Soft tissue

Peripheral nerve

Other benign

Neuroma


Resident / Fellow Advisory Board: Josephine K. Dermawan, M.D., Ph.D.
Deputy Editor-in-Chief: Borislav A. Alexiev, M.D.
Saba Anjum, M.B.B.S.
Nasir Ud Din, M.B.B.S.

Last author update: 19 October 2022
Last staff update: 20 October 2022

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PubMed Search: Neuroma soft tissue

Saba Anjum, M.B.B.S.
Nasir Ud Din, M.B.B.S.
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Cite this page: Anjum S, Ahmed R, Ud Din N. Neuroma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/softtissueneuroma.html. Accessed February 3rd, 2023.
Definition / general
Essential features
  • Benign, circumscribed, often painful lesion developing after trauma or surgical amputation of the limb
  • Composed of disorganized spindle cell proliferation of nerve components
ICD coding
  • ICD-10: T87.30 - neuroma of amputation stump, unspecified extremity
Epidemiology
  • No predilection for a specific age, gender, or geographic location
  • Usually associated with history of trauma, amputation or chronic friction
Sites
Pathophysiology
Etiology
Laboratory
Radiology description
  • Ultrasound: circumscribed, marginated, homogeneously hypoechoic fusiform mass with echogenic strands inside; bulbous end morphology; and in continuity with a normal nerve proximally (Acta Biomed 2020;91:122)
  • MRI: well defined, ovoid lesion with an intermediate signal intensity on T1 weighted images; intermediate - high signal intensity with fascicular pattern on fast spin echo (FSE) T2 weighted images (Acta Biomed 2020;91:122)
Radiology images

Images hosted on other servers:

2 oval, well circumscribed parallel nodules

Sciatic neuroma: T1 sagittal plane, T2 coronal plane

Homogeneous hypoechoic fusiform mass in continuity with nerve

MRI: well defined ovoid subcutaneous mass

Prognostic factors
Case reports
Treatment
Clinical images

Images hosted on other servers:

Circumscribed subepithelial lesion

Bulbous portion of sciatic nerve

Fusiform portion of nerve

Gross description
Gross images

Images hosted on other servers:

Resected hard duodenal wall lesion

Microscopic (histologic) description
Microscopic (histologic) images

Contributed by Nasir Ud Din, M.B.B.S.
Unencapsulated bundles of spindle cells Unencapsulated bundles of spindle cells

Unencapsulated bundles of spindle cells

Variable sized bundles of nerve components Variable sized bundles of nerve components

Variable sized bundles of nerve components


Bundles of spindle cells Bundles of spindle cells

Bundles of spindle cells

Clusters of nerve components Clusters of nerve components

Clusters of nerve components

Cytology description
  • FNAC of traumatic neuroma yields scant aspirate, hypocellular smears showing scattered spindle cells in single or clustered fashion (Patholog Res Int 2014;2014:678628)
Positive stains
Videos

Nerve sheath tumors, etc.
by Dr. Jerad Gardner

Sample pathology report
  • Upper limb, excision:
    • Neuroma (see comment)
    • Microscopy: The sections examined show a circumscribed, unencapsulated lesion composed of variable sized, closely packed nerve bundle along with scar tissue in the background.
    • Comment: It is a benign condition and has been completely excised.
Differential diagnosis
  • Localized interdigital neuritis (Morton neuroma / Morton metatarsalgia):
    • Occurs in female adults
    • Location: interdigital planter nerve between third and fourth toes
    • Histology: markedly distorted nerve with extensive perineurial fibrosis arranged in concentric circles
    • IHC: S100 positive
  • Neurofibroma:
    • In skin, deeply situated medium sized nerve, common in patient with type 1 neurofibromatosis
    • Location: no particular anatomical distribution
    • Histology: haphazard proliferation of Schwann cells, fibroblasts, perineurial cells, few axons and mast cells, shredded collagen fibers and myxoid stroma
    • IHC: S100, SOX10, collagen IV, CD34 positive, EMA positive at periphery
  • Palisaded encapsulated neuroma:
    • Age: middle age
    • Location: small, solitary asymptomatic papule in face skin
    • Histology: dermal encapsulated lesion exhibiting Schwann cells and numerous axons with perineurium
    • IHC: S100, neurofilament, EMA
  • Schwannoma:
    • Age: occurs in all ages with peak incidence in fourth to sixth decade
    • Few sporadic cases associated with type 2 neurofibromatosis
    • Location: flexor surface of extremities, neck, mediastinum, retroperitoneum, spinal roots and cerebellopontine angle
    • Histology: encapsulated lesion with hypocellular and hypercellular areas of spindle cells, Verocay bodies present
    • IHC: S100, H3k27me3
  • Mucosal neuroma:
    • Associated with multiple endocrine neoplasia type 2 (MEN2) caused by RET proto-oncogene, known as mucosal neuroma syndrome
    • Variant of traumatic neuroma with distinctive clinical features; however, not associated with trauma or surgery
    • Syndrome is characterized by presence of medullary carcinoma thyroid, pheochromocytoma, marfanoid features and mucosal neuromas of the tongue, lips, inner cheeks and inner eyelids (J Oral Maxillofac Pathol 2020;24:339)
Board review style question #1

A patient presented with a painful nodule that developed after an amputation of the left first finger. On examination, the nodule is painful. Excision of the lesion is performed which shows the histology above. Which of the following is the most likely diagnosis?

  1. Granular cell tumor
  2. Neurofibroma
  3. Neurothekoma
  4. Traumatic neuroma
  5. Schwannoma
Board review style answer #1
D. Traumatic neuroma

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Reference: Neuroma
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