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Palisaded encapsulated neuromas. A clinicopathologic study.

J S Dover1, L From, A Lewis

  • 1Department of Dermatology, University of Toronto.

Archives of Dermatology
|March 1, 1989
PubMed
Summary

Palisaded encapsulated neuromas are benign skin tumors often misdiagnosed. Electron microscopy suggests they may arise from minor skin injury and nerve regeneration.

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Area of Science:

  • Dermatopathology
  • Surgical Pathology
  • Nerve Biology

Background:

  • Palisaded encapsulated neuromas (PENs) are rare benign nerve sheath tumors.
  • Few cases have been reported since their initial description in 1972.
  • Clinical presentation is often mistaken for other common skin lesions.

Purpose of the Study:

  • To describe the clinical, light microscopic, and electron microscopic features of 81 consecutive palisaded encapsulated neuromas.
  • To differentiate PENs from other cutaneous neoplasms.
  • To elucidate the potential pathogenesis of PENs.

Main Methods:

  • Clinical data collection from 81 patients with PENs.
  • Light microscopy examination of tumor tissue.
  • Electron microscopy analysis of tumor ultrastructure.

Main Results:

  • PENs presented as solitary, asymptomatic, 2-6 mm flesh-colored facial papules in middle-aged patients.
  • Light microscopy showed encapsulated dermal lobules of Schwann cells with variable axons.
  • Electron microscopy revealed abundant nonmyelinated (class C) fibers partially ensheathed by Schwann cells, similar to peripheral nerve regeneration.

Conclusions:

  • Palisaded encapsulated neuromas are distinct true neuromas.
  • Findings suggest a potential traumatic origin, possibly representing regeneration after minor skin injury.
  • Distinguishing PENs from basal cell epithelioma and melanocytic nevi is crucial.

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