Benign Neural Tumors Research Articles

Benign Neural Tumors: A Clinicopathologic Analysis

Background: Benign neural tumors, including schwannomas, neurofibromas, and meningiomas, are non-malignant growths originating from nerve tissues. Despite their benign nature, these tumors can cause significant morbidity due to their location and potential for recurrence, posing challenges in clinical management. Understanding the clinico-pathologic characteristics of these tumors is essential to optimize treatment strategies and improve patient outcomes. Aim: This study aims to analyze the clinical presentations, histopathological features, and surgical outcomes of benign neural tumors, focusing on factors influencing recurrence and complications. Methods: A descriptive observational study was conducted. A total of 57 participants diagnosed with benign neural tumors were included based on specific inclusion criteria. Data on demographics, tumor characteristics, clinical presentations, histopathological findings, and surgical outcomes were collected and analyzed using SPSS version 23.0. Statistical tests included descriptive analysis, Chi-square, and t-tests, with a p-value <0.05 considered significant. Results: The study population consisted of 29 males and 28 females, with a mean age of 42.5 years. Schwannomas were the most common tumor type (56.1%), followed by neurofibromas (31.6%) and meningiomas (12.3%). Localized pain (66.7%) and neurological deficits (45.6%) were the predominant clinical symptoms. Complete resection was achieved in 86% of cases, with a recurrence rate of 5.3%, mainly seen in neurofibromas. The overall complication rate was 10.5%, including cerebrospinal fluid leakage and wound infections. A statistically significant correlation (p=0.023) was observed between neurofibromas and higher recurrence rates. Conclusion: Benign neural tumors present diverse clinical challenges due to their location and histopathological variations. Surgical resection is effective, with low recurrence and complication rates, though neurofibromas exhibit a higher tendency for recurrence. Accurate diagnosis, tailored surgical planning, and vigilant postoperative monitoring are crucial for optimizing outcomes. Recommendations: Future studies should focus on exploring adjunctive therapies, particularly for neurofibromas, to reduce recurrence rates. Additionally, incorporating genetic and molecular profiling could further enhance personalized treatment approaches for patients with benign neural tumors. Keywords: Benign neural tumors, schwannoma, neurofibroma, recurrence, clinico-pathologic analysis

Feasibility study of ResNet-50 in the distinction of intraoral neural tumors using histopathological images.

Neural tumors are difficult to distinguish based solely on cellularity and often require immunohistochemical staining to aid in identifying the cell lineage. This article investigates the potential of a Convolutional Neural Network for the histopathological classification of the three most prevalent benign neural tumor types: neurofibroma, perineurioma, and schwannoma. A model was developed, trained, and evaluated for classification using the ResNet-50 architecture, with a database of 30 whole-slide images stained in hematoxylin and eosin (106, 782 patches were generated from and divided among the training, validation, and testing subsets, with strategies to avoid data leakage). The model achieved an accuracy of 70% (64% normalized), and showed satisfactory results for differentiating two of the three classes, reaching approximately 97% and 77% as true positives for neurofibroma and schwannoma classes, respectively, and only 7% for perineurioma class. The AUROC curves for neurofibroma and schwannoma classes was 0.83%, and 0.74% for perineurioma. However, the specificity rate for the perineurioma class was greater (83%) than in the other two classes (neurofibroma with 61%, and schwannoma with 60%). This investigation demonstrated significant potential for proficient performance with a limitation regarding the perineurioma class (the limited feature variability observed contributed to a lower performance).

Spectrum of endoscopic gastric subepithelial lesions encountered on EUS-FNA: A single center experience.

Endoscopic ultrasound guided fine needle aspiration (EUS-FNA) is a minimally invasive and reliable non-surgical technique for the diagnosis of gastrointestinal lesions. The present study aimed to evaluate the spectrum of lesions encountered in the gastric subepithelium on EUS-FNA at a tertiary care center. Archival data of all patients undergoing EUS-FNA for gastric submucosal lesions over a period of 5 years was retrieved. Patient demographics, clinical presentation, and EUS findings were recorded along with the FNA results. A total of 78 EUS-FNA samples were analyzed. Material was adequate in 62 cases (79.48%) and inadequate in 16 cases (12.82%) patients due to scant cellularity. Of the adequate samples, 34 (43.5%) were reported as neoplastic while 20 (25.64%) were non-neoplastic, and 8 (10.25%) were reported as suspicious of a neoplasm. In the neoplastic category, the predominant diagnosis was of spindle cell neoplasm comprising gastrointestinal stromal tumor (13), benign neural tumor (03), leiomyoma (02), and spindle cell tumors (03). The latter could not be categorized further due to a lack of IHC material. The next common diagnosis was adenocarcinoma (06) followed by neuroendocrine tumor (02) and poorly differentiated carcinoma (01). The non-neoplastic lesions included non-specific pathology (15), inflammatory lesions (08), and one case each of tuberculosis, pancreatic rest, and Brunner gland hamartoma. Cell blocks for ancillary testing were available in 54 cases (65.23%) and follow-up was available in 42 cases (53.84%). EUS-FNA is a good modality for the diagnosis of gastric submucosal lesions with a high diagnostic yield.

A Case of Subcutaneous Schwannoma of the Scalp

Schwannomas are benign neural tumors derived from Schwann cells, which surround the peripheral nerves. Here, we present a case of subcutaneous schwannoma of the scalp, with the goal of increasing awareness of the differential diagnosis of scalp masses. A 45-year-old woman was admitted with a palpable scalp mass on the occiput initially noticed 2 years prior. Palpation revealed a 1.5-cm round subcutaneous mass, which was soft and exhibited a movable tendency. The lesion margin was well-circumscribed and contained under the skin. Computed tomography showed a 6 × 12-mm soft-tissue density subcutaneous nodule in the right paramedian occipital region. Thus, an epidermal cyst or lipoma was suspected. The pathological diagnosis (hematoxylin and eosin staining) revealed evidence indicating a subcutaneous schwannoma of the scalp. We report a subcutaneous schwannoma of the scalp, demonstrating that schwannomas can also occur as subcutaneous scalp lesions. Therefore, we suggest that although the treatment of subcutaneous schwannomas does not differ from other soft-tissue masses, a pathological examination should be performed to establish an exact diagnosis in such cases.

A Rare Presentation of Adrenal Leiomyoma Arising in a Ganglioneuroma: A Case Report

Leiomyomas are benign tumours of smooth muscle origin and can occur in any part of the body with adrenal gland being an uncommon site. Ganglioneuromas of adrenal gland are benign neural crest-derived tumours. Both of these tumours are usually detected incidentally. Hereby, the authors report an unusual case of a 31-year-old woman, who presented with paroxysmal attacks of headache, palpitations and flushing pointing towards a hormone secreting adrenal tumour. However, functional adrenal markers were normal. Radiological investigations revealed 8×3 cm heterogeneously enhancing left suprarenal mass with calcification and extension to left renal vein. Patient underwent left nephrectomy and adrenalectomy with a high clinical suspicion of malignancy because of tumour extension to the renal vein. The histopathological examination revealed a leiomyoma arising in a background of ganglioneuroma which was later on confirmed using immunohistochemistry. Authors have presented the present case because of atypical presentation as a hormone secreting adrenal tumour with radiological features of malignancy and the unique histomorphology of the combined occurrence of leiomyoma and ganglioneuromatous area in the adrenal gland. To the best of author’s knowledge, this is the first case report of such an occurrence in the adrenal gland.

Surgical Approaches for Prevention of Neuroma at Time of Peripheral Nerve Injury.

Painful neuroma is a frequent sequela of peripheral nerve injury which can result in pain and decreased quality of life for the patient, often necessitating surgical intervention. End neuromas are benign neural tumors that commonly form after nerve transection, when axons from the proximal nerve stump regenerate in a disorganized manner in an attempt to recreate nerve continuity. Inflammation and collagen remodeling leads to a bulbous end neuroma which can become symptomatic and result in decreased quality of life. This review covers surgical prophylaxis of end neuroma formation at time of injury, rather than treatment of existing neuroma and prevention of recurrence. The current accepted methods to prevent end neuroma formation at time of injury include different mechanisms to inhibit the regenerative response or provide a conduit for organized regrowth, with mixed results. Approaches include proximal nerve stump capping, nerve implantation into bone, muscle and vein, various pharmacologic methods to inhibit axonal growth, and mechanisms to guide axonal growth after injury. This article reviews historical treatments that aimed to prevent end neuroma formation as well as current and experimental treatments, and seeks to provide a concise, comprehensive resource for current and future therapies aimed at preventing neuroma formation.

Radiolucent lesion of the mandible with an indolent course over 10 years

A 27-year-old man presented in 2009 with a longstanding history of a multiloculated radiolucent lesion in the left mandible. It was assessed, and a biopsy was performed in another country. At the time of the assessment, the patient was asymptomatic. The biopsy was interpreted and reported as a benign fibrous lesion with a differential diagnosis of benign neural tumor such as neurofibroma.

TO INVESTIGATE THE PRESENCE OF MAST CELLS IN BENIGN ORAL NEURAL LESIONS

Objective: Benign neural lesions are rare diseases especially in the oral cavity. These lesions are associated with the peripheral nerves which are mainly composed of Schwann cells. The mast cells are important in benign neural tumors, and according to the lesion, they can be scarce or abundant. One way to identify mast cells is by using histochemical techniques such as toluidine blue dye. The aim of this study was to identify the presence of mast in benign neural lesions diagnosed by the pathology laboratory. Methodology: This is a descriptive and observational pilot study. Four cases of benign neural cases were microscopically evaluated with hematoxylin-eosin and blue toluidine; these include palisaded encapsulated neuroma, schwannoma, traumatic neuroma, and neurofibroma. Results: Intralesional and perilesional mast cells were found in palisaded encapsulated neuroma. The mast cells were more intralesional and associated with an inflammatory infiltrate focus in schwannomas and neurofibromas. In traumatic neuroma, the mast cells were in the connective tissue near the blood vessels. Conclusion: It is important to do a quantitative analysis of mast cells as part of the histopathological diagnosis in an effort to better understand these oral lesions.

Soft tissue huge solitary neurofibroma in the sacral region without neurofibromatosis: a pediatric case report

Neurofibromas are thick and irregular benign neural sheath tumors touching the peripheral nerve and it may occur at any point along a nerve. Neurofibromas occur frequently as a neurofibromatosis manifestation and less commonly solitary, in unusual sites without neurofibromatosis. The imaging especially MRI is relatively helpful to determine radiological features necessary for the diagnosis, but the definitive diagnosis is established basing on the histopathological examination of the specimen. The primary therapeutic approach for neurofibromas is a complete surgical removal to prevent tumor recurrence. This article highlights a rare case of unusual soft tissue huge solitary neurofibroma in the sacral region without neurofibromatosis in a 12-old-girl.

Pediatric sciatic neuropathy: Clinical presentation and long term follow up.

Sciatic neuropathy is rare and difficult to diagnose in pediatrics, and its long-term course has not been completely understood. To analyze the clinical presentation and evolution of a group of pediatric patients with sciatic neuropathy. Retrospective anal ysis of the clinical characteristics of pediatric patients with sciatic neuropathy treated in two hospitals of Santiago between 2014 and 2018. Locomotor examination, muscle trophism, deep tendon reflexes, gait, sensation, and pain were assessed. Sciatic nerve conduction study and electromyography (EMG) were performed, and magnetic resonance imaging (MRI) in three patients. Six patients were included with an average age of 11.8 years. The etiologies were traumatic (N = 2), by compression (N = 2), vascular (N = 1), and tumor (N = 1). All of the 6 patients presented foot drop and Achilles tendon hyporeflexia/areflexia, and 5 patients presented severe neuropathic pain. The EMG showed involvement of the sciatic nerve rami and dependent muscles. In two patients, a pelvic girdle and lower limbs MRI was performed, showing selective muscle involvement in sciatic territory. One patient underwent a lumbosacral plexus MRI, and subsequently histological study showing a benign neural tumor. Out of the three patients who were followed-up longer than one year presented motor sequelae and gait disorder. Sciatic neuropathy in the study group was secondary to different causes, predominantly traumatic and compressive etiologies. The three patients that were ina long-term follow-up presented significant motor sequelae. In most of the cases, neural injury wasassoci- ated with preventable causes, such as accidents and positioning in unconscious children, which is crucial in the prevention of a pathology with a high sequelae degree.

Environmentally-induced alternative oncogenesis: EROS arrows

The cause of the oncological diseases in children and the specific spectrum of this pathology, with hemangiomas prevailing among benign tumors (BT), and leukemia, lymphomas, and neural tissue tumors among malignant neoplasms (MN), remains unknown. The authors studied the similarities and differences of the connections between environmental factors, benign tumors and MN, as well as the relations between BT and MN. The causality of the so-called “sporadic” fluctuations in the incidence of neoplasms and their relations with environmental factors were revealed. A hypothesis of environmentally-induced alternative oncogenesis is suggested. According to the hypothesis, fetal hemoglobin enhances environmentally-related oxidative stress (EROS), leading to epigenomic regulation disorder of SEMA 7A and MICAL family proteins in the endothelium, axon growth cone, and hematopoietic stem cells.

Penile pacinian neurofibroma

Pacinian neurofibroma (PNF) is a lobulated benign neural tumor with prominent structures resembling pacinian bodies. These tumors most commonly occur in areas where normal pacinian bodies are found, such as the hands and feet. Although pacinian bodies are common in the penis, no cases of penile PNF have been reported to date. We present a case of PNF on the dorsal glans penis of a 47-year-old man. The lesion presented as a single flesh-colored papule and the biopsy showed a dermal neurofibroma consisting of bland spindle cells with wavy nuclei, without mitoses or atypia, and some nodular structures with a concentric arrangement and a pacinian appearance. Immunohistochemistry demonstrated positivity for CD34 and Vimetin and negativity for Epithelial Membrane Antigen (EMA). S100 was highly positive in the most central areas of the pacinian-like nodules, while the periphery and non-nodular parts of the neurofibroma were less intensively expressed.

Palisaded Encapsulated (Solitary Circumscribed) Neuroma: A Review of 30 Cases.

Background. Solitary circumscribed neuroma (SCN), also known as palisaded encapsulated neuroma (PEN), is a benign neural tumor. It may be mistaken as either schwannoma or neurofibroma in pathology practice. In this study, we aimed to define clinicopathologic and immunohistochemical features and discuss its differential diagnosis. Materials and Methods. The histopathological features of 30 cases of SCN/PEN were reviewed. The presence of intralesional axons, Schwann, and perineural cell distributions were investigated by performing neuronal immunomarkers. Results. Twelve cases were females, and 18 cases were males. The mean age was 48 years. Lesions were mostly located on the face (27/30). Histologically, 18 had a lobular pattern, 9 were plexiform, 2 fungating, and 1 multilobular. Although the majority of cases were well circumscribed, capsular integrity was at least focally disrupted (73%). Verocay body was noted only in 6 cases (20%). One case showed excessive hyperkeratosis, forming a keratin horn. Adipocytic change was detected in another case. The lesions consisted of S100-positive Schwann cell proliferation and were partially surrounded by perineural cells highlighted by EMA or Claudin-1. The amount of intralesional axons revealed by neurofilament immunostaining was variable. Conclusion. SCN/PEN is a relatively common lesion, and usually seen as an asymptomatic papule on the face of elderly patients. A circumscribed lesion composed of bundles of bland-looking spindle cells thought to be of neural origin is seen in the dermis. Pathologists should be aware of the existence of plexiform and multilobular PEN/SCN variants, to avoid misdiagnosis of plexiform neurofibroma or schwannoma.

Granular Cell Tumor (GCT) of the Breast: Case Report of an Uncommon Benign Neural Tumor with Malignant Imaging Characteristics

Granular Cell Tumor (GCT) of the Breast: Case Report of an Uncommon Benign Neural Tumor with Malignant Imaging Characteristics

Clinical Presentation and Management of 10 Consecutive Cases of Primary Orbital Tumors of Neurological Origin Presenting to a Regional Institute of Ophthalmology

Introduction: Proptosis is a common presentation to our outpatient department. The eyes are as much a visual structure as they are an aesthetic part of the face. We designed a study to document the clinical presentation and management of ten consecutive cases of primary benign neural orbital tumors presenting to a regional institute of ophthalmology. Aim: The aim of the study is to document the clinical presentation and management of ten consecutive cases of primary benign neural orbital tumors presenting to a regional institute of Ophthalmology. Methodology: Ten consecutive cases of primary benign neural orbital tumors were enrolled. They were subjected to a thorough clinical examination and imaging. Thereafter they were managed by observation, surgery or radiotherapy as per the case. Results: There were five cases of schwannoma which responded well to surgery with good visual outcome. The two cases of optic nerve glioma one was subjected to observation due to slow growth and good vision. The second case was managed surgically due to proptosis and poor vision. Two cases of meningioma were subjected to surgery due to proptosis with poor vision. One case was observed and subjected to radiotherapy due to good vision and slow growth. Discussion: We report the clinical presentation and management of primary orbital tumors of neurological origin from our part of the world. The current management scenario from our perspective is in concordance with that reported by other workers from different parts of the globe. Conclusion: Primary benign neural tumors of the orbit can be managed by surgery or observation as per the case. Our unique perspective on these tumors is invaluable to the world oncology literature.

Palisaded encapsulated neuroma

Palisaded encapsulated neuroma (PEN) is a benign cutaneous or mucosal neural tumor which, usually, presents as a solitary, firm, asymptomatic, papule or nodule showing striking predilection for the face. It occurs commonly in middle age, and there is no sex predilection. Oral PEN are not common, and these lesions must be distinguished from other peripheral nerve sheath tumors such as the neurofibroma, neurilemma (schwannoma), and traumatic neuroma. The major challenge in dealing with lesions of PEN is to avoid the misdiagnosis of neural tumors that may be associated with systemic syndromes such as neurofibromatosis and multiple endocrine neoplasia syndrome type 2B. Here, we present a case of benign PEN of the gingiva in the left anterior mandibular region, laying importance on immunohistochemical staining in diagnosing such lesions.

“Rare or Underdiagnosed?” - Solitary Circumscribed Neuroma of the Lip

Solitary circumscribed neuroma, also known as palisaded encapsulated neuroma is a benign neural tissue tumour. This is usually an asymptomatic and often misdiagnosed pathology in the head and neck region. Lip lesions have a broad differential diagnosis. Clinician's awareness and accurate diagnosis are vital for their appropriate management. Here, we present a case report of solitary circumscribed neuroma of the lip, with a one year follow-up.

CR0360 Intraosseous schwannoma of the jaws: updated review of the literature

Schwannomas are benign neural sheath tumors derived from Schwann cells. Although rare, they are the most common of intraosseous neural tumors. We present a case involving the mandible and provide an updated review of the literature on schwannomas arising within the maxilla or the mandible.

Encapsulated Neuroma on Glans Penis: A Case Report and Review of the Literature

One case of palisaded encapsulated neuroma on glans is reported. Palisaded encapsulated neuroma is a benign neural tumor whose location on glans is outstanding. It represents a separate clinicopathological entity. The characteristics of the neoplasm are reported and discussed. J Med Cases. 2014;5(5):257-259 doi: http://dx.doi.org/ 10.14740 / jmc1748w

Encapsulated Neuroma on Glans Penis: A Case Report and Review of the Literature

One case of palisaded encapsulated neuroma on glans is reported. Palisaded encapsulated neuroma is a benign neural tumor whose location on glans is outstanding. It represents a separate clinicopathological entity. The characteristics of the neoplasm are reported and discussed. J Med Cases. 2014;5(5):257-259 doi: http://dx.doi.org/ 10.14740 / jmc1748w