Neurilemmoma Workup

  • Author: Ian D Dickey, MD, FRCSC; Chief Editor: Harris Gellman, MD   more...
 
Updated: Jan 21, 2010
 

Laboratory Studies

  • Laboratory studies generally are not beneficial.
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Imaging Studies

  • Plain radiograph findings generally are not specific. The rare intraosseous lesion presents as a benign-appearing, well-circumscribed lesion. Differential diagnoses for these lesions include giant cell tumors, chordomas (when involving the spine), and chondroblastomas. Massive bony destruction may be present, especially when the lesion involves the sacrum.
  • Special studies to consider are those employing computed tomography (CT) scanning or magnetic resonance imaging (MRI). MRI is particularly useful; it shows a usually round or oval mass with a moderately bright signal on T1-weighted images and a bright, heterogeneous signal on T2-weighted images.[8] The mass is usually less than 2.5 cm in size. The lesion enhances uniformly with gadolinium contrast.
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Diagnostic Procedures

  • Biopsy may be needed to clearly define the tissue type. For bone lesions and for particularly large soft-tissue lesions, biopsy is prudent to ensure correct diagnosis and management. Whenever a biopsy is considered, the strict biopsy guideline principles must be followed.
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Histologic Findings

Lesions of the spinal cord often have a dumbbell shape; otherwise, they are fusiform in shape. They have an epineurium encapsulation, frequently with overlying vessels. The cut surface is pink or white. In very large masses, degenerative cysts, hemorrhage, or dystrophic calcification may be present.

Neurilemmomas have a well-defined, fibrous capsule. Histologically, there are 2 distinct regions, known as Antoni A and B.

Antoni A areas are cellular regions with predominantly benign spindle cells in many intersecting bundles. They may palisade around eosinophilic regions that are called Verocay bodies. Antoni A cells are positive for S100 staining.

Antoni B areas are much less cellular and have a background of loose connective tissue that is myxomatous in appearance.

Occasionally, a more aggressive histologic appearance may predominate, but these forms usually lack mitotic figures.

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Staging

Neurilemmomas are commonly graded using the Enneking system—consisting of grades 1, 2, and 3—for benign lesions. Grade 1 lesions are inactive, grade 2 lesions deform the surrounding tissues but are not destructive or locally aggressive, and grade 3 lesions are locally aggressive and may invade local tissues but do not have a metastatic potential. Generally, neurilemmomas are grade 2 or 3.

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Contributor Information and Disclosures
Author

Ian D Dickey, MD, FRCSC  Adjunct Professor, Department of Chemical and Biological Engineering, University of Maine; Consulting Staff, Adult Reconstruction, Orthopedic Oncology, Department of Orthopedics, Eastern Maine Medical Center

Ian D Dickey, MD, FRCSC is a member of the following medical societies: American Academy of Orthopaedic Surgeons, British Columbia Medical Association, Canadian Medical Association, and Royal College of Physicians and Surgeons of Canada

Disclosure: Stryker Orthopaedics Consulting fee Consulting; Cadence Honoraria Speaking and teaching

Coauthor(s)

James Floyd, MD  Consulting Staff, Section of Orthopedic Surgery, Manatee Memorial Hospital

James Floyd, MD is a member of the following medical societies: Florida Medical Association, Florida Orthopaedic Society, and National Medical Association

Disclosure: Nothing to disclose.

Specialty Editor Board

Howard A Chansky, MD  Associate Professor, Department of Orthopedics and Sports Medicine, University of Washington Medical Center

Howard A Chansky, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD  Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

Sean P Scully, MD, PhD  Professor, Department of Orthopedics, University of Miami

Sean P Scully, MD, PhD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, International Society on Thrombosis and Haemostasis, and Society of Surgical Oncology

Disclosure: Nothing to disclose.

Dinesh Patel, MD, FACS  Associate Clinical Professor of Orthopedic Surgery, Harvard Medical School; Chief of Arthroscopic Surgery, Department of Orthopedic Surgery, Massachusetts General Hospital

Dinesh Patel, MD, FACS is a member of the following medical societies: American Academy of Orthopaedic Surgeons

Disclosure: Nothing to disclose.

Chief Editor

Harris Gellman, MD  Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami, Leonard M Miller School of Medicine

Harris Gellman, MD is a member of the following medical societies: American Academy of Medical Acupuncture, American Academy of Orthopaedic Surgeons, American Orthopaedic Association, American Society for Surgery of the Hand, and Arkansas Medical Society

Disclosure: Nothing to disclose.

References

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The cell of origin for a neurilemmoma is the Schwann cell, which is derived from the neural crest. These cells line the peripheral nerve processes.
Neurilemmomas have very distinctive appearances on magnetic resonance images. Many investigators believe that the presence of a target sign on a peripheral nerve is diagnostic for a neurilemmoma.
Pathology specimen.
 
 
 
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