Dermatologic Manifestations of Neurilemmoma Follow-up

  • Author: Grace F Kao, MD; Chief Editor: Dirk M Elston, MD   more...
 
Updated: Jan 12, 2012
 

Further Outpatient Care

  • Higher recurrence rates are noted with the intraspinal, sacral, intracranial, and plexiform variants of neurilemmoma.
  • Periodic follow-up care following complete removal, with maximum preservation of the parent nerves in these variants, is recommended.
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Deterrence/Prevention

  • Complete removal of the tumors with maximum preservation of parent nerves can prevent local recurrence.
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Prognosis

  • Although neurilemmomas are benign, incomplete excision may be associated with slow recurrence, and higher recurrence rates are noted with the intraspinal, sacral, intracranial, and plexiform variants. Locally aggressive behavior is observed in tumors with increased cellularity, higher mitotic rates (mean, 4 per 10 high-power fields), and underlying bone extension (observed in occasional cases of orbital neurilemmomas).
  • Melanocytic schwannomas of the cervical, thoracic, and lumbar spine reported by Peltier et al[14] demonstrated a guarded prognosis. Two of the 3 cases studied showed unfavorable outcomes, with local recurrence and leptomeningeal metastasis, especially in young patients.
  • Large tumors, such as the so-called giant sacral neurilemmoma (schwannoma), are prone to local recurrence. A recent clinicopathologic study found that patients with asymptomatic schwannomas occurring in association with NF2 not only had more severe neurologic deficits but also experienced little postoperative improvement and a higher rate of tumor recurrence. Malignant change in neurilemmomas is exceedingly rare.
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Contributor Information and Disclosures
Author

Grace F Kao, MD  Clinical Professor of Dermatopathology, Department of Dermatology, University of Maryland School of Medicine and George Washington University Medical School; Director, Dermatopathology Section, Department of Pathology and Laboratory Medicine, Veterans Affairs Maryland Healthcare System, Baltimore, Maryland

Grace F Kao, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and International Society of Dermatopathology

Disclosure: Nothing to disclose.

Specialty Editor Board

Günter Burg, MD  Professor and Chairman Emeritus, Department of Dermatology, University of Zürich School of Medicine; Delegate of The Foundation for Modern Teaching and Learning in Medicine Faculty of Medicine, University of Zürich, Switzerland

Günter Burg, MD is a member of the following medical societies: American Academy of Dermatology, American Dermatological Association, International Society for Dermatologic Surgery, North American Clinical Dermatologic Society, and Pacific Dermatologic Association

Disclosure: Nothing to disclose.

Michael J Wells, MD  Associate Professor, Department of Dermatology, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine

Michael J Wells, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, and Texas Medical Association

Disclosure: Nothing to disclose.

Lester F Libow, MD  Dermatopathologist, South Texas Dermatopathology Laboratory

Lester F Libow, MD is a member of the following medical societies: American Academy of Dermatology, American Society of Dermatopathology, and Texas Medical Association

Disclosure: Nothing to disclose.

Joel M Gelfand, MD, MSCE  Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania

Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology

Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds Investigator; Genentech Grant/research funds investigator; Centocor Consulting fee Consulting; Abbott Grant/research funds investigator; Abbott Consulting fee Consulting; Novartis investigator; Pfizer Grant/research funds investigator; Celgene Consulting fee DMC Chair; NIAMS and NHLBI Grant/research funds investigator

Chief Editor

Dirk M Elston, MD  Director, Ackerman Academy of Dermatopathology, New York

Dirk M Elston, MD is a member of the following medical societies: American Academy of Dermatology

Disclosure: Nothing to disclose.

References

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A schematic illustration of the essential microscopic features of a neurilemoma (schwannoma). A solid lesion arises within a nerve composed of a single fascicle (top). The tumor is composed of Schwann cell proliferation within the epineurium and peripherally displaced nerve fibers, resulting in nodular eccentric growth (middle). No capsule is formed in the early growth phase. The larger tumor (bottom) slightly increases the size of the parent nerve and eventually becomes separated from surrounding fascicles by a capsule formed from the perineurium and epineurium. Occasional axons are present.
A small, clinically freely movable neurilemoma found in the subcutaneous tissue. Note the pale-yellow, somewhat-translucent cut surface. The tumor also exhibits a slight nodular growth pattern on the cut surface. Courtesy of the Atlas of Tumor Pathology Armed Forces Institute of Pathology Fascicles, Tumors of the Peripheral Nervous System. Used with permission.
A larger neurilemoma (5 cm in diameter) arising from a peripheral nerve showing irregularly lobulated and secondary degenerative changes, ie, partly cystic with calcification (the so-called ancient change). Hemorrhage and opaque creamy-yellow areas of tumor are also seen on this cut surface.
Cut surface of an intradermal plexiform (nodular) variety of neurilemoma. The plexiform variants of neurilemoma are rare. The area of nodularity is clearly discernible. Courtesy of the Atlas of Tumor Pathology Armed Forces Institute of Pathology Fascicles, Tumors of the Peripheral Nervous System. Used with permission
A low-power photomicrograph of a dermal plexiform neurilemoma showing nodular aggregates of tumor cells and surrounding loose, myxomatous fibrous stroma. Hematoxylin and eosin stain at 50X magnification.
Photomicrograph of a neurilemoma from an area with a typical Antoni type A pattern. The palisaded benign Schwann cells show nuclear crowding, with cell processes radiating toward the centers of aggregated tumor cells. Inconspicuous loose fibrous stroma is present at the periphery. Hematoxylin and eosin stain at 150X magnification.
A photomicrograph showing a characteristic Verocay body of a neurilemoma, consisting of tight, discrete aggregates of spindle-shaped, palisaded nuclei with a central fibrillary area, representing collections of cytoplasmic processes of tumorous Schwann cells. Courtesy of the Atlas of Tumor Pathology Armed Forces Institute of Pathology Fascicles, Tumors of the Peripheral Nervous System. Used with permission.
Transmission electron micrograph of Antoni type A tumor tissue consisting of prominent arrays of Schwann cell processes with basement membrane substance coated on their surfaces. Note the centrally located nucleus with vesicular nuclear chromatin. Uranium acetate and lead citrate stain at 15,000X magnification.
A transmission electron micrograph of a Luse body, ie, typical collagen fibrils and adjacent basement substance. Note the long-spaced, 130-nm periodicity. Uranium acetate and lead citrate stain at 52,500X magnification. Courtesy of the Atlas of Tumor Pathology Armed Forces Institute of Pathology Fascicles, Tumors of the Peripheral Nervous System. Used with permission.
A photomicrograph of a dermal neurilemoma with anti–S-100 protein immunostaining. The tumorous Schwann cells exhibit uniformly positive staining. Immunoperoxidase stain at 150X magnification.
Solitary cutaneous plexiform neurilemoma shown on photomicrograph.
 
 
 
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