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Tafti DA, Dearborn MC, Ornoff A, Moeck AR, Cecava ND. Nerve Sheath Myxoma in the Lower Extremity: A Rare Case with Description of Magnetic Resonance Imaging and Sonographic Findings. AMERICAN JOURNAL OF CASE REPORTS 2021; 22:e927922. [PMID: 33814549 PMCID: PMC8040932 DOI: 10.12659/ajcr.927922] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND This report is of a nerve sheath myxoma presenting as a slow-growing mass in the back of the left ankle of a 36-year-old man that was investigated by ultrasound and magnetic resonance imaging (MRI) before the diagnosis was confirmed by histopathology. CASE REPORT We report a nerve sheath myxoma of the ankle in a 36-year-old man. The palpable abnormality was falsely assumed to be a ganglion cyst prior to advanced imaging. Magnetic resonance imaging demonstrated a lobular mass with high T2 and intermediate T1 signal as well as moderate enhancement. T2 sequences also demonstrated distinctive internal septae. These internal septae were also noted on sonographic evaluation prior to biopsy. The patient was treated with surgical excision, and pathologic analysis showed myxoid nodules with loose arrangements of spindled cells separated by fibrous septae. S-100 protein and glial fibrillary acidic protein positivity by immunohistochemistry staining was demonstrated. Follow-up imaging at 12 months showed no evidence of tumor recurrence. CONCLUSIONS This case highlights that while nerve sheath myxomas are rare tumors, they should be considered in cases of cutaneous soft-tissue masses with myxoid imaging features. Ultrasound and magnetic resonance imaging features of thin internal septae may be present and correspond well with the unique histopathological characteristics of these lesions. This report shows the importance of imaging of peripheral soft-tissue masses, including ultrasound and MRI, which can identify localized and benign features and the solid, cystic, and myxoid areas, which were characteristic in this case of benign nerve sheath myxoma.
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Affiliation(s)
- Dawood A Tafti
- Department of Radiology, San Antonio Military Medical Center, San Antonio, TX, USA
| | - Micheal C Dearborn
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Ashley Ornoff
- Department of Pathology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Adam R Moeck
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA
| | - Nathan D Cecava
- Department of Radiology, Brooke Army Medical Center, Fort Sam Houston, San Antonio, TX, USA.,Uniformed Services University of Health Sciences, Bethesda, MD, USA.,Texas A&M School of Medicine, Bryan, TX, USA
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Vetrano IG, Levi V, Pollo B, Chiapparini L, Messina G, Nazzi V. Sleeve-Shaped Neurothekeoma of the Ulnar Nerve: A Unique Case of a Still Unclear Pathological Entity. Hand (N Y) 2020; 15:NP7-NP10. [PMID: 30762430 PMCID: PMC6966297 DOI: 10.1177/1558944719828008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Background: Neurothekeomas are slow-growing, well-circumscribed benign neoplasms. They usually involve cutaneous or subcutaneous tissues. Although originally described as myxomas deriving from nerve sheath cells, their exact histological classification is still uncertain. Peripheral nerve localization is rarely reported. Here, we describe a unique case of sleeve-shaped neurothekeoma of the ulnar nerve, which was incidentally discovered during a cubital tunnel release surgery. Methods: A 57-year-old man was admitted at our institution with clinical, ultrasonographic, and electromyographic findings highly suggestive of cubital tunnel syndrome. During ulnar nerve decompression surgery, however, no bony or ligament compression was noticed, but a segment of the nerve wrapped by a thick sleeve-shaped tissue, which had no clear-cut cleavage plane from the nerve. Given this unexpected finding, the en bloc excision of the lesion was avoided. A nerve decompression with biopsy of the swelling portion of the lesion was performed instead. Results: Histological examination described abundant myxoid stroma, with epithelioid and ring-shaped cells arranged in cords, negative to S100 protein at immunohistochemical analysis. This pattern was suggestive of neurothekeoma. The patient showed improvement in hypermyotrophy and intrinsic weakness of the hand. Conclusions: To the best of our knowledge, this is the first report of a sleeve-shaped neurothekeoma of the ulnar nerve. The exact pathological characterization of such rare entities remains uncertain. In case of peripheral nerve localization, and when a clear cleavage plane is absent, the correct management of these lesions should be that of simple nerve decompression followed by biopsy.
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Affiliation(s)
- Ignazio G. Vetrano
- Fondazione I.R.C.C.S Istituto
Neurologico Carlo Besta, Milan, Italy,Ignazio G. Vetrano, Department of
Neurosurgery, Fondazione I.R.C.C.S Istituto Neurologico Carlo Besta, Via G.
Celoria 11, 20133 Milan, Italy
| | - Vincenzo Levi
- Fondazione I.R.C.C.S Istituto
Neurologico Carlo Besta, Milan, Italy
| | - Bianca Pollo
- Fondazione I.R.C.C.S Istituto
Neurologico Carlo Besta, Milan, Italy
| | | | - Giuseppe Messina
- Fondazione I.R.C.C.S Istituto
Neurologico Carlo Besta, Milan, Italy
| | - Vittoria Nazzi
- Fondazione I.R.C.C.S Istituto
Neurologico Carlo Besta, Milan, Italy
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Yadav SK, Singh S, Sarin N, Naeem R, Pruthi SK. Nerve Sheath Myxoma of Scalp: A Rare Site of Presentation. Int J Trichology 2019; 11:34-37. [PMID: 30820132 PMCID: PMC6385516 DOI: 10.4103/ijt.ijt_45_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Nerve sheath myxoma, a superficial myxoid tumor, was first described in 1969 by Harkin and Reed. Tumor has cytological and histological resemblance with neurothekeoma, another cutaneous myxoid lesion. Nerve sheath myxoma affects individuals of all age groups and equal predilection for both genders with most favored sites being the fingers and knee. Here, we present a case report of nerve sheath myxoma of the scalp, diagnosed and confirmed with histopathology and immunohistochemistry.
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Affiliation(s)
- Shakti Kumar Yadav
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Sompal Singh
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Namrata Sarin
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Roshina Naeem
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
| | - Sonam Kumar Pruthi
- Department of Pathology, North Delhi Municipal Corporation Medical College and Hindu Rao Hospital, New Delhi, India
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Kuberappa PH, Bagalad BS, Ananthaneni A, Kiresur MA, Srinivas GV. Certainty of S100 from Physiology to Pathology. J Clin Diagn Res 2016; 10:ZE10-5. [PMID: 27504432 DOI: 10.7860/jcdr/2016/17949.8022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 03/16/2016] [Indexed: 12/29/2022]
Abstract
S100 exists in wide variety of tissues and cell types, originally isolated from brain tissue and they are of low molecular weight proteins. S100 is evenly distributed in cytoplasm and also in nucleoplasm and is involved in both intercellular and extracellular functions. S100 protein is generally expressed in normal and also in pathological conditions. In current review, we discuss: a) update nomenclature of the various S100 proteins, b) expression of S100 in oral diseases (different soft tissue tumors, odontogenic cyst and tumor) for diagnostic value and also to know their histogenesis, c) role of S100 and RAGE receptor in oral squamous cell carcinoma.
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Affiliation(s)
- Puneeth Horatti Kuberappa
- Senior Lecturer, Department of Oral Pathology and Microbiology, St Joseph Dental College , Eluru, Andhra Pradesh, India
| | - Bhavana Shivanand Bagalad
- Senior Lecturer, Department of Oral Pathology and Microbiology, St Joseph Dental College , Eluru, Andhra Pradesh, India
| | - Anuradha Ananthaneni
- Professor, Department of Oral Pathology and Microbiology, St Joseph Dental College , Eluru, Andhra Pradesh, India
| | - Md Asif Kiresur
- Senior Lecturer, Department of Oral Pathology and Microbiology, St Joseph Dental College , Eluru, Andhra Pradesh, India
| | - Guduru Vijay Srinivas
- Professor and Head, Department of Oral Pathology and Microbiology, St Joseph Dental College , Eluru, Andhra Pradesh, India
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Bergamin F, Gangemi EN, Cerato C, Clemente A, Borsetti M, Suriani A, Taraglio S. An unusual case of neurothekeoma of the arm in an adult. J Orthop Traumatol 2015; 17:287-90. [PMID: 26577935 PMCID: PMC4999369 DOI: 10.1007/s10195-015-0386-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 10/17/2015] [Indexed: 12/20/2022] Open
Abstract
Neurothekeomas are uncommon benign neoplasms with a peripheral nerve sheath origin. This tumor usually involves dermis and is described as a small, solitary, slow growing and reddish to flesh-colored nodule or papule. Neurothekeoma preferentially affects the central aspect of the face, the arms or shoulders of women in the second and third decades of life. This is the first case report of neurothekeoma involving the wrist developing from synovial tissue and with uncertain clinical behavior in an adult female. The tumor was completely excised under brachial plexus block. Histopathologically, the examination of the microscopic slides revealed the presence of a 20-mm diameter, well-circumscribed and multilobulated tumor composed of abundant myxoid stroma with cellular elements; with immunohistochemistry there was positivity to vimentin but S100-protein, epithelial membrane antigen, cytokeratin AE1-3, CD99 and CD34 were all negative. This pattern suggested a myxoid tumor form of neurothekeoma, mixed subtype. The patient had an atypical local recurrence and was re-operated after 3 months. After 12 months there was no evidence of clinical recurrences confirmed by magnetic resonance evaluation. Basically, our case report adds an important element in the correct clinical management of neurotecheomas: faced with a histological diagnosis with an unusual localization and mixed or hypercellular type, clinicians must consider the possibility of an early local recurrence, suggesting a close clinical and radiological follow-up.
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Affiliation(s)
- Federica Bergamin
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy.
| | - Ezio Nicola Gangemi
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Claudia Cerato
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Alessandra Clemente
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Marco Borsetti
- Department of Surgical Activities, Division of Plastic Surgery and Hand Surgery, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Adolfo Suriani
- Department of Laboratory Diagnostics, Division of Pathology, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
| | - Stefano Taraglio
- Department of Laboratory Diagnostics, Division of Pathology, Maria Vittoria Hospital, ASL TO2, Via Cibrario 72, 10144, Turin, Italy
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