Intraneural Perineurioma Involving the Median Nerve

Abstract

Intraneural perineurioma is a rare clinical entity, which tends to affect major nerve trunks in the upper extremities. On light microscopy, numerous pseudo-onion-bulb structures having a central clear area are surrounded by concentric layers of eosinophilic elongate cells having spindled nuclei. Immunohistochemistry of concentric cells stains positive for epithelial membrane antigen but negative for S100 protein. Because of the small number of cases, no consensus has been made on proper treatment of this entity. Although none of the patients who have had excision of tumor with nerve grafting have had sensory nerve recovery, we believe each patient should be individualized until more data are available regarding this tumor.

Intraneural synovial sarcoma: two cases

“…There is no predominant histologic feature to confirm the diagnosis of an SS originating in the intraneural location unless a biphasic component (epithelioid cells and spindled cells) is present. Several spindle cell neoplasms may grow inside the nerve trunks, including perineurioma 31,32 and peripheral nerve sheath tumor. [33][34][35] SS with a biphasic component may be easier to diagnose, but the monophasic presentation becomes a diagnosis by exclusion, and needs more sophisticated techniques, particularly molecular biology, to reach a proper diagnosis with certainty.…”

“…20 Like INSS, intraneural perineurioma is a rare clinical entity, which also tends to affect major nerve trunks. 31,32 Thus, intraneural perineurioma may be confused with intraneural monophasic SS. On light microscopic examination, the spindle cells in perineurioma are generally more thin and elongated than seen in SS, and form pseudo-onion bulb structures having a clear central zone.…”

“…The immunohistochemical features of both tumors may be similar, with positivity for EMA and negativity for S-100 protein. 31 By more sophisticated molecular technique study, the intraneural perineurioma has not been shown to have the t(X;18) translocation.…”

Intraneural perineurioma in a child with Beckwith-Wiedemann syndrome

“…Without intervention, this tumor may produce slowly progressive motor neuropathy in an affected peripheral nerve. Surgical excision has been recommended if the lesion can be easily separated from the involved nerve or there is a significant motor deficit caused by tumor occupation [8].…”

Re: Ossifying Lipoma of the Hand

“…According to Jazayeri et al (2000), there is no consensus as to the correct management of these lesions. However, these authors advocated excision of the lesion and interpositional nerve grafting, although return of sensory nerve function was not seen in their case.…”