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Zou X, Dong Y, Alhaskawi A, Zhou H, Ezzi SHA, Kota VG, Abdulla MHAH, Abdalbary SA, Lu H, Wang C. Techniques and graft materials for repairing peripheral nerve defects. Front Neurol 2024; 14:1307883. [PMID: 38318237 PMCID: PMC10839026 DOI: 10.3389/fneur.2023.1307883] [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: 10/05/2023] [Accepted: 12/15/2023] [Indexed: 02/07/2024] Open
Abstract
Peripheral nerve defects refer to damage or destruction occurring in the peripheral nervous system, typically affecting the limbs and face. The current primary approaches to address peripheral nerve defects involve the utilization of autologous nerve transplants or the transplantation of artificial material. Nevertheless, these methods possess certain limitations, such as inadequate availability of donor nerve or unsatisfactory regenerative outcomes post-transplantation. Biomaterials have been extensively studied as an alternative approach to promote the repair of peripheral neve defects. These biomaterials include both natural and synthetic materials. Natural materials consist of collagen, chitosan, and silk, while synthetic materials consist of polyurethane, polylactic acid, and polycaprolactone. Recently, several new neural repair technologies have also been developed, such as nerve regeneration bridging technology, electrical stimulation technology, and stem cell therapy technology. Overall, biomaterials and new neural repair technologies provide new methods and opportunities for repairing peripheral nerve defects. However, these methods still require further research and development to enhance their effectiveness and feasibility.
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Affiliation(s)
- Xiaodi Zou
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
| | - Haiying Zhou
- Faculty of Medicine, The Chinese University of Hong Kong School of Biomedical Science, Shatin, China
| | | | | | | | - Sahar Ahmed Abdalbary
- Department of Orthopedic Physical Therapy, Faculty of Physical Therapy, Nahda University in Beni Suef, Beni Suef, Egypt
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, China
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou, China
| | - Changxin Wang
- Department of Orthopedics, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
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Sun J, Zou X, Fu Q, Wu J, Yuan S, Alhaskawi A, Dong Y, Zhou H, Abdalbary SA, Lu H. Case report: Ultrasound-guided needle knife technique for carpal ligament release in carpal tunnel syndrome treatment. Front Neurol 2023; 14:1291702. [PMID: 38020668 PMCID: PMC10665483 DOI: 10.3389/fneur.2023.1291702] [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: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 12/01/2023] Open
Abstract
Carpal tunnel syndrome (CTS) is a common peripheral neuropathy of the hand, mainly manifesting as sensory disturbances, motor dysfunctions, and pain in the fingers and hand. The pathogenesis of the disease is associated with fibrosis of the transverse carpal ligament in the carpal tunnel, which compresses median nerve. In our case, we demonstrate an ultrasound-guided needle knife technique to treat CTS. We guided the patient to a supine position on the examination table. The skin of the wrist area was sterilized for the procedure. After the skin was dry, we positioned sterile drapes, located the median nerve and compression, and marked the compression point. Local anesthesia was administered. An ultrasound-guided needle knife was inserted. The needle knife was advanced under ultrasound guidance. The carpal ligament was incised. A gradual release of pressure on the median nerve was observed on the ultrasound monitor. After treatment, the patient's finger sensation and motor function can significantly improve, and pain symptoms are markedly reduced, this case demonstrates that small needle-knife treatment can serve as a safe and effective minimally invasive therapeutic method.
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Affiliation(s)
- Jianjun Sun
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Xiaodi Zou
- Second Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Qinyun Fu
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Jianhua Wu
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Shuaishuai Yuan
- Department of Anesthesiology, Pujiang County Hospital of Traditional Chinese Medicine, Jinhua, China
| | - Ahmad Alhaskawi
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanzhao Dong
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Hui Lu
- First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
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Rhoul A, Boubcher M, Gartit M, Noumairi M, Mahla H, Allam AES, El Oumri AA. Post-traumatic radial nerve neuroma: A case report. Trauma Case Rep 2023; 47:100913. [PMID: 37601552 PMCID: PMC10436167 DOI: 10.1016/j.tcr.2023.100913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 08/22/2023] Open
Abstract
Introduction Radial nerve neuromas (RNNs) are mostly post-traumatic conditions that occur after a complete or partial section of a nerve. Here we report a case of post-traumatic RNN with good functional progression after intense physical rehabilitation. Case presentation A 49 years old patient with a post-complete section of the radial nerve underwent intensive physical rehabilitation with two sessions of ultrasound-guided injections of 10 % glucose saline around the neuroma. 12 months later, the patient improved his wrist and hand finger extension functions. Conclusion Several surgical and non-surgical therapies have been proposed for the treatment of neuromas. However, no consensus currently exists, and management is frequently adapted to each patient.
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Affiliation(s)
- Abdelilah Rhoul
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
| | - Mohammed Boubcher
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Orthopaedics Trauma, Mohammed VI University Hospital Oujda, Morocco
| | - Mohammed Gartit
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
| | - Mohammed Noumairi
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
| | - Houssam Mahla
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
| | - Abdallah El-Sayed Allam
- Faculty of Medicine, Tanta University, Egypt
- Department of Physical Medicine, Rheumatology and Rehabilitation, Tanta University, Egypt
| | - Ahmed Amine El Oumri
- Faculty of Medicine and Pharmacy, Mohammed Ist university, Oujda, Morocco
- Department of Physical Medicine and Rehabilitation, Mohammed VI University Hospital Oujda, Morocco
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Duraku LS, Esworthy GP, Nassimizadeh M, Kankam HKN, Power DM. Unusual Clinical Presentation of a Benign Peripheral Nerve Sheath Tumor of the Radial Nerve. EPLASTY 2023; 23:e64. [PMID: 38045102 PMCID: PMC10690796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
Diagnosis of simple benign peripheral nerve tumors (PNT) is usually based on imaging studies and in most cases, surgical excision leads to no significant functional deficit. The clinical presentation is often asymptomatic with incidental imaging findings. We present an unusual clinical presentation of a benign peripheral nerve sheath tumor of the radial nerve.
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Affiliation(s)
- Liron S Duraku
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Plastic, Reconstructive and Hand Surgery Department, Amsterdam UMC, Amsterdam, the Netherlands
| | - George P Esworthy
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- University of Leicester, Leicester Medical School, Leicester, United Kingdom
| | - Mohammad Nassimizadeh
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Hadyn KN Kankam
- Department of Burns and Plastic Surgery, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
- Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
| | - Dominic M Power
- Peripheral Nerve Surgery Department, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Mortada H, Alghamdi AM, Alshammari AN, Alrobaiea S, Alrehaili M, Kattan A. Diagnosing Schwannoma in the Wrist: a Challenging Case of Intraneural Ganglion Cyst Mimicry and a Review of Literature. Case Reports Plast Surg Hand Surg 2023; 10:2249099. [PMID: 37645560 PMCID: PMC10461494 DOI: 10.1080/23320885.2023.2249099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
Schwannoma can rarely mimic an intraneural ganglion cyst clinically and radiographically. This is a rare case report of a wrist schwannoma mimicking an intraneural ganglion cyst. The surgery was successful, and the histopathological report confirmed the diagnosis of benign schwannoma. After two years of follow-up, the patient is still symptom-free.
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Affiliation(s)
- Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery & Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Abdulaziz M. Alghamdi
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Abdulmuhsen N. Alshammari
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Orthopedics, King Salman Bin Abdulaziz Medical City, Almadinah Almunawwarah, Saudi Arabia
| | - Saad Alrobaiea
- Department of Plastic Surgery and Burn Unit, Security Forces Hospital, Riyadh, Saudi Arabia
| | - Musab Alrehaili
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Kattan
- Division of Plastic Surgery, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Pham Quang V, Hoang Quoc H, Nguyen B, Ngo Quang C, Nguyen Chi H, Nguyen N. Giant schwannoma on the lower leg: A case report and review of the literature. Int J Surg Case Rep 2023; 109:108468. [PMID: 37437325 PMCID: PMC10362252 DOI: 10.1016/j.ijscr.2023.108468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2023] [Revised: 06/13/2023] [Accepted: 06/27/2023] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Peripheral nerve sheath tumors are common neoplasm with different biological features ranging from benign to malignant. The majority of these tumors are smaller than 5 cm, whereas those larger are termed giant schwannomas. When localized in the lower legs, the maximum length of the schwannoma is less than 10 cm. We report a case of giant schwannoma of the leg and its management. CASE PRESENTATION A 11-year-old boy presented with a 13 cm × 5 cm firm, smooth, well-defined margin mass in the posterior-medial aspect of right leg. The tumor was fusiform, well capsulated, multi-lobulated soft tissue with 13 cm × 4 cm × 3 cm in size at the biggest region. On MRI the tumor was low signal, isointense with adjacent tissue on T1S, hyper-intense on T2-FS sequences and surrounded by a thin fat-like intense rim. Biopsy findings were considered most consistent with Schwannoma (Antoni A). Tumor resection was performed. The mass appeared capsulated, white, and glistening with 132 mm × 45 mm × 34 mm in size. Postoperative course was uneventful without neurological deficit. CLINICAL DISCUSSION AND CONCLUSION Schwannomas are the most common peripheral nerve sheath tumors that derived almost entirely from Schwann cells. Schwannomas usually affect the head and neck region, localization in the lower extremity is rare. When located in lower extremity, the maximum diameter of 5 cm is described in most studies. Clinical presentation of schwannomas is unclear and unspecific. Diagnosis is based on ultrasound, MRI, and histology. The recommended treatment for schwannoma is surgical enucleation or resection without damaging the involved nerve.
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Affiliation(s)
- Vinh Pham Quang
- Department of Orthopaedics and Rehabilitation, University of Medicine and Pharmacy at Ho Chi Minh City, 217 Hong Bang Street, District 5, Ho Chi Minh City, Viet Nam; Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Huy Hoang Quoc
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Bach Nguyen
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Chuong Ngo Quang
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Hieu Nguyen Chi
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
| | - Ngoc Nguyen
- Department of Orthopaedics, University Medical Center Ho Chi Minh City, 201 Nguyen Chi Thanh Street, District 5, Ho Chi Minh City, Viet Nam.
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Pertea M, Grosu OM, Filip A, Moraru DC, Luca S, Fotea MC, Lunca S, Olinici D, Poroch V, Carp C, Veliceasa B. Rare Benign Tumors and Tumor-like Lesions of the Hand without Skin Damage-Clinical, Imagistic and Histopathological Diagnosis, Retrospective Study. Diagnostics (Basel) 2023; 13:diagnostics13061204. [PMID: 36980511 PMCID: PMC10046979 DOI: 10.3390/diagnostics13061204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The broad spectrum of diagnoses and clinical features of hand tumors and the absence of pathognomonic signs often lead to an inaccurate or delayed diagnosis. However, only a few reports have comprehensively referenced the diagnosis and clinical features of hand tumors. This study intends to highlight the clinical, imaging and histological characteristics of uncommon hand tumors or tumor-like lesions. METHODS In this retrospective study, we report a series of 80 patients diagnosed with rare hand tumors and tumor-like lesions without skin damage. Age, gender, tumor location, imaging examinations and clinical and laboratory findings were analyzed. The histopathological exam established the final diagnosis. Surgery was indicated and performed in all cases. RESULTS This study included: neurofibroma, glomus tumor, lipoma, schwannoma, epidermal inclusion cyst and idiopathic tenosynovitis with "rice bodies." We have described the clinical, imagistic and histopathological particularities of these tumors. Surgical management included the complete removal of tumors, with no recurrence recorded within two years and overall high patient satisfaction. The most common findings were lipomas and the rarest neurofibromas. CONCLUSIONS To optimize the care of hand tumors and reduce diagnostic and treatment errors, knowledge of hand tumor types and their clinical and laboratory characteristics is necessary for every surgeon.
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Affiliation(s)
- Mihaela Pertea
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Oxana Madalina Grosu
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Alexandru Filip
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Dan Cristian Moraru
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Stefana Luca
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Madalina-Cristina Fotea
- Department of Plastic Surgery and Reconstructive Microsurgery, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Sorinel Lunca
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Second Surgical Clinic, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Doinita Olinici
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Dermatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Vladimir Poroch
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Palliative Care, Regional Institute of Oncology, 700483 Iasi, Romania
| | - Claudiu Carp
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
| | - Bogdan Veliceasa
- Department Plastic Surgery and Reconstructive, Faculty of Medicine,"Grigore T. Popa" University of Medicine and Pharmacy, 700115 Iasi, Romania
- Department of Orthopaedics and Traumatology, "Sf. Spiridon" Emergency County Hospital, 700111 Iasi, Romania
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Cognetti PA, Levy E. Left Gluteal Maximus Neuroma Causing Long-Standing Gluteal Pain. Curr Sports Med Rep 2023; 22:76-77. [PMID: 36866949 DOI: 10.1249/jsr.0000000000001043] [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: 03/04/2023]
Abstract
ABSTRACT Diagnosing buttock pain is a challenge due to complex anatomy and multiple causes. Potential pathologies range from common and benign to rare and life-threatening. Common causes for buttock pain include referred pain from the lumbar spine and sacroiliac joint, hamstring origin tendinopathy, myofascial pain, ischiogluteal bursitis, gluteal pathology, and piriformis syndrome. Rarer causes include malignancy, bone infection, vascular anomalies, and spondyloarthropathies. Other conditions may be present concurrently in the lumbar and gluteal area, which can cloud the clinical picture. Correct diagnosis and early treatment may improve quality of life by providing a targetable reason for their distress, improving pain, and allowing the patient to get back to their activities of daily living. When treating a patient with buttock pain, it is essential to reevaluate the diagnosis when symptoms fail to improve despite appropriate intervention.Here, we discuss a case of a peripheral nerve sheath tumor found in the left gluteus medius muscle of a patient that caused persistent, debilitating buttock pain. After years of treatment for piriformis syndrome and possible spinous causes, the patient was ultimately diagnosed with a peripheral nerve sheath tumor through magnetic resonance imaging with contrast. Peripheral nerve sheath tumors are a diverse group of mostly benign tumors that can occur sporadically or associated with certain disease processes. These tumors usually present with pain, a soft tissue mass, or focal neurological deficits. Upon removal of the tumor, her gluteal pain completely resolved.
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Affiliation(s)
| | - Emily Levy
- Tower Health Sports Medicine, Philadelphia, PA
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Yao C, Zhou H, Dong Y, Alhaskawi A, Hasan Abdullah Ezzi S, Wang Z, Lai J, Goutham Kota V, Hasan Abdulla Hasan Abdulla M, Lu H. Malignant Peripheral Nerve Sheath Tumors: Latest Concepts in Disease Pathogenesis and Clinical Management. Cancers (Basel) 2023; 15:cancers15041077. [PMID: 36831419 PMCID: PMC9954030 DOI: 10.3390/cancers15041077] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/02/2023] [Accepted: 02/07/2023] [Indexed: 02/11/2023] Open
Abstract
Malignant peripheral nerve sheath tumor (MPNST) is an aggressive soft tissue sarcoma with limited therapeutic options and a poor prognosis. Although neurofibromatosis type 1 (NF1) and radiation exposure have been identified as risk factors for MPNST, the genetic and molecular mechanisms underlying MPNST pathogenesis have only lately been roughly elucidated. Plexiform neurofibroma (PN) and atypical neurofibromatous neoplasm of unknown biological potential (ANNUBP) are novel concepts of MPNST precancerous lesions, which revealed sequential mutations in MPNST development. This review summarized the current understanding of MPNST and the latest consensus from its diagnosis to treatment, with highlights on molecular biomarkers and targeted therapies. Additionally, we discussed the current challenges and prospects for MPNST management.
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Affiliation(s)
- Chengjun Yao
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
- School of Medicine, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
| | - Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
| | - Sohaib Hasan Abdullah Ezzi
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
- Department of Orthopaedics, Third Xiangya Hospital, Central South University, #138 Tongzipo Road, Changsha 410013, China
| | - Zewei Wang
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
- School of Medicine, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
| | - Jingtian Lai
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
- School of Medicine, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
| | - Vishnu Goutham Kota
- Department of Nuclear Medicine, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
| | | | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, #79 Qingchun Road, Hangzhou 310003, China
- Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, #866 Yuhangtang Road, Hangzhou 310058, China
- Correspondence: ; Tel.: +86-0571-87236121
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AbuMoussa S, Roshan MP, Souza FF, Daley D, Rosenberg A, Pretell J, Fullerton N, Subhawong T. Soft Tissue Masses of the Hand: A Review of Clinical Presentation and Imaging Features. Curr Oncol 2023; 30:2032-2048. [PMID: 36826119 PMCID: PMC9955517 DOI: 10.3390/curroncol30020158] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 02/11/2023] Open
Abstract
More than 15% of all soft-tissue tumors arise in the hand. Because of the location of these tumors, even small abnormalities may be alarming to patients on presentation. Although the majority of lesions are benign and can be diagnosed solely by history and physical examination, additional imaging workup may be required to confirm a diagnosis or define anatomic extent of involvement. This paper aims to review the basic epidemiology, clinical presentation, imaging findings, and treatment options of the more common soft-tissue tumors of the hand.
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Affiliation(s)
- Samuel AbuMoussa
- Department of Radiology, Loma Linda University Medical Center, Loma Linda, CA 92354, USA
| | - Mona Pari Roshan
- Herbert Wertheim College of Medicine, Florida International University, Miami, FL 33199, USA
| | - Felipe Ferreira Souza
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Dane Daley
- Department of Orthopaedic Surgery, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Andrew Rosenberg
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Juan Pretell
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Natalia Fullerton
- Department of Orthopaedic Surgery, University of Miami Miller School of Medicine, Miami, FL 33136, USA
| | - Ty Subhawong
- Department of Radiology, University of Miami Miller School of Medicine, Miami, FL 33136, USA
- Correspondence: ; Tel.: +1-(305)-585-7500
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Chim H, Wiesemann GS, Nasri E. Myofibroma mimicking peripheral nerve sheath tumour with ulnar nerve compression symptoms. BMJ Case Rep 2023; 16:e252939. [PMID: 36731952 PMCID: PMC9896180 DOI: 10.1136/bcr-2022-252939] [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] [Indexed: 02/04/2023] Open
Abstract
We report a case of myofibroma encasing the ulnar nerve on the medial aspect of the left arm with motor and sensory deficit secondary to compression. Initially, the tumour appeared to be a benign peripheral nerve sheath tumour based on preoperative imaging, with clinical examination positive for left hand clawing and a positive Wartenberg's and Froment's sign. However, intraoperative dissection demonstrated that the mass did not originate from the ulnar nerve proper, lowering suspicion for a peripheral nerve sheath tumour. Histopathological analysis showed spindle cell neoplasm, consistent with myofibroma. The patient underwent hand occupational therapy subsequently, with improvement of grip strength from 5 lb to 12 lb by 4 months postoperatively and resolution of clawing of the hand postoperatively. We discuss differentiating features for this rare occurrence of solitary adult myofibroma, where the final diagnosis was only made after formal histopathological analysis.
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Affiliation(s)
- Harvey Chim
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Gayle Suk Wiesemann
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida College of Medicine, Gainesville, Florida, USA
| | - Elham Nasri
- Department of Pathology, Immunology and Laboratory Health, University of Florida Health, Gainesville, Florida, USA
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Fu J, Li X, Jin F, Dong Y, Zhou H, Alhaskawi A, Wang Z, Lai J, Yao C, Ezzi SHA, Kota VG, Hasan Abdulla Hasan Abdulla M, Chen B, Lu H. The potential roles of dental pulp stem cells in peripheral nerve regeneration. Front Neurol 2023; 13:1098857. [PMID: 36712432 PMCID: PMC9874689 DOI: 10.3389/fneur.2022.1098857] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 12/28/2022] [Indexed: 01/12/2023] Open
Abstract
Peripheral nerve diseases are significantly correlated with severe fractures or trauma and surgeries, leading to poor life quality and impairment of physical and mental health. Human dental pulp stem cells (DPSCs) are neural crest stem cells with a strong multi-directional differentiation potential and proliferation capacity that provide a novel cell source for nerve regeneration. DPSCs are easily extracted from dental pulp tissue of human permanent or deciduous teeth. DPSCs can express neurotrophic and immunomodulatory factors and, subsequently, induce blood vessel formation and nerve regeneration. Therefore, DPSCs yield valuable therapeutic potential in the management of peripheral neuropathies. With the purpose of summarizing the advances in DPSCs and their potential applications in peripheral neuropathies, this article reviews the biological characteristics of DPSCs in association with the mechanisms of peripheral nerve regeneration.
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Affiliation(s)
- Jing Fu
- 1Department of Stomatology, Affiliated Hangzhou Xixi Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Xigong Li
- 2Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Feilu Jin
- 3Oral and Maxillofacial Surgery Department, The Second Affiliated Hospital of Zhejiang University, Hangzhou, Zhejiang, China
| | - Yanzhao Dong
- 2Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Haiying Zhou
- 2Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Ahmad Alhaskawi
- 2Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Zewei Wang
- 4Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jingtian Lai
- 4Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Chengjun Yao
- 4Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | | | - Vishnu Goutham Kota
- 2Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | | | - Bin Chen
- 2Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Hui Lu
- 2Department of Orthopedics, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China,6Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou, Zhejiang, China,*Correspondence: Hui Lu ✉
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Zhou H, Yao C, Dong Y, Alhaskawi A, Wang Z, Lai J, Ezzi SHA, Kota VG, Abdulla MHAH, Lu H. Clinical characteristics and management experience of schwannoma in extremities: Lessons learned from a 10-year retrospective study. Front Neurol 2022; 13:1083896. [PMID: 36588891 PMCID: PMC9797853 DOI: 10.3389/fneur.2022.1083896] [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: 10/29/2022] [Accepted: 11/16/2022] [Indexed: 12/23/2022] Open
Abstract
Introduction Schwannomas are the most common neoplastic lesions of the peripheral nerves when growing on the extremities, they usually have adverse effects on patients due to the exposed and functional nature of the region. Methods In the present single-center retrospective study, we included all patients with pathologically confirmed schwannoma located in extremities between 2011 and 2021 totaling 183 patients. Data on gender, age, duration history, clinical presentation, occurrence region, nerve affiliation, imaging data, modus operation, mass volume, immunohistochemistry, postoperative neurological function, and recurrence were collected. Results As in previous studies, patients were predominantly middle-aged with a mean age of 49.5, without gender preference and a male-to-female ratio of 1.2:1. Most patients are first seen for this disease, and only five of them are recurrent. The majority presented with an isolated (91.26%), asymptomatic (37.7%) mass, with tenderness (34.97%) being the second frequent complaint. 60% of lesions occurred in the upper extremity, more commonly on the left side (55.26%) than the right. The average duration of onset was 47.50 months. MRI is more sensitive for neurogenic tumors than ultrasound, as it owns 78.93% correct. In immunohistochemistry, the top three markers for positive labeling schwannoma are S-100 (98.95%), Ki67 (98.68%) and β-Catenin. 98.36% of patients underwent complete resection of the lesion, of which 14.44% required partial sacrifice of the nerve fibers. Thanks to the application of intraoperative peripheral nerve microscopic operation, only 6 patients showed symptoms of postoperative nerve injury, and 3 of them received second surgery. Intraoperative microscopic manipulation, preservation of the main nerve, and the need for reconstruction of the affected nerve fibers are some of the points worth noting. Discussion In summary, the possibility of schwannoma should not be overlooked in the identification of masses that occur in the upper extremities of the middle-aged population. Preoperative ultrasound and MR are useful for determining the nature of the mass, and S100, Ki67, and β-Catenin are sensitive to it. Surgical resection can achieve satisfying functional results and a low risk of nerve injury.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Chengjun Yao
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Yanzhao Dong
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Ahmad Alhaskawi
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Zewei Wang
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - Jingtian Lai
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Vishnu Goutham Kota
- Department of Clinical Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | | | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China,Alibaba-Zhejiang University Joint Research Center of Future Digital Healthcare, Zhejiang University, Hangzhou, China,*Correspondence: Hui Lu
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Muacevic A, Adler JR, Landge S, Pundkar A, Chandanwale R. Unusual Solitary Neurofibroma of Common Peroneal Nerve in a Child. Cureus 2022; 14:e33039. [PMID: 36721607 PMCID: PMC9881391 DOI: 10.7759/cureus.33039] [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: 10/26/2022] [Accepted: 12/28/2022] [Indexed: 12/29/2022] Open
Abstract
Neurofibroma (NF) is a tumour of peripheral nerves, which would be seldom seen in the limbs, particularly in children's limbs. Soft, skin-coloured papules or small sub-mucosal nodules appear as these lesions. Neurofibroma is classified into three types: localized, diffuse, and plexiform. The vast majority of nerve injury is sporadic and localized, with an incredibly low risk of tumour formation. Neurofibromatosis can present as multiple skin lesions along with bone deformities in which a full investigation is critical where an undiscovered widespread illness may arise. This case study describes a neurofibroma on the common peroneal nerve of the left lower limb in a 6-year-old child who visited our hospital with chief complaints of pain and swelling around the left proximal leg.
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Yadav KK, Poudel N, Acharya K, Yadav RK, Pathak P, Hirachan S. Right breast schwannoma in a male: A rare case report. Int J Surg Case Rep 2022; 99:107667. [PMID: 36137432 PMCID: PMC9568748 DOI: 10.1016/j.ijscr.2022.107667] [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: 07/23/2022] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction Schwannoma are benign neoplasms of peripheral nerve sheath. They usually occur in the head, neck and the extremities. Breast is a rare location of Schwannoma. Case presentation Our case describes the occurrence of Schwannoma in the right breast, in a 60-year-old male, who has had a breast lump since the last 6 years. After ultrasonography (showed 3.4 × 2.3 × 2.0 cm heteroechoic mass in the upper outer quadrant of the right breast), and mammography (showed 2.5 × 3.2 cm sized high density mass in upper outer quadrant of right breast), an excisional biopsy was performed, and on histopathologic examination, the diagnosis of breast schwannoma was confirmed. Discussion Clinical and pathological features resemble that of other benign tumors. On ultrasonography they present a well-defined, solid, hypoechoic mass, with some degree of posterior acoustic enhancement. Diagnosis is usually based on histopathologic examination. Microscopically, it exhibits hypercellular antony A areas along with hypocellular antony B areas. Treatment is usually surgical excision. Conclusion Though Schwannomas in breast are rare, they must be considered as differential diagnoses in patients presenting with breast lumps. Schwannomas are rare benign tumors of peripheral nerve sheath. Male breast is a rare location for schwannoma. Diagnosis is usually based on the histopathological findings. It mimics with other benign and malignant lumps occurring in breast, and must be considered as a differential diagnoses of breast lump.
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Yuan Y, Gao J, Xiong G, Guo L. Diagnostic accuracy of multiparametric ultrasound for peripheral nerve schwannoma. Acta Radiol 2022; 64:1608-1614. [PMID: 36071627 DOI: 10.1177/02841851221125109] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Ultrasound (US) diagnostic techniques have the advantages of low cost, convenient operation, and high availability. PURPOSE To explore the diagnostic accuracy of multiparametric US in evaluating signs of peripheral schwannoma. MATERIAL AND METHODS This retrospective case-control study included patients with soft-tissue masses on the limbs (divided into the schwannoma and non-schwannoma groups) between January 2017 and November 2020. US features were compared between the two groups, and receiver operating characteristics analysis was used to evaluate the diagnostic efficacy of these features. RESULTS A total of 165 patients were included in this study; of them, 63 (38.2%) were diagnosed with schwannoma. Regular morphology (95.2% vs. 39.2%), cystic degeneration (71.4% vs. 27.5%), target sign on elastography (82.5% vs. 0), and polar blood supply sign (87.3% vs. 14.7%) were more common in schwannomas than in non-schwannoma lesions (all P < 0.001). Combining the four signs for diagnosis of schwannomas, the sensitivity, specificity, and accuracy were 95.24%, 96.08%, and 95.76%, respectively, with an area under the curve (AUC) of 0.987 (95% confidence interval = 0.955-0.998). Entering and exiting nerve sign was observed in 87.3% of schwannomas and in 3.0% of non-schwannoma lesions (P < 0.001), while split-fat sign was similar between the two groups (9.5% vs. 2.0%; P = 0.068). CONCLUSION Polar blood supply sign and target sign on elastography are specific US signs in peripheral schwannomas. The combination of two-dimensional imaging, color flow imaging, and elastography can achieve an excellent diagnostic accuracy in schwannomas.
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Affiliation(s)
- Yu Yuan
- Department of Ultrasound, 74768Tianjin Hospital, Tianjin, PR China
| | - Jinmei Gao
- Department of Ultrasound, 74768Tianjin Hospital, Tianjin, PR China
| | - Guangyi Xiong
- Department of Pathology, 74768Tianjin Hospital, Tianjin, PR China
| | - Lin Guo
- Department of Radiology, 74768Tianjin Hospital, Tianjin, PR China
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Moran J, Kahan JB, Schneble CA, Lindskog D, Donohue K. Surgical Excision of a Giant Schwannoma of the Hand: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00115. [PMID: 34534146 DOI: 10.2106/jbjs.cc.21.00318] [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: 11/14/2022]
Abstract
CASE We report a 78-year-old man who underwent excision of a 13-year-old benign schwannoma originating from the terminal motor branch of the ulnar nerve. The mass measured 13 cm in diameter on presentation and was successfully excised, preserving a functional hand. At 4-year follow-up, the patient was asymptomatic with intact motor and sensory function and no signs of recurrence. To the best of our knowledge, this is the largest schwannoma of the hand to be reported in the literature. CONCLUSIONS Large schwannomas of the hand can successfully be excised with no postoperative complications.
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Affiliation(s)
- Jay Moran
- Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, Connecticut
| | - Joseph B Kahan
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
| | | | - Dieter Lindskog
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
| | - Kenneth Donohue
- Department of Orthopaedics, Yale School of Medicine, New Haven, Connecticut
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Abstract
Neurofibroma is a rare nerve sheath tumor of neuroectodermal origin, especially the huge and isolated neurofibroma located in the inguinal region. To our knowledge, no such case has previously been reported. We report a case of 34-year-old male patient with a 4-year history of progressive enlargement of the medial root mass in his left thigh with sitting and standing disorders along with pain. The tumor was completely removed by operation, and pathological diagnosis showed neurofibroma. There was no obvious neurologic defect after surgery, and no recurrence tendency was found in the follow-up of 2 years. For a large solitary mass with slow growth and no malignant clinical manifestations for a long time, clinicians cannot rule out the hypothetical diagnosis of neurofibroma, even though its growth site is very rare, such as this case of a huge tumor located in the groin. For neurogenic tumors, early operation should be performed, and the prognosis of patients after tumor resection is excellent.
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Affiliation(s)
- Haiying Zhou
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
| | - Hui Lu
- Department of Orthopedics, The First Affiliated Hospital, Zhejiang University, Hangzhou, Zhejiang Province, P. R. China
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