Solitary nasal neurofibroma presenting as compressive optic neuropathy

Unusual paranasal sinus solitary neurofibroma and literature review

Neurofibroma (NF) is a common benign peripheral neurogenic tumor that is rarely encountered in the paranasal sinus tract. In this report, we present a 55-year-old female who serendipitously discovered a maxillary sinus NF during a medical examination for a pulmonary nodule. The purpose of this article is to enhance medical practitioners' comprehension of paranasal sinus solitary NF by exploring cases, summarizing occurrences located in the paranasal sinus tract and conducting an organized review of paranasal sinus tract NF.

Sinonasal Tract Neurofibroma: A Clinicopathologic Series of 12 Cases with a Review of the Literature

Neurofibroma (NF), a benign peripheral nerve sheath tumor, is very uncommon in the sinonasal tract, with only a few reported cases in the English literature. Cases within the files of the authors' institutions confined to the sinonasal tract were compared to cases reported in the English literature (Medline 1966-2014). The 12 patients included 6 females and 6 males, aged 26-75 years (mean 46.2 years). The patients usually presented clinically with a mass lesion (n = 11), obstruction (n = 4) or pain (n = 3), with an average symptom duration of 42.9 months. Two patients had neurofibromatosis (NF1). Tumors involved the nasal cavity alone (n = 8), maxillary sinus alone (n = 2), or mixed sites (n = 2), with a range of 0.4-4.1 cm (mean 2.2 cm). The tumors were circumscribed, composed of spindled to wavy cells with curvilinear nuclei set in a background of collagenized stroma and mast cells. Nuclear palisading and perivascular hyalinization were not seen. Mitoses were scant. Pleomorphism, necrosis and increased cellularity were absent. By immunohistochemistry, the lesional cells were S100 protein, SOX10 and NFP positive, while CD34 highlighted the perineurium. INI1 was intact, with strong nuclear expression in all cases. All patients had surgical excision without recurrence (mean follow-up 8.6 years). The principle differential diagnoses include schwannoma, perineurioma, fibromatosis, and solitary fibrous tumor. NF of the sinonasal tract occurs in middle-aged patients without a gender predilection, usually with non-specific symptoms present for a long duration. Tumors are relatively large (mean 2.2), and usually affect one site only. Surgery is curative, with only 16.7 % NF1 associated. S100 protein, SOX10 and NFP highlight the Schwann cells, with CD34 highlighting the perineural fibroblasts.

Peripheral neural sheath tumors (PNST)--what a radiologist should know

Peripheral neural sheath tumors (PNST) are rare and the common goal of management focuses on eliminating pain and maximizing function of the affected nerve. Therefore preoperative assessment of the specific morphological behaviour of such tumors regarding the nerves internal architecture is of utmost importance. PNSTs may affect one or more fascicles of a peripheral nerve resulting in a significant functional loss after resection and the necessity of functional reconstruction in one step. Enhancement of preoperative information should also address the biological behaviour of the tumor regarding its dignity and the resulting implications on amount of radical resection, additional treatment and prognosis. Since high-resolution techniques promise more and more detail resolution in many fields of imaging, delineation of intra- and extraneural processes as well as biological informations shall lead towards a well prepared and foreseeable image-guided treatment of PNSTs.

Benign peripheral nerve tumors: treatment algorithm and reconstructive options

Peripheral nerve tumors are mostly benign; however, their excision can result in profound deficits. Nerve reconstruction strategies offer techniques to minimize morbidity. In this prospective study, 20 consecutive patients with benign peripheral nerve tumors were treated using a single-stage surgical paradigm between 2003 and 2007. Nerve fascicles were microdissected off of the tumor; any fascicle that gave origin to the tumor (was inseparable from tumor) was reconstructed using nerve conduits. Patients were followed from 6 to 24 months. All patients had neuropathic pain before tumor excision; only 1 patient had pain persist postoperatively. Seventeen patients had complete functional recovery after nerve reconstruction. No perioperative complications occurred. Benign peripheral nerve tumors require highly specialized surgical care. Tumor excision with immediate nerve reconstruction, for fascicles inseparable from the tumor, optimizes outcomes. Nerve reconstruction with available conduits or allografts should be attempted to restore anatomic integrity to any killed fascicles, thereby minimizing possible deficits.