![]() ![]() Under one of the tumor categories mentioned above. Preimmunoistochemical era, neurothekeomas were often misdiagnosed and classified Plexiform neurofibroma, perineurioma, and cutaneous myxoma. Spindled or stellate cells, such as nerve sheath myxoma, myxoid neurofibroma, Overlap of features with other tumors affecting or arising from peripheral nerves.ĭifferential diagnosis includes those lesions characterized by myxoid material and The exact histopathologic nature of these lesions is still poorly defined, due to the Represent the main indications to surgery, at least for cutaneous/subcutaneous In most cases, local soreness orĪesthetical considerations, along with the need for histological diagnosis, Hypocellular, hypercellular, or mixed types. The predominance of extracellular material, neurothekeomas can be classified into Main histological features include nests orĬords of spindle-like cells with convoluted cytoplasmic membranes and eosinophilicĬytoplasm, surrounded by mucin or collagen fibers. Neurothekeoma of the peripheral nervous system represents aīizarre, unclear pathological entity. TheĪs far as we know, this is the first report documenting a sleeve-shaped neurothekeoma Portion of the lesion was performed under neurophysiological monitoring. Proximally and distally to the enlarged segment. Osteoligamentous structures until a complete nerve decompression was obtained Total excision, the nerve was then dissected free from the surrounding Without any clear-cut cleavage plane from the nerve ( Figure 1). In particular, a 2-cm-long localized swelling of the nerve was noticed, Surprisingly, no severe bony or ligament compression wasįound, but the ulnar nerve enfolded by a poorly cleavable and thick sleeve-shaped Ligament, monopolar stimulation was directly delivered on the partially openedĬubital tunnel, aimed at identifying the ulnar nerve and recording baseline compound After opening the fascia of flexor carpi ulnaris muscle and Osborne’s 15 A curvilinear skin incision anterior to the medial epicondyle at the elbow With continuous free-running and stimulus-triggered electromyographic guidance, as Surgery was performed under generalĪnesthesia, based on intravenous administration of propofol 1% (induction dosage:Ģ-3 mg/kg during surgery: 0.3-0.5 mg/kg/h), and under microscopic magnification A nerve exploration with ulnarĭecompression was then proposed to the patient. Out the need for magnetic resonance imaging (MRI). Strongly suggestive of severe ulnar nerve entrapment at the cubital tunnel, ruling ![]() Stimulation of the first dorsal interosseous muscle. Was of 44.2 m/s) and with a sensory nerve action potential unexcitable after Electromyography/electroneurography (EMG/ENG)ĭocumented a severe neurophysiological damage, with an after-elbow/below-elbow nerveĬonduction velocity of 19.4 m/s (while the same parameter for the right ulnar nerve Thickening of the left ulnar nerve at the cubital tunnel, as in case of inflammatory The preoperative ultrasonographic examination showed inhomogeneous In the left ulnar territory, and initial hypomyotrophy of the remaining intrinsic Hypomyotrophy, a positive Tinel sign at the left cubital tunnel, severe hypesthesia ![]() ![]() Neurological evaluation revealed mild hypothenar and first dorsal interosseous Paresthesias involving the last 2 fingers and the hypothenar eminence of the left This 57-year-old man was admitted at our institution after a 5-month history of Lesions should be that of simple nerve decompression followed by biopsy. In case of peripheral nerve localization,Īnd when a clear cleavage plane is absent, the correct management of these The exact pathological characterization of The best of our knowledge, this is the first report of a sleeve-shaped Hypermyotrophy and intrinsic weakness of the hand. Results: Histological examination describedĪbundant myxoid stroma, with epithelioid and ring-shaped cells arranged inĬords, negative to S100 protein at immunohistochemical analysis. Nerve decompression with biopsy of the swelling portion of the lesion was Given this unexpected finding, the en bloc excision of the lesion was avoided. Sleeve-shaped tissue, which had no clear-cut cleavage plane from the nerve. Methods: Aĥ7-year-old man was admitted at our institution with clinical, ultrasonographic,Īnd electromyographic findings highly suggestive of cubital tunnel syndrome.ĭuring ulnar nerve decompression surgery, however, no bony or ligamentĬompression was noticed, but a segment of the nerve wrapped by a thick Sleeve-shaped neurothekeoma of the ulnar nerve, which was incidentallyĭiscovered during a cubital tunnel release surgery. They usually involve cutaneous or subcutaneous tissues.Īlthough originally described as myxomas deriving from nerve sheath cells, theirĮxact histological classification is still uncertain. Background: Neurothekeomas are slow-growing, well-circumscribedīenign neoplasms. ![]()
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