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Ulnar polydactyly is common. The condition is often successfully treated by pediatricians using string (or suture) ligation in the newborn nursery. Patients with ulnar polydactyly or complications of unsuccessful string ligation such as traumatic neuroma may be referred to pediatric dermatologists. In some cases, the condition is better treated surgically. In case of a bony or ligamentous attachment, surgery is required. Additionally, a wide-base-precluding-string ligation would be better treated with surgery to avoid the need for later revision. We present a series of 10 patients (13 hands) in which previous string ligation produced an unsightly incomplete amputation, a tender neuroma, or both. Patients were successfully treated with completion amputation of the residual stump combined with proximal ligation of the supernumerary digital nerves. We advocate a selective approach in the management of this condition. Treatment options should be fully discussed with families prior to proceeding with suture ligation.

Syringomas are architecturally complex tumors composed of small, cystically dilated segments of dermal eccrine duct. Syringomas typically form isolated flesh-colored periorbital papules, however, in a peculiar condition termed eruptive syringoma; scores develop simultaneously in near confluence over a large surface area. While traditionally regarded as a neoplasm, more recent observations indicate eruptive syringoma is a reactive proliferation secondary to autoimmune disruption of the acrosyringium. We present the case of a 44-year-old woman with eruptive syringoma of the labia majora and prominent lymphocytic inflammation in the acrosyringium. Immunohistochemical stains confirm that the infiltrate is composed of CD4+ and CD8+ T cells, without significant CD20 B cells or CD138 plasma cells. Sequential sections of the syringoma reveal a complex 3-dimensional architecture with functionally isolated cysts, not connected to adjacent cysts or ducts by a discernable epithelium. These findings support the conclusion that eruptive syringoma is a tortuous proliferation of dermal eccrine ducts and fibrous stroma secondary to autoimmune destruction of the acrosyringium. Conceptually, the disorganized expansion of an eccrine duct syringoma may be analogous to a peripheral nerve traumatic neuroma.

Traumatic neuroma, neurofibroma, neurilemmoma, palisaded encapsulated neuroma and malignant peripheral nerve sheath tumor (MPNST) are peripheral nerve sheath tumors and present neural origin. The goal of this study was to describe the epidemiological data of oral peripheral nerve sheath tumors in a sample of the Brazilian population. Biopsies requested from the Oral Pathology Service, School of Dentistry, Federal University of Minas Gerais (MG, Brazil), between 1966 and 2006 were evaluated. Lesions diagnosed as peripheral nerve sheath tumors were submitted to morphologic and to immunohistochemical analyses. All cases were immunopositive to the S-100 protein. Thirty-five oral peripheral nerve sheath tumors were found, representing 0.16% of all lesions archived in the Oral Pathology Service. Traumatic neuroma (15 cases) most frequently affected the mental foramen. Solitary neurofibroma (10 cases) was more frequently observed in the palate. Neurofibroma associated with neurofibromatosis type I (2 cases) was observed in the gingival and alveolar mucosa. Neurilemmoma (4 cases) was more commonly observed in the buccal mucosa. Malignant peripheral nerve sheath tumors (3 cases) occurred in the mandible, palate, and tongue. Palisaded encapsulated neuroma (1 case) occurred in the buccal mucosa. The data confirmed that oral peripheral nerve sheath tumors are uncommon in the oral region, with some lesions presenting a predilection for a specific gender or site. This study may be useful in clinical dentistry and oral pathology practice and may be used as baseline data regarding oral peripheral nerve sheath tumors in other populations.

A 42-year-old man had noticed a small tender papule on his lower lip, and the papule clinically became unnoticeable after cryosurgery. He visited our clinic because the lesion recurred up to the original size after 9 months. On examination, a linear scar and a papule, 4 mm in diameter, were observed on the mucosal lower lip. The papule was resected and histopathologically showed proliferation of nerve fibers in irregular and tortuous fascicles, thus establishing the diagnosis of traumatic neuroma. Immunohistochemical staining by antineuron-specific enolase (NSE) antibody showed proliferation of axons in the upper lamina propria and even in the mucosal epithelium overlying the tumor. Traumatic neuroma of the lower lip is very rare, and a literature search showed only one reported case. Intraepithelial proliferation of axons may be one of the characteristics of mucosal traumatic neuroma.

Traumatic neuroma is a hyperplastic lesion caused by the superfluous regeneration of nerve cells at acut surface. We report a case of traumatic neuroma arising in the lower lip of a 7-year-old boy. The patient wasinvolved in a traffic accident in May 2003, causing a bone fracture of the femoral region and laceration of the lowerlip. The lower lip was sutured surgically. Shortly after treatment, the patient noticed a swelling in the right side ofhis lower lip and consulted our clinic for a detailed examination on January 7, 2004. Macroscopically, an elasticand hemispheric painless soft mass with a diameter of 1.0cm was noticed at the suture line. Under a clinical diagnosisof mucocele, we performed enucleation of the tumor. Histologically, irregular proliferation of the peripheralnerve cells and nodular formation of Schwann cells were observed. The tumor was diagnosed to be a traumaticneuroma. During 2 years of postoperative follow-up, the patient has had no evidence of recurrence.

Traumatic neuroma is a well-known disorder that occurs after trauma or surgery involving the peripheral nerve and develops from a nonneoplastic proliferation of the proximal end of a severed, partially transected, or injured nerve. We present a case of traumatic neuroma around the celiac trunk after gastrectomy in a 56-year-old man, which was confirmed by pathology. CT demonstrated the presence of a lobulated, homogeneous, hypoattenuating mass around the celiac trunk, mimicking a nodal metastasis.

OBJECTIVE Traumatic neuromas are rare benign lesions occurring post-mastectomy, which are usually suspected as tumour recurrences before excision biopsy. We report six cases presenting with palpable nodules post-mastectomy, to emphasize the differential diagnosis of traumatic neuroma from recurrent cancer. METHODS Six cases were reviewed. The age of patients ranged from 33 to 61 years. Nodular masses were found close to the mastectomy scar during follow-up over a period of 2.8 to 8 years. RESULTS In one patient three nodular masses were detected. Five patients had received chemotherapy, three of which had also received radiotherapy. Ultrasound examinations showed a well-circumscribed, homogeneous, hypo-echoic subcutaneous nodular lesion in four cases, and a poorly defined hypoechoic nodule with good conduction in two cases. No obvious distant metastases had been identified. Each patient underwent surgical excisional biopsy. All of nodules had a diameter less than 1 cm. Histopathological examination showed proliferation of nerve fi bre bundles, which were disordered, oriented and well circumscribed in fibro-adipose tissue. CONCLUSION It was concluded that all of the lesions were traumatic neuromas, independent from the initial tumor. Traumatic neuromas occur -ring in mastectomy scars are difficult to distinguish from a tumor recurrence. Although radiological evaluation of the mass with ultrasound is of value, the diagnosis can only be confirmed following a histopathological evaluation.

We report a 15 years old girl who admitted to our hospital with signs of recurrent torticollis after two failed operations and consistent pain at the side of surgery. The past operations were performed at 1 and 6 years of age and she has been suffering pain from previous incisions with neck movements. At physical examination, the sternocleidomastoid (SCM) muscle behaved like a fibrous band, restricting the neck movements and resulting in pain. The operation was indicated for the fibrotic SCM. At operation two separate incisions were performed on each end of the SCM to remove all of the fibrotic muscle. The histopathological examination demonstrated a traumatic neuroma which respectively correlates with the pain symptoms. The patient discharged on the second postoperative day and physiotherapy was started. The patient is symptom free one year after the surgery. This case demonstrates a rare occurrence of traumatic neuroma after torticollis surgery, which can manifest with pain. Keywords : neuroma, torticollis, trauma

To describe the MRI appearance of traumatic neuromas on non-contrast and contrast-enhanced MRI sequences. This IRB-approved, HIPAA-compliant study retrospectively reviewed 13 subjects with 20 neuromas. Two observers reviewed pre-operative MRIs for imaging features of neuroma (size, margin, capsule, signal intensity, heterogeneity, enhancement, neurogenic features and denervation) and the nerve segment distal to the traumatic neuroma. Descriptive statistics were reported. Pearson’s correlation was used to examine the relationship between size of neuroma and parent nerve. Of 20 neuromas, 13 were neuromas-in-continuity and seven were end-bulb neuromas. Neuromas had a mean size of 1.5 cm (range 0.6–4.8 cm), 100 % (20/20) had indistinct margins and 0 % (0/20) had a capsule. Eighty-eight percent (7/8) showed enhancement. All 100 % (20/20) had tail sign; 35 % (7/20) demonstrated discontinuity from the parent nerve. None showed a target sign. There was moderate positive correlation (r = 0.68, p = 0.001) with larger neuromas arising from larger parent nerves. MRI evaluation of the nerve segment distal to the neuroma showed increased size (mean size 0.5 cm ± 0.4 cm) compared to the parent nerve (mean size 0.3 cm ± 0.2 cm). Since MRI features of neuromas include enhancement, intravenous contrast medium cannot be used to distinguish neuromas from peripheral nerve sheath tumours. The clinical history of trauma with the lack of a target sign are likely the most useful clues. • MRI features of neuromas include enhancement and lack of a target sign. • Contrast material cannot be used to distinguish traumatic neuromas from PNSTs. • Traumatic neuromas can simulate peripheral nerve neoplasms on imaging.

Traumatic neuroma of the branches of the deep peroneal nerve that innervate the sinus tarsi can be the source of recalcitrant lateral ankle pain. That these nerves can be the source of the pain can be demonstrated by nerve blocks, and this pain can be surgically treated by resection of the appropriate branch of the deep peroneal nerve. This article documents the clinical results of this approach in 13 patients with sinus tarsi syndrome. At a minimum of 6 months postoperatively, 10 patients (77%) were completely pain-free, wore normal shoes, and had returned to work. Two patients (15%) had a small degree of residual pain but resumed usual activities and wore normal footwear. One patient had some pain relief but could not resume usual activities. We conclude that denervation of the sinus tarsi can relieve recalcitrant pain emanating from the sinus tarsi. This approach may reduce the need for subtalar fusion or evacuation procedures, including arthroereisis, thus avoiding their potential complications. Moreover, sinus tarsi denervation may allow the continued use of an arthroereisis implant in the presence of satisfactory objective findings, despite the subjective presence of postoperative pain. (J Am Podiatr Med Assoc 95(2): 108–113, 2005)

胆道系に発生する外傷性神経腫 (traumatic neuroma: 以下,本症と略記)は稀である.今回,手術既往がなく胆嚢に発症した本症を経験したので報告する.患者は68歳の男性で,検診で胆嚢の異常を指摘されて当院を受診した.腹部症状はなかったが,超音波検査, CT・MRCPなどの精査の結果,胆嚢腫瘍および胃粘膜下腫瘍疑いと診断され,胆嚢摘出術および胃部分切除術を施行した.胆嚢内に有茎性の3×1cmの隆起性腫瘤を認めた.病理組織検査では,胆嚢腫瘤は過形成上皮で被覆されており,腫瘤基部の胆嚢壁に線維化を伴う神経の増生が認められた.同部位はS-100蛋白陽性で本症と診断した.本症の発生には何らかの侵襲による神経の損傷を必要とする.本症例は手術歴や胆嚢結石の存在もなく,有茎性ポリープの牽引による物理的刺激が,その原因と推測された.胆道系腫瘍の鑑別に留意すべき疾患と考え報告した.

We present a case of retroperitoneal femoral nerve injury after cut wounds at the lower abdomen. Electrodiagnostic tests revealed impaired function of nerve and muscles. A mass was observed at the retroperitoneal part of the femoral nerve by ultrasound, indicating that a traumatic neuroma composed of disordered fascicles was configurated after the injury. Postoperative pathology confirmed hypertrophic and hyperplastic nerve bundles of the mass. Great improvements were shown in the patient's symptoms and electrodiagnostic tests in the subsequent 3 months. This case presented a rare position of neuroma formation by ultrasound.

Mucocele and traumatic neuroma are two lesions related to the traumatic events; however there is only one reported case in which these two entities were perceived simultaneously. The current study reported a 21-year-old man who complained of painless recurrent swelling, accompanied by paresthesia on his left lower labial mucosa. He had a previous history of similar lesion and had been treated with surgery and cauterization last year. The primary clinical impression was a recurrent mucocele. Microscopic surveys displayed a traumatic neuroma in the vicinity of a mucocele which seems to be arising from the previous surgical treatment.

Surg Oral Med Oral Pathol 51:394, 1981 3. Zain RB, Ling KC: Traumatic neuroma in wall of recurrent unicystic ameloblastoma: A case report. Med J Malaysia 40:49, 1985 4. Lee HT: Amputation neuroma of the maxilla. Dent J Malaysia Singapore 11:17, 1971 5. Cawson RA, Binnie WH, Speight PM, et al: Lucas’s Pathology of Tumors of the Oral Tissues (ed 5). New York, NY, Churchill Livingstone, 1998 6. Lee EJ, Calcaterra TC, Zuckerbraun L: Traumatic neuromas of the head and neck. Ear Nose Throat J 77:670, 1998 7. Badalamente MA, Hurst LC, Ellstein J, et al: The pathobiology of human neuromas: An electron microscopic and biochemical study. J Hand Surg [Am] 10:49, 1985 8. Macias MY, Lehman CT, Sanger JR, et al: Myelinated sensory and alpha motor axon regeneration in peripheral nerve neuromas. Muscle Nerve 21:1748, 1998 9. Kryger GS, Kryger Z, Zhang F, et al: Nerve growth factor inhibition prevents traumatic neuroma formation in the rat. J Hand Surg [Am] 26:635, 2001 10. Xu QG, Zochodne DW: Ischemia and failed regeneration in chronic experimental neuromas. Brain Res 946:24, 2002

uation and in situ hybridization in a case of oral inverted ductal papilloma. J Oral Maxillofacial Surg 52:503, 1994 4. Marx RE, Stern D: Oral and Maxillofacial Pathology. Carol Stream, IL, Quintessence Publishing Co, 2003 5. Hegarty DJ, Hopper C, Speight PM: Inverted ductal papilloma of minor salivary glands. J Oral Pathol Med 23:334, 1994 6. Neville BW, Damin OD, Allen CM: Oral and Maxillofacial Pathology. Philadelphia, PA, Saunders, 1995, pp 347-349 7. Woodson GE, Robbins KT, Michaels L: Inverted papillomas, considerations in treatment. Arch Otolaryngol 111:806, 1985 8. Ulrich HP, Mohr C, Schettler D, et al: Inverted papilloma: Implications for the oral and maxillofacial surgeon. Dtsch Z Mund Kiefer Gesichtschir 14:165, 1990 9. Weissler MC, Montgomery WW, Turner PA, et al: Inverted papilloma. Ann Otol Rhinol Laryngol 95:215, 1986 10. Augulo JC, Lopez JI, Toledo JD, et al: Inverted papillary carcinoma. Arch Esp Urol 46:695, 1993 11. Takagi M, Ishikawa G: Benign papillary squamous tumors of the mouth. Bull Tokyo Med Dent Univ 29:17, 1982 12. Boesen PV, Laszewski MJ, Robinson RA, et al: Squamous cell carcinoma in an inverted papilloma of the buccal mucosa. Ann Otol Rhinol Laryngol 100:748, 1991 13. Lesperance MM, Esclamado RM: Squamous cell carcinoma arising in inverted papilloma. Laryngoscope 105:178, 1995 14. Lawson W, Ho B, Shaari C, et al: Inverted papilloma: A report of 112 cases. Laryngoscope 105:282, 1995 15. Hegarty DJ, Hopper C, Speight PM: Inverted ductal papilloma of minor salivary glands. J Oral Pathol Med 23:334, 1994 16. Brannin RB, Sciubba JJ, Giulani M: Ductal papillomas of salivary gland origin, a report of 19 cases. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 92:68, 2001 17. White DK, Miller AS, McDaniel RK, et al: Inverted ductal papilloma. Cancer 49:519, 1982 18. Ellis GL, AuClair PL: Tumors of the Salivary Glands—Ductal Papillomas. Philadelphia, PA, Saunders, 1991, p 238 19. Clark DB, Priddy RW, Swanson AE: Oral inverted ductal papilloma. Oral Surg Oral Med Oral Pathol 69:487, 1990 20. Wilson DF, Robinson BW: Oral inverted ductal papilloma. Oral Surg Oral Med Oral Pathol 57:520, 1984

胆道系の断端神経腫は,胆管周囲のSchwann細胞を含む神経線維が過剰再生し,神経線維に覆われた結節を形成したものである.手術操作などによる胆管周囲の神経線維の損傷を誘因として発生してくることが多い.今回われわれは,胆管胆管吻合術を施行後,総胆管完全閉塞をきたし,病理組織検査で断端神経腫と診断された1例を経験した.症例は70歳,女性.全身倦怠感,黄疸を主訴として当科を受診し,急性膵炎,胆嚢炎の診断にて入院した.炎症の改善を待って腹腔鏡下胆嚢摘出術を施行したか,総胆管を損傷し,総胆管の端々吻合術を施行した.術後7カ月目に閉塞性黄疸にて再入院となり,画像診断にて総胆管の完全閉塞を認め, CT検査にて腫瘤状陰影が認められたため,悪性疾患も否定できず再手術を施行した.術後の病理組織学的検査にて胆管の断端神経腫と診断された.

Traumatic neuroma is a reactive tumor of the peripheral neural tissue produced after an injury. This entity appears in the oral cavity usually after a trauma or surgical procedures such as tooth extraction. We report a case of traumatic neuroma in the palate of a 71-year-old man and review the most important clinicopathological features of this tumor.

We describe a 40-year-old man who was found to have a cystic mass in the pancreatic tail during workup for weight loss and abdominal discomfort. Although computed tomography scan showed a single cyst associated with dilatation of the main pancreatic duct, gross and histologic examination of the distal pancreatectomy specimen actually revealed a central cyst that was surrounded by multiple smaller cystic spaces. This distinctive appearance was formed from extensive cystic dilatation and squamous metaplasia of the native pancreatic duct system. Further, a traumatic neuroma was discovered near the junction between normal and abnormal parenchyma. We believe that this case represents a variant of the newly-described squamoid cyst of pancreatic ducts which we term squamoid cystosis of pancreatic ducts. The presence of chronic pancreatitis and a traumatic neuroma supports the hypothesis that squamoid cysts are non-neoplastic lesions arising from prior duct obstruction.

Traumatic neuroma is a well-known disorder involving peripheral nerves, which occurs following trauma or surgery. The lesion develops most commonly in the soft tissues of the mental foramen area, lower lip and tongue. Intra-osseous lesions arising in jawbones are very uncommon. In this paper, we report a new case of an intra-osseous traumatic neuroma, discovered incidentally on a panoramic radiograph obtained for orthodontic documentation. In addition, the case herein described developed spontaneous remission, a situation not previously reported in the literature. Finally, we discuss relevant demographic, clinical, microscopic, immunohistochemical and treatment aspects of traumatic neuromas. Key words:Amputation neuroma, traumatic neuroma, mandible, spontaneous remission.

Traumatic neuromas are tumors produced by a reactive process to regenerate injured nerves that result in a disordered proliferation of nerve bundles. These tumors are usually related to previous surgery or trauma. We describe a case of traumatic neuroma on the penis of a 24-year-old man; the tumor was initially suspected to be a condyloma. A shave biopsy was both diagnostic and curative.

Nerve growth factor (NGF) is thought to play a role in the pathogenesis of neuroma formation as well as in the development of neuropathic pain. In this study we attempted to antagonize NGF by using trkA-IgG, an inhibitor of NGF, consisting of the NGF receptor linked to an immunoglobulin. It was delivered by an implanted osmotic pump directly to the site of a sciatic nerve transection in 16 rats for 30 days. The animals were monitored daily for the first 2 weeks for evidence of auto-cannibalization (autotomy) of the denervated foot (a sign of neuropathic pain). Four (25%) of the 16 rats receiving trkA-IgG exhibited such cannibalization compared with 9 of 15 control rats (60%) that underwent an identical procedure but were not treated with the trkA-IgG solution. One month after surgery the sciatic nerves and representative dorsal root ganglia (DRG) from these rats were evaluated histologically. Six of the 16 experimental rats (38%) demonstrated histological evidence of neuroma formation compared with 12 of the 15 controls (80%). There were no histological differences between the DRG from the two groups. These results support the notion that inhibiting NGF following peripheral nerve injury in the rat can reduce neuroma formation and neuropathic pain without damaging the cell bodies of the transected neurons.

We report the MRI findings of six unusual lesions of the internal auditory canal: three haemangiomas, one lipoma, one metastasis and one traumatic neuroma. We compare the findings to those of 20 intracanalicular schwannomas. We noted the site and size of the tumour, its signal intensity, borders and the homogeneity of enhancement were studied on T1-weighted images before and after intravenous contrast medium and T2-weighted images. Most schwannomas were homogeneous lesions, isointense on T1- and T2-weighted images, and strongly enhancing. Spontaneous high signal on T1-weighted images, heterogeneous contrast enhancement and extranodular enhancement were helpful for recognising lesions other then schwannomas; site, size and signal on T2-weighted images were not. All the haemangiomas had a specific pattern of contrast enhancement, with an anterior core intensely enhancing portion and a posterior portion which enhanced moderately or not at all.

Summary This paper describes the history, examination and clinical findings in a riding horse with a gait abnormality. The lesion was localised to the carpal area of one of the forelimbs, but could not be properly characterised until post mortem examination, when a diagnosis of a traumatic neuroma of the medial palmar nerve could be reached. Thus, the most plausible explanation for the gait abnormality of the horse was found in the peripheral nervous system.

Objective To describe a case of facial, vestibular, and cochlear nerve avulsion secondary to blunt trauma without an associated temporal bone fracture. Study design Clinical capsule report. Setting University hospital. Patient A 3.5-year-old girl presented with immediate facial nerve paralysis and complete deafness after being struck by an automobile. High-resolution computed tomography demonstrated a depressed occipital bone fracture with no visible fracture of the temporal bone. Magnetic resonance imaging sequence raised the question of VIIth nerve bundle discontinuity at the distal end of the internal auditory canal. Intervention The patient underwent a posterior fossa craniotomy via a translabyrinthine approach 9 months after the initial injury, and facial and auditory nerve avulsion at the fundus was confirmed at the time of surgery. The proximal segment of the facial nerve had formed a traumatic neuroma, which was resected, and primarily anastomosed to the rerouted distal segment. Main outcome measures Facial nerve function. Results Patient has regained facial function to Grade III/VI House-Brackmann with no asymmetry at rest. Conclusion An unusual pattern of injury is described. We suggest that in patients presenting with facial nerve paralysis secondary to blunt trauma, without an associated temporal bone fracture, high-resolution magnetic resonance imaging is recommended to evaluate internal auditory canal discontinuity of the VIIth and VIIIth nerve complexes. A potential mechanism of avulsion is explained.

Objective To describe 2 patients with traumatic neuromas of the intratemporal facial nerve in the absence of trauma. Study design Retrospective case review. Setting Tertiary care referral center. Patients Patients included underwent resection of an intratemporal facial nerve mass. Upon pathologic evaluation, the patients were found to have traumatic neuromas of the facial nerve. Intervention(s) Patients underwent resection of an intratemporal facial traumatic neuroma. Histopathologic evaluation was performed including an immunohistochemistry evaluation. Results Two patients were identified with intratemporal facial nerve traumatic neuromas. The patients had no significant history of trauma or chronic inflammatory process. Pathologic evaluations, including immunohistochemistry, of the excised masses were consistent with traumatic neuromas. All tumors were noted to have a disorganized collection of axons and were not consistent with the expected diagnosis of schwannoma. Tumors involved the tympanic and vertical segments of the facial nerve. A cavernous angioma was found within one mass and is thought to be the etiology of neuroma formation. Conclusion Traumatic neuromas are possible in the intratemporal facial nerve in the absence of trauma. A cavernous angioma of the facial nerve is a newly described possible cause of traumatic neuroma formation.

Traumatic neuromas are relatively rare entities that characteristically arise following surgery or trauma. In this report, a case of a traumatic neuroma of the mental nerve following chin augmentation is described. Magnetic resonance imaging showed a well-defined oval mass. Part of the lesion was removed and histopathological examination confirmed the lesion to be a traumatic neuroma.

Traumatic neuromas are characterized by the presence of pain, burning, or paresthesia, associated with a history of trauma, normally surgery, in the same site. In the oral cavity, the most commonly affected sites are the lip, tongue, and mental nerve area. Pressure on the suspected area usually provokes pain. They microscopically consist of a proliferation of nerve fascicles embedded in a background of collagen. We present a case of a 42-year-old Latin American female patient complaining of a painful solitary nodule erupting on the lingual surface of the mandibular body. Histopathological analysis showed a traumatic neuroma associated with mature ganglion cells, which is an extremely unusual finding. After complete removal of the lesion the symptoms disappeared. To the best of our knowledge, this is the first case of a unique lesion with unusual clinical and histopathological features reported in the English language literature.

Numerous neurogenic tumors can affect the musculoskeletal system, including traumatic neuroma, Morton neuroma, neural fibrolipoma, nerve sheath ganglion, neurilemoma, neurofibroma, and malignant peripheral nerve sheath tumors (PNSTs). The diagnosis of neurogenic tumors can be suggested from their imaging appearances, including lesion shape and intrinsic imaging characteristics. It is also important to establish lesion location along a typical nerve distribution (eg, plantar digital nerve in Morton neuroma, median nerve in neural fibrolipoma, large nerve trunk in benign and malignant PNSTs). Traumatic and Morton neuromas are commonly related to an amputation stump or are located in the intermetatarsal space, respectively. Neural fibrolipomas show fat interspersed between nerve fascicles and are often associated with macrodactyly. Nerve sheath ganglion has a cystic appearance and commonly occurs about the knee. Radiologic characteristics of neurilemoma, neurofibroma, and malignant PNST at computed tomography (CT), ultrasonography, and magnetic resonance imaging include fusiform shape, identification of entering and exiting nerve, low attenuation at CT, target sign, fascicular sign, split-fat sign, and associated muscle atrophy. Although differentiation of neurilemoma from neurofibroma and of benign from malignant PNST is problematic, recognition of the radiologic appearances of neurogenic tumors often allows prospective diagnosis and improves clinical management of patients.

Objective. The purpose of this investigation was to confirm the presence of subepithelial nerve plexuses associated with taste buds in the human tongue and to study the histomorphologic features of each plexus. Study Design. Through use of a light microscope, several hundred microslides representing biopsies of the human tongue were reviewed so that the histomorphologic character of subepithelial nerve plexuses could be detected and studied. Tissue sections were stained with hematoxylin-erythrosin, Bodian, and Masson’s trichrome, as well as with immunohistochemical stains for neuron-specific enolase and S-100 protein. Results. Twelve examples of the subepithelial nerve plexus, many with mature ganglion cells, were selected for microscopic evaluation. The plexuses were quite small, ranging from 1 to 3 millimeters in diameter. With one exception, each plexus was an incidental finding in a biopsy of a definitive soft tissue lesion, such as fibroma, papilloma, granular cell tumor, lymphoepithelial cyst, lingual tonsil, or foliate papilla. Ganglion cells, 1 to 5 in number and confirmed by neuron-specific enolase and S-100 protein, were observed in 9 of the cases. Conclusions. The subepithelial (subgemmal) nerve plexus is a tortuous neural proliferation associated with the taste buds of the human tongue, with ganglion cells and intergemmal/intragemmal branches. When hyperplastic, it should be recognized as such and not diagnosed as a neoplastic process—eg, a ganglioneuroma, neurofibroma, syndrome-associated neuroma, or traumatic neuroma. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1999;87:605-9)

Objective To show that traumatic neuroma of the tympanic (Jacobson's) nerve may be a cause of recurrent intractable otalgia in patients following radical mastoidectomies. Study Design Histologic evaluation of four temporal bones from three patients with a history of recurrent otalgia following radical mastoidectomy. Subjects and Methods The medical records of three patients with multiple middle ear surgeries in four ears because of recurrent otalgia were reviewed. Histopathologic studies of the four temporal bones were performed. Results All four of the temporal bones that underwent multiple surgeries were found to have traumatic neuromas of the tympanic (Jacobson's) nerve. Conclusion Recurrent otalgia in patients after radical middle ear surgery may be caused by a traumatic neuroma of the tympanic (Jacobson's) nerve.

An interesting case of a traumatic neuroma of the greater auricular nerve provides the impetus for a discussion of head and neck neuromas. Traumatic neuromas of the head and neck are relatively rare. Division of the greater auricular nerve during parotidectomy occasionally results in a traumatic neuroma. We report a case of a 73-year-old woman who presented with a traumatic neuroma nine years after undergoing superficial parotidectomy with dissection of the facial nerve for a mixed tumor. The patient had a 1.5 cm x 1.0 cm mass located below the old surgical site over the anteromedial border of the sternocleidomastoid muscle. The patient's past history was significant for Frey's syndrome, which is the result of abnormal neurologic growth. On first impression, the tumor was thought to be a recurrence of neoplastic disease; however, because of the evaluation, traumatic neuroma was suspected. An attempt at fine-needle aspiration of the mass was too painful to be carried out. At surgery, a whitish tumor was excised which, on final pathologic examination, revealed traumatic neuroma. The surgical literature is reviewed and the subject of head and neck neuromas, including their evaluation and management, is thoroughly discussed. Knowledge of this possible diagnosis may spare the patient and the surgeon needless worry, as well as unnecessary procedures, once tumor recurrence has been ruled out.

Background Traumatic vaginal neuromas are a rarely documented finding in the setting of vaginal pain after posterior colporrhaphy. They arise as a result of trauma or surgery and are often mistaken for scar tissue. Case After a total vaginal hysterectomy and posterior colporrhaphy, a 32-year-old woman presented with debilitating vaginal pain, presumed to be secondary to scar tissue formation. Excision of the tissue from the rectovaginal septum revealed a traumatic neuroma. After the removal of the neuroma, the patient's vaginal pain resolved. Conclusion Traumatic neuromas may be a cause of significant point tenderness and thickened tissue after vaginal surgery or repair of obstetric lacerations. If conservative treatment methods have failed, surgical excision of the neuroma can be considered.

We report our first case of symptomatic traumatic neuroma in the liver hilum after orthotopic liver transplantation. Compression of the hepatic artery caused extraluminal obstruction and resulted in perfusion damage to the graft. Moreover, intimal hyperplasia of the hepatic artery was present. Retransplantation was necessary because the hepatic artery was not salvageable. Potential pathophysiological mechanisms for these findings are discussed.

specimen. The patient received psychologic counseling and support in adjusting to the results of the mastectomy. To date, she has not elected to pursue reconstruction, but requested that her unique experience be shared and change policy. False-positive core needle biopsies (CNB) are rarely reported in the literature. False positives in most cases are in screening patients (

Selected abstracts delivered at the 8th Annual AOSpine North America Fellows Forum Consistent with EBSJ's commitment to fostering quality research, we are pleased to feature some of the most highly rated abstracts from the 8th Annual AOSpine North America Fellows Forum in Banff Canada. Enhancing the quality of evidence in spine care means acknowledging and supporting the efforts of young researchers within our AOSpine North America network. We look forward to seeing more from these promising researchers in the future. Abstract Study type: Basic science research report Introduction: Spinal nerve-injury management and prevention constitute a substantial proportion of a spinal surgeon's practice. Functional recovery after peripheral nerve injuries is often unsatisfactory and to optimize the outcomes, an intimate understanding of these injuries is required. Sunderland classified peripheral nerve injuries into five grades.1 Grade 1 (neurapraxia) and grade 2 (axonal disruption) injuries usually recover with no or insignificant functional deficits within weeks to a few months, respectively. Injuries that are most difficult to manage clinically are the often mixed grade 3 (endoneurial disruption) and grade 4 (perineurial disruption) lesions where spontaneous functional recovery is limited or absent, resulting in neuroma in continuity (NIC). Traumatic NIC is characterized by aberrant intra- and extra- fascicular axonal regeneration and scar formation within an unsevered injured nerve, resulting in impaired and erroneous end-organ reinnervation.2,3 Animal models reproducing grade 1, 2, 3, and 5 lesions have been developed, but to our knowledge a clinically relevant rodent model of NIC has not been developed.4,5,6,7,8 The effective peripheral nerve regeneration and resilience of rodents make it challenging to recreate the NIC scenario. Objective: Our goal was to develop a practical rodent model for focal traumatic NIC, demonstrating the characteristic histological features, supported by concordant functional deficits. Such a model may help us to identify this injury pattern earlier and allow development of intervention strategies to reduce neuronal misdirection, scar formation, and enhance regeneration for improved functional recovery. Methods: Various injury techniques were tested on freshly harvested Lewis rat sciatic nerves ex vivo, and examined histologically before inflicting more refined injuries in vivo. The optimal experimental injuries combined a 50 g traction force applied with a spring scale hooked around the sciatic nerve, and focal three second maximal compression using a malleus nipper (Figure 1). Nerves were harvested at 0, 5, 13, 21, and 65 days, and processed for longitudinal 8 micron cryostat sectioning, H&E, laminin, neurofilament, and Masson's trichrome staining. Skilled locomotion (tapered beam, ladder rung) and flat plane locomotion for ground reaction force (GRF) analysis were performed serially up to 9 weeks with the experimental (n = 4) and simple (control) crush (n = 1) injuries by blinded animal behavior experts, using methods as recently described.9 Figure 1 Photograph illustrating the experimental injury. Fifty grams of traction is applied in a direction orthogonal to the native nerve course after external neurolysis, simultaneously, three second maximal compression is applied at the sciatic trifurcation, just distal to a mesoneurial suture. Malleus nipper with tip detail and 100 g spring scale in bottom left. In situ sciatic nerve immediately after injury (top right). Results: Disruption of the endoneurium and perineurium with aberrant intra- and extrafascicular axonal regeneration and progressive fibrosis was consistently demonstrated histologically in ten out of ten nerves with experimental injuries. In contrast, crush injuries showed only signs of Wallerian degeneration (Figure 2). At 8 weeks, experimental animals made more errors during skilled locomotion as compared to nerve crush animals. GRFs revealed impaired vertical and fore-aft force generation by the injured limbs at week 9 in the experimental group, whereas GRFs from the simple crush animal revealed recovery at the same time point (Figure 3). Figure 2 Injury zones at five days (a–d, bar = 200 µm) and 65 days (e–h, bar = 50 µm), comparing crush (top) to experimental (bottom) injuries; Masson's trichrome and neurofilament. Note the aberrant axonal sprouting and regeneration in the experimental injury group, associated with increased intrafascicular collagen, in contrast to orderly regeneration and lack of scar in the simple crush group. Figure 3 Mean vertical and fore-aft ground reaction forces at both baseline and 9 weeks from representative animals. Compared to baseline and crush-injured animal at 9 weeks, animals in the experimental group bear less weight on both their right (surgical) hind limb (solid line), and fore limb (dotted line) at 9 weeks. Comparable with historical data, the crush animal have improved braking (*) and propulsive (#) forces in fore and hind limbs (injured side) compared to the experimental group, though these have not returned to baseline values. Conclusions: We have demonstrated histological features and poor functional recovery consistent with NIC formation in a rodent model. The injury mechanism employed combines traction and compression forces akin to the physical forces at play in clinical nerve injuries. Additional validating experiments are in progress.

Fine-needle aspiration cytology (FNA) is useful because of its low cost, quick turn around time, and low incidence of complications. This study investigates the role FNA plays in the evaluation of sarcoma. We reviewed all the pathologic material from patients with sarcoma or a FNA diagnosis suggestive of sarcoma at the University of California-Davis Medical Center (1985-1994). Fifty-two of 196 patients identified (26.5%) were evaluated with FNA exhibiting 46 soft tissue and 6 bone lesions located in the extremities (19), trunk (19), head and neck (8), retroperitoneum (3), and abdominal cavity (3). Among 196 patients identified, those evaluated by FNA had soft tissue rather than bone lesions (P < .001) and primary sites other than in the extremities (P < .001). The primary neoplasms for the 52 FNA patients included 47 sarcomas (10 malignant fibrous histiocytomas and 16 other types), 1 intramuscular myxoma, 2 lymphomas, and 2 spindle cell (sarcomatoid) carcinomas. In 43 patients (22% of total), FNA was used first, before a primary diagnosis. The FNA report showed the correct specific neoplasm in only 20.9%. However, the FNA reports reflected an effective positive diagnosis leading to appropriate diagnostic biopsy in 88.4%, while only 7.0% were misleading (benign or inflammatory) and 4.6% inadequate. Review of FNA slides for 32 of 43 patients in which FNA was used first, in a blinded fashion, exhibited 21.9% specificity for the specific neoplasm, and 88.4% effective positive diagnoses. In 9 patients, FNA was utilized to investigate recurrence. Five out of 5 instances of recurrent sarcoma were identified by FNA. However, FNA misidentified recurrence in 3/4 instances, exhibiting suspicious cells from regenerating skeletal muscle (2) and a traumatic neuroma (1). The specific diagnosis for sarcomas is challenging even with surgical material. FNA usually does not provide a specific diagnosis (only in 20.9% of cases) and review of routinely prepared slides showed the same specificity as reflected by the original FNA report, at times formulated with the benefit of immunohistochemistry or electron microscopy. FNA effectively evaluated lesions in 45 of 52 patients (86.5%), confirming the useful screening role for this technique in sarcomas.

Three cases of solitary circumscribed neuroma (so-called palisaded, encapsulated neuroma) arising in the dermis have been studied. Two patients were male and one was female, with ages ranging from 27 to 59 years. All lesions arose on the forehead. Histologically, the neoplasms were partly encapsulated and were composed of broad fascicles, nests, and whorl-like structures of bland appearing spindle cells often separated by artefactual clefts. Immunohistochemically, most of the tumour cells stained positive for S-100 protein, and a considerable number also for CD 34, but failed to stain for epithelial membrane antigen and melanoma associated antigens. Solitary circumscribed neuroma has to be distinguished from long-standing dermal melanocytic nevus, mucosal neuromas seen in type IIb multiple endocrine neoplasia (MEN) syndrome, classical and cellular schwannoma, neurofibroma, perineurioma, traumatic neuroma, and angioleiomyoma.

Background and Objective The purpose of this study was to determine whether the milliwatt laser can suppress neuroma formation at the end of a divided nerve. Study Design/Materials and Methods The peripheral nerves of eight rats were transected with microscissors and the cross-sectional area of their proximal ends was irradiated using the CO2 milliwatt laser. The power ranges used were similar to those applied to weld neural tissue. Results None of the eight irradiated nerve ends formed a neuromatous bulb and only one of them regenerated into the surrounding tissues. Histologically, these nerve ends did not show the disorganized picture of classic neuromas. On morphometric measurements, they contained less connective tissue than the control nerve ends (P < 0.001) and their nerve fibers were larger in diameter (P < 0.001) and better myelinated (P < 0.001). Conclusion These findings in rats show that the CO2 milliwatt laser has the ability to suppress neuroma formation at the end of a divided nerve. © 1996 Wiley-Liss, Inc.