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Kletskaya I, Belousova I, Makarova O, Narbutov A, Oganesyan R, Donati M, Říčař J, Salgado CM, Reyes-Múgica M, Kazakov DV. Schwannian and Perineuriomatous Differentiation in a Series of Giant Congenital Melanocytic Nevi. Am J Dermatopathol 2024; 46:483-491. [PMID: 38842402 DOI: 10.1097/dad.0000000000002754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
ABSTRACT Close relationship between melanocytes and neural cells is accepted to reflect their common derivation from the neural crest and tumors combining both elements. We present a series of 10 patients with giant congenital melanocytic nevi (CMN) in which a secondary proliferation (11 lesions) with schwannian and/or perineuriomatous differentiation developed in the course of the disease. The age of the patients (4 male and 6 female) at the time of surgery and histological assessment varied from 3 months to 57 years. Histopathologically, the following subgroups were delineated: (1) nodular/tumoriform "neurotization" in CMN, (2) diffuse neurofibroma-like proliferation within CMN, (3) plexiform neurofibroma-like proliferation within CMN, and (4) diffuse perineuriomatous (hybrid schwannomatous-perineuriomatous) differentiation in CMN. We review the pertinent literature, including the role of recently identified Schwann cell precursors which are believed to represent the nerve-associated state of neural crest-like cells that persists into later developmental stages.
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Affiliation(s)
- Irina Kletskaya
- Russian Children's Clinical Hospital of Pirogov's Russian National Research Medical University of the Ministry of Healthcare, Russian Federation, Moscow, Russia
- Dmitry Rogachev's National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Irena Belousova
- Department of Dermatology, Medical Military Academy, Saint Petersburg, Russia
| | - Olga Makarova
- Russian Children's Clinical Hospital of Pirogov's Russian National Research Medical University of the Ministry of Healthcare, Russian Federation, Moscow, Russia
| | - Anton Narbutov
- Russian Children's Clinical Hospital of Pirogov's Russian National Research Medical University of the Ministry of Healthcare, Russian Federation, Moscow, Russia
| | - Raisa Oganesyan
- Dmitry Rogachev's National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - Michele Donati
- Department of Pathology, University Hospital Campus Bio-Medico, Rome, Italy
| | - Jan Říčař
- Department of Dermatology, Charles University Medical Faculty Hospital, Pilsen, Czech Republic
| | - Claudia M Salgado
- Division of Pathology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh; and
| | - Miguel Reyes-Múgica
- Division of Pathology, UPMC Children's Hospital of Pittsburgh, University of Pittsburgh School of Medicine, Pittsburgh; and
| | - Dmitry V Kazakov
- IDP Institut für Dermatohistopathologie, Pathologie Institut Enge, Zürich, Switzerland
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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] [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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Goyal-Honavar A, Gupta A, Chacko G, Chacko AG. Trigeminal hybrid nerve sheath tumor - a case report and literature review. Br J Neurosurg 2023; 37:1326-1329. [PMID: 34151661 DOI: 10.1080/02688697.2020.1867061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Accepted: 12/17/2020] [Indexed: 10/21/2022]
Abstract
BACKGROUND Hybrid nerve sheath tumors (HNST) contain elements of more than one established sub-type of nerve sheath tumor and have been recently recognized in the 2016 WHO classification of central nervous system tumors. While common in the peripheral nerves and extracranial branches of cranial nerves, only one case has been previously documented of an intracranial HNST arising from a cranial nerve. CASE DESCRIPTION We describe a large, multi-compartmental intracranial hybrid nerve sheath tumor arising from the trigeminal nerve in a 22-year-old lady who presented with clinical and radiological features suggestive of a right cerebellopontine angle mass. Histopathological examination following retrosigmoid excision of the tumor revealed histological and immunohistochemical features of a schwannoma and a perineurioma. CONCLUSIONS HNSTs are likely to be underreported in the intracranial region. The clinical course of these tumors and the reason for their occurrence in this location are not known.
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Affiliation(s)
| | - Ankush Gupta
- Department of Neurosurgery, Christian Medical College, Vellore
| | - Geeta Chacko
- Department of Pathology, Christian Medical College, Vellore
| | - Ari G Chacko
- Department of Neurosurgery, Christian Medical College, Vellore
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Mendes Penafort PV, Leite AA, Noronha-Júnior F, Vargas PA. Letter to Editor Regarding "Hybrid Neurofibroma/Schwannoma of the Oral Cavity: A Rare Case Report and Literature Review" by Leite et al. Int J Surg Pathol 2023; 31:1163-1165. [PMID: 36314442 DOI: 10.1177/10668969221129891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | - Amanda Almeida Leite
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Fernando Noronha-Júnior
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), São Paulo, Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), São Paulo, Brazil
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Leite AA, Mariz BALA, Oliveira LA, Assunção Júnior JNR, Almeida OPD, Vargas PA. Hybrid Neurofibroma/Schwannoma of the Oral Cavity: A Rare Case Report and Literature Review. Int J Surg Pathol 2023; 31:695-701. [PMID: 35971291 DOI: 10.1177/10668969221117978] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Hybrid peripheral nerve sheath tumors show combined features of more than one type of conventional benign peripheral nerve sheath tumors. There are few cases reported of hybrid peripheral nerve sheath tumors in the head and neck region. A 68-year-old female patient was referred for evaluation of an oral swelling lasting five years. Intraoral examination revealed a small mobile nodule located in the lower vestibule. The patient underwent excisional biopsy and microscopic evaluation showed typical features of neurofibroma enclosing areas with palisading nuclei compatible with Antoni A pattern, which are seen in schwannomas. These regions showed strong and diffuse immunoreactivity for S100 protein and moderate positivity in the neurofibroma area. CD34 was positive in the neurofibroma area and entrapped axons were positive for neurofilament. The final diagnosis was oral hybrid neurofibroma-schwannoma tumor. Hybrid peripheral nerve sheath tumors, although extremely rare, may arise within the oral cavity. To the best of our knowledge, this is the first neurofibroma-schwannoma tumor reported in the oral cavity. Recognizing hybrid peripheral nerve sheath tumors as a distinct clinicopathological entity is important because they may also be associated with syndromic disorders.
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Affiliation(s)
- Amanda Almeida Leite
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Brazil
| | | | | | | | - Oslei Paes de Almeida
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Brazil
| | - Pablo Agustin Vargas
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas (UNICAMP), Brazil
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Lenartowicz KA, Monie DD, Amrami KK, Klein CJ, Giannini C, Spinner RJ. Hybrid tumors with perineurioma components: a systematic review of the literature and illustrative case. Acta Neurochir (Wien) 2023; 165:935-945. [PMID: 36396843 PMCID: PMC10073291 DOI: 10.1007/s00701-022-05413-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 10/26/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE Hybrid peripheral nerve sheath tumors (HPNST) are a newly recognized class of peripheral nerve sheath tumor, composed of at least two areas characteristic of perineurioma, schwannoma, or neurofibroma. The literature consists only of case reports and small series; therefore, we present an illustrative case and an analysis of all reported cases of HPNST with a perineurioma component in the literature. METHODS A systematic search of the literature was performed to identify all reported cases of hybrid perineurioma-schwannoma or perineurioma-neurofibroma in the world's literature. Individual cases were analyzed for demographics, clinical features, imaging, and outcomes. RESULTS A total of 159 cases were identified across 41 studies. Hybrid tumors tended to present in mid-adulthood (median 38.5 years), predominantly affected females (57%, 89/156), as a painless (63%, 63/100) mass, or swelling. Ten patients (10/74, 14%) had a history of neurofibromatosis 1, and 2 patients a history of neurofibromatosis 2 (2/74, 3%). The majority (78%, 122/157) of cases occurred superficially, most commonly in the lower extremity (25%, 39/157). Perineurioma-schwannoma was the most reported (86%, 137/159) pathologic diagnosis, with 3 cases presenting with malignant features. Two cases reocurred after resection. CONCLUSION HPNST tend to occur in mid-adulthood and present as slowly progressive, painless, superficial masses, with a heterogeneous appearance on imaging. These entities pose a unique diagnostic challenge and likely remain under-recognized in the literature and current clinical practice. They pose low risk of recurrence or malignant transformation, and future work regarding the association with neurofibromatosis and genetic profiles is needed.
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Affiliation(s)
- Karina A Lenartowicz
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Dileep D Monie
- Mayo Clinic Alix School of Medicine, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Kimberly K Amrami
- Department of Radiology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Christopher J Klein
- Department of Neurology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Caterina Giannini
- Department of Anatomic Pathology, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA
| | - Robert J Spinner
- Department of Neurologic Surgery, Mayo Clinic, 200 First St SW, MN, 55905, Rochester, USA.
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Practical Approach to Histological Diagnosis of Peripheral Nerve Sheath Tumors: An Update. Diagnostics (Basel) 2022; 12:diagnostics12061463. [PMID: 35741273 PMCID: PMC9222088 DOI: 10.3390/diagnostics12061463] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/01/2022] Open
Abstract
Peripheral nerve sheath tumors encompass a wide spectrum of lesions with different biological behavior, including both benign and malignant neoplasms as well as the recent diagnostic category, i.e., “atypical neurofibromatous neoplasm with uncertain biologic potential” to be used only for NF1 patients. Neurofibromas and schwannomas are benign Schwann-cell-derived peripheral nerve sheath tumors arising as isolated lesions or within the context of classical neurofibromatosis or schwannomatoses. Multiple tumors are a hallmark of neurofibromatosis type 1(NF1) and related forms, NF2-related-schwannomatosis (formerly NF2) or SMARCB1/LZTR1-related schwannomatoses. Perineuriomas are benign, mostly sporadic, peripheral nerve sheath tumors that show morphological, immunohistochemical, and ultrastructural features reminiscent of perineurial differentiation. Hybrid tumors exist, with the most common lesions represented by a variable mixture of neurofibromas, schwannomas, and perineuriomas. Conversely, malignant peripheral nerve sheath tumors are soft tissue sarcomas that may arise from a peripheral nerve or a pre-existing neurofibroma, and in about 50% of cases, these tumors are associated with NF1. The present review emphasizes the main clinicopathologic features of each pathological entity, focusing on the diagnostic clues and unusual morphological variants.
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Haghayeghi K, Telang G, Chen S, Bevivino J, Mangray S, Hui Y, Robinson-Bostom L. A Rare Perineurioma/Granular Cell Tumor Hybrid Peripheral Nerve Sheath Tumor. Am J Dermatopathol 2021; 42:762-765. [PMID: 31977319 DOI: 10.1097/dad.0000000000001606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Hybrid peripheral nerve sheath tumors (PNSTs) are rare benign composite neoplasms demonstrating features of multiple endogenous nerve sheath cell types. Hybrid PNSTs with granular cell components are exceedingly rare. Only a handful number of hybrid PNSTs composed of granular cell tumor and perineurioma have been described to date. We present a rare hybrid of perineurioma and granular cell tumor and review the literature.
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Affiliation(s)
- Koorosh Haghayeghi
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI. Dr. Mangray is now with the Nationwide Children's Hospital, Columbus, OH. Dr. Hui is now with the Memorial Sloan Kattering Institude; and
| | | | - Sonja Chen
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI. Dr. Mangray is now with the Nationwide Children's Hospital, Columbus, OH. Dr. Hui is now with the Memorial Sloan Kattering Institude; and
| | - Jack Bevivino
- Surgery, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI
| | - Shamlal Mangray
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI. Dr. Mangray is now with the Nationwide Children's Hospital, Columbus, OH. Dr. Hui is now with the Memorial Sloan Kattering Institude; and
| | - Yiang Hui
- Department of Pathology and Laboratory Medicine, Warren Alpert Medical School of Brown/Rhode Island Hospital, Providence, RI. Dr. Mangray is now with the Nationwide Children's Hospital, Columbus, OH. Dr. Hui is now with the Memorial Sloan Kattering Institude; and
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9
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Hirose T, Kobayashi A, Nobusawa S, Jimbo N. Hybrid Schwannoma/Perineurioma: Morphologic Variations and Genetic Profiles. Appl Immunohistochem Mol Morphol 2021; 29:433-439. [PMID: 33337633 DOI: 10.1097/pai.0000000000000896] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/11/2020] [Indexed: 11/25/2022]
Abstract
To clarify the morphologic spectrum and molecular profiles of hybrid schwannoma/perineurioma (HSP), we investigated 15 tumors clinicopathologically and cytogenetically. HSP was classified into 2 morphologic types: mixed cellular and combined tumor types. The former comprising of 14 tumors mostly arose in the subcutaneous tissue of the extremities and the trunk of middle-aged adults. They were well-circumscribed and composed of elongated spindle-shaped tumor cells arranged in storiform and whorl patterns. Immunostaining revealed a mixed cellular proliferation of S-100 protein-positive and SOX10-positive Schwann cells and epithelial membrane antigen-positive, claudin 1-positive, and GLUT1-positive perineurial cells. During follow-up, no tumors were found to have recurred in any cases. In contrast, in the combined tumor type arising in the mediastinum of a young male with neurofibromatosis type 2, the intraneural perineurioma-like areas, characterized by small whorl-like structures, were present in plexiform schwannoma-like areas. No recurrence was noted in the case. Molecular analyses (array comparative genomic hybridization and fluorescence in situ hybridization) revealed LOH 22q in 2 tumors of 5 studied: one each of the mixed cellular and combined tumor types. Although the same diagnostic term, HSP, has been applied to both mixed and combined types, they should be separated from each other.
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Affiliation(s)
- Takanori Hirose
- Departments of Pathology for Regional Communication
- Department of Diagnostic Pathology, Hyogo Cancer Center, Akashi
- Department of Diagnostic Pathology, Tokushima Prefectural Central Hospital, Tokushima
| | - Anna Kobayashi
- Department of Diagnostic Pathology, Hyogo Cancer Center, Akashi
| | - Sumihito Nobusawa
- Department of Human Pathology, Gunma University School of Medicine, Maebashi, Japan
| | - Naoe Jimbo
- Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe
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Dickson BC, Antonescu CR, Demicco EG, Leong I, Anderson ND, Swanson D, Zhang L, Fletcher CD, Hornick JL. Hybrid schwannoma-perineurioma frequently harbors VGLL3 rearrangement. Mod Pathol 2021; 34:1116-1124. [PMID: 33649458 PMCID: PMC8154639 DOI: 10.1038/s41379-021-00783-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/02/2021] [Accepted: 02/03/2021] [Indexed: 12/11/2022]
Abstract
Benign peripheral nerve tumors include schwannoma, neurofibroma, and perineurioma, as well as a recently recognized group of tumors with dual patterns of differentiation. The molecular pathogenesis of these so-called "hybrid" tumors remains poorly understood. Following identification of a novel CHD7-VGLL3 fusion gene in a hybrid schwannoma-perineurioma, we evaluated an expanded cohort of this tumor-type-as well as tumors with VGLL3 rearrangement identified from a curated molecular database-to characterize the prevalence of fusion genes among these tumors. Eighteen tumors met the inclusion criteria for this study. RNA sequencing identified VGLL3 rearrangement in 14 of these cases; the partner genes included CHD7 (ten cases), CHD9 (two cases), and MAMLD1 (two cases). Two cases possessed altogether unrelated fusions, including: DST-BRAF and SQSTM1-CDX1 fusion genes. Finally, two cases lacked identifiable fusion products. These findings highlight the molecular diversity of these neoplasms, with frequent rearrangement of VGLL3. More importantly, despite their dual pattern of differentiation, our results reveal the pathogenesis of hybrid schwannoma-perineurioma is unrelated to conventional schwannoma and perineurioma, thereby implying this tumor represents an altogether pathologically distinct entity.
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Affiliation(s)
- Brendan C. Dickson
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada,Corresponding Authors: Brendan C. Dickson, MD, MSc, Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Suite 6.500.12.5, Toronto, Ontario, Canada M5G 1X5, P: (416) 586-4800 / F: (416) 586-8628, ; Jason L. Hornick, MD, PhD, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA 02115, P: (617) 525-7257 / F: (617) 566-3897,
| | | | - Elizabeth G. Demicco
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Iona Leong
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nathaniel D. Anderson
- Cellular Genetics Programme, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - David Swanson
- Department of Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Toronto, Ontario, Canada M5G 1X5; Department of Pathobiology and Laboratory Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lei Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Christopher D.M. Fletcher
- Department of Pathology, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, USA, 02115; Harvard Medical School, Boston, Massachusetts, USA
| | - Jason L. Hornick
- Department of Pathology, Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, USA, 02115; Harvard Medical School, Boston, Massachusetts, USA,Corresponding Authors: Brendan C. Dickson, MD, MSc, Pathology & Laboratory Medicine, Mount Sinai Hospital, 600 University Ave, Suite 6.500.12.5, Toronto, Ontario, Canada M5G 1X5, P: (416) 586-4800 / F: (416) 586-8628, ; Jason L. Hornick, MD, PhD, Department of Pathology, Brigham and Women’s Hospital, Boston, Massachusetts, USA 02115, P: (617) 525-7257 / F: (617) 566-3897,
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11
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Bergamini ML, Noberto LPM, Torres GBMDA, Soares HA, Martins F, Costa ALF, de Souza SOCM, Braz-Silva PH. Primary intra-osseous Hybrid Schwannoma-Perineurioma in the mandible. J Clin Exp Dent 2020; 12:e888-e891. [PMID: 32994880 PMCID: PMC7511049 DOI: 10.4317/jced.57035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2020] [Accepted: 05/14/2020] [Indexed: 11/05/2022] Open
Abstract
Benign nerve sheath tumours include perineuriomas, schwannomas and neurofibromas. Hybrid schwannoma-perineurioma represents a cutaneous, subcutaneous or occasionally intra-osseous tumour with schwannian cytomorphology and perineurioma-like architecture consisting of a mixture of both types of cells. These tumours can develop at any age and there is no gender-predilection. Tongue is the most frequently affected site, followed by palate, mouth floor, jugal mucosa, lips and, more rarely, mandible. We present a case of hybrid tumour with schwannoma-perineurioma morphology located on the right mandibular body (intra-osseous) of a 54-year-old female patient. The tumour was symptomatic and evolving for six months. Microscopically, it was encapsulated and highly cellularised, presenting fascicular aspect and exhibiting scant mitotic activity. The tumour consisted of distinct cellular populations involving fusiform cells, cells with wavy and hyperchromatic nucleus or even epithelioid cells. Positive immunostaining for S-100 and epithelial membrane antigen (EMA) was observed. The lesion was completely removed under general anaesthesia, with the patient showing no clinical or radiographic sign of relapse after two-year follow-up. Despite the limited knowledge on the pathogenesis of Hybrid Schwannoma-Perineurioma, these tumours seem to present a non-aggressive biological behaviour. Conservative surgery provides adequate solution without recurrence, even after a long-term follow-up. Key words:Nerve sheath tumours, Schwannoma, Perineurioma, Immunohistochemistry.
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Affiliation(s)
- Mariana-Lobo Bergamini
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil
| | | | | | - Haroldo-Arid Soares
- Division of Odontology, Municipal Hospital Carmino Caricchio, São Paulo, Brazil
| | - Fabiana Martins
- Department of Dentistry, University of Santo Amaro, São Paulo, Brazil
| | | | | | - Paulo-Henrique Braz-Silva
- Department of Stomatology, School of Dentistry, University of São Paulo, São Paulo, Brazil.,Laboratory of Virology, Institute of Tropical Medicine of São Paulo, School of Medicine, University of São Paulo, São Paulo, Brazil
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12
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Meyer A, Billings SD. What's new in nerve sheath tumors. Virchows Arch 2019; 476:65-80. [PMID: 31707590 DOI: 10.1007/s00428-019-02671-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 08/22/2019] [Accepted: 09/22/2019] [Indexed: 12/16/2022]
Abstract
Peripheral nerve sheath tumors are commonly encountered and frequently pose challenges to the pathologist and the clinician. This review discusses the wide range of entities with an emphasis on new discoveries in the past decade. Clinical, histologic, immunohistochemical, and pathogenetic findings are discussed with an emphasis on clinical implications and differential diagnosis.
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13
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Kilic Bagir E, Acikalin A, Gonlusen G, Zorludemir S, Deveci MA. Hibrid periferik sinir kılıfı tümörleri. CUKUROVA MEDICAL JOURNAL 2019. [DOI: 10.17826/cumj.491823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Ud Din N, Ahmad Z, Abdul-Ghafar J, Ahmed R. Hybrid peripheral nerve sheath tumors: report of five cases and detailed review of literature. BMC Cancer 2017; 17:349. [PMID: 28526004 PMCID: PMC5438510 DOI: 10.1186/s12885-017-3350-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 05/12/2017] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Hybrid peripheral nerve sheath tumors (PNSTs) have been recognized recently and were first included in the 4th edition of World Health Organization (WHO) Classification of Tumors of Soft tissue and Bone, published in 2013. These tumors show combined features of more than one type of conventional benign peripheral nerve sheath tumors. The most common combinations are those of schwannoma/perineurioma followed by combinations of neurofibroma/schwannoma and neurofibroma/perineurioma. A detailed literature review of published cases is presented. We have discussed the types and etiology, epidemiology and sites of localization, gross and microscopic appearances and immunohistochemical features of hybrid PNSTs and association of these tumors with tumor syndromes. CASE PRESENTATION We have included five cases which were diagnosed in our department as we believe that publication of these new cases is relevant for the improved understanding of these specific tumors. Four of our five patients were males, mean age was 24 years. There was wide variation in the location of these tumors. Mean size of excised tumors was 5.5 cms in the greatest dimensions. Three out of five cases represented hybrid schwannoma/perineurioma histologically. No significant nuclear atypia, mitotic activity or necrosis seen. All five cases were completely excised. All five patients are alive and well at the time of writing with no recurrence. CONCLUSION Hybrid PNSTs are distinct tumors and are usually benign. However, rare case reports have described local recurrence and at least two recent case reports have described malignant transformation in these tumors. Further studies on large number of cases are required to determine the exact pathogenetic basis of these tumors.
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Affiliation(s)
- Nasir Ud Din
- 0000 0004 0606 972Xgrid.411190.cDepartment of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Zubair Ahmad
- 0000 0004 0606 972Xgrid.411190.cDepartment of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Jamshid Abdul-Ghafar
- Department of Pathology and Laboratory Medicine, French Medical Institute for Mothers & Children (FMIC), Behind Kabul Medical University Aliabad, P.O. Box: 472, Kabul, Afghanistan
| | - Rashida Ahmed
- 0000 0004 0606 972Xgrid.411190.cDepartment of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Michal M, Kazakov DV, Agaimy A, Hosova M, Michalova K, Grossmann P, Steiner P, Skenderi F, Vranic S, Michal M. Whorling cellular perineurioma: A previously undescribed variant closely mimicking monophasic fibrous synovial sarcoma. Ann Diagn Pathol 2017; 27:74-78. [PMID: 28325366 DOI: 10.1016/j.anndiagpath.2017.02.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 02/01/2017] [Indexed: 11/18/2022]
Abstract
The authors present a distinctive perineurioma (PN) variant which morphologically strongly resembles monophasic fibrous synovial sarcoma (MSS). The patients were 3 males and 1 female. The age ranged from 15 to 61years (mean: 44years). Locations included the sole, lower jaw, palm and foot. The tumor size ranged from 1.3cm to 2.5cm in the largest dimension (mean 1.8cm). Morphologically, all tumors had an identical, monotonous appearance. The perineurial cells were closely packed and created a confluent cellular whorls and/or sheets in a scarce stroma, with only focally discernible long, slender cytoplasmic processes typical for perineurial differentiation. The nuclei were rounded or slightly elongated to tapered, without nuclear atypia. Mitoses were rare to completely absent. Atypical mitoses, hemorrhage, necrosis or calcifications were not present. The proliferative index (Ki-67) was 1-3%. All analyzed tumors were positive for EMA, Claudin-1, GLUT-1 and negative with S100 protein, CD34, OSCAR, CK7 and TLE-1. Two cases were tested by fluorescence in situ hybridization and neither showed alterations of the SYT gene. One case studied by electron microscopy showed characteristic features of perineurial differentiation. Follow-up was available for two patients both of which showed no evidence of disease at 8years and 6months, respectively. Based on their bland morphology, perineurial features and presumably benign clinical outcome we propose the term "whorling cellular perineurioma" for these tumors, which may represent an extremely cellular variant of sclerosing PN. Awareness of this PN subtype and its distinction from MSS is of utmost clinical significance.
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Affiliation(s)
- Michael Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic; Biomedical Center of the Faculty of Medicine in Pilsen, Alej Svobody 80, 304 60 Pilsen, Czech Republic.
| | - Dmitry V Kazakov
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Abbas Agaimy
- Institute of Pathology, Friedrich-Alexander University Erlangen-Nürnberg, University Hospital, Krankenhausstrasse 8-10, 910 54, Erlangen, Germany
| | - Marta Hosova
- Department of Pathology, Faculty Hospital, Budínova 67/2, 180 81 Prague, Czech Republic
| | - Kvetoslava Michalova
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Petr Grossmann
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Petr Steiner
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
| | - Faruk Skenderi
- Department of Pathology, Clinical Center, University of Sarajevo, Bolnička 25, 710 00 Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- Department of Pathology, Clinical Center, University of Sarajevo, Bolnička 25, 710 00 Sarajevo, Bosnia and Herzegovina; School of Medicine, Bolnička 25, 710 00 Sarajevo, Bosnia and Herzegovina
| | - Michal Michal
- Department of Pathology, Faculty of Medicine in Pilsen, Charles University, Alej Svobody 80, 304 60 Pilsen, Czech Republic
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16
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Torres-Mora J, Ud Din N, Ahrens WA, Folpe AL. Pseudolipoblastic perineurioma: an unusual morphological variant of perineurioma that may simulate liposarcoma. Hum Pathol 2016; 57:22-27. [PMID: 27395366 DOI: 10.1016/j.humpath.2016.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/07/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022]
Abstract
Perineuriomas are rare peripheral nerve sheath tumors arising from or differentiating along the lines of normal perineurial cells. They can be divided into intraneural and soft tissue types, with the latter category including a significant number of morphological variants. Herein, we further expand their morphological spectrum to include "pseudolipoblastic" perineuriomas. These lesions occurred in the tongue of a 30-year-old man and in the triceps of a 67-year-old woman and were characterized by bland, epithelioid cells with striking intracytoplasmic vacuolization. The architecture varied, with some areas showing a striking "net-like" or "microreticular" pattern and smaller areas having a more typical spindled and whorled appearance. Clinical follow-up (5months and 52months, respectively) showed no evidence of local recurrence or metastasis. Multiple perineurial markers, including epithelial membrane antigen, claudin-1, GLUT-1, and collagen IV, were diffusely positive. Both cases were submitted in consultation out of concern that they represented high-grade liposarcomas. To the best of our knowledge, this unusual morphological variant of perineurioma has not been reported. These tumors appear to be entirely benign and should be cured with simple excision. Pseudolipoblastic perineuriomas should be distinguished from round cell and epithelioid pleomorphic liposarcomas, as well as from other tumors that may show prominent intracytoplasmic vacuolization.
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Affiliation(s)
- Jorge Torres-Mora
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester 55905, MN, USA
| | - Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester 55905, MN, USA.
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17
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Kazakov DV, Magro G, Yu Orlov A, Shelekhova KV, Matsko DE, Spagnolo DV, Michal M. Benign Schwannoma With Perineurioma-Like Areas: A Clinicopathologic Study of 11 Cases. Int J Surg Pathol 2016; 14:320-5. [PMID: 17041195 DOI: 10.1177/1066896906293417] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Eleven schwannomas are described. All tumors were well demarcated and surrounded by a true capsule or pseudocapsule and manifested Antoni A and Antoni B areas, Verocay bodies, and hyalinized vessels. In addition to typical schwannoma, there were clear cell areas composed of spindled cells arranged either in parallel sheets or in loops within the myxoid matrix, morphologically identical to retiform (reticular) perineurioma. The Schwann cells in the conventional schwannomatous areas displayed typical ultrastructural features. Those comprising the perineurioma-like areas revealed a primitive morphology. They were slender or polygonal and were devoid of an external lamina, pinocytic vesicles, or junctions. These findings suggest that the perineurioma-like areas consist of primitive or modified Schwann cells, or, alternatively, these perineurioma-like areas represent true, but incomplete perineurial differentiation within otherwise ordinary benign schwannomas. These neoplasms represent a morphologic variant of schwannoma having distinctive perineurial-like areas, a pattern which may elicit diagnostic difficulties.
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Affiliation(s)
- Dmitry V Kazakov
- Sikl's Department of Pathology, Charles University, Medical Faculty Hospital, Pilsen, Czech Republic
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18
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19
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Abstract
Neurofibromas and schwannomas are common lesions that may be idiopathic or may occur in association with neural crest genetic syndromes such as neurofibromatosis type 1, neurofibromatosis type 2, and schwannomatosis. A hybrid tumor that contains pathological characteristics of both neurofibroma and schwannoma has been described as a rare entity. We present the clinical, radiographic, and pathological findings of such a case.
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Affiliation(s)
| | | | | | - Michael Glantz
- Department of Neurosurgery, Penn State Hershey Medical Center
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20
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Abstract
This article presents an overview of the diagnostic categories of benign and malignant nerve sheath tumors, including neuroma, neurofibroma, nerve sheath myxoma, perineurioma, schwannoma, and malignant peripheral nerve sheath tumor. The discussion emphasizes histologic patterns; ancillary studies, such as immunohistochemistry; and differential diagnoses. The information is of value to practicing pathologists in both community and academic settings.
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Affiliation(s)
- Ashley M Cimino-Mathews
- Department of Pathology, The Johns Hopkins Hospital, Weinberg 2242, 401 North Broadway, Baltimore, MD 21231-2410, USA
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21
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Panda KM, Reena N. Intraneural Hybrid Neurofibroma/Schwannoma In Scalp: A Case Report. J Clin Diagn Res 2015; 9:ED05-6. [PMID: 26557528 DOI: 10.7860/jcdr/2015/15723.6600] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2015] [Accepted: 08/28/2015] [Indexed: 11/24/2022]
Abstract
Benign Peripheral Nerve Sheath Tumours (BPNSTs) are traditionally classified into schwannoma, neurofibroma and perinurioma. Due to advances in molecular techniques, hybrid BPNSTs containing more than one histologic types have been documented. Recent studies have demonstrated their frequent association with inherited syndromes like schwannomatosis and neurofibromatosis. Intraneural variant of hybrid neurofibroma/schwannoma is yet to be described. Here we report such a case in a 30-year-old male, who presented with a scalp swelling and histology showed intraneural neurofibromatous tumour admixed with schwannoma-like nodules. IHC (immunohistochemistry) showed variable S100 staining in neurofibromatous areas, diffuse S100 staining in schwannoma-like areas and negative EMA staining in the tumour.
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Affiliation(s)
- Kishori Moni Panda
- Professor and HOD, Department of Pathology, Government Medical College (LSLAMMC) , Raigarh, Chhattishgarh, India
| | - Naik Reena
- Demonstrator, Department of Pathology, Government Medical College (LSLAMMC) , Raigarh, Chhattishgarh, India
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22
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Luzar B, Tanaka M, Schneider J, Calonje E. Cutaneous microcystic/reticular schwannoma: a poorly recognized entity. J Cutan Pathol 2015; 43:93-100. [PMID: 26350054 DOI: 10.1111/cup.12624] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Revised: 07/19/2015] [Accepted: 08/02/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND Microcystic/ reticular schwannoma is exceptionally rare yet distinctive morphological variant of schwannoma with predilection for visceral sites lacking association with neurofibromatosis. AIMS To further delineate clinicopathological features of cutaneous microcystic/reticular schwannoma and to discuss its differential diagnosis. RESULTS We analyzed three cutaneous microcystic/reticular schwannomas, occurring in two males and one female (mean age: 37.6 years). The tumors presented as a non-painful slightly raised papule (mean: 0.7 cm) on upper arm (n = 2) and back (n = 1). No recurrences were observed despite marginal excision (mean follow up: 42 months). Histopathologically, a multilobular proliferation was present in the dermis composed of bland tumor cells forming distinctive microcystic, reticular, lace-like or pseudoglandular structures, containing abundant myxoid/mucinous material. By immunohistochemistry, tumor cells lining microcystic structures corresponded to Schwann cells (diffuse S100 positive, variable GFAP positivity). A discontinuous EMA-positive perineurium was present at the periphery of some of the lobules. CONCLUSION Cutaneous microcystic/reticular schwannoma expands the spectrum of benign peripheral nerve sheath tumors with reticular morphology encountered in the skin. Other tumors in this group include reticular perineurioma and hybrid tumors with reticular morphology, e.g. reticular perineurioma/schwannoma and reticular perineurioma/neurofibroma.
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Affiliation(s)
- Boštjan Luzar
- Institute of Pathology, Medical Faculty University of Ljubljana, Ljubljana, Slovenia
| | - Maiko Tanaka
- Department of Dermatology, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - Johann Schneider
- Division of Anatomical Pathology at University of Stellenbosch, Cape Town, South Africa
| | - Eduardo Calonje
- Department of Dermatopathology, St John's Institute of Dermatology, St Thomas' Hospital, London, UK
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23
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McLaughlin CT, Kaffenberger BH, Gru AA. A hybrid tumor with schwannoma-perineurioma-neurofibroma morphology. J Cutan Pathol 2015; 42:911-3. [PMID: 26147119 DOI: 10.1111/cup.12544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/19/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Colin T McLaughlin
- Division of Dermatology, Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Alejandro A Gru
- Division of Dermatology, Ohio State University College of Medicine, Columbus, OH, USA.
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24
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Primary intraosseous hybrid nerve sheath tumor of femur: A hitherto undescribed occurrence in bone with secondary aneurysmal bone cyst formation resulting in pathological fracture. Pathol Res Pract 2015; 211:409-14. [DOI: 10.1016/j.prp.2014.10.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2014] [Revised: 10/25/2014] [Accepted: 10/31/2014] [Indexed: 11/21/2022]
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25
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Abstract
This article reviews key changes in the current 2013 World Health Organization Classification of soft tissue tumors.
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Affiliation(s)
- K V Shelekhova
- Clinical Research and Practical Center for Specialized Oncological Care, N.N. Petrov Research Institute of Oncology, Saint Petersburg
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26
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Hechtman JF, Harpaz N. Neurogenic polyps of the gastrointestinal tract: a clinicopathologic review with emphasis on differential diagnosis and syndromic associations. Arch Pathol Lab Med 2015; 139:133-9. [PMID: 25549149 DOI: 10.5858/arpa.2013-0431-rs] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Primary neurogenic gastrointestinal polyps are encountered relatively frequently in routine pathology practice. They encompass a variety of neoplastic entities with clinical, morphologic, and molecular features that reflect the diversity of neural elements within the gastrointestinal system. Although most are benign and encountered incidentally, accurate diagnosis may have important clinical implications because of the associations of certain neurogenic polyps with familial syndromes or other conditions. We review the pathology of these polyps with an emphasis on the diagnostic challenges that they pose and on newly described subtypes.
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Affiliation(s)
- Jaclyn F Hechtman
- From the Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York (Dr Hechtman); and the Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, New York (Dr Harpaz)
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27
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Benign Cutaneous Biphasic Hybrid Tumor of Perineurioma and Cellular Neurothekeoma. Am J Dermatopathol 2015; 37:319-22. [DOI: 10.1097/dad.0000000000000105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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28
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Saeki H, Ito K, Nobeyama Y, Ishiji T, Fukunaga M, Nakagawa H. Hybrid peripheral nerve sheath tumour with intermingled perineuriomatous and schwannomatous areas reflected in skin ultrasonography image. Clin Exp Dermatol 2014; 39:747-9. [PMID: 24985502 DOI: 10.1111/ced.12370] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 11/27/2022]
Affiliation(s)
- H Saeki
- Department of Dermatology, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
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29
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Misago N, Toda S, Narisawa Y. The Relationship Between Palisaded Encapsulated Neuroma and the Mucocutaneous Neuroma Seen in Multiple Endocrine Neoplasia 2b Syndrome. Am J Dermatopathol 2014; 36:562-9. [DOI: 10.1097/dad.0000000000000021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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30
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Agaimy A, Buslei R, Coras R, Rubin BP, Mentzel T. Comparative study of soft tissue perineurioma and meningioma using a five-marker immunohistochemical panel. Histopathology 2014; 65:60-70. [DOI: 10.1111/his.12366] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Accepted: 01/04/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Abbas Agaimy
- Institute of Pathology; University Hospital; Erlangen Germany
| | - Rolf Buslei
- Institute of Neuropathology; University Hospital; Erlangen Germany
| | - Roland Coras
- Institute of Neuropathology; University Hospital; Erlangen Germany
| | - Brian P Rubin
- Robert J. Tomsich Pathology and Laboratory Medicine Institute; Cleveland Clinic; Cleveland OH USA
| | - Thomas Mentzel
- Dermatopathologische Gemeinschaftspraxis; Friedrichshafen Germany
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31
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Las Heras F, Martuza R, Caruso P, Rincon S, Stemmer-Rachamimov A. 24-year-old woman with an internal auditory canal mass. Hybrid peripheral nerve sheath tumor with schwannoma/perineurioma components. Brain Pathol 2013; 23:361-2. [PMID: 23587143 DOI: 10.1111/bpa.12055] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Benign peripheral nerve sheath tumors are divided into schwannomas, neurofibromas and perineuriomas. In recent years, tumors with hybrid features, composed of multiple, discrete areas of different histological types, were described. These tumors may represent a diagnostic challenge. A 24-year-old woman with multiple sclerosis was found to have a 1.3 cm TV × 0.7 cm AP T2 intermediate lesion within the left internal auditory canal. Gross examination revealed a tan-white, well circumscribed mass. Histologic examination demonstrated a well demarcated, cellular, solid neoplasm with a biphasic pattern. Most of the tumor was composed of spindle cells arranged in fascicles with focal Verocay body formation and diffuse S100 positivity. A second, minor area showed concentric proliferation of neoplastic spindle cells around one or more axons. Tumor cells in this area were positive for perineurial markers, claudin-1 and Glut-1, and focally immunopositive for CD34.We present here a case of a benign peripheral nerve sheath tumor with histological and immunohistochemical features consistent with a dual pattern of differentiation of schwannoma and perineurioma, in the VIIIth cranial nerve. This is, to our knowledge, the first case of a hybrid perineurioma/schwannoma reported in a cranial nerve.
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Affiliation(s)
- Facundo Las Heras
- Department of Anatomical Pathology, University of Chile Clinical Hospital
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32
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Yamada S, Kitada S, Nabeshima A, Noguchi H, Sasaguri Y, Hisaoka M. Benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma arising from the nose. Diagn Pathol 2013; 8:165. [PMID: 24103568 PMCID: PMC3853886 DOI: 10.1186/1746-1596-8-165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/28/2013] [Indexed: 11/10/2022] Open
Abstract
Very recently, Requena et al. have demonstrated the detailed clinicopathological features of 9 cases of a benign cutaneous plexiform nerve sheath tumor with hybrid characteristics of perineurioma and cellular neurothekeoma, given the name as a benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma, all of which were peculiarly located on the lips. Herein we described the first case of that arising from the nose, but not the lip, representing a histological hybridoma of perineurioma and cellular neurothekeoma after thorough consideration especially with its immunohistochemical profile.
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Affiliation(s)
- Sohsuke Yamada
- Department of Pathology and Cell Biology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, Yahatanishi-ku 807-8555, Japan.
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33
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Hybrid Peripheral Nerve Sheath Tumors, Including a Malignant Variant in Type 1 Neurofibromatosis. Am J Dermatopathol 2013; 35:641-9. [DOI: 10.1097/dad.0b013e31827e2917] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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34
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Hayashi T, Hirose T, Nishimura Y, Fukuoka J, Kishikawa M. Hybrid schwannoma/perineurioma of the spinal nerve: Multifocal occurrence, and recurrence as an intraneural perineurioma. Pathol Int 2013; 63:368-73. [DOI: 10.1111/pin.12073] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 05/28/2013] [Indexed: 11/30/2022]
Affiliation(s)
| | - Takanori Hirose
- Department of Diagnostic Pathology; Tokushima Prefectural Central Hospital; Tokushima; Japan
| | | | - Junya Fukuoka
- Department of Pathology; Nagasaki University Hospital; Nagasaki; Japan
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35
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A Benign Cutaneous Plexiform Hybrid Tumor of Perineurioma and Cellular Neurothekeoma. Am J Surg Pathol 2013; 37:845-52. [DOI: 10.1097/pas.0b013e31827edfda] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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36
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Fuertes L, Santonja C, Kutzner H, Requena L. Inmunohistoquímica en dermatopatología: revisión de los anticuerpos utilizados con mayor frecuencia (parte ii). ACTAS DERMO-SIFILIOGRAFICAS 2013; 104:181-203. [DOI: 10.1016/j.ad.2012.02.018] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 02/02/2012] [Indexed: 11/28/2022] Open
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37
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Fuertes L, Santonja C, Kutzner H, Requena L. Immunohistochemistry in Dermatopathology: A Review of the Most Commonly Used Antibodies (Part II). ACTA ACUST UNITED AC 2013. [DOI: 10.1016/j.adengl.2013.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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38
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Wang L, Wang G, Gao T. Congenital melanocytic nevus with features of hybrid schwannoma/perineurioma. J Cutan Pathol 2013; 40:497-502. [PMID: 23485147 DOI: 10.1111/cup.12076] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Revised: 12/12/2012] [Accepted: 12/16/2012] [Indexed: 11/28/2022]
Affiliation(s)
- Lei Wang
- Department of Dermatology, Xijing Hospital; Fourth Military Medical University; Xian; China
| | - Gang Wang
- Department of Dermatology, Xijing Hospital; Fourth Military Medical University; Xian; China
| | - Tianwen Gao
- Department of Dermatology, Xijing Hospital; Fourth Military Medical University; Xian; China
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39
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Laulajainen M, Melikova M, Muranen T, Carpén O, Grönholm M. Distinct overlapping sequences at the carboxy-terminus of merlin regulate its tumour suppressor and morphogenic activity. J Cell Mol Med 2013; 16:2161-75. [PMID: 22325036 PMCID: PMC3822986 DOI: 10.1111/j.1582-4934.2012.01525.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
The Neurofibromatosis 2 (NF2) gene product merlin is a tumour suppressor, which in addition to inhibiting cell proliferation regulates cell morphology. The morphogenic properties of merlin may play a role in tumour suppression, as patient-derived tumour cells demonstrate cytoskeletal abnormalities. However, it is still unclear how these functions are linked. The N-terminal FERM-domain of merlin is highly homologous to the oncogenic protein ezrin, while the C-termini are less conserved, suggesting that the opposite effect of the proteins on proliferation could be mediated by their distinct C-terminal regions. In this study we characterize the role of the most C-terminal residues of merlin in the regulation of proliferation, cytoskeletal organization, phosphorylation and intramolecular associations. In addition to the two full-length merlin isoforms and truncating mutations found in patients, we focused on the evolutionally conserved C-terminal residues 545-547, also harbouring disease-causing mutations. We demonstrate that merlin induces cell extensions, which result from impaired retraction of protrusions rather than from increased formation of filopodia. The residues 538-568 were found particularly important for this morphogenic activity. The results further show that both merlin isoforms are able to equally inhibit proliferation, whereas C-terminal mutants affecting residues 545-547 are less effective in growth suppression. This study demonstrates that the C-terminus contains distinct but overlapping functional domains important for regulation of the morphogenic activity, intramolecular associations and cell proliferation.
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Affiliation(s)
- Minja Laulajainen
- Biomedicum Helsinki, Department of Pathology, University of Helsinki, Helsinki, Finland.
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40
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Izquierdo FM, Suárez-Vilela D, Honrado E. Intraneural hybrid granular cell tumor-perineurioma. APMIS 2012; 121:678-80. [DOI: 10.1111/apm.12038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Francisco M. Izquierdo
- Servicio de Anatomía Patológica; Complejo Asistencial Universitario de León; León; Spain
| | - Dimas Suárez-Vilela
- Servicio de Anatomía Patológica; Hospital Valle del Nalón; Riaño-Langreo; Asturias; Spain
| | - Emiliano Honrado
- Servicio de Anatomía Patológica; Complejo Asistencial Universitario de León; León; Spain
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Lang SS, Zager EL, Coyne TM, Nangunoori R, Kneeland JB, Nathanson KL. Hybrid peripheral nerve sheath tumor. J Neurosurg 2012; 117:897-901. [DOI: 10.3171/2012.8.jns111841] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
In recent literature, there have been case reports of an extremely rare entity characterized by hybrid peripheral nerve tumors consisting of elements of neurofibroma, schwannoma, and/or perineurioma. The authors present a unique case of a patient with multiple painful hybrid tumors with negative genetic testing for neurofibromatosis Type 1 and no clinical evidence of neurofibromatosis Type 2 or schwannomatosis.
A 28-year-old woman presented with tentatively diagnosed schwannomatosis. She had painful bilateral retromastoid scalp tumors as well as multiple other painful tumors in the distribution of the saphenous, femoral, and sciatic nerves. Her family history was significant for a paternal grandfather with a solitary schwannoma. The patient underwent multiple surgical procedures for tumor resection, including tumors in the regions of the retromastoid scalp, bilateral sciatic nerves, left femoral nerve, and left axilla. These tumors were examined and evaluated histologically. Within the tumors, components of both neurofibromas and schwannomas were found, even though these 2 peripheral nerve sheath tumors have been long considered to be distinct entities. This case report suggests a distinct syndrome that has not previously been appreciated.
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Affiliation(s)
| | | | - Thomas M. Coyne
- 2Pathology and Laboratory Medicine, Division of Neuropathology,
| | | | - J. Bruce Kneeland
- 5Department of Radiology, Pennsylvania Hospital, Philadelphia, Pennsylvania
| | - Katherine L. Nathanson
- 3Medicine, Translational Medicine and Human Genetics, and
- 4Abramson Cancer Center, Perelman School of Medicine at the University of Pennsylvania; and
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Yang X, Zeng Y, Wang J. Hybrid schwannoma/perineurioma: report of 10 Chinese cases supporting a distinctive entity. Int J Surg Pathol 2012; 21:22-8. [PMID: 22832113 DOI: 10.1177/1066896912454566] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Hybrid schwannoma/perineurioma is a recently described benign nerve sheath tumor that typically manifests as a dermal tumor on the extremities and trunk. Occurrence outside the skin is uncommon. This article describes 10 cases of hybrid schwannoma/perineurioma arising in diverse anatomic locations. They all occurred in adult patients (age range 27-81 years, median 35 years) with a marked female predominance (2 males and 8 females). Of the 10 tumors, 7 were situated in the subcutis of trunk (n = 3), extremities (n = 2), neck (n = 1), and labium majus (n = 1) and 3 in the submucosa of nasal cavity, sigmoid colon, and rectum, respectively. Histologically, they were composed of intimately admixed plump spindle cells and elongated slender spindle cells forming storiform, lamellar or fascicular architecture. By immunohistochemistry, the tumor showed dual differentiation of schwannian cells (plump-spindled) and perineurial cells (slender-spindled), characterized by strong S100 protein expression in the former component and variable immunoreactivity of epithelial membrane antigen, claudin-1, and CD34 in the latter. Awareness of its morphological characteristics and potential occurrence in diverse sites may aid in the recognition of this rare tumor type.
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Affiliation(s)
- Xiaoqun Yang
- Fudan University, Shanghai Cancer Hospital, Shanghai, China
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Abstract
Neurogenic tumors are an uncommon yet important category of soft tissue tumors in children and adolescents because of their frequent association with various genetic syndromes. The heterogeneous cellular composition of the peripheral nerve and the wide metaplastic capacity of the neural crest and its derivatives generate a variety of neoplasms with neurogenic differentiation. This article reviews the clinicopathologic features and differential diagnosis of neurogenic tumors in the first two decades of life, and highlights use of selected ancillary methods for diagnosis.
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Affiliation(s)
- Justin M M Cates
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Matter A, Hewer E, Kappeler A, Fleischmann A, Vajtai I. Plexiform hybrid granular cell tumor/perineurioma: A novel variant of benign peripheral nerve sheath tumor with divergent differentiation. Pathol Res Pract 2012; 208:310-4. [DOI: 10.1016/j.prp.2012.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 02/18/2012] [Accepted: 02/27/2012] [Indexed: 12/14/2022]
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Rodriguez FJ, Folpe AL, Giannini C, Perry A. Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems. Acta Neuropathol 2012; 123:295-319. [PMID: 22327363 DOI: 10.1007/s00401-012-0954-z] [Citation(s) in RCA: 402] [Impact Index Per Article: 33.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2011] [Revised: 01/30/2012] [Accepted: 01/31/2012] [Indexed: 12/11/2022]
Abstract
Peripheral nerve sheath tumors are common neoplasms, with classic identifiable features, but on occasion, they are diagnostically challenging. Although well-defined subtypes of peripheral nerve sheath tumors were described early in the history of surgical pathology, controversies regarding the classification and grading of these tumors persist. Advances in molecular biology have provided new insights into the nature of the various peripheral nerve sheath tumors, and have begun to suggest novel targeted therapeutic approaches. In this review, we discuss current concepts and problematic areas in the pathology of peripheral nerve sheath tumors. Diagnostic criteria and differential diagnosis for the major categories of nerve sheath tumors are proposed, including neurofibroma, schwannoma, and perineurioma. Diagnostically challenging variants, including plexiform, cellular and melanotic schwannomas are highlighted. A subset of these affects the childhood population, and has historically been interpreted as malignant, although current evidence and outcome data suggest they represent benign entities. The growing current literature and the author's experience with difficult to classify borderline or "hybrid tumors" are discussed and illustrated. Some of these classification gray zones occur with frequency in the gastrointestinal tract, an anatomical compartment that must always be entertained when examining these neoplasms. Other growing recent areas of interest include the heterogeneous group of pseudoneoplastic lesions involving peripheral nerve composed of mature adipose tissue and/or skeletal muscle, such as the enigmatic neuromuscular choristoma. Malignant peripheral nerve sheath tumors (MPNST) represent a diagnostically controversial group; difficulties in grading and guidelines to separate "atypical neurofibroma" from MPNST are provided. There is an increasing literature of MPNST mimics which neuropathologists must be aware of, including synovial sarcoma and ossifying fibromyxoid tumor. Finally, we discuss entities that are lacking from the section on cranial and paraspinal nerves in the current WHO classification, and that may warrant inclusion in future classifications. In summary, although the diagnosis and classification of most conventional peripheral nerve sheath tumors are relatively straightforward for the experienced observer, yet borderline and difficult-to-classify neoplasms continue to be problematic. In the current review, we attempt to provide some useful guidelines for the surgical neuropathologist to help navigate these persistent, challenging problems.
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Affiliation(s)
- Fausto J Rodriguez
- Division of Neuropathology, Department of Pathology, Johns Hopkins University, 720 Rutland Avenue, Ross Building, 512B, Baltimore, MD 21205, USA.
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Ohata C, Imai N, Hinogami H, Akamatsu K, Sumimura Y. Hybrid schwannoma/perineurioma: a report of two cases including a possible radiation-induced case. J Cutan Pathol 2011; 39:56-62. [DOI: 10.1111/j.1600-0560.2011.01805.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Dendritic Cell Neurofibroma Sine Pseudorosettes: Report of a Case With a Granulomatous Appearance. Am J Dermatopathol 2011; 33:742-4. [DOI: 10.1097/dad.0b013e318206f66a] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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48
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Routine Use of Immunohisto-chemistry May Increase the Frequency of Hybrid Peripheral Nerve Sheath Tumors. Am J Dermatopathol 2011; 33:634-6. [DOI: 10.1097/dad.0b013e318200f722] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Agaimy A, Bohle RM, Schick B, Bumm K. Perineurioma of the parotid gland: first case report. Hum Pathol 2011; 42:904-8. [DOI: 10.1016/j.humpath.2010.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2010] [Revised: 09/05/2010] [Accepted: 09/08/2010] [Indexed: 10/18/2022]
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50
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Reply to letter to the editor: hybrid peripheral nerve sheath tumor. Med Mol Morphol 2011. [DOI: 10.1007/s00795-010-0527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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