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Sun KH, Goyal SP, Kim EM, Mantilla-Rivas E, Rogers GF, Gulino SP. Rare Hybrid Perineurioma and Granular Cell Tumor: A Pediatric Case. Pediatr Dev Pathol 2024:10935266241274529. [PMID: 39248325 DOI: 10.1177/10935266241274529] [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] [Indexed: 09/10/2024]
Abstract
We present a case of a 13-year-old patient with a distinct tumor with both granular cell and perineurial elements, located on the lower lip. The patient presented with a long-standing lip mass that was clinically felt to most likely represent a mucocele. Following surgical excision, histopathological examination revealed a well-circumscribed tumor composed of granular cells with positive S100 protein staining and spindled cells positive for EMA and GLUT-1, confirming mixed neuroectodermal and perineurial origin. This is the first case documenting a perineurial-granular cell hybrid tumor in a patient under 18 years old, and the first to be reported in the head and neck. This case expands our understanding of hybrid PNSTs, emphasizing the importance of considering diverse clinical presentations, especially in the context of rare pediatric occurrences in atypical locations.
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Affiliation(s)
- Kennedy H Sun
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | - Sonia P Goyal
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
| | - Evelyn M Kim
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Esperanza Mantilla-Rivas
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Gary F Rogers
- Division of Plastic and Reconstructive Surgery, Children's National Hospital, Washington, DC, USA
| | - Sam P Gulino
- Division of Pathology and Laboratory Medicine, Children's National Hospital, Washington, DC, USA
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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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3
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Singh S, Choong P, Ali M, Lindsay D, Saifuddin A. Hybrid peripheral nerve sheath tumours: MRI features with pathological correlation in 24 cases. Br J Radiol 2024; 97:126-134. [PMID: 38263815 PMCID: PMC11008504 DOI: 10.1093/bjr/tqad001] [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: 02/03/2023] [Revised: 09/13/2023] [Accepted: 09/25/2023] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES To describe the MRI features of histologically proven hybrid peripheral nerve sheath tumours (HPNST). METHODS A retrospective analysis of the MRI features of 24 histologically proven cases of HPNST over 7 years. Demographic data obtained from clinical records included age, gender, and date of diagnosis. Two readers independently assessed MRI studies and assessed the following features: involvement of a major nerve, intramuscular location, lesion morphology, entering nerve sign, exiting nerve sign, target sign, fascicular sign, split fat sign, and ancient change (cystic change). Inter-observer agreement was assessed with Cohen's kappa coefficient. Histological diagnosis was based on either image-guided needle biopsy or resection histology. RESULTS The study included 9 males and 15 females with mean age 50 years (range: 24-78 years). Nine tumours (35%) involved a major nerve including spinal roots (5), radial (1), median (1), tibial (1), and axillary (1), while 5 (21%) tumours were intramuscular. The mean tumour size was 4.2 cm (standard deviation of 2.4 cm). The frequency of MRI features was as follows: lobular contour (71%; 17/24), ancient change (38%; 9/24), fascicular sign (17%; 4/24), entering nerve sign (21%; 5/24), exiting nerve sign (13%; 3/24), target sign (13%; 3/24), and split fat sign (8%; 2/24). Inter-observer agreement was high, ranging from 0.7 to 0.83. CONCLUSIONS HPNST infrequently demonstrate the classical MRI signs of benign peripheral nerve sheath tumours, but commonly have a lobular morphology and can show ancient/cystic change. ADVANCES IN KNOWLEDGE This is the first study in the literature analysing the MRI features of histologically proven HPNST. HPNST infrequently shows the classical MRI signs that would be expected with benign peripheral nerve sheath tumours although commonly have a lobular morphology and show cystic change.
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Affiliation(s)
- Saurabh Singh
- Department of Medical Imaging, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Paul Choong
- Department of Medical Imaging, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Mohamed Ali
- Department of Psychiatry, Barnet, Enfield and Haringey Mental Health Trust, London HA8 0AD, United Kingdom
| | - Daniel Lindsay
- Department of Histopathology, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
| | - Asif Saifuddin
- Department of Medical Imaging, Royal National Orthopaedic Hospital, London HA7 4LP, United Kingdom
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Giannini C, Righi A. Peripheral nerve tumors. HANDBOOK OF CLINICAL NEUROLOGY 2024; 201:251-271. [PMID: 38697744 DOI: 10.1016/b978-0-323-90108-6.00016-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The chapter is focused on the neoplastic peripheral nerve lesions, which primarily involve "cranial and paraspinal nerves," as outlined in the CNS volume (WHO_Classification_of_Tumours_Editorial_Board, 2021). These include classic peripheral nerve sheath tumors such as schwannoma, neurofibroma, intraneural perineurioma, and malignant peripheral nerve sheath tumors, with their variants as well as new and more precisely defined entities, including hybrid nerve sheath tumors and malignant melanotic nerve sheath tumor (previously melanotic schwannoma).
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Affiliation(s)
- Caterina Giannini
- Division of Anatomic Pathology, Laboratory Medicine/Pathology and Neurosurgery, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, MN, United States; Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum, University of Bologna, Bologna, Italy.
| | - Alberto Righi
- Department of Pathology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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El-Haj M, Eliav T, Vorobeitchik SA, Yusef A, Fellig Y, Safran O. Rare Median Nerve and Digital Nerve Tumor Resection and Distal Nerve Transfers: A Report of 2 Cases. JBJS Case Connect 2024; 14:01709767-202403000-00010. [PMID: 38207087 DOI: 10.2106/jbjs.cc.23.00252] [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: 01/13/2024]
Abstract
CASES We present 2 cases of median nerve reconstruction using distal nerve transfers after resection of unusual benign median nerve tumors. Critical sensation was restored in case 1 by transferring the fourth common digital nerve to first web digital nerves. Thumb opposition was regained by transferring the abductor digiti minimi ulnar motor nerve branch to the recurrent median motor nerve branch. Critical sensation was restored in case 2 by transferring the long finger ulnar digital nerve to the index finger radial digital nerve. CONCLUSION Distal nerve transfers, even with short grafts, are reliable median nerve deficit treatments, sparing the need for larger autologous nerve grafts and late tendon opponensplasties.
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Affiliation(s)
- Madi El-Haj
- Department of Orthopedics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal Eliav
- Medical School for International Health, Faculty of Health Sciences, Ben Gurion University of the Negev, Beer Sheva, Israel
| | - Sofia A Vorobeitchik
- Department of Orthopedics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Azraq Yusef
- Department of Orthopedics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yakov Fellig
- Department of Pathology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Ori Safran
- Department of Orthopedics, Hadassah Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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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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Kao WT, Chu CY, Shen KH. Hybrid Schwannoma/Neurofibroma of the Neck: A Case Report. EAR, NOSE & THROAT JOURNAL 2023:1455613231200834. [PMID: 37747125 DOI: 10.1177/01455613231200834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/26/2023] Open
Abstract
Neck hybrid schwannoma/neurofibromas are uncommon and classified as peripheral nerve sheath tumors (PNSTs). PNSTs develop from soft tissues, of which schwannoma, perineurioma, and neurofibroma are the most common. Hybrid PNSTs consist of more than 1 type of PNST, such as hybrid schwannoma/neurofibromas. The exact epidemiology and pathogenesis of these tumors are still largely unknown because of the limited studies on this topic. Such tumors can spread over the soft tissues, although most cases reported involve the subcutaneous layer or dermis. Some studies have suggested that hybrid schwannoma/neurofibromas may be associated with neurofibromatosis. We present a case of a 51-year-old female patient with a neck hybrid schwannoma/neurofibroma diagnosed by histopathology and immunohistochemistry. The patient was referred to the neurology department for neurofibromatosis screening, which reported negative results. After 12 months, the patient showed no evidence of tumor recurrence.
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Affiliation(s)
- Wei-Ting Kao
- Department of Otolaryngology and Head & Neck Surgery, Mackay Memorial Hospital, Taitung
- Department of Otolaryngology and Head & Neck Surgery, Mackay Memorial Hospital, Taipei
| | - Chia-Ying Chu
- Department of Pathology, Mackay Memorial Hospital, Taitung
| | - Kuang-Hsuan Shen
- Department of Otolaryngology and Head & Neck Surgery, Mackay Memorial Hospital, Taitung
- Department of Otolaryngology and Head & Neck Surgery, Mackay Memorial Hospital, Taipei
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8
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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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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.
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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
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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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Benign Neurofibroma/Schwannoma Hybrid Peripheral Nerve Sheath Tumor of the Ulnar Nerve Harboring a Metastatic Papillary Thyroid Carcinoma Deposit: A Case Report of Tumor-to-Tumor Metastasis. Case Rep Pathol 2022; 2022:9038222. [PMID: 36570791 PMCID: PMC9771651 DOI: 10.1155/2022/9038222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/22/2022] [Accepted: 11/26/2022] [Indexed: 12/15/2022] Open
Abstract
A 74-year-old man with a medical history significant for papillary thyroid cancer (PTC) presented with a rapidly enlarging grape-sized mass in his right medial arm with paresthesia in the ulnar nerve distribution. Imaging was suspicious for a peripheral nerve sheath tumor (PNST), but an ultrasound-guided biopsy was equivocal. The mass was excised with final histopathology demonstrating a benign neurofibroma/schwannoma hybrid nerve sheath tumor (N/S HNST) harboring a metastatic PTC deposit, ultimately mimicking the rare glandular schwannoma subtype. Next-generation sequencing (NGS) of the lesion demonstrated somatic variants in BRAF and TERT (common in PTC) and NF2 (common in PNSTs). After excision, the patient's nerve symptoms improved. A postsurgical PET/CT scan also showed progression in the lungs/mediastinum. Due to the metastatic nature of his PTC, he was treated with 14 mg of Lenvima (lenvatinib) daily, and his PET/CT surveillance was performed at more frequent intervals. Tumor-to-tumor metastasis (TTM) is a rare occurrence. To our knowledge, this is the first case reported on PTC metastasizing into a benign (hybrid) PNST, which mimicked glandular schwannoma. Symptomatology, imaging characteristics, NGS, and histopathological characteristics that can decipher between different benign PNST subtypes (schwannoma, neurofibroma, glandular, hybrid, etc.), malignant PNSTs (MPNSTs), and TTM are described.
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12
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Merker VL, Slobogean B, Jordan JT, Langmead S, Meterko M, Charns MP, Elwy AR, Blakeley JO, Plotkin SR. Understanding barriers to diagnosis in a rare, genetic disease: Delays and errors in diagnosing schwannomatosis. Am J Med Genet A 2022; 188:2672-2683. [PMID: 35678462 PMCID: PMC9378587 DOI: 10.1002/ajmg.a.62860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/15/2022] [Accepted: 04/21/2022] [Indexed: 01/24/2023]
Abstract
Diagnosis of rare, genetic diseases is challenging, but conceptual frameworks of the diagnostic process can guide quality improvement initiatives. Using the National Academy of Medicine diagnostic framework, we assessed the extent of, and reasons for diagnostic delays and diagnostic errors in schwannomatosis, a neurogenetic syndrome characterized by nerve sheath tumors and chronic pain. We reviewed the medical records of 97 people with confirmed or probable schwannomatosis seen in two US tertiary care clinics. Time-to-event analysis revealed a median time from first symptom to diagnosis of 16.7 years (95% CI, 7.5-26.0 years) and median time from first medical consultation to diagnosis of 9.8 years (95% CI, 3.5-16.2 years). Factors associated with longer times to diagnosis included initial signs/symptoms that were intermittent, non-specific, or occurred at younger ages (p < 0.05). Thirty-six percent of patients were misdiagnosed; misdiagnoses were of underlying genetic condition (18.6%), pain etiology (16.5%), and nerve sheath tumor presence/pathology (11.3%) (non-mutually exclusive categories). One-fifth (19.6%) of patients had a clear missed opportunity for genetics workup that could have led to an earlier schwannomatosis diagnosis. These results suggest that interventions in clinician education, genetic testing availability, expert review of pathology findings, and automatic triggers for genetics referrals may improve diagnosis of schwannomatosis.
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Affiliation(s)
- Vanessa L. Merker
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Bronwyn Slobogean
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD
| | - Justin T. Jordan
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA
| | - Shannon Langmead
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD
| | - Mark Meterko
- Analytics and Performance Integration, Office of Quality and Patient Safety, Veterans Health Administration, Bedford, MA
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
| | - Martin P. Charns
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, Boston, MA
| | - A. Rani Elwy
- Center for Healthcare Organization and Implementation Research (CHOIR), VA Bedford Healthcare System, Bedford, MA
- Department of Psychiatry and Human Behavior, Brown University Warren Alpert Medical School, Providence, RI
| | - Jaishri O. Blakeley
- Department of Neurology and Neurosurgery, Johns Hopkins University, Baltimore, MD
| | - Scott R. Plotkin
- Department of Neurology and Cancer Center, Massachusetts General Hospital, Boston, MA
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Salazar-Huayna L, Naranjo L, Romagosa C, Arcediano MÁ, Siurana S, Ramón y Cajal S, Dinarès C. Hybrid neurofibroma/schwannoma of the orbit. REVISTA ESPAÑOLA DE PATOLOGÍA 2022; 56:140-143. [PMID: 37061243 DOI: 10.1016/j.patol.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 03/08/2022] [Accepted: 03/09/2022] [Indexed: 10/18/2022]
Abstract
Hybrid neurofibroma/schwannoma is a rare variant of hybrid peripheral nerve sheath tumours (HPNST). A Medline search up to December 2021 identified only six cases of this tumour in the orbit. We report the case of a 78-year-old man who presented with left exophthalmos. Computed tomography showed a left intraconal orbital mass. The clinico-radiological diagnosis was consistent with an intraconal cavernous angioma. Orbitotomy was performed, obtaining an 18×16×11mm mass. Two different morphologies were seen microscopically, diagnostic of hybrid neurofibroma/schwannoma. HPNSTs of the orbit are uncommon and most reported cases showed a hybrid neurofibroma/schwannoma morphology. Hybrid neurofibroma/schwannomas have been associated with neurofibromatosis and schwannomatosis. Local recurrences have been reported. The correct identification of these tumours is important due to their potential use as a syndromic marker.
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14
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Chaturvedi HT, Chaturvedi C, Nandy DJ. Hybrid peripheral nerve sheath tumor of parapharyngeal space having features of neurofibroma and schwannoma in an 8-year-old child - A rare entity. J Oral Maxillofac Pathol 2022; 26:S96-S102. [PMID: 35450249 PMCID: PMC9017848 DOI: 10.4103/jomfp.jomfp_123_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2021] [Accepted: 08/06/2021] [Indexed: 11/29/2022] Open
Abstract
Tumors of the parapharyngeal space (PPS) are extremely rare inpediatric age group. Out of all head-and-neck neoplasms, PPS tumors comprise only 0.5%. Majority of neoplasms in poststyloid PPS are neurogenic tumors. Conventional benign peripheral nerve sheath tumor (PNST) includes neurofibromas, schwannomas and perineuriomas. Hybrid PNSTs are rare entities having combined features of more than one histologic type, and the World Health Organization Classification of Tumors of the Central Nervous System, in the latest 2016, 4th edition, has recently recognized and published it. The most common hybrid tumor is schwannoma/perineuroma followed by neurofibroma/schwannoma and neurofibroma/perineuroma. Here, we are reporting a hybrid PNST which was completely excised and having combined features of neurofibroma and schwannoma, confirmed by both histopathologically and immunohistochemically, in an 8-year-old child, in PPS.
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15
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Pak KY, Pun S, Cassarino DS. Case of Symptomatic Dermal Neurofibroma With Microcystic Features. Am J Dermatopathol 2021; 43:e290-e292. [PMID: 33989218 DOI: 10.1097/dad.0000000000001961] [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: 11/26/2022]
Abstract
ABSTRACT A neurofibroma is a benign neural tumor arising within a peripheral nerve sheath composed of Schwann cells, fibroblasts, and immune cells involved in the nerve. Microcystic elements have been rarely described in these tumors. Neurofibromas are classically described as unencapsulated tumors of interspersed spindle cells and mast cells in a hypocellular, myxoid stroma. These tumors are most commonly dermal and seen in almost all patients with neurofibromatosis type 1; however, they may also occur sporadically, as seen in our case here. We report a 23-year-old patient with no significant medical history who presented with a dome-shaped papule on her cheek. This slow-growing mass had been present for multiple years and was soft, inflamed, and painful. Shave biopsy was collected and sent for evaluation. The shave biopsy diagnosed a benign neural tumor with features of a rare microcystic neurofibroma. This unencapsulated tumor consisted of microcystic spaces lined by oval-shaped to spindle-shaped cells in a matrix of myxoid to collagenous-like areas. Scattered lymphocytes and mast cells were noted, with few true vessels enclosing red blood cells. The stromal cells and cells lining the microcystic spaces stained S100 and SOX-10 positive. These cells had limited CD34 staining; however, most microcystic spaces were negative. Only the few true vessels stained CD31 positive. It is important to distinguish the prominent microcystic features in neurofibromas versus schwannomas by the lack of encapsulation or Antoni A features with Verocay bodies, which are typical of the latter. Further differentiating neurofibromas versus malignant peripheral nerve sheath tumors is required, where the latter should exhibit much greater nuclear atypic, higher cellularity, necrosis, hemorrhage, and increased mitotic activity. Excision of this benign microcystic neurofibroma was not deemed necessary because of lack of clinical concern and recurrent lesions.
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Affiliation(s)
- Kaitlynne Y Pak
- Wright State University Boonshoft School of Medicine, Dayton, OH; and
| | - Stacey Pun
- Departments of Dermatology and Pathology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - David S Cassarino
- Departments of Dermatology and Pathology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
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16
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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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17
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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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18
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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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19
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Aladawi M, Punsoni M, Piccione E. Clinical Reasoning: A 40-Year-Old Woman With Scapular Winging and Dysphonia. Neurology 2021; 97:503-507. [PMID: 33980702 DOI: 10.1212/wnl.0000000000012179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Mohammad Aladawi
- From the Departments of Neurological Sciences (M.A., E.P.) and Pathology and Microbiology (M.P.), University of Nebraska Medical Center, Omaha.
| | - Michael Punsoni
- From the Departments of Neurological Sciences (M.A., E.P.) and Pathology and Microbiology (M.P.), University of Nebraska Medical Center, Omaha
| | - Ezequiel Piccione
- From the Departments of Neurological Sciences (M.A., E.P.) and Pathology and Microbiology (M.P.), University of Nebraska Medical Center, Omaha
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20
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Ronellenfitsch MW, Harter PN, Kirchner M, Heining C, Hutter B, Gieldon L, Schittenhelm J, Schuhmann MU, Tatagiba M, Marquardt G, Wagner M, Endris V, Brandts CH, Mautner VF, Schröck E, Weichert W, Brors B, von Deimling A, Mittelbronn M, Steinbach JP, Reuss DE, Glimm H, Stenzinger A, Fröhling S. Targetable ERBB2 mutations identified in neurofibroma/schwannoma hybrid nerve sheath tumors. J Clin Invest 2021; 130:2488-2495. [PMID: 32017710 DOI: 10.1172/jci130787] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2019] [Accepted: 01/30/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUNDNeurofibroma/schwannoma hybrid nerve sheath tumors (N/S HNSTs) are neoplasms associated with larger nerves that occur sporadically and in the context of schwannomatosis or neurofibromatosis type 2 or 1. Clinical management of N/S HNSTs is challenging, especially for large tumors, and established systemic treatments are lacking.METHODSWe used next-generation sequencing and array-based DNA methylation profiling to determine the clinically actionable genomic and epigenomic landscapes of N/S HNSTs.RESULTSWhole-exome sequencing within a precision oncology program identified an activating mutation (p.Asp769Tyr) in the catalytic domain of the ERBB2 receptor tyrosine kinase in a patient with schwannomatosis-associated N/S HNST, and targeted treatment with the small-molecule ERBB inhibitor lapatinib led to prolonged clinical benefit and a lasting radiographic and metabolic response. Analysis of a multicenter validation cohort revealed recurrent ERBB2 mutations (p.Leu755Ser, p.Asp769Tyr, p.Val777Leu) in N/S HNSTs occurring in patients who met diagnostic criteria for sporadic schwannomatosis (3 of 7 patients), but not in N/S HNSTs arising in the context of neurofibromatosis (6 patients) or outside a tumor syndrome (1 patient), and showed that ERBB2-mutant N/S HNSTs cluster in a distinct subgroup of peripheral nerve sheath tumors based on genome-wide DNA methylation patterns.CONCLUSIONThese findings uncover a key biological feature of N/S HNSTs that may have important diagnostic and therapeutic implications.FUNDINGThis work was supported by grant H021 from DKFZ-HIPO, the University Cancer Center Frankfurt, and the Frankfurt Research Funding Clinician Scientist Program.
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Affiliation(s)
- Michael W Ronellenfitsch
- Dr. Senckenberg Institute of Neurooncology and.,University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Frankfurt am Main, Germany.,Frankfurt Cancer Institute and
| | - Patrick N Harter
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Frankfurt am Main, Germany.,Frankfurt Cancer Institute and.,Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Martina Kirchner
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christoph Heining
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden and German Cancer Research Center (DKFZ), Dresden, Germany.,DKTK partner site Dresden, Dresden, Germany.,Center for Personalized Oncology, NCT Dresden and University Hospital Carl Gustav Carus Dresden at Technical University Dresden, Dresden, Germany
| | - Barbara Hutter
- Division of Applied Bioinformatics, DKFZ and NCT Heidelberg, Heidelberg, Germany.,Heidelberg Center for Personalized Oncology (HIPO), DKFZ, Heidelberg, Germany.,DKTK partner site Heidelberg, Heidelberg, Germany
| | - Laura Gieldon
- DKTK partner site Dresden, Dresden, Germany.,Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,European Reference Network for Genetic Tumour Risk Syndromes, Hereditary Cancer Syndrome Center Dresden, Dresden, Germany.,DKFZ, Heidelberg, Germany.,NCT Dresden, Dresden, Germany.,Institute of Human Genetics, Heidelberg University, Heidelberg, Germany
| | - Jens Schittenhelm
- Department of Neuropathology, Institute of Pathology and Neuropathology, and Comprehensive Cancer Center Tübingen-Stuttgart
| | - Martin U Schuhmann
- Department of Neurosurgery, and.,Center for Neurofibromatosis, Center for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | - Marcos Tatagiba
- Department of Neurosurgery, and.,Center for Neurofibromatosis, Center for Rare Diseases, University Hospital Tübingen, Tübingen, Germany
| | | | | | - Volker Endris
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - Christian H Brandts
- University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Frankfurt am Main, Germany.,Frankfurt Cancer Institute and.,Hematology/Oncology, Department of Medicine, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany
| | - Victor-Felix Mautner
- Department of Neurology, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Evelin Schröck
- DKTK partner site Dresden, Dresden, Germany.,Institute for Clinical Genetics, Faculty of Medicine Carl Gustav Carus, Technical University Dresden, Dresden, Germany.,European Reference Network for Genetic Tumour Risk Syndromes, Hereditary Cancer Syndrome Center Dresden, Dresden, Germany.,DKFZ, Heidelberg, Germany.,NCT Dresden, Dresden, Germany
| | - Wilko Weichert
- Institute of Pathology, Technical University Munich, Munich, Germany.,DKTK partner site Munich, Munich, Germany
| | - Benedikt Brors
- Division of Applied Bioinformatics, DKFZ and NCT Heidelberg, Heidelberg, Germany.,Heidelberg Center for Personalized Oncology (HIPO), DKFZ, Heidelberg, Germany.,DKTK partner site Heidelberg, Heidelberg, Germany
| | - Andreas von Deimling
- DKTK partner site Heidelberg, Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, DKFZ, Heidelberg, Germany
| | - Michel Mittelbronn
- Institute of Neurology (Edinger Institute), University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,Luxembourg Centre of Neuropathology (LCNP), Dudelange, Luxembourg.,Luxembourg Centre for Systems Biomedicine (LCSB), University of Luxembourg, Luxembourg City, Luxembourg.,Department of Oncology, Luxembourg Institute of Health (LIH), Strassen, Luxembourg.,National Center of Pathology (NCP), Laboratoire National de Santé, Dudelange, Luxembourg
| | - Joachim P Steinbach
- Dr. Senckenberg Institute of Neurooncology and.,University Cancer Center (UCT) Frankfurt, University Hospital Frankfurt, Goethe University, Frankfurt am Main, Germany.,German Cancer Consortium (DKTK), Frankfurt am Main, Germany.,Frankfurt Cancer Institute and
| | - David E Reuss
- DKTK partner site Heidelberg, Heidelberg, Germany.,Department of Neuropathology, Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,Clinical Cooperation Unit Neuropathology, DKFZ, Heidelberg, Germany
| | - Hanno Glimm
- Department of Translational Medical Oncology, National Center for Tumor Diseases (NCT) Dresden and German Cancer Research Center (DKFZ), Dresden, Germany.,DKTK partner site Dresden, Dresden, Germany.,Center for Personalized Oncology, NCT Dresden and University Hospital Carl Gustav Carus Dresden at Technical University Dresden, Dresden, Germany.,Translational Functional Cancer Genomics and
| | - Albrecht Stenzinger
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany.,DKTK partner site Heidelberg, Heidelberg, Germany
| | - Stefan Fröhling
- Heidelberg Center for Personalized Oncology (HIPO), DKFZ, Heidelberg, Germany.,DKTK partner site Heidelberg, Heidelberg, Germany.,Division of Translational Medical Oncology, NCT Heidelberg and DKFZ, Heidelberg, Germany
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21
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Rekhi B. Recent updates in the diagnosis of soft tissue tumors: Newly described tumor entities, newer immunohistochemical and genetic markers, concepts, including "inter-tumor relationships". INDIAN J PATHOL MICR 2021; 64:448-459. [PMID: 34341252 DOI: 10.4103/ijpm.ijpm_1361_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
During the last two decades, there have been significant strides in the diagnosis of soft tissue tumors, including identification of various tumor entities, newer immunohistochemical markers, and an increasing number of molecular signatures, defining certain tumors. Lately, there are certain emerging tumor entities, defined by their molecular features with an impact on treatment. At the same time, there is a certain degree of overlap in the expression of certain immunohistochemical antibody markers, as well as genetic markers, with certain gene rearrangements and chimeric fusions observed among completely different tumors. Moreover, a certain amount of clinicopathological, immunohistochemical, and molecular proximity has been unraveled among certain tumor types. Over the years, the World Health Organization (WHO) fascicles on tumors of soft tissue have succinctly brought out these aspects. The present review describes recent updates in the diagnosis of soft tissue tumors, including certain newly described tumor entities; emphasizing upon newer, specific immunohistochemical and molecular markers, along with concepts, regarding "intertumor relationships".
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Affiliation(s)
- Bharat Rekhi
- Department of Surgical Pathology, Tata Memorial Hospital, Homi Bhabha National Institute (HBNI), Mumbai, Maharashtra, India
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22
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Wang WY, Liao SL, Wei YH. Orbital exenteration: A 20-year experience from a tertiary center in Taiwan. J Formos Med Assoc 2020; 120:1493-1499. [PMID: 33191092 DOI: 10.1016/j.jfma.2020.10.030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 03/18/2020] [Accepted: 10/29/2020] [Indexed: 12/26/2022] Open
Abstract
PURPOSE To describe the prognostic factors and survival outcomes in patients who underwent orbital exenteration surgery at a tertiary center over a 20-year period. METHODS This institutional retrospective study reviewed all patients who underwent orbital exenteration between January 1999 and January 2019 at Department of Ophthalmology, National Taiwan University Hospital. Patient demographics, tumor site, histopathology, status of surgical margins, additional resection, local recurrence, metastases, survival, and treatment data were recorded. Log-rank tests were used to verify the difference in survival curves among various potential prognostic factors. RESULTS Thirty patients (27 with malignancy, 1 with hybrid neurofibroma/schwannoma, and 2 with mucormycosis) were included. Malignant melanoma (n = 11) and sebaceous gland carcinoma (n = 8) were the most common indications for exenteration. Survival rates were 83% at 1 year, 42% at 3 years, and 33% at 5 years. Among patients with malignancies, 71% patients had clear margins after exenteration. All the incidences of local recurrence developed in the first 2 years postoperatively. Postoperative survival was significantly related to lymphovascular invasion (p = 0.018), but was independent from surgical margins, presence of metastasis, local recurrence, or perineural invasion. CONCLUSION We found worse prognosis with positive lymphovascular invasion. Although not significant, malignant melanoma showed poorer survival times compared to sebaceous gland carcinoma. Close follow-up, especially in the first 2 years after orbital exenteration, is crucial to identify disease recurrence.
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Affiliation(s)
- Wen-Yi Wang
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan
| | - Shu-Lang Liao
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan; College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Hsuan Wei
- Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan.
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23
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Leung KCP, Ko TCS. Orbital hybrid peripheral nerve sheath tumors. Taiwan J Ophthalmol 2020; 10:181-183. [PMID: 33110748 PMCID: PMC7585476 DOI: 10.4103/tjo.tjo_28_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Accepted: 04/28/2020] [Indexed: 12/12/2022] Open
Abstract
Hybrid peripheral nerve sheath tumors (HPNST) are recently classified tumors from the World Health Organization Classification of soft tissue tumors that display combined features of more than one peripheral nerve sheath tumor. Acknowledgment is important because of its association with the development of neurofibromatosis type 1, type 2, and schwannomatosis. Orbital involvement is rare and only six cases of HPNST have been documented on literature. This article serves to review the pathophysiology, clinical manifestation, diagnosis, treatment, and prognosis of this infrequent but important orbital tumor.
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Affiliation(s)
| | - Tak Chuen Simon Ko
- Department of Ophthalmology, Tung Wah Eastern Hosptial, Causewaybay, Hong Kong
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24
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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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Alomair A, Dababo M, Velagapudi S. Supraclavicular Solitary Hybrid Schwannoma/Neurofibroma: A Case Report. Cureus 2020; 12:e8531. [PMID: 32665878 PMCID: PMC7352814 DOI: 10.7759/cureus.8531] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Peripheral nerve sheath tumors (PNSTs) are benign lesions arising from the connective tissue sheath surrounding the neurons and are labeled schwannoma, perineurioma, or neurofibroma according to their histopathological characteristics. Lesions with a mixture of two or more of the aforementioned tumors are known as hybrid peripheral nerve sheath tumors (HPNSTs). These hybrid tumors have been described as rare entities. In this report, we present a case of a solitary hybrid schwannoma/neurofibroma in an unusual location.
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Affiliation(s)
- Alanoud Alomair
- Otolaryngology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Mohammad Dababo
- Anatomic Pathology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
| | - Suresh Velagapudi
- Otolaryngology, King Faisal Specialist Hospital and Research Centre, Riyadh, SAU
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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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27
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Multiple primary malignancies associated with a germline SMARCB1 pathogenic variant. Fam Cancer 2019; 18:445-449. [PMID: 31240424 DOI: 10.1007/s10689-019-00138-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
A 51-year old presented with a 6-month history of increasing pelvic/lower back pain with nocturnal waking and episodes of anorexia and vomiting. Examination revealed right torticollis and Horner's syndrome, and a large abdominal mass arising from the pelvis. Magnetic resonance and positron emission tomography imaging revealed (A) a 14 cm heterogeneous enhancing mass, abutting the left kidney with standardised uptake value max = 2.9, (B) a large heterogeneous enhancing pelvic mass (C) mesenteric adenopathy standardised uptake value max = 10.3 and (D) 6 cm right lung apex mass standardised uptake value max = 4.3. Computerised tomography-guided biopsy of lesion A was reported as neurofibroma with occasional atypia, lesion B a benign uterine leiomyoma and lesion C follicular lymphoma world health organisation Grade 2. Although she had been given the diagnosis of Neurofibromatosis Type-1 (NF1) 25-years previously following removal of an intradural extramedullary schwannoma she had no cutaneous stigmata of NF1. Genetic analysis of blood lymphocyte DNA identified a pathogenic variant in SMARCB1 confirming a diagnosis of schwannomatosis. Following 6-months chemotherapy for lymphoma, surgery was performed to remove lesion A. Histology revealed a malignant peripheral nerve sheath tumour with areas of low and high-grade change. An incidental, well-differentiated small bowel neuroendocrine carcinoma was also excised. Close surveillance continues with no recurrence after 6 years. This case study describes a novel finding of three separate synchronous primary malignancies in a patient with schwannomatosis and a proven SMARCB1 pathogenic variant.
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Lang Y, Liu D, Xiang P, Wang J, Li Y. Primary intraosseous hybrid epithelioid schwannoma/perineurioma in the proximal tibia: a case report of benign hybrid neoplasm with local hypercellularity. Diagn Pathol 2019; 14:51. [PMID: 31153384 PMCID: PMC6545219 DOI: 10.1186/s13000-019-0829-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Accepted: 05/15/2019] [Indexed: 02/01/2023] Open
Abstract
Background As a new entity included in the 4th edition of the WHO classification of tumours of soft tissue and bone in 2013, hybrid peripheral nerve sheath tumours are benign composite neoplasms that demonstrate features of more than one type of nerve sheath tumour, with a wide age distribution and a predilection for superficial location. Those involving deep sites are relatively rare. To the best of our knowledge, only one case of primary intraosseous hybrid peripheral nerve sheath tumours has been documented. In this article, we report another case of hybrid peripheral nerve sheath tumours occurring in bone with different clinical, radiological and pathological features from those in the previously reported cases. Case presentation A 28-year-old female presented with a painful nodule in the right tibia. Radiological examination revealed an oval eccentric osteolytic lesion in the proximal tibia. Histologically, the circumscribed but unencapsulated lesion demonstrated biphasic cellular differentiation. Bland, small epithelioid cells arranged in clusters in the myxoid or collagenous stroma and inconspicuous spindle cells scattered in the hypercellular areas were suggested to originate from Schwann cells according to the detection of S100. Both the elongated spindle cells with thin, wavy nuclei and the spindle cells in fascicular or storiform pattern in hypercellular areas showed a positive immunoreaction for epithelial membrane antigen, indicating perineurial differentiation. Based on histological and immunochemical examinations, the patient was diagnosed with hybrid epithelioid schwannoma/perineurioma. The lesion was resected and has not recurred for 8 months since resection. Conclusion The present case is the second primary intraosseous hybrid peripheral nerve sheath tumour to be reported. This is also the first reported intraosseous tumour composed of epithelioid schwannoma and perineurioma with hypercellularity, indicating diverse involvement sites and a wide range of histological features among hybrid peripheral nerve sheath tumours. Awareness of such diversity is critical for accurate diagnoses. The morphological overlap with other spindle and epithelioid cell neoplasms, especially pure peripheral nerve sheath tumours, requires that immunochemical and molecular examinations be used as objective tools to provide the necessary information for a differential diagnosis. Electronic supplementary material The online version of this article (10.1186/s13000-019-0829-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yuejiao Lang
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Dawei Liu
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Pei Xiang
- Department of Medical Imaging, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510000, People's Republic of China
| | - Jilin Wang
- Department of Pathology, Central People's Hospital of Zhanjiang, Zhanjiang, Guangdong, 524000, People's Republic of China
| | - Yang Li
- Department of Pathology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, Guangdong, 510000, People's Republic of China.
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Isaiah A, Sengupta AL, Mitchell RB. An Unusual Neck Mass in a Child. EAR, NOSE & THROAT JOURNAL 2019; 99:103-104. [PMID: 32162551 DOI: 10.1177/0145561318823965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Amal Isaiah
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern and Children's Health, Dallas, TX, USA
| | - Anita L Sengupta
- Department of Pathology, UT Southwestern and Children's Health, Dallas, TX, USA
| | - Ron B Mitchell
- Department of Otolaryngology-Head and Neck Surgery, UT Southwestern and Children's Health, Dallas, TX, USA
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Pollock RE, Payne JE, Rogers AD, Smith SM, Iwenofu OH, Valerio IL, Zomerlei TA, Howard JH, Dornbos D, Galgano MA, Goulart C, Mendel E, Miller ED, Xu-Welliver M, Martin DD, Haglund KE, Bupathi M, Chen JL, Yeager ND. Multidisciplinary sarcoma care. Curr Probl Surg 2018; 55:517-580. [PMID: 30526918 DOI: 10.1067/j.cpsurg.2018.10.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Affiliation(s)
- Raphael E Pollock
- The Ohio State University Comprehensive Cancer Center, Columbus, OH.
| | - Jason E Payne
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Alan D Rogers
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Stephen M Smith
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - O Hans Iwenofu
- Department of Pathology & Laboratory Medicine, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Ian L Valerio
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - David Dornbos
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Ehud Mendel
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Eric D Miller
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | | | - Karl E Haglund
- The Ohio State University Wexner Medical Center, Columbus, OH
| | | | - James L Chen
- The Ohio State University Wexner Medical Center, Columbus, OH
| | - Nicholas D Yeager
- Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, OH
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Reinert CP, Schuhmann MU, Bender B, Gugel I, la Fougère C, Schäfer J, Gatidis S. Comprehensive anatomical and functional imaging in patients with type I neurofibromatosis using simultaneous FDG-PET/MRI. Eur J Nucl Med Mol Imaging 2018; 46:776-787. [DOI: 10.1007/s00259-018-4227-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 11/25/2018] [Indexed: 12/31/2022]
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33
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Basa RM, Crowley AM, Johnson KA. Neurofibroma of the ulnar nerve in the carpal canal in a dog: treatment by marginal neurectomy. J Small Anim Pract 2018; 61:512-515. [PMID: 30338846 PMCID: PMC7496079 DOI: 10.1111/jsap.12945] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Revised: 02/12/2018] [Accepted: 02/21/2018] [Indexed: 11/28/2022]
Abstract
Peripheral nerve sheath tumours arising in the plexus or peripheral nerves can be treated by limb amputation. There are few reports of these tumours affecting peripheral nerves in the distal regions of the limbs. Here we describe a case of neurofibroma affecting the palmar branch of the ulnar nerve in an Irish setter. Surgical treatment in the region of the carpus by ulnar neurectomy resulted in resolution of chronic thoracic limb lameness. At 11 months following the surgery, clinical examination and MRI did not detect any evidence of recurrence. Neurectomy may be a feasible option for management of selected cases of distally located peripheral nerve sheath tumours.
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Affiliation(s)
- R M Basa
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, 2006, Australia
| | - A M Crowley
- Anapath, PO Box 504, Newport, New South Wales, 2106, Australia
| | - K A Johnson
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Sydney, New South Wales, 2006, Australia
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Liu C, Yan L, Liu Q, Li J, Jin H, Wang J, Deng Y. Lumbar intraspinal microcystic/reticular schwannoma: Case report and literature review. Medicine (Baltimore) 2018; 97:e12474. [PMID: 30278533 PMCID: PMC6181603 DOI: 10.1097/md.0000000000012474] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE Microcystic/reticular schwannoma (MRS) is a rare histological variant of schwannoma which was initially described in 2008 with a predilection for the visceral organs. This distinct tumor had been reported to mainly affect gastrointestinal tract, subcutaneous and soft tissue, various glands and head and neck region. However, MRS involving spine is extremely rare. PATIENT CONCERNS The authors report the first case of MRS occurring in the lumbar (L) spinal canal of a 40-year-old male who presented with continuous pain and numbness in both feet for 2.5 years. Physical examination revealed weakness of lower extremities and hyperalgesia of both feet. DIAGNOSES AND INTERVENTIONS The findings of pre-operative investigation were suspicious for either a schwannoma or a spinal meningioma. Accordingly, total laminectomy, complete tumor resection, instrumentation and spinal fusion were performed. Post-operative histopathologic examination revealed a well-encapsulated neoplasm with reticular and microcystic growth pattern. Antoni A and Antoni B regions, Verocay bodies and hyalinized blood vessels were observed. And cytologic atypia, necrosis or mitosis was absent. Immunohistochemically, the tumor cells showed strong and diffuse positivity for S-100 as well as SOX 10. Therefore, a histopathological diagnosis of MRS was finally made. OUTCOMES The patient remains well with no evidence of recurrence at a 22-month follow-up. LESSONS This is the first case of MRS which is located in the L spinal canal. Awareness of this distinctive entity is helpful in preventing diagnostic pitfalls and making correct treatment strategies.
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Affiliation(s)
- Congcong Liu
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan
| | - Lianqi Yan
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan
- Department of Orthopedics, Clinical medical college of Yangzhou University
- Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu
| | - Qing Liu
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan
| | - Jing Li
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan
| | - Hongtao Jin
- Department of Pathology, Shen Zhen People's Hospital, Second Clinical Medical College of Jinan University, Shenzhen, Guangdong
| | - Jingcheng Wang
- Department of Orthopedics, The Second Xiangya Hospital, Central South University, Changsha, Hunan
- Department of Orthopedics, Clinical medical college of Yangzhou University
- Orthopedics Institute, Subei People's Hospital of Jiangsu Province, Yangzhou, Jiangsu
| | - Youwen Deng
- Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan
- Department of Emergency Medicine, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China
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Roman M, Burbidge O, McCulloch T, Majewski A. Endobronchial benign nerve sheath tumour presenting with significant shortness of breath and haemoptysis. Oxf Med Case Reports 2018; 2018:omy033. [PMID: 30026957 PMCID: PMC6047445 DOI: 10.1093/omcr/omy033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Revised: 04/23/2018] [Accepted: 05/02/2018] [Indexed: 11/13/2022] Open
Abstract
Peripheral nerve sheath tumours are rare within the thoracic cavity, with non-specific presentation. A 29-year-old patient presented with shortness of breath, cough, haemoptysis and recurrent chest infections. Suspicion of a primary lung carcinoma or a neuroendocrine tumour was raised following a CT and PET-CT. An endobronchial tumour suggested on histology a diagnosis of benign nerve sheath tumour, with positive staining for S100, CD56 and CD34. Following lung resection, the patient complained of fatigue and developed subcutaneous erythematous nodules on the anterior right chest, which raised the suspicion for a differential diagnosis of neurofibromatosis type I. The nodules resolved spontaneously within two weeks and the diagnosis of neurofibromatosis was ruled out on subsequent magnetic resonance imaging head and chest.
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Affiliation(s)
- Marius Roman
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Oliver Burbidge
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Tom McCulloch
- Department of Histopathology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Andrzej Majewski
- Department of Thoracic Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
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El Khatib N, Nehme A, Nasser S, Moukarzel N, Abtar HK. Intramasseteric Schwanoma mimicking an isolated cheek mass: Case report and review of literature. Int J Surg Case Rep 2018; 46:24-27. [PMID: 29656234 PMCID: PMC6000762 DOI: 10.1016/j.ijscr.2018.03.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 03/29/2018] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Schwannoma is a benign well circumscribed tumor of the nerve sheath and it is mostly localized in the head and neck. Intramasseteric schwannoma represents a very rare entity and a few cases have been described in the literature. PRESENTATION OF CASE We present a case of an isolated, asymptomatic and slowly progressive right cheek tumor in a middle aged man. Although multiple investigations, including neck scanner and fine needle aspiration, were done, the diagnosis was obscure and difficult before definite surgical resection. Surgery showed an isolated and well-defined tumor inside the masseter muscle which was completely resected. Histopathologic finding confirmed the diagnosis of schwannoma with the characteristic Antoni A and Antoni B cells. DISCUSSION Among benign tumors of the peripheral nerves, schwannoma is a specific type that originates from Schwann cells. It is typically slowly growing, neoplasm that is displacing neural structures without direct invasion. History, physical examination, fine needle aspiration, and magnetic resonance imaging are used as diagnostic modalities, however definitive diagnosis and identification of the affected nerve are often difficult up to the time of surgery. CONCLUSION Herby we describe a very rare localization of schwannoma arising from masseter muscle in a 30 year old man who presents with painless neck mass. This rare entity should be considered in the differential diagnosis in any patient presented with cheek mass.
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Affiliation(s)
- Nazir El Khatib
- Sacre-Coeur Hospital, Lebanese University, ENT Department, Beirut, Lebanon.
| | - Antoine Nehme
- Sacre-Coeur Hospital, Lebanese University, ENT Department, Beirut, Lebanon.
| | - Selim Nasser
- Sacre-Coeur Hospital, Lebanese University, Department of Pathology, Beirut, Lebanon.
| | - Nabil Moukarzel
- Sacre-Coeur Hospital, Lebanese University, ENT Department, Beirut, Lebanon.
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Civello ANE, Dunkel B, Summers BA, Martineau HM. Spinal Cord Compression in a Horse due to a Granular Cell Variant of Neurofibroma. J Comp Pathol 2017; 157:303-307. [PMID: 29169628 DOI: 10.1016/j.jcpa.2017.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Revised: 09/11/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
Abstract
A neurofibroma of granular cell subtype is described in a 7-year-old horse. The horse had a 3-month history of ataxia affecting the forelimbs and hindlimbs, suggesting a C1-C6 neuroanatomical localization. Post-mortem examination revealed an intradural mass arising from the right sixth cervical spinal nerve and compressing the spinal cord. Histologically, the mass was composed largely of wavy spindle cells (a mixture of Schwann cells, perineurial cells and fibroblasts) intimately associated with ropy collagen fibres. Approximately 25% of the spindle cells were swollen and contained densely-packed, eosinophilic and periodic acid-Schiff-positive cytoplasmic granules. Immunohistochemistry for S100 and glial fibrillary acidic protein antigens labelled a proportion of neoplastic cells, while the cytoplasmic granules were positive for S100 and neuron specific enolase. This is the first report of a neurofibroma with granular cell differentiation in an animal. Granular cell differentiation in other peripheral nerve sheath tumours of animals is briefly discussed.
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Affiliation(s)
- A N E Civello
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK.
| | - B Dunkel
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
| | - B A Summers
- Melbourne Veterinary School, 250 Princes Hwy, Werribee, Victoria, Australia
| | - H M Martineau
- Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire, UK
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38
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Plana-Pla A, Bielsa-Marsol I, Carrato-Moñino C. Diagnostic and Prognostic Relevance of the Cutaneous Manifestations of Neurofibromatosis Type 2. ACTAS DERMO-SIFILIOGRAFICAS 2017. [DOI: 10.1016/j.adengl.2016.12.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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39
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Shanouda S, Kaya G. Benign Cutaneous Peripheral Nerve Sheath Tumor with Hybrid Features: Report of Two Cases with Schwannoma/Perineurioma and Schwannoma/Neurofibroma Components. Dermatopathology (Basel) 2017; 4:1-6. [PMID: 29456994 PMCID: PMC5803675 DOI: 10.1159/000478854] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Hybrid benign peripheral nerve sheath tumors are rare tumors exhibiting areas of more than one neural neoplasm such as schwannoma/neurofibroma, neurofibroma/perineurioma, or schwannoma/perineurioma. These tumors usually arise in the skin of the extremities and trunk, and less commonly affect extracutaneous sites. Here we report two cases of these tumors exhibiting hybrid features of schwannoma/perineurioma and schwannoma/neurofibroma located in the scalp and the ankle, respectively.
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Affiliation(s)
- Shirien Shanouda
- Division of Clinical Pathology, University Hospital of Geneva, Geneva, Switzerland
| | - Gürkan Kaya
- Division of Dermatology and Venereology, University Hospital of Geneva, Geneva, Switzerland
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40
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Chen SJT, Patel RM, Hans CP, Chan MP, Fullen DR. Superficial papular neuroma: Case series of a new entity. J Cutan Pathol 2017. [PMID: 28627021 DOI: 10.1111/cup.12981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Dermal neural lesions arise in various circumstances and may be difficult to classify. METHODS We describe the clinical, histopathologic and immunophenotypic features of a series of terminally differentiated neural lesions not described previously, to our knowledge. RESULTS Four cases from men aged 58 to 66 years were included. Some lesions reportedly bled, but no inciting trauma or prior biopsies were reported. None recurred after biopsy, with follow-up ranging from 19 to 113 months. All lesions were papular, with vertically oriented S100-positive spindled cells and nerve fibers in the papillary dermis. Slight epidermal hyperplasia, dilated superficial thin-walled vessels and minimal to mild inflammation were seen in each. Fibers were uniformly fine in 3 cases, with slightly thicker central fibers in the fourth. Three had parakeratotic scale. None were associated with dermal fibrosis or adnexal proliferation. Neurofilament stained axons in each. EMA was negative in all cases. CD34, melan-A and HMB45 were negative when performed. CONCLUSIONS We report a small series of benign neural lesions and propose the name "superficial papular neuroma" for this distinct entity. Awareness is important to understand the clinical significance of these lesions and avoid misinterpretation that could lead to overtreatment, unnecessary work-up and increased cost.
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Affiliation(s)
| | - Rajiv M Patel
- Department of Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Christine P Hans
- Department of Pathology, Methodist Health System, Omaha, Nebraska
| | - May P Chan
- Department of Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan
| | - Douglas R Fullen
- Department of Pathology, University of Michigan, Ann Arbor, Michigan.,Department of Dermatology, University of Michigan, Ann Arbor, Michigan
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41
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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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Hybrid Neurofibroma/Schwannoma of the Supraorbital Nerve: Clinicopathologic Correlation of a Rare Tumor. Ophthalmic Plast Reconstr Surg 2017; 33:S104-S106. [DOI: 10.1097/iop.0000000000000597] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Diagnostic and Prognostic Relevance of the Cutaneous Manifestations of Neurofibromatosis Type 2. ACTAS DERMO-SIFILIOGRAFICAS 2017; 108:630-636. [PMID: 28237041 DOI: 10.1016/j.ad.2016.12.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 12/20/2016] [Accepted: 12/22/2016] [Indexed: 02/07/2023] Open
Abstract
Neurofibromatosis type 2 is an autosomal dominant hereditary disease with complete penetrance. It gives rise to multiple central and peripheral nervous system tumors, ocular alterations, and various types of skin lesion. In general, neither dermatologists nor other specialists have in-depth knowledge of the clinical manifestations of neurofibromatosis type 2. In some cases, this can lead to delayed diagnosis, which can increase morbidity and mortality. We describe the less well known clinical manifestations of NF2, focusing particularly on skin lesions specific to this disease. Identification of these lesions, when present, can facilitate diagnosis.
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Tumors displaying hybrid schwannoma and neurofibroma features in patients with neurofibromatosis type 2. Clin Neuropathol 2017; 35:78-83. [PMID: 26709712 PMCID: PMC7264817 DOI: 10.5414/np300895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2016] [Indexed: 11/18/2022] Open
Abstract
Although schwannoma and neurofibroma tumors are generally reported as distinct pathologic diagnoses, sporadic schwannoma/neurofibroma hybrid nerve sheath tumors have been reported in the general population with components of both entities. We report the clinicopathological features of these hybrid nerve sheath tumors in patients with neurofibromatosis type 2 (NF2). A retrospective review of nerve sheath tumor surgical specimens from patients with NF2 enrolled at the National Institutes of Health was performed. Those specimens reported to have schwannoma-like and neurofibroma-like features were selected for further characterization by morphology, immunohistochemical panel (CD34, S100, neurofilament triplet protein (immunostain) (NFTP), epithelial membrane antigen (EMA)), and confirmation as hybrid tumors. Of 43 total NF2 patients undergoing resection of nerve sheath tumors, 11 specimens from 11 (26%) patients were found to be benign nerve sheath tumors exhibiting hybrid features of both neurofibroma and schwannoma. Immunohistochemical studies showed the schwannoma component to be S100+, CD 34- while the neurofibroma component was CD34+, variable S100+. Our experience emphasizes the importance of including this distinct tumor subtype, the schwannoma/neurofibroma hybrid tumor, in the differential diagnosis of nerve sheath tumors in NF2 patients and suggests that the relationship between neurofibroma and schwannoma tumors is closer than previously suspected.
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Affiliation(s)
- Teruo Iwasaki
- Department of General Thoracic Surgery, Japan Community Healthcare Organization Osaka Hospital, Osaka, Japan
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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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Shrikrishna BH, Jyothi AC, Kulkarni NH, Mazhar MS. Extracranial Head and Neck Schwannomas: Our Experience. Indian J Otolaryngol Head Neck Surg 2016; 68:241-7. [PMID: 27340644 PMCID: PMC4899365 DOI: 10.1007/s12070-015-0925-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2015] [Accepted: 12/07/2015] [Indexed: 11/26/2022] Open
Abstract
Schwannomas are benign neoplasms of the peripheral nerves originating in the Schwann cells. They are rare and usually solitary, with clearly delimited capsules. They occur in the head and neck region in only 25 % of the cases, and may be associated with Von Recklinghausen's disease. Schwannomas are always a diagnostic dilemma as they are asymptomatic for long time and histopathology is the gold standard for diagnosis. The present study retrospectively analysed data of 4 patients with schwannomas and reviewed the literature on the subject. Retrospective study at ENT & Head and Neck Surgery Department of Navodaya Medical College, Raichur. Data of 4 patients between 2008 and 2014 were reviewed. The sites of cervical schwannomas and the intraoperative, histopathological and postoperative clinical status of these cases were studied. Diagnostic methods, type of surgery and associated nerve of origin (NOO) were evaluated. The patients' age ranged from 18 to 50 years. None of them had type I neurofibromatosis or Von Recklinghausen's disease. The nerves affected included the brachial plexus, vagus nerve, sympathetic chain and lingual nerve. The nerve of origin was identified based on intra-operative findings and post-operative neurological deficits. Tumour was removed by debulk operation with the preservation of NOO method. Schwannomas are generally benign, and rarely recur. An accurate preoperative workup with the identification of NOO is very important not only for a correct diagnosis, but also for surgical planning and informing the patient about the possible complications.
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Affiliation(s)
- B. H. Shrikrishna
- Department of ENT and Head-Neck Surgery, Navodaya Medical College Hospital and Research Centre, Mantralayam Road, Raichur, Karnataka 584 103 India
| | - A. C. Jyothi
- Department of ENT and Head-Neck Surgery, Navodaya Medical College Hospital and Research Centre, Mantralayam Road, Raichur, Karnataka 584 103 India
| | - N. H. Kulkarni
- Department of ENT and Head-Neck Surgery, Navodaya Medical College Hospital and Research Centre, Mantralayam Road, Raichur, Karnataka 584 103 India
| | - Md. Shafiuddin Mazhar
- Department of ENT and Head-Neck Surgery, Navodaya Medical College Hospital and Research Centre, Mantralayam Road, Raichur, Karnataka 584 103 India
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Chow LTC. Critical reappraisal of primary osseous composite sarcoma (malignant mesenchymoma) - analysis of four cases and literature review. APMIS 2016; 124:487-99. [DOI: 10.1111/apm.12540] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 03/14/2016] [Indexed: 01/07/2023]
Affiliation(s)
- Louis T. C. Chow
- Department of Anatomical and Cellular Pathology; Prince of Wales Hospital; Hong Kong China
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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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