Surgical Pathology Criteria

Gastrointestinal Tract Perineurioma

Differential Diagnosis

We consider Fibroblastic Polyp to be the same lesion as GI Perineurioma

Inflammatory Fibroid Polyp GI Perineurioma
Submucosal Predominantly lamina propria
Eosinophil rich inflammatory infiltrate Eosinophils and inflammation infrequent
Perivascular concentric cuffing common Lacks prominent concentric cuffing
Fibromyxoid background with regular vascular pattern Rarely may be myxoid but lacks regular vascular pattern
CD34 positive in 80% CD34 weak focal in 15-30%

GI Schwannoma GI Perineurioma
Peripheral lymphoid cuff common Lacks lymphoid cuff
Frequent cell size variation Generally uniform cell size
Most cases intramural Predominantly lamina propria
S100 100% S100 negative
GFAP 65-100% GFAP negative
Perineurial markers negative Perineurial markers positive

GI Ganglioneuroma GI Perineurioma
Ganglion cells present No ganglion cells
S100 100% S100 negative
Perineurial markers negative Perineurial markers positive

GI Neurofibroma GI Perineurioma
S100 positive S100 negative
Perineurial markers negative Perineurial markers positive
Axons present No axons in lesion

GI Mucosal Schwann Cell Hamartoma GI Perineurioma
Abundant cytoplasm Scant cytoplasm
No association with hyperplastic crypts Frequently associated with hyperplastic crypts
Perineurial markers negative Perineurial markers positive
S100 positive S100 negative

Mucosal Prolapse / Cloacogenic Polyp GI Perineurioma
Fibrovascular stroma Lacks vascularity
Inflammatory infiltrate Inflammation infrequent
Prominent gland component Mostly a spindled stromal lesion, crypts pushed aside
Villiform eroded surface Surface intact and normal
Smooth muscle extends into lamina propria around crypts Lamina propria spindled lesion is smooth muscle actin negative and positive for perineurial markers

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