جستجوی مقالات مرتبط با کلیدواژه "neuroma" در نشریات گروه "پزشکی"

Median nerve injury has an incidence of approximately 2.8% among trauma patients. Electromyographic tests cannot provide clear information regarding the type of injury, imaging of the severed nerve, presence or absence of neuroma, or assessment of scar tissue formation around the lesion, which are essential for surgical intervention planning. Ultrasound is a reliable, inexpensive, useful, and quickly accessible diagnostic method at the patient's bedside.

In this descriptive-analytical study, patients with symptoms of acute median nerve injury and tear due to penetrating trauma, admitted to an orthopedic teaching department over one year, were included. Patients with congenital neurological disorders, diabetes, other systemic diseases, previous wrist nerve surgeries, or cervical discopathies were excluded. Patients underwent clinical examination, electromyographic tests, and ultrasound follow-ups three months post nerve repair.

Over one year, 21 patients, including 12 men and 9 women aged between 20 to 55, with median nerve repairs were retrospectively included in the study. The average thickness of the repaired nerve at the proximal site was 2.58 ± 0.51 mm and 2.51 ± 0.61 mm at the distal site. The average thickness of the repaired nerve at the proximal injury site was significantly higher in males. Clinically, 12 cases (57.1%) showed complete recovery, and 9 cases (42.9%) showed partial recovery three months post-surgery. Ultrasound analysis indicated that the volume of neuroma formed at the repair site was less in patients with complete recovery compared to those with partial recovery. The neuroma volume at the repair site was lower in patients with electromyographic evidence of nerve regeneration compared to those with severe axonal injury, but no significant correlation was found. Additionally, patients with injuries at the carpal tunnel entry had complete recovery post-surgery, although no significant relationship was observed.

Ultrasound can be used as a low-cost, non-invasive method for assessing peripheral nerve injury treatment outcomes and follow-ups post-repair.

 Fibrous obliteration or appendiceal neuroma is a rare type of appendiceal tumor that causes appendiceal obstruction and then presents as appendicitis. This neural tumor has no specific presentation and, after appendectomy, is diagnosed by the pathologist accidentally. Fibrous obliteration is described as a proliferative lesion. The pathogenesis of this lesion is unknown, but it is mentioned that the etiology of this problem is secondary to recurrent inflammation processes. These processes cause neuroendocrine cell hyperplasia in the submucosa and lamina propria of the wall of the appendix. The repetitive occurrence of these sub-clinical inflammatory processes causes fibrosis.

Cases Report: 

We presented a 55-year-old woman who was referred to our clinic with persistent pain in the right lower quadrant for five days in this report. The pain mimicked appendicitis presentation, and it suddenly started from the periumbilical area and then shifted to the right lower quadrant of the abdomen. Her laboratory study showed a 9600/microliter white blood cell count with 70% neutrophils. An increase in the appendix loop with 9 millimeters diameter was reported in the ultrasound. There was also severe fat haziness around the tissues and visceral inflammation of the terminal ileum in the sonogram. She underwent an appendectomy after the diagnosis of appendicitis, and the pathologist diagnosed fibrous obliteration or appendiceal neuroma.

 It is concluded that fibrous obliteration or appendiceal neuroma mimics acute appendicitis, and in patients with this presentation, appendectomy is the best choice for treatment. The main diagnostic method is pathologic assessment, and it is important for the differentiation of this tumor from other malignant tumors of the appendix because fibrous obliteration is a benign tumor.

A 16-year- old girl with history of hypertension was referred to the surgery department due to multiple hypertrophied lesions in both lips and on the lateral sides of the tongue. The lesions have been appeared gradually within the last year and only issued as a cosmetic concern. Which one could not be considered as the differential diagnosis of the patient? neurofibroma neurilemoma Leukoplakia Neuroma Correct answer: This figure demonstrates enlarged lip and hypertrophied tongue lesions which can be seen in neurofibroma, traumatic neuroma, neurilemoma, granular cell tumor, and neuroma; the net diagnosis is made by microscopic examination of a tissue biopsy. Leucoplakia as it is understood by its name is a white plaque with wide range of differential diagnosis; trauma, lichen planus, systemic lupus erythematous (SLE), leukoedema, and malignancy. On retrograde history taking, the patient had a total thyroidectomy due to medullary thyroid carcinoma (MTC) two years ago and right adrenalectomy due to pheochromocytoma last year. What would be the most probable diagnosis? Neurofibromatosis type 1 MEN 2A syndrome MEN 2B syndrome MEN 1 syndrome Correct answer: The classic combination of the mucosal neuroma, MTC, and pheochromocytoma together define the multiple endocrine neoplasia type 2B (MEN 2B). Patients with MEN 2B syndrome also might have marfanoid features. In Neurofibromatosis type 1, neurofibromas, multiple café- au- lait spots, iris hamartomas, skeletal abnormalities, glioma, and cognitive disorders are expected. MEN 2A is identical with MEN 2B but instead of marfanoid features and neuromas, parathyroid hyperplasia is seen. MEN 1 syndrome is characterized by pituitary adenoma, parathyroid hyperplasia, and pancreatic tumor. Due to the high fatality of MTC, early detection of MEN 2B cases and prophylactic thyroidectomy is of great importance and clinical suspicion to MEN 2B by non- endocrinologic features is critical in patients [1]. Currently, growing evidence is affecting our mindset about the clinical picture of MEN 2B syndrome. While MEN 2B patients are classically considered to be tall with marfanoid features, current studies report pediatric patients with proportionate short stature. It is also highlightable that intestinal ganglioneuromatosis associated with MEN 2B, should be considered in the differential diagnosis of Hirschsprung’s disease in children with constipation during early infancy.

The rarity of oral soft tissue spindle cell tumors combined with overlapping microscopic patterns can make challenges in their diagnosis and treatment. Oral cavity palisaded encapsulated neuroma is an uncommon lesion which occurs often on the hard palate. It is essential for oral pathologists to be familiar with its histopathology of this lesion is essential since many lesions are probably diagnosed microscopically as neurofibroma or schwannoma. Here, we report a case of oral palisaded encapsulated (solitary circumscribed) neuroma in an unusual site.

Palisaded encapsulated (solitary circumscribed) neuromas (PENs) are relatively common intraoral neurogenic tumors, which occur most frequently on the hard palate. Herein, we describe the clinicopathological characteristics of a palisaded encapsulated neuroma of the tongue. This tumor was an exophytic sessile mass measuring 0.3× 0.4 cm with rubbery consistency on the anterior one-third of the dorsum of the tongue. The tumor was excised under the impression of a pyogenic granuloma (PG). No recurrence was reported at 12 months postoperatively. Histopathological examination showed a well-circumscribed mass that composed of interlacing fascicles of spindle cells. The cells were S-100 positive. The nuclei, showing parallel orientation within the fascicles, were wavy and pointed and showed no sign of mitotic activity. Giemsa staining revealed no mast cells within the stroma.

Peripheral nerve repair is often complicated by fibroblastic scar formation, nerve dysfunction, and traumatic neuroma formation. Use of silicone may improve outcomes of these repairs. In this study, we tried to evaluate effectiveness of silicone gel on rats’ sciatic nerve repair, axon regeneration and scar formation around and in the nervous tissues. This experimental study was performed on 18 rats. They underwent bilateral sciatic nerve dissection. Then, right and left damaged sciatic nerves were sutured. In left side, silicone gel was applied. Two months later, both sides were evaluated regarding to myelin fiber diameter (µm), total fascicular area (mm2), axon diameter (µm), myelin thickness (µm), G- ratio (axon diameter/myelin thickness), connective tissue area, ratio of connective tissue area/fascicular area, neuroma and foreign body formation in liver and lungs and spleen reaction. Results of right and left sides were compared. Silicone was significantly more effective in increasing myelin thickness in the side that silicone was applied) than the control side. It was not associated with inflammation, scar formation, granuloma, and neuroma formation. No foreign body reaction occurred in liver, spleen and lungs after silicone application; but axonal regeneration did not improve with after its use. According to our findings, it seems that silicone application in the cases with significant complications or in the cases that nerve graft is not possible would be an ideal option.