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Perineural differentiation in neurotized nevi.
Cem Leblebici1, Beste Noyan Mod1, Merve Cin1
1Department of Pathology, University of Health Science, Istanbul Training and Research Hospital, Istanbul, Turkey.
Pathology, Research and Practice
|February 7, 2024
Summary
Perineural differentiation is common in neurotized nevi, identified via immunohistochemistry. Awareness of perineuromatous nevi is crucial to avoid misdiagnosing melanoma.
Area of Science:
- Dermatopathology
- Neuro-oncology
- Surgical Pathology
Background:
- Perineuriomatous melanocytic nevi are rare, possibly linked to shared neural crest origins of melanocytes and peripheral nerves.
- Neurotized nevi can histologically mimic nerve sheath tumors, showing schwannian differentiation.
- The differentiation of neurotized nevi into perineural cells remains a controversial topic in literature.
Purpose of the Study:
- To investigate the presence and extent of perineural differentiation in neurotized nevi.
- To evaluate immunohistochemical markers for perineural differentiation in these lesions.
- To differentiate neurotized nevi from other cutaneous neoplasms.
Main Methods:
- Prospective evaluation of 100 benign nevi with significant neurotized components.
- Analysis of excisional biopsy samples using immunohistochemical staining.
- Specific markers used: Epithelial membrane antigen (EMA), Claudin1, Glucose transporter 1 (Glut1), and neurofilament.
Main Results:
- Perineural differentiation was detected in 61% of cases with EMA and 100% with Glut1 and Claudin1.
- Axonal differentiation was not observed with neurofilament staining.
- Specific staining patterns (e.g., surrounding Meissner's corpuscle-like structures with Glut1) were noted, with one case resembling perineuromatous nevus.
Conclusions:
- Perineural differentiation is frequently observed in neurotized nevi.
- Immunohistochemistry, particularly with Glut1 and Claudin1, supports perineural differentiation.
- Recognizing perineuromatous nevi is vital to prevent misdiagnosis of desmoplastic melanoma and unnecessary overtreatment.
