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| ==Perineurioma== | | ==Perineurioma== |
| ===General===
| | {{Main|Perineurioma}} |
| *Benign tumour derived from perineurial cells (intraneural or soft tissue).
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| **ICD-O 9571/0
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| ** WHO grade I
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| *Rarely malignant soft tissue perineurioma.
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| Variant:
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| *Reticular perineurioma.<ref name=pmid11257623>{{Cite journal | last1 = Graadt van Roggen | first1 = JF. | last2 = McMenamin | first2 = ME. | last3 = Belchis | first3 = DA. | last4 = Nielsen | first4 = GP. | last5 = Rosenberg | first5 = AE. | last6 = Fletcher | first6 = CD. | title = Reticular perineurioma: a distinctive variant of soft tissue perineurioma. | journal = Am J Surg Pathol | volume = 25 | issue = 4 | pages = 485-93 | month = Apr | year = 2001 | doi = | PMID = 11257623 }}</ref>
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| ===Macroscopy===
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| *Intraneural perineurioma: segmental tubular enlargement of the nerve.
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| *Soft tissue perineurioma: Well circumscribed, but not encapsulated.
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| ===Microscopic===
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| Features:<ref name=Ref_Sternberg5_424>{{Ref Sternberg5|424}}</ref>
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| *Perineural epithelioid cells.
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| **Abundant pale, fluffy appearing cytoplasm.
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| Note:
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| *May be intraneural.<ref name=Ref_Sternberg5_424>{{Ref Sternberg5|424}}</ref>
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| **Typical pseudo-onion bulbs.
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| **Long considered hypertrophic neuropathy.
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| **Rare (less than 1% of all nerve sheath tumours).
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| DDx:
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| *[[Neuroma]].
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| *[[Neurofibroma]].
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| *[[Schwannoma]].
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| **S100 +ve, EMA -ve.<ref name=Ref_Sternberg5_424>{{Ref Sternberg5|424}}</ref>
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| *[[Liposarcoma]] - reticular perineurioma.
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| Images:
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| *[http://www.conganat.org/seap/reuniones/almagro2000/scruz/tnerviog5.htm Perineurioma (conganat.org)].
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| <gallery>
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| File:Perineurioma,_HE_stain.jpg | Pseudo-onion bulbs in a intraneural perioneurioma (WC/jensflorian)
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| </gallery>
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| ===IHC===
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| Features:<ref name=pmid15958848>{{Cite journal | last1 = Hornick | first1 = JL. | last2 = Fletcher | first2 = CD. | title = Soft tissue perineurioma: clinicopathologic analysis of 81 cases including those with atypical histologic features. | journal = Am J Surg Pathol | volume = 29 | issue = 7 | pages = 845-58 | month = Jul | year = 2005 | doi = | PMID = 15958848 }}</ref><ref name=pmid1497116>{{Cite journal | last1 = Tsang | first1 = WY. | last2 = Chan | first2 = JK. | last3 = Chow | first3 = LT. | last4 = Tse | first4 = CC. | title = Perineurioma: an uncommon soft tissue neoplasm distinct from localized hypertrophic neuropathy and neurofibroma. | journal = Am J Surg Pathol | volume = 16 | issue = 8 | pages = 756-63 | month = Aug | year = 1992 | doi = | PMID = 1497116 }}</ref>
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| *S100 -ve.
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| *EMA +ve.
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| *CD34 ~65% +ve.<ref name=pmid15958848/>
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| ==Traumatic neuroma== | | ==Traumatic neuroma== |
| ===General===
| | :May be referred to as ''[[neuroma]]''. |
| *Consequence of trauma - diagnosis requires history of trauma.
| | {{Main|Traumatic neuroma}} |
| **May mimic a cancer recurrence at the site of a surgery.<ref name=pmid22330690/>
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| ===Microscopic===
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| Features:<ref name=Ref_DCHH317>{{Ref DCHH|317}}</ref><ref name=pmid22330690/>
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| *+/-Nerve - that was injured.
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| *Grouping of disordered nerve fibre bundles in fibrous tissue (collagen) - '''key feature'''.
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| *+/-Myxoid change.
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| *+/-Axonal swellings (ovoid pink/purple blobs).
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| DDx:
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| *[[Morton neuroma]] (foot).
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| Images:
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| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3296625/figure/F2/ Traumatic neuroma (nih.gov)].<ref name=pmid22330690>{{Cite journal | last1 = Li | first1 = Q. | last2 = Gao | first2 = EL. | last3 = Yang | first3 = YL. | last4 = Hu | first4 = HY. | last5 = Hu | first5 = XQ. | title = Traumatic neuroma in a patient with breast cancer after mastectomy: a case report and review of the literature. | journal = World J Surg Oncol | volume = 10 | issue = | pages = 35 | month = | year = 2012 | doi = 10.1186/1477-7819-10-35 | PMID = 22330690 }}</ref>
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| *[http://path.upmc.edu/cases/case502.html Traumatic neuroma - several images (upmc.edu)].
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| *[http://www.sarcomaimages.com/index.php?v=Neuroma,-Traumatic Traumatic neuroma (sarcomaimages.com)].
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| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2627419/figure/F1/ Traumatic neuroma (nih.gov)].<ref name=pmid17554193>{{Cite journal | last1 = Kwon | first1 = JH. | last2 = Ryu | first2 = SW. | last3 = Kang | first3 = YN. | title = Traumatic neuroma around the celiac trunk after gastrectomy mimicking a nodal metastasis: a case report. | journal = Korean J Radiol | volume = 8 | issue = 3 | pages = 242-5 | month = | year = | doi = | PMID = 17554193 | PMC = 2627419 }}</ref>
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| *[http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2835865/figure/F3/ Neuroma (nih.gov)].<ref name=pmid20224738>{{Cite journal | last1 = Kitcat | first1 = M. | last2 = Hunter | first2 = JE. | last3 = Malata | first3 = CM. | title = Sciatic neuroma presenting forty years after above-knee amputation. | journal = Open Orthop J | volume = 3 | issue = | pages = 125-7 | month = | year = 2009 | doi = 10.2174/1874325000903010125 | PMID = 20224738 }}</ref>
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| ===Sign out===
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| <pre>
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| SOFT TISSUE LESION, RIGHT WRIST, EXCISION:
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| - TRAUMATIC NEUROMA.
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| - BENIGN FIBROADIPOSE TISSUE.
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| </pre>
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| ====Micro====
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| The sections show disordered nerve fibre bundles in fibrous tissue.
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| ==Palisaded encapsulated neuroma== | | ==Palisaded encapsulated neuroma== |
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| ==Neurothekeoma== | | ==Neurothekeoma== |
| *[[AKA]] ''myxoma of the nerve sheath'', [[AKA]] ''nerve sheath myxoma''.
| | {{Main|Neurothekeoma}} |
| *There is growing evidence that neurothekomas and dermal nerve sheath myxomas are distinct entities.<ref>{{Cite journal | last1 = Sheth | first1 = S. | last2 = Li | first2 = X. | last3 = Binder | first3 = S. | last4 = Dry | first4 = SM. | title = Differential gene expression profiles of neurothekeomas and nerve sheath myxomas by microarray analysis. | journal = Mod Pathol | volume = 24 | issue = 3 | pages = 343-54 | month = Mar | year = 2011 | doi = 10.1038/modpathol.2010.203 | PMID = 21297585 }}</ref>
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| ===General===
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| *Rare.
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| *Female > male.
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| ===Microscopic===
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| Features:<ref name=pmid17325474>{{cite journal |author=Hornick JL, Fletcher CD |title=Cellular neurothekeoma: detailed characterization in a series of 133 cases |journal=Am. J. Surg. Pathol. |volume=31 |issue=3 |pages=329–40 |year=2007 |month=March |pmid=17325474 |doi=10.1097/01.pas.0000213360.03133.89 |url=}}</ref>
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| *Superficial dermal lesion:
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| **Usu. lobulated or micronodular architecture - '''key feature'''.
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| ***+/-Focal sheeting.
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| **Spindle/epithelioid morphology with pale eosinophilic cytoplasm - '''key feature'''.
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| **+/-Inflammation around lesion.
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| **+/-Surrounded by collagen.
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| Notes:
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| *No atypia.
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| *Mitoses rare/none.
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| *Often poorly circumscribed.
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| Subtypes:<ref name=pmid10555009>{{cite journal |author=Wang AR, May D, Bourne P, Scott G |title=PGP9.5: a marker for cellular neurothekeoma |journal=Am. J. Surg. Pathol. |volume=23 |issue=11 |pages=1401–7 |year=1999 |month=November |pmid=10555009 |doi= |url=}}</ref>
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| *Cellular.
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| *[[Myxoid]].
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| *Intermediate.
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| DDx:
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| *[[Dermatofibroma]].
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| *[[Angiomatoid fibrous histiocytoma]] -- have cystic blood filled spaces, inflammation.<ref>URL: [http://surgpathcriteria.stanford.edu/softfib/angiomatoid_fibrous_histiocytoma/ http://surgpathcriteria.stanford.edu/softfib/angiomatoid_fibrous_histiocytoma/]. Accessed on: 11 May 2011.</ref>
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| Images:
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| *[http://en.wikipedia.org/wiki/File:Neurothekeoma2.JPG Neurothekeoma (WP)].
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| *[http://path.upmc.edu/cases/case586.html Neurothekeoma - several images (upmc.edu)].
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| *[http://www.dermpedia.org/files/images/Image2_49.jpg Nerve sheath myxoma (dermpedia)]]
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| ===IHC===
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| Features:<ref name=pmid17325474/>
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| *NKI/C3 ([[AKA]] NKI-C3) +ve.
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| *NSE +/-ve.
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| Others:<ref name=pmid17592278>{{cite journal |author=Fetsch JF, Laskin WB, Hallman JR, Lupton GP, Miettinen M |title=Neurothekeoma: an analysis of 178 tumors with detailed immunohistochemical data and long-term patient follow-up information |journal=Am. J. Surg. Pathol. |volume=31 |issue=7 |pages=1103–14 |year=2007 |month=July |pmid=17592278 |doi=10.1097/PAS.0b013e31802d96af |url=}}</ref>
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| *Vimentin +ve.
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| *CD10 +ve.
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| *Microphthalmia transcription factor +ve.
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| *PGP9.5 +ve.
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| Exclusionary:
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| *S100 -ve.
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| **Exclude other peripheral nerve sheath tumours. (???)
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| **Myxoid variant +ve. {{fact}}
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| ==Malignant peripheral nerve sheath tumour== | | ==Malignant peripheral nerve sheath tumour== |