Abstract
BackgroundPerineuriomas have been defined as tumorous lesions of the peripheral nerves which derive from perineurial cell proliferation and may be associated with abnormalities on chromosome 22.Case presentationThree years after a painful cubital vein procaine injection, a 33 year-old man developed a median nerve lesion, initially diagnosed as carpal tunnel syndrome. Symptoms progressed despite appropriate surgery. Clinical and electrophysiological re-evaluation revealed a fusiform mass at the distal upper arm, confirmed by MRI. Immunohistochemical studies classified the tumor as a mixed perineurioma and neuroma.ConclusionsPerineurioma mixed with neuroma may potentially caused by the previous trauma or cytotoxic effects of procaine.
Highlights
Perineuriomas have been defined as tumorous lesions of the peripheral nerves which derive from perineurial cell proliferation and may be associated with abnormalities on chromosome 22
Perineurioma mixed with neuroma may potentially caused by the previous trauma or cytotoxic effects of procaine
There has been much confusion concerning the definition of the entity of rare focal lesions of the peripheral nerves since terms such as perineurioma, localized hypertrophic neuropathy, or hypertrophic neuritis have been used as synonyms [1,2,3,4,5]
Summary
There has been much confusion concerning the definition of the entity of rare focal lesions of the peripheral nerves since terms such as perineurioma, localized hypertrophic neuropathy, or hypertrophic neuritis have been used as synonyms [1,2,3,4,5]. Three years after a cubital procaine-HCL 0.05% injection had caused acute severe local pain radiating to his forearm and wrist, a 33-year old man complained about pain in his right hand Two months later, he suffered from numbness in the distribution of the right median nerve and wasting of thenar muscles. Histological investigation revealed marked peri- and endoneurial fibrosis, severe axonal loss as well as proliferation of concentric whorl-like formations resulting in multicompartment arrangement These pseudo onion-bulb formations showed strong immunoreactivity for the epithelial membrane antigen and were predominantly negative for S-100 protein, suggesting a proliferation of perineurial cells rather than Schwann cells. On clinical follow-up four years later a partial recovery of forearm muscle strength could be noted and the patient was free from pain
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