Palisaded encapsulated neuroma: An unusual presentation

Batra, Jaskaran; Ramesh, V.; Molpariya, Anupama; Maan, Khushpreet Kaur

doi:10.4103/idoj.idoj_354_17

Cited by 8 publications

(14 citation statements)

References 10 publications

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“…13 Schwannomas, unlike solitary circumscribed neuromas, are usually deep seated in soft tissue and contain Antoni A and B type tissues with Verocay bodies, with no axons traversing the tumor (if present they are at the periphery), hence are usually negative for neurofilament. 14 Intraneural schwannoma can present a challenging differential diagnosis but again, the absence of Antoni A/B areas, lack of interfascicular clefts and the immunophenotypic profile, will facilitate accurate diagnosis. Solitary circumscribed neuroma is negative for glial fibrillary acid protein whereas schwannomas can be positive.…”

Section: Discussionmentioning

confidence: 99%

Multiple Cutaneous Solitary Circumscribed Neuroma in a Patient with Neurofibromatosis Type 2: An “Incidentaloma” or New Association?

et al. 2022

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Solitary circumscribed neuroma formerly known as palisaded encapsulated neuroma is a rare, benign neural tumor that usually presents as a painless firm nodule or papule on the face and within oral cavity, although they can occur elsewhere on the body. No association with neurofibromatosis has been reported in the literature. Herein, we report, a previously unreported unique association of neurofibromatosis type 2 (NF-2) with multiple cutaneous solitary circumscribed neuromas in a 24-year-old female. A 24-year-old female with history of NF-2 presented with two slow-growing soft-to-firm papules on the chin and forehead that had been gradually increasing in size over a period of 5 years. The papule on the chin was increasingly tender to palpation. Histologic sections demonstrated a dermal based almost encapsulated, smoothly contoured tumefactive mass composed of spindle cell proliferation with neuroid structures and foci of palisaded growth (resembling schwannoma) and intralesional cleft like spaces. By immunohistochemistry, the lesional cells were strongly and diffusely positive for S-100 and SOX10 with multifocal neurofilament expression while the “capsule” was diffusely reactive for epithelial membrane antigen. The overall features were considered prototypic for solitary circumscribed neuroma. The patient is 18-months post-surgical resection with no evidence of recurrence. In summary, we report for the first time a case of multiple solitary circumscribed neuromas in a patient with known NF2. We highlight pertinent diagnostic clues relevant to surgical pathologist to facilitate recognition (as this tumor is often mistaken for schwannoma or neurofibroma). The clinical behavior is excellent and surgical resection is considered curative.

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Section: Discussionmentioning

confidence: 99%

Multiple Cutaneous Solitary Circumscribed Neuroma in a Patient with Neurofibromatosis Type 2: An “Incidentaloma” or New Association?

et al. 2022

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“…1,2 A distinctive finding is the presence of cleft artifacts among the fascicles of spindle cells, without significant intervening stroma, likely due to tissue shrinkage. 3,4 The eponymous palisading of aggregated spindle cells may be variable and focal, and may give the impression of Antoni A areas of a schwannoma. 5 Immunohistochemical staining helps confirm the diagnosis, with positive staining for S100 and Sox-10, markers of cells of neural crest origin like Schwann cells and other neural tumors.…”

Section: Case Reportmentioning

confidence: 99%

“…Schwannomas, although have even more prominent palisading and thicker complete capsules, they lack clefts, have none-to-few axons, have cells arranged in tight cellular and less/loosely cellular areas (Antoni A and Antoni B, respectively), are GFAP positive, and if seen in skin biopsies, are located deeper in subcutis. [3][4][5]7 Neurofibromas lack a capsule and have a loose myxoid stroma and intervening mast cells. [3][4][5]7 Plexiform neurofibromas have a nodular arrangement of spindle cells within a capsule formed by perineurium, but they are located in the subcutis and lack clefts.…”

Section: Case Reportmentioning

confidence: 99%

Multiple palisaded encapsulated neuromas presenting as cobblestoned plaques over palms and oral cavity

Mehta,

Sathyan,

Agarwal

et al. 2024

J Cutan Pathol

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Palisaded encapsulated neuroma (PEN) is a benign circumscribed nerve sheath tumor usually seen as a solitary painless papule on the face in middle‐aged adults. We report a 22‐year‐old male with multiple adolescent‐onset PENs distributed extensively, including the oral cavity and palms, contrary to the typical presentations. The lesions formed cobblestoned plaques and were confirmed through a skin biopsy, showing characteristic nodules of wavy spindle cells forming interlacing fascicles with interspersed clefts, and positive staining for specific markers, including markers for axons and perineurium. Notably, this case deviates from the usual presentation, shedding light on atypical manifestations of PEN in a young individual without any features suggestive of a neurocutaneous syndrome or multiple endocrine neoplasia syndrome.

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“…Palisaded encapsulated neuroma is a benign neural tumor in the skin first described by Reed et al [22].…”

Section: Figure 5: Cutaneous Myopericytoma (Hande 10x)mentioning

confidence: 99%

“…Histologically they are well-circumscribed encapsulated tumor composed of wavy spindle cells arranged in a palisading pattern [22,23]. In our study it was seen in a (60years) elderly patient but it is most common in middle-aged adults as per Batra et al Pigmented pilomatricoma is a variant of pilomatricoma a very rare entity with wellcircumscribed nodular lesion characterised by aggregates of basaloid cells, centrally filled with ghost cells, presence of melanin pigment within the cytoplasm of basiloid cells and ghost cells which was seen in our study too [24,25].…”

Section: Figure 5: Cutaneous Myopericytoma (Hande 10x)mentioning

confidence: 99%

Cutaneous cystic lesions: its clinicopathological correlation with emphasis on unusual findings.

Inbasekaran

Ramachandran

Sivadharshini.

et al. 2021

Trop J Pathol Microbiol

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Background: Cutaneous cysts are the most common lesions encountered in surgical practice withcosmetic and psychological concern to the patient. Aim: To establish the clinicopathologicalcorrelation of these lesions and also the importance of histological evaluation for the prevention ofmisdiagnosing a benign-appearing malignant lesion. Methods: A retrospective descriptive studywith data collected from archives of histopathology from January 2018 to December 2020 ofclinically diagnosed cutaneous cyst along with age, gender, location and histopathological evaluationwere analysed. Results: 88 cases that were clinically diagnosed as cutaneous cysts had a higherfemale proportion 52.3%. The most common clinical diagnosis is epidermal/ sebaceous cyst. 35.2%of cases were clinically diagnosed accurately but 64.8% of cases did not correlate with clinicaldiagnosis. 4 malignant lesions were misdiagnosed as benign cutaneous cyst clinically. Conclusion:Most often clinically diagnosed cutaneous cysts are not sent for histopathological evaluation which isa very important tool to confirm the diagnosis.

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Palisaded encapsulated neuroma: An unusual presentation

Cited by 8 publications

References 10 publications

Multiple Cutaneous Solitary Circumscribed Neuroma in a Patient with Neurofibromatosis Type 2: An “Incidentaloma” or New Association?

Multiple Cutaneous Solitary Circumscribed Neuroma in a Patient with Neurofibromatosis Type 2: An “Incidentaloma” or New Association?

Multiple palisaded encapsulated neuromas presenting as cobblestoned plaques over palms and oral cavity

Cutaneous cystic lesions: its clinicopathological correlation with emphasis on unusual findings.

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