high likelihood of improvement in symptomatology. There are multiple peritumoral tissue layers, and finding the correct plane is critical to safe tumor enucleation. The contents of the pseudocapsule tissue surrounding a schwannoma are not well described, and the consequences of resecting or leaving pseudocapsules are unknown. METHODS An institutional database was searched for any pathology reports that contained both of the words "schwannoma" and "capsule." Charts and histopathologic specimens were reviewed to determine the contents of various tissue layers and determine if there was any correlation between pseudocapsular contents and clinical outcomes. RESULTS A pseudocapsule was separately sent for pathology in 36 patients during schwannoma resection. Ten pseudocapsule specimens contained microscopic foci of tumor. In a separate 6 patients, there was evidence of nerve fascicles. There were no correlations between the tumor or nerve in the pseudocapsule and postoperative neurologic deficits. After an average follow-up time of 3.1 years, no patients developed a recurrence either clinically or on follow-up imaging (imaging available in 52.7%). Histopathologically, the pseudocapsule was made of dense hypocellular collagen and occasionally contained arteries, veins, and nerve fascicles. CONCLUSIONS The pseudocapsule surrounding a schwannoma occasionally contained nerve tissue and blood vessels. While a microscopic focus of tumor was often found in this tissue layer, recurrence is exceedingly rare and did not occur in this case series. The risk of undue pseudocapsule dissection likely outweighs any negligible benefit from microscopic cytoreduction.
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Affiliation(s)
- Jonathan J Stone
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jennifer M Boland
- Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Departments of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
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Abstract
Pancreatic ductal adenocarcinoma continues to be a highly lethal disease, despite advances in modern medicine. Curative surgical options continue to carry significant morbidity and offer little improvement in overall 5-year survival. Currently, imaging plays an essential role in the pre-operative evaluation of patients who are undergoing evaluation for resection. However, some pancreatic cancers have particularly aggressive biology, despite appearing resectable by conventional imaging criteria. Imaging biomarkers that serve as surrogates for tumors with such aggressive phenotype have been recently described, namely duodenal invasion and extrapancreatic perineural invasion. In this pictorial review, we will summarize key concepts of extrapancreatic perineural invasion, describe its association with a poor prognosis, and highlight the role of imaging in its detection.
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Affiliation(s)
- Bhavik N Patel
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., H1307, Stanford, CA, 94305, USA.
| | - Eric Olcott
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., H1307, Stanford, CA, 94305, USA
- Department of Radiology, Veterans Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA, 94304, USA
| | - R Brooke Jeffrey
- Department of Radiology, Stanford University School of Medicine, 300 Pasteur Dr., H1307, Stanford, CA, 94305, USA
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Hooper J, O'Connor IT, Golub IJ, Decilveo AP, Wittig JC. Retrospective Analysis of 20 Patients With Schwannomas: Magnetic Resonance Imaging Characteristics, Pain, and Outcomes Following Excision. Orthopedics 2017; 40:e1036-e1043. [PMID: 28968477 DOI: 10.3928/01477447-20170925-05] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Accepted: 08/14/2017] [Indexed: 02/03/2023]
Abstract
A Tinel's sign, a percussion-induced, painful sensation, has been reported as the most useful sign for diagnosing a schwannoma. On magnetic resonance imaging, schwannomas often exhibit a split fat sign and a target sign. The typical treatment for schwannomas is surgical excision; however, excision often results in high rates of neurological deficit. The authors retrospectively reviewed 20 patients who underwent excision of a schwannoma from 2007 to 2015. Twenty patients presented with a split fat sign and 12 patients presented with a Tinel's sign on magnetic resonance imaging. Only 3 patients presented with a target sign on magnetic resonance imaging. The operative approach involved removing the schwannoma, preserving the nearby nerve fascicles, and leaving the epineurium open. Follow-up ranged from 3 to 91 months (average, 29 months). At final follow-up, all patients were pain free. Nineteen patients had normal sensation and full function of their affected limb. One patient developed postoperative posterior interosseous nerve palsy. A Tinel's sign, preoperative pain, and a split fat sign on preoperative magnetic resonance imaging are the clinical symptoms most useful for diagnosing a schwannoma. Schwannomas can be safely removed via intracapsular surgical excision with minimal complications, yielding eradication of preoperative pain, normal sensation, and full function. [Orthopedics. 2017; 40(6):e1036-e1043.].
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Trahair T, Sorrentino S, Russell SJ, Sampaio H, Selek L, Plantaz D, Freycon C, Simon T, Kraal K, Beck-Popovic M, Haupt R, Ash S, De Bernardi B. Spinal Canal Involvement in Neuroblastoma. J Pediatr 2017. [PMID: 28645442 DOI: 10.1016/j.jpeds.2017.05.051] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Toby Trahair
- Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia; School of Women's & Children's Health, University of New South Wales Medicine, Randwick, Australia.
| | - Stefania Sorrentino
- Unit of Pediatric Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Susan J Russell
- Kids Cancer Center, Sydney Children's Hospital, Randwick, Australia
| | - Hugo Sampaio
- Department of Neurology, Sydney Children's Hospital, Randwick, Australia
| | - Laurent Selek
- Neurosurgery Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Dominique Plantaz
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Claire Freycon
- Pediatric Department, University Hospital Centre of Grenoble, Grenoble, France
| | - Thorsten Simon
- Pediatric Oncology and Hematology, University of Cologne, Cologne, Germany
| | - Kathelijne Kraal
- Department Pediatric Oncology, Princess Máxima Center, Utrecht, the Netherlands
| | - Maja Beck-Popovic
- Department of Pediatrics, Hematology-Oncology Unit, University Hospital, Lausanne, Switzerland
| | - Riccardo Haupt
- Epidemiology and Biostatistics Unit, Giannina Gaslini Children's Hospital, Genova, Italy
| | - Shifra Ash
- The Rina Zaizov Hematology-Oncology Division, Schneider Children's Medical Center of Israel, Petach-Tikva, Israel
| | - Bruno De Bernardi
- Unit of Pediatric Oncology, Giannina Gaslini Children's Hospital, Genova, Italy
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Chick G, Victor J, Hollevoet N. Six cases of sporadic schwannomatosis: Topographic distribution and outcomes of peripheral nerve tumors. Hand Surg Rehabil 2017; 36:378-383. [PMID: 28781128 DOI: 10.1016/j.hansur.2017.07.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 06/09/2017] [Accepted: 07/03/2017] [Indexed: 11/18/2022]
Abstract
The diagnosis of schwannomatosis is often overestimated and is based on the existence of multiple peripheral nerve tumors composed exclusively of schwannomas, in the absence of clinical signs of neurofibromatosis type 2 (NF2). Sporadic forms are much more frequent than familial forms. The objective of this study was to describe the distribution of peripheral nerve tumors and investigate the outcomes of schwannomas in the context of sporadic schwannomatosis. We conducted a retrospective study of patients who fulfilled clinical diagnostic criteria for sporadic schwannomatosis. Six patients were reviewed with a mean follow-up of 38.5months (27-60months). Patients' demographic, clinical, radiographic, and pathologic data were extracted. All patients underwent slit-lamp examination, enhanced brain magnetic resonance imaging (MRI) and a spinal MRI. Enucleation that preserved nerve continuity was performed in symptomatic patients. On average, patients were 36years of age at the time of diagnosis with no sex predominance. The topographic distribution of the peripheral nerve tumors was always unilateral and most frequently targeted the upper limb. In four cases, the tumors involved the same peripheral nerve exclusively. The average number of nerve tumors observed per patient was 4.7 (2-8). The outcome after enucleation was marked by the systematic appearance of new tumors. After enucleation, no recurrence or malignant transformation was observed at the final follow-up. There was no transition to a NF2 configuration. The absence of neurofibroma and NF2 criteria makes schwannomatosis a diagnosis of exclusion. While a good prognosis can be expected following enucleation, two risks related to neurofibromatosis type 3 (NF3) are worth monitoring: the transition to NF2, particularly in young patients, and the appearance of new tumors.
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Affiliation(s)
- G Chick
- Department of Hand Surgery and Peripheral Nerve Surgery, hôpital de la Tour, 1, avenue J.D. Maillard, 1217 Meyrin, Geneva, Switzerland.
| | - J Victor
- Ghent University Hospital, Department of Orthopaedic Surgery and Traumatology, De Pintelaan 185, 9000 Gent, Belgium.
| | - N Hollevoet
- Ghent University Hospital, Department of Orthopaedic Surgery and Traumatology, De Pintelaan 185, 9000 Gent, Belgium.
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Battaglia PJ, Carbone-Hobbs V, Guebert GM, Mackinnon SE, Kettner NW. High-resolution ultrasonography and shear-wave sonoelastography of a cystic radial nerve Schwannoma. J Ultrasound 2017; 20:261-266. [PMID: 28900529 DOI: 10.1007/s40477-017-0254-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 12/03/2016] [Accepted: 05/03/2017] [Indexed: 01/30/2023] Open
Abstract
Peripheral nerve tumors are often evaluated with magnetic resonance imaging (MRI), although there are many advantages offered with high-resolution ultrasonography (HRUS). This case report emphasizes the value of HRUS in the diagnosis and management of a patient with a cystic radial nerve Schwannoma. In addition, information on tumor stiffness, obtained with shear-wave sonoelastography (SWE), is presented.
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Affiliation(s)
- Patrick J Battaglia
- Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO 63017 USA
| | | | - Gary M Guebert
- Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO 63017 USA
| | - Susan E Mackinnon
- Shoenberg Professor and Chief Division of Plastic and Reconstructive Surgery, Washington University School of Medicine, 660 S Euclid Ave, St. Louis, MO 63110 USA
| | - Norman W Kettner
- Department of Radiology, Logan University, 1851 Schoettler Road, Chesterfield, MO 63017 USA
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31
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Chang KV, Wu WT, Özçakar L. Ultrasound Imaging for Posterior Knee Pain: Tibial Nerve Schwannoma Not Popliteus Muscle Strain. Med Ultrason 2017; 19:237-238. [PMID: 28440363 DOI: 10.11152/mu-1024] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Ke-Vin Chang
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
| | - Wei-Ting Wu
- Department of Physical Medicine and Rehabilitation, National Taiwan University Hospital, Bei-Hu Branch, Taipei, Taiwan.
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey.
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García-Montero P, Segura Palacios JM, de Troya Martín M. Tumor With a 40-Year History. Actas Dermosifiliogr 2017; 108:951. [PMID: 28108008 DOI: 10.1016/j.ad.2016.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 10/12/2016] [Indexed: 11/19/2022] Open
Affiliation(s)
- P García-Montero
- Departamento de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España.
| | - J M Segura Palacios
- Departamento de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
| | - M de Troya Martín
- Departamento de Dermatología, Hospital Costa del Sol, Marbella, Málaga, España
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Lyckhage LF, Tfelt-Hansen P, Kjær TW. [Hourglass neurinoma resulted in symptoms of polyneuropathy]. Ugeskr Laeger 2016; 178:V08160529. [PMID: 27959264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Distal symmetric polyneuropathy (DSP) is a common condition where limited diagnostic evaluation is usually required. We present a case story of a 50-year-old male who had symptoms of DSP, but electrodiagnostic testing suggested a more proximal lesion, and magnetic resonance imaging showed a spinal nerve root schwannoma. The patient recovered completely after surgery. This case exemplifies relevant use of electrodiagnostic testing. Based on a recent review, we briefly mention atypical features which should prompt further testing, emphasizing that evaluation should be reserved to a limited group of patients.
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Giasna GK, Micu MC, Micu R. Schwannoma of the median nerve mimicking carpal tunnel syndrome in a pregnant patient. Case report. Med Ultrason 2016; 18:521-523. [PMID: 27981288 DOI: 10.11152/mu-883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
In patients with symptoms of a peripheral neuropathy especially during pregnancy, use of imaging techniques such as Ultrasound (US) and Magnetic Resonance Imaging (MRI) may be essential for the diagnostic accomplishment. A 30-weekspregnant diabetic female attending US evaluation due to intermittent hand pain, numbness, and weakness bilaterally. Although, the US evaluation revealed the median nerve (MN) normal size, echogenicity and echo-texture within the right carpal tunnel; the US assessment applied proximally to the carpal tunnel, revealed a hypoechoic tumor-like mass and increased MN cross section area. In transverse view, the MN was detected as an eccentric, hypoechoic structure compressed by the aforementioned mass. A presence of MN schwannoma or neurofibroma was suspected. US has been proved to be extremely useful to determine location, extent as well as the type of nerve lesion.
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Affiliation(s)
- Giokits-Kakavouli Giasna
- Department of Sports Medicine and physiology, University of Medicine, 69 Svetozara Markovica Street, 34000 Kragujevac, Serbia, Private Office, 10 Solomou Street, 60132 Katerini, Greece
| | - Mihaela C Micu
- Rheumatology Division, 2nd Rehabilitation Department, Clinical Rehabilitation Hospital Cluj- Napoca, Romania
| | - Romeo Micu
- Assisted Reproduction Department, Gynecology I Clinic Cluj- Napoca, "Iuliu Hatieganu" University of Medicine and Pharmacy Cluj- Napoca, Romania.
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35
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Wang G, Liu Y, He F. Primary lymphoma involving cranial nerves and cauda equina detected by (18)F-FDG PET/CT and MRI. Nuklearmedizin 2016; 55:N46-N48. [PMID: 27668300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/07/2016] [Indexed: 06/06/2023]
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Bugelli G, Dell'Osso G, Bottai V, Celli F, Loggini B, Guido G, Giannotti S. Giant Schwannoma of the Saphenous Nerve in The Distal Thigh: A Case Report. Surg Technol Int 2016; 28:285-288. [PMID: 27121412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
CASE Schwannomas are benign nerve myelin sheath tumors that can occur anywhere in the peripheral nervous system. It is very rare for Schwannomas to become malignant, but surgery is still the principal treatment to eliminate symptoms and to correctly diagnosis the tumor. We report an interesting case of a schwannoma of the saphenous nerve at the distal third of the posteromedial thigh: the patient complained of muscle weakness at left lower limb and vague anteromedial knee pain, mimicking a meniscal tear. Magnetic resonance images of the thigh showed a well-defined and oval mass lesion measuring 8.5 cm x 4.5 cm. Before investigating for a possible meniscal tear, we decided to remove the mass from the thigh, because we felt that it could itself be the cause of the mild pain complained about by the patient. Post-surgery, histological analysis conducted confirmed that this was a benign schwannoma. DISCUSSION Schwannomas generally can be asymptomatic or present as a mass. The clinical presentation of this rare tumor makes the diagnosis difficult. CONCLUSION This reported case is particularly interesting because of the rarity of the lesion localization along the course of the saphenous nerve. The combination of the location, and especially the large size of the tumor, led us to believe that there is a correlation with the particular clinical presentation.
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Affiliation(s)
- Giulia Bugelli
- Department of Anatomical Pathology, University of Pisa, Pisa, Italy
| | | | - Vanna Bottai
- Department of Anatomical Pathology, University of Pisa, Pisa, Italy
| | - Fabio Celli
- Department of Anatomical Pathology, University of Pisa, Pisa, Italy
| | - Barbara Loggini
- Department of Anatomical Pathology, University of Pisa, Pisa, Italy
| | - Giulio Guido
- Department of Anatomical Pathology, University of Pisa, Pisa, Italy
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Ryu JA, Lee SH, Cha EY, Kim TY, Kim SM, Shin MJ. Sonographic Differentiation Between Schwannomas and Neurofibromas in the Musculoskeletal System. J Ultrasound Med 2015; 34:2253-2260. [PMID: 26543170 DOI: 10.7863/ultra.15.01067] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 03/31/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVES The purpose of this study was to determine key features and define a strategy for differentiation between schwannomas and neurofibromas using sonography. METHODS This retrospective study was approved by the Institutional Review Board at our hospital, and informed consent was waived. We reviewed sonograms of pathologically proven schwannomas and neurofibromas of the extremities and body wall. On grayscale images, tumors were evaluated on the basis of their size, maximum-to-minimum diameter ratio, shape, contour, margin, location, encapsulation, echogenicity, echo texture, cystic changes, presence of intratumoral calcifications, presence of a target sign, and presence of an entering or exiting nerve. If an entering or exiting nerve was identified, the nerve-tumor position and nerve-tumor transition were characterized. On color Doppler images, the presence and amount of vascularity were evaluated. Student t tests were used for analysis of continuous variables (size, maximum-to-minimum diameter ratio, and age); χ(2) and Fisher exact tests were used for analysis of categorical variables. RESULTS A total of 146 pathologically proven tumors, including 115 schwannomas and 31 neurofibromas of the extremities and body wall, were included. The maximum diameter, maximum-to-minimum diameter ratio, contour, cystic portion, nerve-tumor position, nerve-tumor transition, and vascularity were significantly different in schwannomas versus neurofibromas (P < .05), and a lobulated contour, fusiform shape, and hypovascularity of neurofibromas could be helpful for differentiation when a prediction model is considered. The nerve-tumor position, nerve-tumor transition, and maximum-to-minimum diameter ratio were also significantly different between groups (P < .05) and thus could be useful for differentiation of neurogenic tumors. CONCLUSIONS Sonographic findings are helpful in differentiating between schwannomas and neurofibromas.
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Affiliation(s)
- Jeong Ah Ryu
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
| | - Sang Hoon Lee
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.).
| | - Eun-Young Cha
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
| | - Tae Yeob Kim
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
| | - Sung Moon Kim
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
| | - Myung Jin Shin
- Departments of Radiology (J.A.R.) and Internal Medicine (T.Y.K.), Hanyang University College of Medicine, Guri Hospital, Seoul, Korea; and Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea (S.H.L., E.-Y.C., S.M.K., M.J.S.)
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Fader RR, Mitchell JJ, Chadayammuri VP, Hill J, Wolcott ML. Percutaneous Ultrasound-Guided Hydrodissection of a Symptomatic Sural Neuroma. Orthopedics 2015; 38:e1046-50. [PMID: 26558670 DOI: 10.3928/01477447-20151020-15] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 02/23/2015] [Indexed: 02/03/2023]
Abstract
Symptomatic neuromas of the sural nerve are a rare but significant cause of pain and debilitation in athletes. Presentation is usually in the form of chronic pain and dysesthesias or paresthesias of the lateral foot and ankle. Treatment traditionally ranges from conservative measures, such as removing all external compressive forces, to administration of nonsteroidal anti-inflammatory drugs, vitamin B6, tricyclic antidepressants, antiepileptics, or topical anesthetics. This article reports a case of sural nerve entrapment in a 34-year-old male triathlete with a history of recurrent training-induced right-sided gastrocnemius strains. The patient presented with numbness in the right lateral foot and ankle that had persisted for 3 months, after he was treated unsuccessfully with extensive nonoperative measures, including anti-inflammatory drugs, activity modification, and a dedicated physical therapy program of stretching and strengthening. Orthopedic assessment showed worsening pain with forced passive dorsiflexion and manual pressure applied over the distal aspect of the gastrocnemius. Plain radiographs showed normal findings, but in-office ultrasound imaging showed evidence of sural nerve entrapment with edema and neuromatous scar formation in the absence of gastrocnemius or soleus pathology. Percutaneous ultrasound-guided hydrodissection of the sural nerve at the area of symptomatic neuroma and neural edema was performed the same day. The patient had complete relief of symptoms and full return to the preinjury level of participation in competitive sports. This case report shows that hydrodissection, when performed by an experienced physician, can be an effective, minimally invasive technique for neurolysis in the setting of sural nerve entrapment, resulting in improvement in clinical symptoms.
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Tong AK, Neo SH, Kok TY. Disseminated Lymphoma Evolving into Neurolymphomatosis during Mid-cycle of Chemotherapy Detected by (18)F-FDG PET/CT. Ann Acad Med Singap 2015; 44:545-547. [PMID: 27089963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Aaron Kt Tong
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
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40
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Lieba-Samal D, Pivec C, Platzgummer H, Gruber GM, Seidel S, Bernathova M, Bodner G, Moritz T. High-Resolution Ultrasound for Diagnostic Assessment of the Great Auricular Nerve--Normal and First Pathologic Findings. Ultraschall Med 2015; 36:342-347. [PMID: 24824761 DOI: 10.1055/s-0034-1366354] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The great auricular nerve (GAN) is a sensory branch of the superficial cervical plexus. While its blockade is an established procedure, little is known about the ultrasound appearance of pathologic conditions of the GAN itself. We, therefore, aimed to evaluate the possibility of the visualization and diagnostic assessment of the GAN along its entire course by means of high-resolution ultrasound (HRUS). MATERIALS AND METHODS To assess the feasibility of visualization, we performed HRUS with an 18 MHz probe, HRUS-guided, fine-needle ink markings and consecutive dissection in six anatomical specimens. Then, we measured the diameter of the GAN in healthy volunteers and finally performed a retrospective review of patients referred for HRUS examinations because of pain within GAN territory between August 1, 2012 and August 1, 2013. RESULTS The GAN was clearly visible with HRUS from its formation to the final branches, and was marked successfully on both sides in all anatomical specimens (n = 12). The mean average in-vivo was 0.14 cm ± 0.03 (range 0.08-0.2). Seven cases of patients with GAN pathologies of various origins (idiopathic, traumatic, tumorous and iatrogenic) were identified, of which 6 were visible on HRUS and all of which could be confirmed by complete resolution of symptoms after selective HRUS-guided GAN block. CONCLUSION This study confirms the reliable ability to visualize the GAN with HRUS throughout its course, both in anatomical specimens and in vivo. The provided cases show that pathologies of the GAN seem to have a variety of causes and may not be rare. We, therefore, encourage the use of HRUS in patients with unclear pain in the auricular, periauricular and posterior-lateral head.
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Affiliation(s)
| | - C Pivec
- Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - H Platzgummer
- Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - G M Gruber
- Systematic Anatomy, Medical University of Vienna, Austria
| | - S Seidel
- Neurology, Medical University of Vienna, Austria
| | - M Bernathova
- Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - G Bodner
- Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
| | - T Moritz
- Biomedical Imaging and Image-guided Therapy, Medical University of Vienna, Austria
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41
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Crouzet G, Dorland P, Doyon D, Jeanmart JL, Legre J, Metzer J, Simon J, Sterkers JM, Trujillo M, Vignaud J. Results of 514 opaque cisternograms. Adv Otorhinolaryngol 2015; 21:76-81. [PMID: 4545523 DOI: 10.1159/000395089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Snow JB. Clinical manifestations other than audiologic findings of retrocochlear lesions. Adv Otorhinolaryngol 2015; 20:258-70. [PMID: 4541190 DOI: 10.1159/000393103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
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Zheng M, Zhu Y, Zhou X, Chen S, Cong R, Chen D. Diagnosis of closed injury and neoplasm of the brachial plexus by ultrasonography. J Clin Ultrasound 2014; 42:417-422. [PMID: 24677066 DOI: 10.1002/jcu.22155] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Revised: 08/12/2013] [Accepted: 03/06/2014] [Indexed: 06/03/2023]
Abstract
PURPOSE To evaluate the feasibility and accuracy of high-frequency sonography (US) in diagnosing traumatic brachial plexus (BP) lesions and neoplasms in the adult. METHODS Eleven patients with suspected BP closed trauma, 6 patients with BP neoplasm, and 12 healthy volunteers were scanned. The US findings were compared with surgical findings. RESULTS The interscalene space and intervertebral foramina were useful anatomic markers in identifying the BP. In the 24 sites examined in the normal group (12 subjects examined on both sides), the fifth to seventh cervical nerve roots (C5-7, including upper and middle trunk) were seen, whereas the eighth cervical and first thoracic nerve roots (C8, T1, including the lower trunk) were seen in 91.7% (22/24) of the subjects. The BP appeared as three or four discrete rounded hypoechoic nodules between the anterior scalene and middle scalene muscle in transverse views at the C5-7 level, representing the trunks in the sagittal oblique section. In the BP trauma group (n = 11), the normal nerve trunk was interrupted, and lesions were shown as thickening and swelling with indistinct inner structures. In the neoplasm group (n = 6), masses were shown as hypoechoic masses. CONCLUSIONS High-frequency US is valuable in diagnosing BP closed injuries and neoplasms.
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Affiliation(s)
- Minjuan Zheng
- Ultrasound Department, Xijing Hospital, Fourth Military Medical University, Xi'an, China, 710032
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Gruber H, Peer S, Gruber L, Loescher W, Bauer T, Loizides A. Ultrasound imaging of the axillary nerve and its role in the diagnosis of traumatic impairment. Ultraschall Med 2014; 35:332-338. [PMID: 24647764 DOI: 10.1055/s-0034-1366089] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PURPOSE The axillary nerve (AN) is frequently injured during shoulder trauma and imaging is required to define the site and extent of nerve injury. However, the AN has a rather complex course through several soft tissue compartments of the shoulder and axilla. Therefore, imaging of the nerve with MRI and sonography is troublesome. Thus detection and sonographic assessment bases on thorough knowledge of local topography. MATERIALS AND METHODS This investigation aimed at defining reliable anatomical landmarks for AN-sonography in 5 volunteers and later validating the proposed sonographic examination protocol in 10 unselected patients. RESULTS With strict adherence to the proposed examination algorithm, sonography of the AN was feasible in all volunteers and patients. Furthermore, sonographic findings correlated nicely with the golden standard "surgical exploration" concerning severity and topography of neural impairment. CONCLUSION Based on our study results we propose our algorithm for AN-sonography as the first-line imaging tool for the assessment of axillary nerve trauma.
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Affiliation(s)
- H Gruber
- Department of Radiology, Medical University Innsbruck
| | - S Peer
- Radiology, CTI GesmbH and Roentgeninstitut B7, Innsbruck
| | - L Gruber
- Department of Radiology, Medical University Innsbruck
| | - W Loescher
- Department of Neurology, Medical University Innsbruck
| | - T Bauer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University Innsbruck
| | - A Loizides
- Department of Radiology, Medical University Innsbruck
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Kundu S, Biswas D, Misra S, Dutta S, Sen A. Ancient schwannoma of vagus nerve mimicking hamartoma. Indian J Chest Dis Allied Sci 2014; 56:183-185. [PMID: 25823116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Schwannomas arising from vagus nerve sheath are rare mediastinal neurogenic tumours. Schwannomas usually arise from left hemithorax. Unlike a hamartoma, radiologically, calcification is rarely seen in schwannomas. We present the rare case of an ancient schwannoma arising from vagus nerve sheath from the right hemithorax presenting with gross calcification.
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Zhu YS, Mu NN, Zheng MJ, Zhang YC, Feng H, Cong R, Zhou XD, Chen DZ. High-resolution ultrasonography for the diagnosis of brachial plexus root lesions. Ultrasound Med Biol 2014; 40:1420-1426. [PMID: 24768481 DOI: 10.1016/j.ultrasmedbio.2014.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2013] [Revised: 01/10/2014] [Accepted: 02/08/2014] [Indexed: 06/03/2023]
Abstract
The aim of this study was to investigate the feasibility of using high-resolution ultrasonography in the diagnosis of brachial plexus (BP) root lesions. A prospective study of ultrasonographic evaluation of BP nerve roots was performed in 37 patients with BP root lesions (29 with root injuries, 8 with tumors). The pre-operative ultrasonographic findings were compared with the surgical and pathohistological findings. All C5-7 roots were detected by ultrasonography in all patients, whereas 92% (68/74) of C8 and 51% (38/74) of T1 nerve roots were visualized. Among 29 patients with BP root avulsion, partial injuries or totally interrupted BP roots were detected in all patients. Cystic masses and neuromas were detected in 16 and 23 patients, respectively. In 8 patients with BP root tumors, 8 hypo-echoic masses were detected inside or partly outside of intervertebral foramina connecting to nerve roots. Surgical exploration revealed that there were 57 BP root avulsions in 29 patients. However, 2 T1 nerve root avulsions had been missed by pre-operative ultrasonography. Pathohistology revealed that all 8 BP root tumors pre-operatively diagnosed by ultrasonography were schwannomas. High-resolution ultrasonography can provide a convenient and accurate imaging modality for quick diagnosis and location of BP root lesions.
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Affiliation(s)
- Yong-Sheng Zhu
- Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, Xi'An, China
| | - Nan-Nan Mu
- Department of Ultrasonography, General Hospital of Jinan Military Area Command of Chinese PLA, Ji'Nan, China
| | - Min-Juan Zheng
- Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, Xi'An, China
| | - Yun-Chu Zhang
- Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, Xi'An, China
| | - Hua Feng
- Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, Xi'An, China
| | - Rui Cong
- Department of Orthopedics, Xijing Hospital, Fourth Military Medical University, Xi'An, China
| | - Xiao-Dong Zhou
- Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, Xi'An, China
| | - Ding-Zhang Chen
- Department of Ultrasonography, Xijing Hospital, Fourth Military Medical University, Xi'An, China.
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Amouyel-Castier M, Goëb V, Deramond H, Bonnaire B. A relapsing macrodactyly. Clin Rheumatol 2014; 34:803-5. [PMID: 24687379 DOI: 10.1007/s10067-014-2580-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Revised: 02/25/2014] [Accepted: 03/11/2014] [Indexed: 11/30/2022]
Abstract
Lipofibromatous hamartoma is an uncommon benign tumor, usually unknown or misdiagnosed. We report the case of a 61-year-old patient presenting an acquired painful macrodactyly of the left thumb with paresthesia in the median nerve territory. Clinical examination reveals a tumefaction of the volar side of the wrist. She had a medical history of amputation of the forefinger for macrodactyly without any diagnosis. Paraclinical exploration guided us to the correct diagnosis; hypertrophic bone structures of the affected finger were detected on radiographs. The left median nerve appeared hypertrophic, with a fatty infiltration on the ultrasound exploration. These pathological findings revealed a late discovered lipofibromatous hamartoma of the median nerve, a rare entity often associated with macrodactyly and diagnosed in childhood. Therefore, we retrospectively made the same diagnosis for the amputated index finger with the analysis of her ancient paraclinical exams. Lipofibromatous hamartoma remains an obscure pathology and its treatment stays controversial.
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Affiliation(s)
- Mélody Amouyel-Castier
- Department of Radiology, University Picardie Jules Verne, Place Victor Pauchet, Amiens, 80054, France,
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Dhingra S, Bakshi J, Mohindra S. Schwannoma of the nasal septum: an unusual finding. Ear Nose Throat J 2014; 93:E4-E6. [PMID: 24652570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Schwannomas of the nasal cavity are rare benign tumors, and those that arise from the nasal septum are even rarer. When they do occur, they usually become symptomatic early because of the close confines of the nasal cavity. We describe a case of nasal septal schwannoma that was noteworthy in that the patient-a 28-year-old woman-waited 8 months after the onset of symptoms to seek medical care. Her symptoms included complete right-sided nasal obstruction, occasional epistaxis, and hemifacial pain. The tumor was completely removed via an endoscopic approach. We discuss the clinical presentation, differential diagnosis, and treatment of this rarely encountered neoplasm.
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Affiliation(s)
- Shruti Dhingra
- Department of Otolaryngology-Head and Neck Surgery, Chacha Nehru Children's Hospital, Geeta Colony, PO Box 110031, New Delhi, India.
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Anghel A, Tudose I, Terzea D, Răducu L, Sinescu RD. Unusual median nerve schwannoma: a case presentation. Rom J Morphol Embryol 2014; 55:159-164. [PMID: 24715182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Peripheral nerve sheath tumors are common soft tissue neoplasms and their characterization is often challenging. Although the surgical pathology defines some typical entities, some degree of controversy regarding the classification of these tumors still exists. Newer imagistic and histopathological techniques are crucial for their accurate diagnosis and grading. We present an unusual case of median nerve schwannoma in a young patient, discussing the clinical, surgical and pathological elements, including immunohistochemistry.
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Affiliation(s)
- Andrea Anghel
- Department of Plastic Surgery and Reconstructive Microsurgery, "Elias" Emergency University Hospital, Bucharest, Romania;
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Mueller WP, Coppenrath E, Pfluger T. Nuclear medicine and multimodality imaging of pediatric neuroblastoma. Pediatr Radiol 2013; 43:418-27. [PMID: 23151727 DOI: 10.1007/s00247-012-2512-1] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2012] [Revised: 06/22/2012] [Accepted: 06/23/2012] [Indexed: 12/20/2022]
Abstract
Neuroblastoma is an embryonic tumor of the peripheral sympathetic nervous system and is metastatic or high risk for relapse in nearly 50% of cases. Therefore, exact staging with radiological and nuclear medicine imaging methods is crucial for defining the adequate therapeutic choice. Tumor cells express the norepinephrine transporter, which makes metaiodobenzylguanidine (MIBG), an analogue of norepinephrine, an ideal tumor specific agent for imaging. MIBG imaging has several disadvantages, such as limited spatial resolution, limited sensitivity in small lesions and the need for two or even more acquisition sessions. Most of these limitations can be overcome with positron emission tomography (PET) using [F-18]2-fluoro-2-deoxyglucose [FDG]. Furthermore, new tracers, such as fluorodopa or somatostatin receptor agonists, have been tested for imaging neuroblastoma recently. However, MIBG scintigraphy and PET alone are not sufficient for operative or biopsy planning. In this regard, a combination with morphological imaging is indispensable. This article will discuss strategies for primary and follow-up diagnosis in neuroblastoma using different nuclear medicine and radiological imaging methods as well as multimodality imaging.
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Affiliation(s)
- Wolfgang Peter Mueller
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Ziemssenstr. 1, 80336, Munich, Germany.
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