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Nagrani NS, Bhawan J. Histopathological Variants of Cutaneous Neurofibroma: A Compendious Review. Dermatopathology (Basel) 2022; 10:1-19. [PMID: 36648779 PMCID: PMC9844430 DOI: 10.3390/dermatopathology10010001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 12/19/2022] [Accepted: 12/21/2022] [Indexed: 12/28/2022] Open
Abstract
The first description of histopathological variants of neurofibroma dates back to 1994. Over the years, many individual case reports elucidating unusual histologic features in neurofibroma have been added to the literature, some of which have defined criteria, with the others falling under the roof of benign neural neoplasms. These unusual features, which sometimes may lead to pauses in identifying a common benign tumor such as neurofibroma. Awareness of these variants may help dermatopathologists avoid misinterpretation. Thus, this review aims to summarize all novel and unusual histopathological variants of cutaneous neurofibroma reported to date, in addition to any unusual variants that we encountered in our practice.
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Prabhu S, Athikari R, Jose M, Shetty M. Floret-like giant cells in intra-osseous schwannoma. J Oral Maxillofac Pathol 2020; 24:395-396. [PMID: 33456253 PMCID: PMC7802845 DOI: 10.4103/jomfp.jomfp_156_20] [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: 04/16/2020] [Revised: 07/09/2020] [Accepted: 07/21/2020] [Indexed: 11/19/2022] Open
Abstract
Floret-like giant cells are very commonly seen in neurofibroma and as an indication to be associated with neurofibromatosis type 1 gene. This particular case of intraosseous schwannoma of mandible showing such giant cells, which is rarely reported.
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Affiliation(s)
- Sudeendra Prabhu
- Department of Oral Pathology, Yenepoya Dental College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
| | - Roshan Athikari
- Department of Oral Pathology, Yenepoya Dental College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
| | - Maji Jose
- Department of Oral Pathology, Yenepoya Dental College, Yenepoya Deemed to be University, Mangalore, Karnataka, India
| | - Mohitha Shetty
- Arogya Multispeciality Dental Clinic, Moodbidri, Mangalore, Karnataka, India
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Delbaz A, Chen M, Jen FEC, Schulz BL, Gorse AD, Jennings MP, St John JA, Ekberg JAK. Neisseria meningitidis Induces Pathology-Associated Cellular and Molecular Changes in Trigeminal Schwann Cells. Infect Immun 2020; 88:e00955-19. [PMID: 31964742 PMCID: PMC7093114 DOI: 10.1128/iai.00955-19] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 01/09/2020] [Indexed: 02/06/2023] Open
Abstract
Neisseria meningitidis, a common cause of sepsis and bacterial meningitis, infects the meninges and central nervous system (CNS), primarily via paracellular traversal across the blood-brain barrier (BBB) or blood-cerebrospinal fluid barrier. N. meningitidis is often present asymptomatically in the nasopharynx, and the nerves extending between the nasal cavity and the brain constitute an alternative route by which the meningococci may reach the CNS. To date, the cellular mechanisms involved in nerve infection are not fully understood. Peripheral nerve glial cells are phagocytic and are capable of eliminating microorganisms, but some pathogens may be able to overcome this protection mechanism and instead infect the glia, causing cell death or pathology. Here, we show that N. meningitidis readily infects trigeminal Schwann cells (the glial cells of the trigeminal nerve) in vitro in both two-dimensional and three-dimensional cell cultures. Infection of trigeminal Schwann cells may be one mechanism by which N. meningitidis is able to invade the CNS. Infection of the cells led to multinucleation and the appearance of atypical nuclei, with the presence of horseshoe nuclei and the budding of nuclei increasing over time. Using sequential window acquisition of all theoretical mass spectra (SWATH-MS) proteomics followed by bioinformatics pathway analysis, we showed that N. meningitidis induced protein alterations in the glia that were associated with altered intercellular signaling, cell-cell interactions, and cellular movement. The analysis also suggested that the alterations in protein levels were consistent with changes occurring in cancer. Thus, infection of the trigeminal nerve by N. meningitidis may have ongoing adverse effects on the biology of Schwann cells, which may lead to pathology.
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Affiliation(s)
- Ali Delbaz
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Brisbane, QLD, Australia
- Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Mo Chen
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Brisbane, QLD, Australia
- Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Freda E-C Jen
- Institute for Glycomics, Griffith University, Southport, QLD, Australia
| | - Benjamin L Schulz
- Australian Infectious Diseases Research Centre, School of Chemistry and Molecular Biosciences, the University of Queensland, St. Lucia, Brisbane, Australia
| | - Alain-Dominique Gorse
- QFAB Bioinformatics, Institute for Molecular Bioscience, The University of Queensland, St. Lucia, Brisbane, Australia
| | | | - James A St John
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Brisbane, QLD, Australia
- Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - Jenny A K Ekberg
- Clem Jones Centre for Neurobiology and Stem Cell Research, Griffith University, Brisbane, QLD, Australia
- Griffith Institute for Drug Discovery, Griffith University, Brisbane, QLD, Australia
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
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Rozza-de-Menezes RE, Brum CDAI, Gaglionone NC, de Sousa Almeida LM, Andrade-Losso RM, Paiva BVB, Faveret PLS, da Silva AV, Siqueira OHK, Riccardi VM, Cunha KS. Prevalence and clinicopathological characteristics of lipomatous neurofibromas in neurofibromatosis 1: An investigation of 229 cutaneous neurofibromas and a systematic review of the literature. J Cutan Pathol 2018; 45:743-753. [PMID: 29959804 DOI: 10.1111/cup.13315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 06/10/2018] [Accepted: 06/25/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Lipomatous neurofibroma (Lnf) is a histopathological variant with adipocytes noted among cells of cutaneous neurofibromas. We aimed to investigate the prevalence and clinicopathological features of Lnfs of neurofibromatosis 1 (NF1)-associated cutaneous neurofibromas and to review the literature systematically. We also evaluated the expression of leptin (a hormone involved in lipid metabolism) in neurofibromas to better understand the pathogenesis of Lnfs. METHODS A prospective histologic study was conducted on 229 cutaneous neurofibromas from 85 NF1 individuals. Leptin expression was immunohistochemically evaluated in 111 cutaneous neurofibromas. To systematically review the literature, two authors independently performed literature searches without year restriction. RESULTS Forty (17.5%) neurofibromas were lipomatous. Lnfs were significantly larger lesions and associated with females. Eighteen (7.9%) of all neurofibromas had multinucleated floret-like giant cells, and these were associated with Lnfs. All neurofibromas expressed leptin. We systematically reviewed 13 articles. Three large studies investigated Lnfs mainly in sporadic neurofibromas and suggested that 0.3% to 8.0% of tumors (NF1 and sporadic) are Lnfs. CONCLUSION In NF1, Lnfs are common, mainly in larger tumors and women. All cutaneous NF1-neurofibromas express leptin. It is unknown if the expression of leptin accounts for the lipomatous variant, but it may have a role in the pathogenesis of cutaneous neurofibroma.
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Affiliation(s)
- Rafaela Elvira Rozza-de-Menezes
- Department of Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose, CNNF), Rio de Janeiro, Brazil
| | | | | | - Lilian Machado de Sousa Almeida
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose, CNNF), Rio de Janeiro, Brazil
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
| | - Raquel Machado Andrade-Losso
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose, CNNF), Rio de Janeiro, Brazil
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
| | | | | | - André Vallejo da Silva
- Breast Surgery Service, Antônio Pedro University Hospital, Universidade Federal Fluminense, Niterói, Brazil
| | | | | | - Karin Soares Cunha
- Department of Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
- Neurofibromatosis National Center (Centro Nacional de Neurofibromatose, CNNF), Rio de Janeiro, Brazil
- Graduate Program in Pathology, School of Medicine, Universidade Federal Fluminense, Niterói, Brazil
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Kim EJ, Park HS, Yoon HS, Cho S. A case of perforating dermatofibroma with floret-like giant cells. Clin Exp Dermatol 2014; 40:305-8. [PMID: 25534666 DOI: 10.1111/ced.12539] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2014] [Indexed: 11/29/2022]
Abstract
Dermatofibromas are slow-growing solitary nodules, composed mostly of a dermal proliferation of spindle cells and epithelioid cells. Some dermatofibromas present with multinucleated giant cells, such as Touton, foreign body, and osteoclast-like cells. We report a case of dermatofibroma containing both Touton giant cells and floret-type cells. A 12-year-old boy presented with a 6-mm, firm, nontender, dusky-red to greyish dermal nodule on his left popliteal fossa. As suggested clinically by the central opening, perforation of the epidermis with partial extrusion of the dermal components, including macrophages and vertically oriented collagen bundles, via transepidermal elimination, were detected. In the upper dermis, collagen trapping and mostly epithelioid cells with many giant cells were seen, while the lower part contained mainly spindle cells in a storiform pattern. Multinucleated giant cells scattered in the upper dermis were mainly floret-type multinucleated giant cells with star-shaped cytoplasmic projections, associated with some Touton giant cells. To our knowledge, this is the first report of a perforating dermatofibroma with floret-type multinucleated giant cells.
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Affiliation(s)
- E J Kim
- Department of Dermatology, Seoul National University Boramae Hospital, Seoul, Korea
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Stanger K, De Kerviler S, Vajtai I, Constantinescu M. The riddle of multinucleated "floret-like" giant cells and their detection in an extensive gluteal neurofibroma: a case report. J Med Case Rep 2013; 7:189. [PMID: 23890233 PMCID: PMC3751089 DOI: 10.1186/1752-1947-7-189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Accepted: 05/07/2013] [Indexed: 11/20/2022] Open
Abstract
Introduction The neurofibromatoses are inherited tumor predisposition syndromes involving two major clinical phenotypes: neurofibromatosis type 1 (von Recklinghausen's disease) is linked to chromosome 17q, and tends to occur seven times more frequently than neurofibromatosis type 2. Neurofibromatosis type 1 entails a distinctive cutaneous manifestation prevailed upon by benign neurofibromas, which may vary in size, number and distribution. On the histological level, neurofibromas are composed of an admixture of neurilemmal cells, including Schwann cells, fibroblasts, and – to a lesser extent – perineurial cells. Case presentation The case of a 39-year-old Caucasian man with a voluminous recurrent neurofibroma of 27×15cm extending from the left gluteal region to thoraco-lumbar levels Th6 through L4 is reported. Within the soft tissue tumor a pseudocyst of 7.3×9.3cm was found preoperatively. Conclusion Histopathological study of the excised mass was conspicuous for revealing a large number of multinucleated floret-like giant cells within an otherwise classical soft tissue neurofibroma. Previous reports on neurofibromas with multinucleated floret-like giant cells are distinctly scant. Available evidence from the literature does not suggest any consistent correlation of multinucleated floret-like giant cells in neurofibromas with gender, age, traumatic antecedents, size of the lesion, recurrence, or malignant transformation. Furthermore, the presence of such cells may not be specific for neurofibromatosis type 1, as they occasionally are encountered in some unrelated mesenchymal neoplasms as well.
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Affiliation(s)
- Katrin Stanger
- Department of Plastic and Hand Surgery, University Hospital, Inselspital and University of Bern, Bern, Switzerland.
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Affiliation(s)
- José Luis Rodríguez-Peralto
- Department of Pathology, Hospital Universitario 12 de Octubre, Instituto de Investigación i+12, Universidad Complutense, Madrid, Spain.
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Black J, Coffin CM, Dehner LP. Fibrohistiocytic tumors and related neoplasms in children and adolescents. Pediatr Dev Pathol 2012; 15:181-210. [PMID: 22420728 DOI: 10.2350/11-03-1001-pb.1] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Fibrohistiocytic tumors (FHTs) in children and adolescents range from the benign fibrous histiocytoma, or dermatofibroma, to a variety of intermediate and malignant neoplasms, such as dermatofibrosarcoma protruberans and high-grade undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma). Those tumors as a group are comprised of fibroblasts, myofibroblasts, and histiocytes-dendritic cells with a variably prominent inflammatory infiltrate consisting of lymphocytes and eosinophils. Dendritic cells are also a major constituent of another group of neoplasms that include Langerhans cell histiocytosis, follicular and interdigitating cell sarcomas, and juvenile xanthogranuloma. These latter tumors are considered in this discussion for the sake of differential diagnosis and their possible histogenetic relationship to FHTs. Recent studies have suggested that the relationship between the fibroblast and histiocyte in the FHTs may reflect the intrinsic capacity to transdifferentiate from one to the other morphologic and functional state. The so-called "facultative fibroblast," as a cell with fibroblastic and histiocytic properties, was discussed in the context of the fibrous xanthoma 50 years ago. Possibly the entire histogenetic concept of FHTs should be reconsidered in light of current studies.
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Affiliation(s)
- Jennifer Black
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University, Nashville, TN, USA.
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Atypical Cellular Unguioblastic Fibroma-A Rare Case With More Atypical Histological Features Than Previously Reported. Am J Dermatopathol 2010; 32:387-91. [DOI: 10.1097/dad.0b013e3181c03402] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Magro G, Amico P, Vecchio GM, Caltabiano R, Castaing M, Kacerovska D, Kazakov DV, Michal M. Multinucleated floret-like giant cells in sporadic and NF1-associated neurofibromas: a clinicopathologic study of 94 cases. Virchows Arch 2009; 456:71-6. [PMID: 19937344 DOI: 10.1007/s00428-009-0859-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2009] [Revised: 10/28/2009] [Accepted: 11/01/2009] [Indexed: 02/01/2023]
Abstract
Multinucleated floret-like giant cells (MNFGCs), similar to those commonly observed in pleomorphic lipoma and giant cell fibroblastoma, have been occasionally reported in gynecomastia and neurofibromas from patients affected by neurofibromatosis type 1 (NF1). Accordingly, it has been suggested that their detection, especially in an otherwise typical neurofibroma, could be a morphological clue to diagnosis of NF1. The aim of the present study was the identification of MNFGCs in a large series (94 cases) of sporadic and NF1-associated neurofibromas, to assess if their presence may indeed be a morphological marker of NF1. Numerous MNFGCs, namely, those that were easily apparent at low magnification (x50 and x100), were identified only in 5.3% of cases. In 18.1% of cases, a low number of these cells could be observed but only after a careful search, especially at higher magnification (x200 and x400). Immunohistochemically, all MNFGCs were stained with vimentin and CD34, but not with S-100 protein. Interestingly, there was no statistically significant correlation between MNFGCs (presence or absence) and NF1 (p = 0.73), gender (p = 0.59), age (p = 0.43), and site of tumor (cutaneous vs deep-seated soft tissue; p = 0.27). Our clinicopathologic findings suggest that MNFGCs in an otherwise typical neurofibroma are not a reliable marker of NF1, likely representing a morphological reactive change of the indigenous dermal or endoneurial fibroblasts or dendritic cells in response to unknown microenvironmental stimuli.
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Affiliation(s)
- Gaetano Magro
- Dipartimento G.F. Ingrassia, Policlinico Universitario G. Rodolico, Anatomia Patologica, Università di Catania, Via S. Sofia 87, Catania, Italy.
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