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Li J, Winter SP, Gattu R, Perry KD, Gaetke-Udager K, Abdulfatah E, McHugh JB, Konopka KE, Bedewi MA, Soliman SB. A 22-year-old man with a posterior left shoulder mass. Skeletal Radiol 2024:10.1007/s00256-024-04696-2. [PMID: 38683468 DOI: 10.1007/s00256-024-04696-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 04/19/2024] [Accepted: 04/24/2024] [Indexed: 05/01/2024]
Affiliation(s)
- Joy Li
- Department of Radiology, Division of Musculoskeletal Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Stephen P Winter
- Department of Radiology, Division of Musculoskeletal Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Rishabh Gattu
- Department of Radiology, Division of Musculoskeletal Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Kyle D Perry
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Kara Gaetke-Udager
- Department of Radiology, Division of Musculoskeletal Radiology, University of Michigan, Ann Arbor, MI, USA
| | - Eman Abdulfatah
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Mohamed Abdelmohsen Bedewi
- Department of Internal Medicine, Prince Sattam Bin Abdulaziz University, College of Medicine, Al-Kharj, Kingdom of Saudi Arabia
| | - Steven B Soliman
- Department of Radiology, Division of Musculoskeletal Radiology, University of Michigan, Ann Arbor, MI, USA.
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2
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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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3
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Colizza A, Covello R, Greco A, Ralli M, Coppola G, Gilardi A, Riminucci M, de Vincentiis M, Corsi A. Extraneural Sclerosing Perineurioma of the Tongue. EAR, NOSE & THROAT JOURNAL 2023; 102:NP436-NP439. [PMID: 34074156 DOI: 10.1177/01455613211020539] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Perineurioma (PN) is an uncommon benign peripheral nerve sheath tumor. For the rarity of this tumor in the oral cavity, otolaryngologists and oral surgeons might not be familiar with this entity. Perineuriomas are typically benign and complete excision is deemed adequate management. Thus, their histological recognition is mandatory to avoid unnecessary overtreatment. We report the clinicopathologic findings of an uncommon variant, the Extraneural Sclerosing PN, in an unusual and never described site, the tongue.
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Affiliation(s)
- Andrea Colizza
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Renato Covello
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonio Greco
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Massimo Ralli
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Giulia Coppola
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Antonio Gilardi
- Department of Sense Organs, Sapienza University of Rome, Italy
| | - Mara Riminucci
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Marco de Vincentiis
- Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy
| | - Alessandro Corsi
- Department of Pathology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Vizcaino MA, Belzberg A, Ahlawat S, Belakhoua S, Chen L, Staedtke V, Rodriguez FJ. Localized Hypertrophic Neuropathy as a Neoplastic Manifestation of KRAS-Mediated RASopathy. J Neuropathol Exp Neurol 2020; 79:647-651. [PMID: 32388560 DOI: 10.1093/jnen/nlaa034] [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: 02/28/2020] [Indexed: 12/12/2022] Open
Abstract
Localized hypertrophic neuropathy is a rare Schwann cell proliferation that usually affects single nerves from the extremities, and it is of unclear etiology in its pure form. RASopathies are a defined group of genetic diseases with overlapping clinical features, usually secondary to germline mutations in genes encoding either components or regulators of the RAS/MAPK pathway. Herein, we report an 11-year-old boy presenting with café au lait spots and right leg length discrepancy. A fascicular nerve biopsy of the tibial nerve demonstrated a Schwann cell proliferation with prominent onion-bulb formation, satisfying criteria for localized hypertrophic neuropathy. Molecular genetic analysis demonstrated identical KRAS mutations (c38_40dupGCG) in the peripheral nerve lesion and melanocytes from café au lait spots, but not in blood, supporting a diagnosis of a KRAS-mediated rasopathy with mosaicism. Immunohistochemical staining in the peripheral nerve lesion demonstrated strong pERK staining consistent with downstream MAPK pathway activation. This report suggests that at least a subset of localized hypertrophic neuropathies are bonafide, well-differentiated Schwann cell neoplasms developing through oncogenic RAS signaling, which provides new insights into the controversial entity historically known as localized hypertrophic neuropathy.
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Affiliation(s)
- M Adelita Vizcaino
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Allan Belzberg
- Department of Neurosurgery, Baltimore, Maryland.,Sydney Kimmel Cancer Center, Baltimore, Maryland
| | | | - Sarra Belakhoua
- Department of Pathology, Baltimore, Maryland.,Johns Hopkins University School of Medicine, Baltimore, Maryland.,University of Tunis el Manar School of Medicine, Tunis, Tunisia
| | - Liam Chen
- Department of Pathology, Baltimore, Maryland
| | - Verena Staedtke
- Department of Neurology, Baltimore, Maryland.,Sydney Kimmel Cancer Center, Baltimore, Maryland
| | - Fausto J Rodriguez
- Department of Pathology, Baltimore, Maryland.,Department of Ophthalmology, Baltimore, Maryland.,Sydney Kimmel Cancer Center, Baltimore, Maryland
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5
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Association of intraneural perineurioma with neurofibromatosis type 2. Acta Neurochir (Wien) 2020; 162:1891-1897. [PMID: 32529330 DOI: 10.1007/s00701-020-04439-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Accepted: 05/27/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Neurofibromatosis type 2 (NF2) is a genetic disorder characterized by mutations of the NF2 tumor suppressor gene that predisposes patients to develop multiple tumors in the peripheral and central nervous system. The most common neoplasms associated with the disease are schwannomas and meningiomas. Both have been shown to contain abnormalities in chromosome 22 and the NF2 gene, suggesting a genetic component to their pathogenesis. Perineuriomas are rare benign tumors arising from the perineural cells. They are commonly classified as intraneural and soft tissue perineuriomas. Several studies have reported mutations in genes on chromosome 22 in both types of perineuriomas, and there are reports of soft tissue perineuriomas associated with NF2 gene mutations. Despite this, perineuriomas are not considered as part of the NF2 constellation of tumors. METHOD The electronic medical records were searched for patients with a radiologic or pathologic diagnosis of intraneural perineurioma. Patients with clinical signs and genetic testing consistent with a diagnosis of NF2 were further evaluated. RESULTS Of 112 patients meeting inclusion criteria, there were two cases of intraneural perineurioma in patients with NF2 treated at our institution (1.8%). We include a third patient treated at another facility for whom we performed a virtual consultation. CONCLUSIONS The rarity of both NF2 and perineuriomas could explain the rarity of perineuriomas in the setting of NF2. Furthermore, there is divergent intraneural and soft tissue perineurioma somatic mutation pathogenesis, and there may be cytogenetic overlap between perineuriomas and multiple tumor syndromes. Our observed occurrence of intraneural perineurioma in the setting of NF2 in several patients provides further evidence of a potential link between the NF2 gene and the development of intraneural perineurioma.
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6
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Limb Undergrowth in Intraneural Perineuriomas: An Under-Recognized Association. World Neurosurg 2020; 141:e670-e676. [PMID: 32522650 DOI: 10.1016/j.wneu.2020.05.280] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 05/28/2020] [Accepted: 05/30/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND Intraneural (IN) perineuriomas are a rare benign hypertrophic nerve tumor, most frequently occurring in young patients. Patients with IN perineurioma have been anecdotally found to have limb undergrowth; however, this has not been systematically evaluated. METHODS Archived electronic records from 1990 to 2018 from a single institution were reviewed for pathology or radiology reports documenting a diagnosis of IN perineurioma. This identified 111 patients; 3 patients with IN perineurioma of cranial nerves were excluded. We further reviewed the 108 patients and identified those with a documented limb length discrepancy (LLD) or hand/foot size discrepancy (HFD) and tried to correlate findings with nerve-territory distribution. RESULTS Twenty-seven (25.0%) patients had either LLD or HFD. Nine patients had only an LLD, 6 patients had only an HFD, and 12 patients had both. Patients with undergrowth were significantly younger at diagnosis than patients without (6.14 vs. 22.9 years, respectively). Although there was a trend toward a greater incidence of LLD in lower extremity IN perineuriomas, this was not statistically significant. Patients with proximal IN perineuriomas had a higher incidence of LLD or HFD than patients with distal IN perineuriomas. The difference between the 2 groups was statistically significant (P < 0.0001). All instances of undergrowth were explained by nerve-territory bone innervation. CONCLUSIONS Limb undergrowth occurs in the affected nerve territory and is likely under-reported in patients with IN perineuriomas. Within our series, patients with documented LLD and HFD were likely to be significantly younger at diagnosis than patients without undergrowth.
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8
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Al-Adnani M. Soft Tissue Perineurioma in a Child With Neurofibromatosis Type 1: A Case Report and Review of the Literature. Pediatr Dev Pathol 2017; 20:444-448. [PMID: 28812461 DOI: 10.1177/1093526617689895] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Soft tissue perineurioma is a rare benign peripheral nerve sheath tumor, especially in children. This manuscript presents an unusual case of soft tissue perineurioma in a 10-year-old boy with neurofibromatosis type 1. The patient presented with a lump in the region of the right breast. A subcutaneous, well circumscribed mass was removed. The cut surface was cream with a vaguely nodular appearance. Histology showed a spindle cell lesion with variable architecture and biphasic morphology. There was no nuclear atypia or pleomorphism. The differential diagnosis and other soft tissue lesions that can be seen in neurofibromatosis type 1 are discussed.
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Affiliation(s)
- Mudher Al-Adnani
- 1 Department of Cellular Pathology, St Thomas' Hospital, London, UK
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9
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Gomes da Silva W, Martínez MM, Miranda ÁMMA, Silva RB, da Silveira HM, de Almeida OP, Pires FR. Oral perineurioma: clinicopathologic features from two cases and review of literature. Oral Surg Oral Med Oral Pathol Oral Radiol 2017; 123:e91-e98. [DOI: 10.1016/j.oooo.2016.09.223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2015] [Revised: 09/12/2016] [Accepted: 09/30/2016] [Indexed: 01/29/2023]
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10
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McMillan HJ, Torres C, Michaud J, Ying Y, Boyd KU, Bourque PR. Diagnosis and outcome of childhood perineurioma. Childs Nerv Syst 2016; 32:1555-60. [PMID: 27086131 DOI: 10.1007/s00381-016-3089-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2016] [Accepted: 04/13/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Intraneural perineurioma is a rare peripheral nerve tumor of childhood and early adulthood. Patients demonstrate progressive muscle weakness and atrophy largely without sensory complaints. CASE We report two children with perineurioma affecting the radial and femoral nerves. Electromyography (EMG), ultrasound, and 3-T MR imaging were important tools for localizing perineurioma and permitting its differentiation from other nerve lesions. The first patient underwent surgical excision of the perineurioma and a traditional nerve graft. At 10 months post-operative follow-up, she demonstrated no meaningful recovery of muscle strength compared to her pre-operative assessment. EMG did confirm axonal continuity indicating that reinnervation had occurred via the nerve graft. The second patient underwent a two-staged surgical procedure that included an end-to-side nerve transfer. At 18 months post-operative follow-up, she demonstrated mild improvement in muscle strength and EMG evidence of ongoing reinnervation. CONCLUSION The surgical management of perineurioma remains controversial, and reports of clinical recovery after nerve grafts and nerve transfers vary. Nerve transfers have been reported to provide superior results to traditional nerve grafting in adults with post-traumatic plexus injuries. The modest gain in strength of our patient who underwent a nerve transfer raises the question if this may also apply to patients with perineurioma. Additional studies will be required, which must also take into consideration that features of long-standing neuropathy (i.e., limb length discrepancy) have the potential to reduce the likelihood of reinnervation and clinical recovery.
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Affiliation(s)
- Hugh J McMillan
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
| | - C Torres
- The Ottawa Hospital, Civic Campus, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - J Michaud
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - Y Ying
- Children's Hospital of Eastern Ontario Research Institute, University of Ottawa, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada
| | - K U Boyd
- The Ottawa Hospital, Civic Campus, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
| | - P R Bourque
- The Ottawa Hospital, Civic Campus, University of Ottawa, 1053 Carling Ave, Ottawa, ON, K1Y 4E9, Canada
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Abstract
Peripheral nerve sheath tumors are common neoplasms in daily practice. Diagnosis and classification of most conventional peripheral nerve sheath tumors are relatively straightforward for the experienced observer; but on occasion, they are diagnostically challenging (especially with locally aggressive and malignant tumors). This article aims to provide an update of the data (clinical, histological, immunohistochemistry and genomic) of benign, intermediate and malignant peripheral nerve sheath tumors, thanks to the latest WHO "Classification of Tumors of Soft Tissue and Bone", published in 2013, which includes a new chapter on "Nerve Sheath Tumors". Advances in molecular biology have provided new insights into the nature of the various peripheral nerve sheath tumors, and have begun to suggest novel targeted therapeutic approaches.
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Affiliation(s)
- Sophie Le Guellec
- Département de pathologie, institut universitaire du cancer Toulouse-Oncopole, 1, avenue Irène-Joliot-Curie, 31059 Toulouse cedex 9, France.
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12
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Duff DJ, Guzman MA, Batanian JR. ABL1 gene involvement within a complex three-way translocation (2;9;4) in perineurioma characterized by molecular cytogenetic methods. Cancer Genet 2014; 207:263-7. [DOI: 10.1016/j.cancergen.2014.05.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2013] [Revised: 05/23/2014] [Accepted: 05/30/2014] [Indexed: 10/25/2022]
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13
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Coffin CM, Davis JL, Borinstein SC. Syndrome-associated soft tissue tumours. Histopathology 2013; 64:68-87. [DOI: 10.1111/his.12280] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Cheryl M Coffin
- Department of Pathology, Microbiology, and Immunology; Vanderbilt University School of Medicine; Nashville TN USA
| | - Jessica L Davis
- Department of Anatomic Pathology; Laboratory Medicine; University of California at San Francisco; San Francisco CA USA
| | - Scott C Borinstein
- Division of Pediatric Hematology/Oncology; Department of Pediatrics; Vanderbilt University School of Medicine; Nashville TN USA
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14
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Abstract
Neurogenic tumors are an uncommon yet important category of soft tissue tumors in children and adolescents because of their frequent association with various genetic syndromes. The heterogeneous cellular composition of the peripheral nerve and the wide metaplastic capacity of the neural crest and its derivatives generate a variety of neoplasms with neurogenic differentiation. This article reviews the clinicopathologic features and differential diagnosis of neurogenic tumors in the first two decades of life, and highlights use of selected ancillary methods for diagnosis.
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Affiliation(s)
- Justin M M Cates
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University Medical Center, Nashville, TN, USA.
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15
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Matter A, Hewer E, Kappeler A, Fleischmann A, Vajtai I. Plexiform hybrid granular cell tumor/perineurioma: A novel variant of benign peripheral nerve sheath tumor with divergent differentiation. Pathol Res Pract 2012; 208:310-4. [DOI: 10.1016/j.prp.2012.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 02/18/2012] [Accepted: 02/27/2012] [Indexed: 12/14/2022]
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16
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Park JY, Park NJ, Kim SP, Kwon KY, Lee SS. A soft tissue perineurioma and a hybrid tumor of perineurioma and schwannoma. KOREAN JOURNAL OF PATHOLOGY 2012; 46:75-8. [PMID: 23109982 PMCID: PMC3479702 DOI: 10.4132/koreanjpathol.2012.46.1.75] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Revised: 04/05/2011] [Accepted: 04/07/2011] [Indexed: 01/17/2023]
Abstract
Perineuriomas are composed of differentiated perineurial cells. Perineuriomas have been recently recognized by the immunoreactivity for epithelial membrane antigen (EMA). Microscopically, perineuriomas show proliferation of spindle cells with wavy nuclei and delicate elongated bipolar cytoplasmic processes. The tumor cells are usually negative for the S-100 protein. Ultrastructurally, perineurial cells reveal slender, nontapered processes containing pinocytic vesicles and discontinuous basal lamina. Interestingly, hybrid tumors of benign peripheral nerve sheath tumor (PNST) have been recently reported by using immunohistochemical and ultrastructural investigations. Herein, we report a case of soft tissue perineurioma arising in the skin of a 56-year-old female; another case of a hybrid tumor of perineurioma and schwannoma in the posterior mediastinum occurred in a 53-year-old male, which is the first case of the hybrid PNST tumor reported in Korea.
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Affiliation(s)
- Ji Young Park
- Department of Pathology, Keimyung University School of Medicine, Daegu, Korea
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17
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Vajtai I, Hewer E, Andres R, Neuenschwander M, Kappeler A, Gugger M. Meningial perineurioma: a benign peripheral nerve sheath tumor in a previously unrecognized central nervous system location, mimicking meningioma. Pathol Res Pract 2011; 207:592-6. [PMID: 21831532 DOI: 10.1016/j.prp.2011.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2011] [Accepted: 07/14/2011] [Indexed: 02/07/2023]
Abstract
Perineurioma is an uncommon, mostly benign, spindle-cell tumor of peripheral nerve sheath origin with a predilection for the soft tissues. Although increasing awareness points to the sites of involvement by perineurioma possibly being as ubiquitous as those frequented by schwannian tumors, only one intracerebral example has been described to date. We report on a surgically resected perineurioma of the falx cerebri in an 86-year-old woman. Preoperative imaging showed an enhancing extraaxial mass of 6 cm × 5.7 cm × 3.7 cm. Histologically, the tumor consisted of a proliferation of spindle cells interwoven by a lattice of basal lamina. Alongside a prevailing soft tissue perineurioma pattern, sclerosing and reticular areas were seen as well. Tumor cells coexpressed EMA and GLUT-1, and a minority immunoreacted for smooth muscle actin. Pericellular basal lamina was decorated with collagen type IV. No staining for S100 protein was detected. Mitotic activity was virtually absent, and the MIB1 labeling index averaged 2%. Ultrastructural examination revealed abundant pinocytotic vesicles within and conspicuous tight junctions between slender cytoplasmic processes which, in turn, were encased by discontinuous basal lamina. FISH analysis confirmed loss of at least part of one chromosome 22q. This observation calls attention to perineurioma as a novel item in the repertoire of low-grade meningial spindle cell neoplasms, in the differential diagnostic context of which it is apt to being misconstrued as either meningioma, solitary fibrous tumor, or neurofibroma. Confusion with the latter bears the risk of overgrading innocuous features of perineurioma as criteria for malignancy.
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Affiliation(s)
- Istvan Vajtai
- Neuropathology Service, Institute of Pathology, University of Bern, Switzerland.
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18
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Noonan VL, Greene DJ, Brodsky G, Kabani SP. Extraneural sclerosing perineurioma of the buccal mucosa: a case report and clinicopathologic review. Head Neck Pathol 2010; 4:169-73. [PMID: 20364337 PMCID: PMC2878626 DOI: 10.1007/s12105-010-0175-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 03/20/2010] [Indexed: 11/25/2022]
Abstract
The perineurioma is an infrequently encountered benign peripheral nerve sheath tumor composed of a clonal proliferation of perineurial cells. Rare cases of perineurioma have been reported in the oral cavity. An extraneural sclerosing perineurioma arising in the buccal mucosa of a 17-year-old male is presented. Histopathologically, the tumor is composed of a well circumscribed nodular proliferation of spindle cells arranged in a storiform growth pattern, in some areas subtly arranged around vascular channels. The tumor cells reveal positive immunostaining for epithelial membrane antigen (EMA), collagen type IV and vimentin, and negative immunostaining for S-100 protein, consistent with a perineurial origin. To the best of our knowledge, this case represents the first report of an extraneural sclerosing perineurioma involving the oral cavity.
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Affiliation(s)
- Vikki L. Noonan
- Department of Pathology, Harvard Vanguard Medical Associates, 133 Brookline Ave., 6th Floor, Boston, MA 02215 USA
| | - David J. Greene
- Oral and Maxillofacial Surgery, Private Practice, Nashua, NH USA
| | - Gilbert Brodsky
- Department of Pathology, Harvard Vanguard Medical Associates, 133 Brookline Ave., 6th Floor, Boston, MA 02215 USA
| | - Sadru P. Kabani
- Department of Pathology, Harvard Vanguard Medical Associates, 133 Brookline Ave., 6th Floor, Boston, MA 02215 USA
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Piña-Oviedo S, Del Valle L, Baquera-Heredia J, Ortiz-Hidalgo C. Immunohistochemical characterization of Renaut bodies in superficial digital nerves: further evidence supporting their perineurial cell origin. J Peripher Nerv Syst 2009; 14:22-6. [PMID: 19335536 DOI: 10.1111/j.1529-8027.2009.00202.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Renaut bodies are well-demarcated cylindrical (circular in cross section) hyaline structures attached to the inner layer of the perineurium that can be found in normal and pathological nerves of various animals and humans. They are composed of spidery fibroblasts and perineurial cells immersed in an extracellular matrix that contains randomly oriented collagen fibers and elastin precursors but not axons or Schwann cells. Frequently, they are associated with thickened subperineurial capillaries. As Renaut bodies are mainly located at sites of nerve compression, it is hypothesized they may act as 'protective cushions' for endoneurial components, and that they may be formed as a secondary reaction to trauma. Herein, we report the presence of Renaut bodies within numerous small dermal nerve trunks in an amputated finger. By immunohistochemistry, Renaut bodies expressed markers identical to those of perineurial cells (epithelial membrane antigen, Glut-1, and claudin-1), supporting the concept of a closely associated perineurial but not endoneurial origin. In addition, expression of hypoxia-inducible factor 1 alpha (which has been shown to increase Glut-1 transcription), neurofibromatosis 1 gene related product and NF-2, were also detected in these peripheral nerve structures.
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Affiliation(s)
- Sergio Piña-Oviedo
- Department of Neuroscience, Neuropathology Core, Temple University School of Medicine, Philadelphia, PA, USA
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20
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Fang WS, Emerson LL, Hunt JP, Salzman KL. An unusual sinonasal tumor: soft tissue perineurioma. AJNR Am J Neuroradiol 2009; 30:437-9. [PMID: 19182108 DOI: 10.3174/ajnr.a1284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Soft tissue perineuriomas are an unusual type of peripheral nerve sheath tumors distinct from schwannomas and neurofibromas, with interesting histologic findings. They are not well characterized on radiographic examination. We report this case of a patient with sinonasal perineurioma to help define the imaging and pathologic features of this rare head and neck tumor.
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Affiliation(s)
- W S Fang
- Department of Neuroradiology, University of Utah, Salt Lake City, Utah 84132, USA.
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21
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Abstract
Hybrid peripheral nerve sheath tumors (PNSTs) are recently recognized, rarely reported entities. Very few hybrid PNSTs with elements of perineurioma have been reported. We report a case of a 47-year-old man who presented with multiple (>20) cutaneous nodules on all 4 extremities, present since childhood. The patient and his family had no history of other PNSTs, other neural-origin tumors, or genetic disorders, including neurofibromatosis. Five excised lesions are well circumscribed but unencapsulated nodular tumors composed of cytologically bland spindled cells with tapering nuclei and indistinct cytoplasm arranged in a storiform pattern in a collagenous matrix. Scattered among these cells are large granular eosinophilic cells. The spindled cells are epithelial membrane antigen-positive and S-100 protein negative. The cytoplasm of the granular cells contains abundant S-100 protein, NK1/C3, and CD68-positive granules. Sparse nerve fascicles contain neurofilament-positive axons. Each tumor also contains poorly marginated areas that histologically resemble pure granular cell tumor, and superficial biopsies of these tumors can histologically resemble pure granular cell tumors. Considering a Schwannian origin for both perineurial and granular cells can provide a logical explanation for the pathogenesis of this case. To the best of our knowledge, our case is the first report of multiple hybrid granular cell tumor-perineurioma.
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Abstract
Peripheral nerves consist of 3 layers with differing characteristics: the endoneurium, perineurium, and epineurium. The perineurium represents a continuum with the pia-arachnoid from the central nervous system and extends distally with the sheath of capsular cells of peripheral sensorial organs and propioceptive receptors. It is made of layers of flattened cells surrounded by a basement membrane and collagen fibers, forming concentrically laminated structures around single nerve fascicles. Functionally, the perineurium modulates external stretching forces (that could be potentially harmful for nerve fibers), and along with endoneurial vessels, forms the blood-nerve barrier. Multiple pathologic conditions associated with the perineurium have been described. Perineurial invasion is considered an important prognostic factor in several malignant neoplasms. Perineuriomas are true benign infrequent perineurial cell neoplasms that have been divided in 2 categories: those with intraneural localization and a more common extraneural (soft tissue) group, including sclerosing and reticular variants. Sporadic cases of malignant perineuromas have been reported. Interestingly, neurofibromas and malignant peripheral nerve sheath tumors may also display perineurial cell differentiation. The histologic appearance of perineuriomas may overlap with other soft tissue spindle cell neoplasms. Immunohistochemistry is imperative for the diagnosis, although in certain cases ultrastructural studies may be needed. Typical perineuriomas are positive for epithelial membrane antigen, glucose transporter-1-1, and claudin-1, and negative for S-100 protein and neurofilaments. Perineuriomas have mostly simple karyotypes, with one or few chromosomal rearrangements or numerical changes and it seems that specific cytogenetic aberrations may correlate with perineurioma subtype.
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