Peripheral nerve tumors of the hand: Clinical features, diagnosis, and treatment

Abstract

The majority of the tumors arising from the peripheral nerves of the hand are relatively benign. However, a tumor diagnosed as malignant peripheral nerve sheath tumor (MPNST) has destructive consequences. Clinical signs and symptoms are usually caused by direct and indirect effects of the tumor, such as nerve invasion or compression and infiltration of surrounding tissues. Definitive diagnosis is made by tumor biopsy. Complete surgical removal with maximum reservation of residual neurologic function is the most appropriate intervention for most symptomatic benign peripheral nerve tumors (PNTs) of the hand; however, MPNSTs require surgical resection with a sufficiently wide margin or even amputation to improve prognosis. In this article, we review the clinical presentation and radiographic features, summarize the evidence for an accurate diagnosis, and discuss the available treatment options for PNTs of the hand.

Clinical and pathological features of upper limb nerve tumors – four years retrospective study

“…Schwannoma (neurilemmoma) is the most common tumor type of the peripheral nerve, presenting as slow growing, encapsulated lesions, occasionally of considerable size (as presented in Figure 1, A-C) [1,4]. Schwannomas encountered in the limbs have different clinical presentations, from asymptomatic features to pain of various intensities, or paresthesia resulting from peripheral nerve compression [4].…”

“…Nerve tumors represent uncommon upper extremity tumors in adults and include benign peripheral nerve sheath tumors (BPNSTs) and malignant peripheral nerve sheath tumors (MPNSTs) [ 1 , 2 ]. Benign nerve tumors present slow growing evolution and are minimally symptomatic, whereas malignant masses should be suspected when a more aggressive growth pattern is encountered [ 1 , 3 ].…”

“…Neurofibromas occur in two disease patterns: sporadic or associated with neurofibromatosis [ 1 , 5 ]. Malignant transformation is rare in isolated neurofibromas.…”

“…Peripheral nerve tumors are evaluated and located anatomically using imaging tests, such as echography, computed tomography, or magnetic resonance imaging (MRI). The latter is the most accurate in establishing tumor relative location to the nerve and renders precise adjacent tissue involvement [ 1 , 9 , 10 , 11 ]. Such examinations do not differentiate peripheral nerve tumors from other types, but may aid in revealing malignant features, such as necrosis, adjacent invasion, and increased dimensions.…”

“…Such examinations do not differentiate peripheral nerve tumors from other types, but may aid in revealing malignant features, such as necrosis, adjacent invasion, and increased dimensions. The definitive diagnosis, regardless of its benign or malignant nature is done by histopathological (HP) examination and immunohistochemistry [ 1 , 9 ].…”