Malignant peripheral nerve sheath tumor arising in a traumatic neuroma: a case report

• Published in: Human pathology Vol. 44; no. 10; pp. 2360 - 2364
• Main Authors: Kos, Zuzana, MD, Robertson, Susan J., MD, FRCPC, Purgina, Bibianna M., MD, FRCPC, Verma, Shailendra, MD, FRCPC, FACP, Gravel, Denis H., MD, FRCPC
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-10-2013; Elsevier Limited
• Subjects: Aged; Breast cancer; Case report; Cellular biology; Epithelioid Cells - metabolism; Epithelioid Cells - pathology; Female; Humans; Lumbar Vertebrae; Malignant peripheral nerve sheath tumor; Medical imaging; Neoplasms, Second Primary; Nerve Sheath Neoplasms - etiology; Nerve Sheath Neoplasms - metabolism; Nerve Sheath Neoplasms - pathology; Neuroma - etiology; Neuroma - metabolism; Neuroma - pathology; Pathology; Patients; Rare Diseases; Soft Tissue Neoplasms - etiology; Soft Tissue Neoplasms - metabolism; Soft Tissue Neoplasms - pathology; Spinal Injuries - complications; Spinal Injuries - pathology; Surgery; Traumatic neuroma; Treatment Outcome; Tumors; Traumatic neuroma; Case report; Malignant peripheral nerve sheath tumor
• ISSN: 0046-8177; 1532-8392
• DOI: 10.1016/j.humpath.2013.02.020

Summary A 67-year-old woman with a history of breast cancer presented with a soft tissue mass at the site of a remote, non-neoplastic lumbar surgery. Excisional biopsy revealed a traumatic neuroma. Five years later she re-presented with a rapidly growing, tender nodule at the same site. An excisional biopsy was again performed and revealed a tumor composed of malignant epithelioid and spindle cells merging imperceptibly with residual traumatic neuroma. The malignant cells were positive for vimentin, S-100 and micropthalmia transcription factor. They were negative for cytokeratins, muscle markers, Melan-A, HMB45, glial fibrillary acidic protein, and myelin basic protein. Electron microscopy showed no melanosomes. The diagnosis of malignant peripheral nerve sheath tumor arising within a long-standing traumatic neuroma was rendered and represents a hitherto unreported origin of this rare, aggressive soft tissue sarcoma.