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Pathologic remodeling in human neuromas: insights from clinical specimens
Mark A Mahan1, Hussam Abou-Al-Shaar2, Michael Karsy3
1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 North Medical Drive East, Salt Lake City, UT, 84132, USA. mark.mahan@hsc.utah.edu.
Acta Neurochirurgica
|October 16, 2019
Summary
Neuromas exhibit consistent architectural elements and molecular features, including small axons and persistent T-cells, suggesting a role in chronic pain after nerve injury.
Area of Science:
- Nerve regeneration and repair
- Peripheral nerve pathology
- Pain mechanisms
Background:
- Neuroma pathology is often considered unstructured.
- Consistent architectural elements and molecular features in neuromas were observed.
Purpose of the Study:
- To identify molecular features characterizing neuroma pathophysiology.
- To understand the structural basis of neuroma formation and associated pain.
Main Methods:
- Immunohistochemical analysis of 30 human nerve specimens (12 NICs, 11 stump neuromas, 2 avulsions, 5 controls).
- Antibodies used targeted components of normal nerve substructures.
Main Results:
- Neuromas (NICs and stump) showed similar histopathology, with NICs having intact but abnormal fascicles.
- Laminin staining revealed a double-lumen configuration; GLUT1 indicated perineurium, NF200 showed small axons, and S100 identified Schwann cells.
- Persistent T-cells and small-diameter axons were noted, potentially linked to chronic pain.
Conclusions:
- Consistent pathophysiologic remodeling occurs after fascicle disruption.
- The predominance of small axons and persistent T-cells may contribute to chronic neuroma pain.
- Intact but abnormal fascicles in NICs may explain poor neurological outcomes.
