Inflammatory pseudotumor of nerve: clinicopathological characteristics and a potential therapy

Mauermann, Michelle L.; Scheithauer, Bernd W.; Spinner, Robert J.; Amrami, Kimberly K.; Nance, Christopher; Kline, David G.; O’Connor, Mary I.; Engelstad, JaNean; Dyck, Peter J.

doi:10.1111/j.1529-8027.2010.00273.x

Cited by 16 publications

(8 citation statements)

References 15 publications

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“…Nerve biopsies usually demonstrate chronic inflammatory infiltrates, interstitial fibrosis, excess vascularity and increased lipocytes. The lesions are steroid‐responsive in some patients 48 . NMCs are characterized by the presence of well‐differentiated muscle (usually skeletal) fibers admixed among mature nerve fascicles.…”

Section: Methodsmentioning

confidence: 99%

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Nerve biopsy: Current indications and decision tools

et al. 2021

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After initial investigation of patients presenting with symptoms suggestive of neuropathy, a clinical decision is made for a minority of patients to undergo further assessment with nerve biopsy. Many nerve biopsies do not demonstrate a definitive pathological diagnosis and there is considerable cost and morbidity associated with the procedure. This highlights the need for appropriate selection of patients, nerves and neuropathology techniques. Additionally, concomitant muscle and skin biopsies may improve the diagnostic yield in some cases. Several advances have been made in diagnostics in recent years, particularly in genomics. The indications for nerve biopsy have consequently changed over time. This review explores the current indications for nerve biopsies and some of the issues surrounding its use. Also included are comments on alternative diagnostic modalities that may help to supplant or reduce the use of nerve biopsy as a diagnostic test. These primarily include extraneural biopsy and neuroimaging techniques such as magnetic resonance neurography and nerve ultrasound. Finally, we propose an algorithm to assist in deciding when to perform nerve biopsies.

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Section: Methodsmentioning

confidence: 99%

“…Nerve biopsy is typically required to diagnose tumors of peripheral 48 NMCs are characterized by the presence of welldifferentiated muscle (usually skeletal) fibers admixed among mature nerve fascicles. While diagnostic, nerve biopsies are frequently complicated by subsequent aggressive fibromatosis.…”

Section: Nerve and Nerve Sheath Tumors And Pseudotumorsmentioning

confidence: 99%

Nerve biopsy: Current indications and decision tools

et al. 2021

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“…Although little is known about the true nature of these lesions, they seem to lack the HMGA2 rearrangements characteristic of soft tissue lipoma[116]. A last, apparently reactive lesion of major nerves is inflammatory pseudotumor, which presents as a mononeuropathy and responds favorably to intravenous steroids [91]…”

Section: Rare Pseudoneoplastic Lesions and Mimics Of Benign Nerve Shementioning

confidence: 99%

Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems

et al. 2012

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Peripheral nerve sheath tumors are common neoplasms, with classic identifiable features, but on occasion, they are diagnostically challenging. Although well defined subtypes of peripheral nerve sheath tumors were described early in the history of surgical pathology, controversies regarding the classification and grading of these tumors persist. Advances in molecular biology have provided new insights into the nature of the various peripheral nerve sheath tumors, and have begun to suggest novel targeted therapeutic approaches. In this review we discuss current concepts and problematic areas in the pathology of peripheral nerve sheath tumors. Diagnostic criteria and differential diagnosis for the major categories of nerve sheath tumors are proposed, including neurofibroma, schwannoma, and perineurioma. Diagnostically challenging variants, including plexiform, cellular and melanotic schwannomas are highlighted. A subset of these affects the childhood population, and has historically been interpreted as malignant, although current evidence and outcome data suggests they represent benign entities. The growing current literature and the authors experience with difficult to classify borderline or “hybrid tumors” are discussed and illustrated. Some of these classification gray zones occur with frequency in the gastrointestinal tract, an anatomical compartment that must always be entertained when examining these neoplasms. Other growing recent areas of interest include the heterogeneous group of pseudoneoplastic lesions involving peripheral nerve composed of mature adipose tissue and/or skeletal muscle, such as the enigmatic neuromuscular choristoma. Malignant peripheral nerve sheath tumors (MPNST) represent a diagnostically controversial group; difficulties in grading and guidelines to separate “atypical neurofibroma” from MPNST are provided. There is an increasing literature of MPNST mimics which neuropathologists must be aware of, including synovial sarcoma and ossifying fibromyxoid tumor. Finally, we discuss entities that are lacking from the section on cranial and paraspinal nerves in the current WHO classification, and that may warrant inclusion in future classifications. In summary, although the diagnosis and classification of most conventional peripheral nerve sheath tumors are relatively straightforward for the experienced observer, borderline and difficult to classify neoplasms continue to be problematic. In the current review, we attempt to provide some useful guidelines for the surgical neuropathologist to help navigate these persistent, challenging problems.

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“…Typical presentation is progressive, painful mononeuropathy with associated sensory and strength loss. Nerve biopsy of inflammatory pseudotunors typically reveal chronic inflammatory infiltrates, increased vascularity and lipocytes, and interstitial fibrosis [34,35]. Nerve biopsy of neuromuscular choristomas usually demonstrate well differentiated muscle fibers, typically skeletal muscle fibers, interspersed among nerve fascicles.…”

Section: Pseudoneoplastic Peripheral Nerve Tumors (Pseudotumors)mentioning

confidence: 99%

Neurosurgical Intervention for Nerve and Muscle Biopsies

Mohamed,

Caussat,

Mouhawasse

et al. 2024

Preprint

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(1) Background: Neurologic and musculoskeletal diseases represent a considerable portion of the underlying etiologies responsible for the widely prevalent symptoms of pain, weakens, numbness, and paresthesia. Because of the subjective and often nonspecific nature of these symptoms, different diagnostic modalities have been explored and utilized.; (2) Methods: Literature review; (3) Results: Nerve and muscle biopsy remains the gold standard for diagnosing many of the responsible neurological and musculoskeletal conditions. However, the need for invasive tissue sampling is diminishing as more investigations explore alternative diagnostic modalities. Because of this, it is important to explore the current role of neurosurgical intervention for nerve and muscle biopsies and its current relevance in the diagnostic landscape of neurological and musculoskeletal disorders. With consideration of the role of nerve and muscle biopsy, it is also important to explore innovations and emerging techniques for conducting these procedures. This review explores the indications and emerging techniques for neurological intervention for nerve and muscle biopsies; (4) Conclusions: The role of neurosurgical intervention for nerve and muscle biopsy remains relevant in diagnosing many neurological and musculoskeletal disorders. Biopsy is especially relevant as a supportive point of evidence for diagnosis in atypical cases. Additionally, emerging techniques have been explored to guide diagnostics and biopsy, conduct less invasive biopsies, and reduce risks of worsening neurologic function and other symptoms secondary to biopsy.

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Inflammatory pseudotumor of nerve: clinicopathological characteristics and a potential therapy

Cited by 16 publications

References 15 publications

Nerve biopsy: Current indications and decision tools

Nerve biopsy: Current indications and decision tools

Pathology of peripheral nerve sheath tumors: diagnostic overview and update on selected diagnostic problems

Neurosurgical Intervention for Nerve and Muscle Biopsies

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