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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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Fernández de los Reyes I, Córdoba Iturriagagoitia A, Larrea García M, Fernández Figueras M. Tumor benigno cutáneo plexiforme híbrido de perineuroma y neurotecoma celular agminado en un niño de 9 meses. ACTAS DERMO-SIFILIOGRAFICAS 2022; 113:632-635. [DOI: 10.1016/j.ad.2020.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 05/30/2020] [Accepted: 08/23/2020] [Indexed: 11/30/2022] Open
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Fernández de los Reyes I, Córdoba Iturriagagoitia A, Larrea García M, Fernández Figueras M. [Translated article] Benign Cutaneous Plexiform Hybrid Tumor Composed of Agminated Perineurioma and Cellular Neurothekeoma Components in a 9-Month-Old Boy. ACTAS DERMO-SIFILIOGRAFICAS 2022. [DOI: 10.1016/j.ad.2020.08.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Tomás-Velázquez A, Surrey LF, Miele E, Li MM, Alaggio R, Goitz RJ, Reyes-Múgica M, Salgado CM. Mesenchymal PLAG1 Tumor With PCMTD1-PLAG1 Fusion in an Infant: A New Type of "Plagoma". Am J Dermatopathol 2021; 44:54-57. [PMID: 34291746 DOI: 10.1097/dad.0000000000001978] [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
ABSTRACT In the past decade, there have been major advances in knowledge related to mesenchymal tumors, and new genetic alterations are being delineated. We report a mesenchymal spindle cell neoplasm harboring a novel gene fusion in an infant. Histopathologically, the neoplasm shared some features with sclerosing perineurioma, but immunohistochemically, EMA was negative, whereas GLUT1, NK1-C3, and BCOR were positive. Next-generation sequencing revealed a PCMTD1-pleomorphic adenoma gene 1 (PLAG1) fusion. PLAG1 contributes to the expression of a variety of genes implicated in regulating cell proliferation, and PCMTD1 has been related to the development of certain carcinomas. Recently, other soft tissue tumors in young children associated with PLAG1 fusion variants have been reported. Perhaps, mesenchymal neoplasms presenting PLAG1 fusions with different genes would confirm a specific group (PLAG mesenchymal tumours or "plagomas") in the near future.
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Affiliation(s)
- Alejandra Tomás-Velázquez
- Department of Dermatology, University Clinic of Navarra, School of Medicine, University of Navarra, Pamplona, Spain; Department of Pathology and Laboratory Medicine, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA; Department of Pediatric Hematology/Oncology, IRCCS Bambino Gesù Children's Hospital, Roma, Italy; Department of Pathology, Ospedale Bambino Gesù, Roma, Italy; Orthopedic Division, University of Pittsburgh Medical Center, Pittsburgh, PA; and Department of Pathology, UPMC Children's Hospital of Pittsburgh, Pittsburgh, PA
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Sakaguchi Y, Komori T, Kaku Y, Fujimoto M, Endo Y, Kabashima K. Benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma on the leg. J Dermatol 2021; 48:e372-e373. [PMID: 33942353 DOI: 10.1111/1346-8138.15943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/26/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Yuri Sakaguchi
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takaya Komori
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yo Kaku
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan.,Department of Dermatology, Kagawa University Graduate School of Medicine, Kagawa, Japan
| | - Masakazu Fujimoto
- Department of Diagnostic Pathology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Yuichiro Endo
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Kenji Kabashima
- Department of Dermatology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Meningioma-like Tumor of the Skin Revisited: A Distinct CD34+ Dermal Tumor With an Expanded Histologic Spectrum. Am J Surg Pathol 2020; 43:1518-1525. [PMID: 31490235 DOI: 10.1097/pas.0000000000001357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The term meningioma-like tumor of the skin (MLTS) was coined in 1993 to designate a particular whorled spindle cell superficial cutaneous tumor. No additional confirmed cases of this entity have been reported to date. Some authors have speculated that these cases might be cellular neurothekeomas. In order to delineate the histologic spectrum and the immunophenotype of this unusual tumor, we studied 5 cases, 2 previously unreported and the 3 original cases. The immunohistochemical findings of case 5, however, were limited to those from the original study. Clinically, the tumor presented as a reddish papule, plaque, or nodule, located in the extremities or trunk. The patient often referred to a recent growth of a longstanding lesion. Histologically, the characteristic whorled spindle and stellate dendritic cell population, commonly in a perivascular arrangement, and variable myxoid component, were consistently found in all cases. A prominent microvasculature was also a constant finding. The presence of large deciduoid cells was conspicuous in one case. A reticular pattern of multivacuolated cells giving a chordoma-like appearance was evident in another case. Tumor cells were diffusely positive for CD34 in all 4 cases studied, and negative for S-100, EMA, NKI-C3, CD68, and smooth muscle markers. No complete loss of retinoblastoma protein was found. No brachyury immunostaining was found in the case with chordoid features. No EWSR1 or NAB2-STAT6 gene fusions were found. From these findings, we demonstrate that MLTS is a distinct CD34 spindle cell benign dermal tumor, unrelated to cellular neurothekeoma, and exhibiting myxoid, deciduoid, or chordoma-like features.
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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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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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Torres-Mora J, Ud Din N, Ahrens WA, Folpe AL. Pseudolipoblastic perineurioma: an unusual morphological variant of perineurioma that may simulate liposarcoma. Hum Pathol 2016; 57:22-27. [PMID: 27395366 DOI: 10.1016/j.humpath.2016.06.017] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 06/07/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022]
Abstract
Perineuriomas are rare peripheral nerve sheath tumors arising from or differentiating along the lines of normal perineurial cells. They can be divided into intraneural and soft tissue types, with the latter category including a significant number of morphological variants. Herein, we further expand their morphological spectrum to include "pseudolipoblastic" perineuriomas. These lesions occurred in the tongue of a 30-year-old man and in the triceps of a 67-year-old woman and were characterized by bland, epithelioid cells with striking intracytoplasmic vacuolization. The architecture varied, with some areas showing a striking "net-like" or "microreticular" pattern and smaller areas having a more typical spindled and whorled appearance. Clinical follow-up (5months and 52months, respectively) showed no evidence of local recurrence or metastasis. Multiple perineurial markers, including epithelial membrane antigen, claudin-1, GLUT-1, and collagen IV, were diffusely positive. Both cases were submitted in consultation out of concern that they represented high-grade liposarcomas. To the best of our knowledge, this unusual morphological variant of perineurioma has not been reported. These tumors appear to be entirely benign and should be cured with simple excision. Pseudolipoblastic perineuriomas should be distinguished from round cell and epithelioid pleomorphic liposarcomas, as well as from other tumors that may show prominent intracytoplasmic vacuolization.
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Affiliation(s)
- Jorge Torres-Mora
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester 55905, MN, USA
| | - Nasir Ud Din
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Andrew L Folpe
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester 55905, MN, USA.
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Areán C, Córdoba A, Requena L, Álvarez M. Tumor benigno cutáneo plexiforme híbrido de perineuroma y neurotecoma celular. ACTAS DERMO-SIFILIOGRAFICAS 2016; 107:607-10. [DOI: 10.1016/j.ad.2016.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2015] [Revised: 01/28/2016] [Accepted: 03/06/2016] [Indexed: 10/21/2022] Open
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Areán C, Córdoba A, Requena L, Álvarez M. Benign Cutaneous Plexiform Hybrid Tumor of Perineurioma and Cellular Neurothekeoma. ACTAS DERMO-SIFILIOGRAFICAS 2016. [DOI: 10.1016/j.adengl.2016.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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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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McLaughlin CT, Kaffenberger BH, Gru AA. A hybrid tumor with schwannoma-perineurioma-neurofibroma morphology. J Cutan Pathol 2015; 42:911-3. [PMID: 26147119 DOI: 10.1111/cup.12544] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 05/19/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Colin T McLaughlin
- Division of Dermatology, Ohio State University College of Medicine, Columbus, OH, USA
| | | | - Alejandro A Gru
- Division of Dermatology, Ohio State University College of Medicine, Columbus, OH, USA.
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Benign Cutaneous Biphasic Hybrid Tumor of Perineurioma and Cellular Neurothekeoma. Am J Dermatopathol 2015; 37:319-22. [DOI: 10.1097/dad.0000000000000105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Weng YC, Shen JL, Yang CS, Li WH. Desmoplastic cellular neurothekeoma mimicking basal cell carcinoma. J Dtsch Dermatol Ges 2015; 13:243-5. [PMID: 25706811 DOI: 10.1111/ddg.12523] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Yu-Ching Weng
- Department of Dermatology, Taichung Veterans General Hospital, Taichung, Taiwan
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Misago N, Toda S, Narisawa Y. The Relationship Between Palisaded Encapsulated Neuroma and the Mucocutaneous Neuroma Seen in Multiple Endocrine Neoplasia 2b Syndrome. Am J Dermatopathol 2014; 36:562-9. [DOI: 10.1097/dad.0000000000000021] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Agaimy A. Microscopic intraneural perineurial cell proliferations in patients with neurofibromatosis type 1. Ann Diagn Pathol 2013; 18:95-8. [PMID: 24461704 DOI: 10.1016/j.anndiagpath.2013.12.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 12/17/2013] [Indexed: 10/25/2022]
Abstract
Benign peripheral nerve sheath tumors (PNSTs) showing more than one line of differentiation (hybrid PNSTs) have been increasingly recognized, mainly due to awareness of their existence and as a consequence of increased use of immunohistochemisty during the last decade. Two recent studies suggested overrepresentation of hybrid tumors among benign PNSTs in patients with neurofibromatosis type 1 (NF-1). This study was performed to assess the presence of perineurial cells in microscopic (early) neurofibromatous lesions and normal-looking peripheral nerves in specimens from 5 patients with NF-1 using markers of perineurial cell differentiation (epithelial membrane antigen, claudin-1, and glucose transporter 1). In 2 patients, multiple normal looking nerve fibers as well as hypertrophied nerves and microscopic tumor nodules showed variable intraneural perineurial cell proliferations that frequently occupied the whole nerve fascicle resulting in multiple microscopic reticular perineurioma-like nodules (microscopic hybrid neurofibromatosis/perineuriomatosis). None of the cases showed the onion skin pattern of intraneural perineurioma. However, other nerve fibers within the same specimens showed normal compact rim of perineurium without any detectable intraneural perineurial cells. Both patients had concurrent multiple larger PNSTs (plexiform neurofibromas, hybrid neurofibroma/perineurioma and lesions with features intermediate between the 2 types). One specimen harboring high-grade malignant PNST and 2 specimens with large solitary neurofibromas displayed no intraneural perineurial cells. These observations suggest that intraneural perineurial proliferations are part of the early lesions in the setting of constitutional NF-1 inactivation and support the concept of pure and hybrid perineuriomatous lesions as novel member of the spectrum of PNSTs in NF-1.
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Affiliation(s)
- Abbas Agaimy
- Institute of Pathology, University Hospital, Erlangen, Germany.
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Yamada S, Kitada S, Nabeshima A, Noguchi H, Sasaguri Y, Hisaoka M. Benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma arising from the nose. Diagn Pathol 2013; 8:165. [PMID: 24103568 PMCID: PMC3853886 DOI: 10.1186/1746-1596-8-165] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/28/2013] [Indexed: 11/10/2022] Open
Abstract
Very recently, Requena et al. have demonstrated the detailed clinicopathological features of 9 cases of a benign cutaneous plexiform nerve sheath tumor with hybrid characteristics of perineurioma and cellular neurothekeoma, given the name as a benign cutaneous plexiform hybrid tumor of perineurioma and cellular neurothekeoma, all of which were peculiarly located on the lips. Herein we described the first case of that arising from the nose, but not the lip, representing a histological hybridoma of perineurioma and cellular neurothekeoma after thorough consideration especially with its immunohistochemical profile.
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Affiliation(s)
- Sohsuke Yamada
- Department of Pathology and Cell Biology, University of Occupational and Environmental Health, 1-1 Iseigaoka, Kitakyushu, Yahatanishi-ku 807-8555, Japan.
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