1
|
Aru MG, Davis JL, Stacy GS, Mills MK, Yablon CM, Hanrahan CJ, McCallum R, Nomura EC, Hansford BG. Beyond schwannomas and neurofibromas: a radiological and histopathological review of lesser-known benign lesions that arise in association with peripheral nerves. Skeletal Radiol 2023; 52:649-669. [PMID: 36280619 DOI: 10.1007/s00256-022-04207-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/06/2022] [Accepted: 10/07/2022] [Indexed: 02/02/2023]
Abstract
Peripheral nerve sheath tumors comprise a significant percentage of both benign and malignant soft tissue tumors. The vast majority of these lesions are schwannomas and neurofibromas, which most radiologists are familiar with including the well-described multimodality imaging features. However, numerous additional often under-recognized benign entities associated with nerves exist. These rarer entities are becoming increasingly encountered with the proliferation of cross-sectional imaging, particularly magnetic resonance imaging (MRI). It is important for the radiologist to have a basic understanding of these entities as many have near-pathognomonic MR imaging features as well as specific clinical presentations that when interpreted in concert, often allows for a limited differential or single best diagnosis. The ability to provide a prospective, pre-intervention diagnosis based solely on imaging and clinical presentation is crucial as several of these entities are "do not touch" lesions, for which even a biopsy may have deleterious consequences. To our knowledge, the majority of these benign entities associated with nerves have only been described in scattered case reports or small case series. Therefore, the aim of this article is to provide a radiopathologic comprehensive review of these benign entities that arise in association with nerves with a focus on characteristic MRI features, unique histopathologic findings, and entity specific clinical exam findings/presentation.
Collapse
Affiliation(s)
- Marco G Aru
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA.
| | - Jessica L Davis
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-471, Portland, OR, 97239, USA
| | - Gregory S Stacy
- Department of Diagnostic Radiology, University of Chicago, 5841 South Maryland Avenue, MC2026, Chicago, IL, 60637, USA
| | - Megan K Mills
- Department of Radiology and Imaging Sciences, University of Utah, 30 N 1900 E, Rm #1A71, Salt Lake City, UT, 84132, USA
| | - Corrie M Yablon
- Department of Diagnostic Radiology, University of Michigan Health System, 1500 E. Medical Center Dr, TC2910Q, Ann Arbor, MI, 48109, USA
| | - Christopher J Hanrahan
- Department of Diagnostic Radiology, University of Utah School of Medicine, Intermountain Healthcare, Salt Lake City, UT, 84132, USA
| | - Raluca McCallum
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Eric C Nomura
- Department of Pathology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, L-471, Portland, OR, 97239, USA
| | - Barry G Hansford
- Department of Diagnostic Radiology, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA
| |
Collapse
|
2
|
Marek T, Spinner RJ, Carter JM, Murthy NK, Amrami KK, Broski SM. PET imaging characteristics of neuromuscular choristoma and associated desmoid-type fibromatosis. Acta Neurochir (Wien) 2023; 165:1171-1177. [PMID: 36917362 DOI: 10.1007/s00701-023-05547-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 03/01/2023] [Indexed: 03/16/2023]
Abstract
BACKGROUND Neuromuscular choristoma (NMC) is a rare peripheral nerve lesion characterized by abnormal presence of muscle within nerve. Associated desmoid-type fibromatosis (NMC-DTF) often develops. We report 18F-fluorodeoxyglucose positron emission tomography (FDG PET) characteristics of NMC and NMC-DTF and propose that increased FDG activity within NMCs may be associated with subclinical NMC-DTF or NMC-DTF "precursor" tissue. METHODS Our institutional database was searched for all NMC cases. Inclusion criteria were 1) confirmed diagnosis of NMC with or without biopsy, and 2) available PET and MRI studies. PET data included SUVmax and SUVmean of NMCs, contralateral limb normal skeletal muscle and unaffected nerves, and SUVmax of NMC-DTF if present. SUV values were compared using paired t-test. A p value of < 0.05 was considered statistically significant. RESULTS Our cohort consisted of 9 patients with NMC, 8 cases involving sciatic nerve and 1 of brachial plexus. On PET imaging, all NMC-affected nerve segments showed significantly higher FDG uptake (SUVmax/mean) compared to both contralateral normal nerve and normal skeletal muscle (all P < 0.05). Similar to sporadic DTF, NMC-DTF was highly FDG-avid (average SUVmax of 4.2). SUVmax in NMC with or without concurrent NMC-DTF did not differ (p = 0.76). Within NMC-affected nerve segment, FDG activity was relatively higher in areas with low T1/T2 MR signal. CONCLUSION All NMCs were more FDG avid compared to both normal skeletal muscle and contralateral unaffected nerve, arguing against the presence of heterotopic muscle in NMC as the source of FDG avidity. FDG avidity within NMC may reflect subclinical NMC-DTF or a precursor lesion, as NMC-DTF are highly FDG-avid, and the highest regions of FDG avidity in NMC occurred in regions with MR characteristics associated with NMC-DTF (i.e., lower T1/T2 signal). We believe that the integration of FDG PET with serial MR imaging in patient follow up will clarify its utility in both detection and surveillance of NMC-DTF.
Collapse
Affiliation(s)
- Tomas Marek
- Department of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA.,Department of Radiology, University of Florida, Jacksonville, FL, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA.
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Nikhil K Murthy
- Department of Neurologic Surgery, UC San Diego Health, San Diego, CA, USA
| | | | | |
Collapse
|
3
|
Guo W, Wang H, Chen T, Yang W, Wang SF, Chen SL. Clinical features and ultrasound findings of a rare musculoskeletal system disease-neuromuscular choristoma. BMC Musculoskelet Disord 2022; 23:464. [PMID: 35581638 PMCID: PMC9112477 DOI: 10.1186/s12891-022-05238-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
Background Neuromuscular choristomas (NMCs), are extremely rare developmental lesions that, have been previously established associated with recurrent fibromatosis after surgery, leading to several operations or even amputation. However, reports on the ultrasound imaging features and clinical conditions of NMCs are rare. The purpose of this study is to describe the ultrasound features and clinical analysis of NMCs to provide suggestions to identify the optimal management strategy. Methods From September 2020 to September 2021, 7 patients with a confirmed diagnosis of NMC who underwent ultrasound examination in our department were enrolled in our study. Physical examinations were performed to detect motor deficits, sensory deficits, neuropathic pain, limb undergrowth, muscular atrophy, cavus foot and bone dysplasia. Ultrasound imaging was performed and investigated both in affected nerves and neuromuscular choristomas associated desmoid-type fibromatosis (NMC-DTF). All patients had a definite history and regular follow-up. The clinical course, physical examinations, ultrasound features and pathologic results of NMC patients were analyzed. Results Seven patients with an average age of 7.0 ± 7.2 years (range: 2–22 years) were enrolled in our study. The affected nerves included the sciatic nerve (6 cases) and the brachial plexus (1 case). Six patients (85.7%) presented with limb undergrowth, 6 (85.7%) with muscular atrophy, and 5 (71.4%) with cavus foot deformity. Based on ultrasound findings, all the visibly affected nerve segments presented with hypoechoic and fusiform enlargement with intraneural skeletal muscle elements. Five patients (71.4%) had NMC-DTFs at the site of the affected nerve. All NMC-DTFs were shown as hypoechoic solid lesions adjacent to the nerve and were well circumscribed. In the subset of the surgery group, all 5 patients presented with progression to NMC-DTFs at the site of the NMCs. No fibromatosis was detected in the other two nonsurgical patients. Conclusions Understanding the typical ultrasound features and clinically associated conditions would support the early diagnosis of this rare disease. When a potential diagnosis is determined, an invasive procedure such as biopsy or resection might not be a good choice given the frequent occurrence of complications such as aggressive recurrence.
Collapse
Affiliation(s)
- Wen Guo
- Department of Ultrasound, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Hong Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Haidian District, 52 Fucheng Road, Beijing, 100142, China
| | - Tao Chen
- Department of Ultrasound, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China.
| | - Wei Yang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Ultrasound, Peking University Cancer Hospital and Institute, Haidian District, 52 Fucheng Road, Beijing, 100142, China
| | - Shu-Feng Wang
- Department of Hand Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| | - Shan-Lin Chen
- Department of Hand Surgery, Beijing Jishuitan Hospital, Fourth Clinical College of Peking University, No.31 Xinjiekou East Street, Xicheng District, Beijing, 100035, China
| |
Collapse
|
4
|
Murthy NK, Amrami KK, Matthew Howe B, Broski SM, Carter JM, Spinner RJ. Revisiting the imaging appearance of neuromuscular choristoma versus lipomatous lesions of nerve: Nuancing the 50% rule. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101322] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
5
|
Marek T, Mahan MA, Carter JM, Howe BM, Bartos R, Amrami KK, Spinner RJ. What's known and what's new in adipose lesions of peripheral nerves? Acta Neurochir (Wien) 2021; 163:835-842. [PMID: 33089450 DOI: 10.1007/s00701-020-04620-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND Adipose lesions of nerve primarily include intra- and extraneural lipomas and lipomatosis of nerve (LN). This paper will summarize the advances that have been made in the past decade, particularly related to LN and nerve territory overgrowth that have improved our understanding of the natural history, genetic background, diagnosis, imaging features, and clinical management. METHODS AND MATERIALS Articles about adipose lesions of nerve were reviewed from 2011, when the last comprehensive review on this topic was published. Papers reporting advances on natural history, genetic background, diagnosis, imaging features, and clinical management were screened using PubMed and Google Scholar databases and then analyzed. Case reports and small case series were included only if they reported model examples of discussed pathologies, as these types of articles were summarized in recent systematic reviews on intraneural lipomas and LN. All eligible papers were assessed by the authors, who are subject matter experts. RESULTS The first screen revealed 404 articles. After careful evaluation, a total of 53 articles were analyzed which includes advances in diagnosis (especially imaging), classification of the lesions, the role of somatic mutations in PIK3CA in LN, and treatment approaches for all adipose lesions of the peripheral nerve. CONCLUSION Many advances have been made in the understanding of adipose lesions of nerve in the past decade. These pathologic entities are more readily recognized as a spectrum of lesions that share common phenotypic features.
Collapse
Affiliation(s)
- Tomas Marek
- Department of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA
- First Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Mark A Mahan
- Department of Neurologic Surgery, University of Utah, Salt Lake City, UT, 84132, USA
| | - Jodi M Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Benjamin M Howe
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, USA
| | - Robert Bartos
- First Faculty of Medicine, Charles University, Prague, Czech Republic
- Institute of Anatomy, First Faculty of Medicine, Charles University, Prague, Czech Republic
- Department of Neurologic Surgery, Masaryk Hospital, Usti nad Labem, Czech Republic
| | | | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, Gonda 8-214, Rochester, MN, 55905, USA.
| |
Collapse
|