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Surgical Pathology Criteria
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Traumatic Neuroma

Definition

  • Reactive proliferation of axons, Schwann cells and perineurial cells

Alternate/Historical Names

  • Amputation neuroma

Diagnostic Criteria

  • Usually occurs post-surgically, however can also follow minor trauma
    • If injury occurs in a nerve plexus, multiple neuromas can arise
  • Typically clinically a painful or tender nodule
    • One of the five painful tumors of skin (see Lists at left)
    • Nearly all < 5cm in greatest dimension
  • Composed of haphazardly arranged tangles of variably sized regenerating nerve twigs
    • Composed of axons ensheathed by Schwann cells surrounded by perineurium
    • Unencapsulated
    • Extension into adipose tissue or skeletal muscle is uncommon
      • If present, usually limited
  • Stroma usually fibrous
    • May be myxoid
  • Regenerating nerve twigs contain many neurofilament or Bielschowsky positive axons
    • Surrounding Schwann cells are S100 positive
    • Nerve twigs are surrounded by EMA and GLUT1 positive perineurium
  • Excision is typically curative

Jason Karamchandani MD
Department of Pathology
Stanford University School of Medicine
Stanford CA 94305-5342

Original posting : 11/13/10

Differential Diagnosis

Traumatic Neuroma Localized Interdigial Neuritis (Morton Neuroma)
Can occur anywhwere Occurs in plantar and palmar digital nerves
History of trauma or surgery No history of prior trauma or surgery
Disorganized, microfascicular architecture Nerve is intact
Haphazardly arranged axons Axons decreased in number

Mucosal Neuromatosis Traumatic Neuroma
Typically multiple Generally isolated lesions
Solitary mucosal neuromas resemble traumatic neuromas, and the two lesions may be related

Traumatic Neuroma Solitary Circumscribed (Palisaded Encapsulated) Neuroma
Can occur anywhere 90% of lesions affect the face
Usually located in soft tissue Usually located in dermis
History of trauma or surgery No history of prior trauma or surgery
Can have irregular margin Generally circumscribed
Numerous well formed small nerve twigs Random proliferation of Schwann cells and axons
EMA+ perineurium surrounds individual nerve twigs EMA+ perineurium restricted to periphery of the entire neuroma

Neurofibroma Traumatic Neuroma
No history of prior trauma or surgery History of trauma or surgery
Random proliferation of Schwann cells and axons Numerous well formed small nerve twigs
Widespread soft tissue infiltration Limited soft tissue infiltration
Contain scarce admixed axons Contain abundant haphazardly arranged axons

Schwannoma Traumatic Neuroma
No history of prior trauma or surgery History of trauma or surgery
Random proliferation of Schwann cells and axons Numerous well formed small nerve twigs
Circumscribed/encapsulated Ill defined
Antoni A, Antoni B areas and Verocay bodies No such patterns in traumatic neuroma
Contain rare axons (predominantly subcapsular) Contain abundant haphazardly arranged axons

Lists

Tumors of Peripheral Nerves


Five painful tumors of skin

Bibliography

  • Scheithauer BW, Woodruff JM, Erlandson RA. Tumors of the Peripheral Nervous System, Atlas of Tumor Pathology, AFIP Third Series, Fascicle 24, 1999.
  • Argenyi ZB, Santa Cruz D, Bromley C. Comparative light-microscopic and immunohistochemical study of traumatic and palisaded encapsulated neuromas of the skin. Am J Dermatopathol. 1992 Dec;14(6):504-10.
  • Swanson HH.. Traumatic neuromas. A review of the literature. Oral Surg Oral Med Oral Pathol. 1961 Mar;14:317-26.
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