71/305. Traumatic neuroma of the bile duct causing cholangitis and atrophy of the right hepatic lobe. Intraluminal traumatic neuromas are an unusual cause of bile duct obstruction. These benign collections of disorganized nerve fibers arise from a bile duct injury during cholecystectomy. Symptoms associated with obstruction or cholangitis may develop decades after the operation. Our patient's neuroma imitated a malignant neoplasm, but the patient has been returned to good health by resection of the right hepatic duct and the atrophic right hepatic lobe. ( info) |
72/305. Painful foot neuromas after toe-to-thumb transfer. Reconstruction of the thumb by transfer of a toe has evolved technically to the point that this complex procedure can result in a mobile, sensate, and aesthetically pleasing digit that contributes to an almost-normally functioning hand. Donor site deformity is well recognized, primarily as it relates to the appearance of the foot after transfer of the hallux to the thumb position and stiffness of the remaining portions of the big toe. The present report describes donor site disability related to painful neuromas of the superficial and deep peroneal nerves and the common plantar digital nerve to the first webspace. Salvage of the disabled donor foot is possible by applying techniques used to treat painful neuromas of the upper extremity, neuroma resection, and muscle implantation. The specific techniques used in treating this painful foot donor site after toe-to-thumb transfer are described. ( info) |
73/305. Palisaded encapsulated neuroma--a classic presentation of a commonly misdiagnosed neural tumor. We present a case report of a classical presentation of palisaded encapsulated neuroma (PEN) of the skin occurring on the nasolabial crease and a review of the literature. A young woman presented with a smooth lobulated papule on the cheek enlarging over 2 years. Histologic examination revealed a well-circumscribed dermal nodule of small spindle cells with wavy nuclei arranged in fascicles, consistent with the diagnosis of PEN. PEN is a previously described, benign cutaneous neural tumour, with a histological appearance between that of a neurofibroma and a schwannoma. Though not uncommon, PEN remains under-diagnosed by many pathologists. Clinically, PEN is most commonly misdiagnosed as a basal cell carcinoma, a nevus, or as a neurofibroma. ( info) |
74/305. Coverage of painful peripheral nerve neuromas with vascularized soft tissue: method and results. OBJECTIVE: Our goals are to describe a method of treating painful peripheral nerve neuromas by means of vascularized tissue coverage, report the results in seven patients, and discuss the indications for this treatment modality. An analysis of pain, functionality of the affected body part, professional activities of the patients, and medications before and after surgery is presented. methods: Seven male patients (mean age, 45.1 yr) with posttraumatic nerve injuries, who had developed painful stump neuromas or neuromas-in-continuity, and who had unsuccessfully undergone several treatment procedures, were selected for the surgery described here. The operation included resection of the stump neuroma (four patients) or neurolysis of the neuroma-in-continuity (three patients) and coverage of the nerve with a vascularized fascial, fasciocutaneous, or perforator flap (three pedicled regional flaps and four free flaps). A modified quadruple visual analog scale was used to quantify pain before and after surgical treatment. The mean follow-up was 16.6 months. RESULTS: The mean values of the quadruple visual analog scale (pain now/typically/at its best/at its worst) before surgery were 6.5/6.5/4.7/7.9. These values changed to 0.3/0.4/0/0.9 at a mean follow-up of 16.6 months after surgery. Five patients returned to their original profession, one receives a pension, and one began a less demanding job after undergoing surgery. Six of the seven patients received opioids before surgery (one had a spinal cord stimulator). After surgery, all patients stopped taking regular pain killers and the spinal cord stimulator was deactivated in one; two patients still take nonsteroidal anti-inflammatory drugs occasionally, but not on a regular basis. CONCLUSION: Vascularized soft tissue coverage of painful peripheral nerve neuromas seems to be an effective and attractive, but also complex, method of treatment. This option may be considered and reserved for patients who have already undergone several pain treatment modalities without success. ( info) |
| BACKGROUND: Familial dysautonomia (FD) is a rare autosomal recessive disorder of the peripheral nervous system, affecting exclusively Jewish children of Ashkenazi extraction. The typical clinical features consist of somatic abnormalities: failure to thrive, characteristic facies, excessive sweating, labile blood pressure, recurrent aspiration pneumonias, lack of tears, and diminished and later absent deep tendon reflexes with generalized reduction of pain sensation. Oro-dental features include a lack of tongue fungiform papillae, impairment of taste, oro-dental self-mutilation, dental crowding, excessive plaque and calculus accumulation, salivary over production and low caries experience. CASE REPORT: A child with multiple endocrine neoplasia type 2b (MEN 2B) received, at the age of 11 months, an incorrect diagnosis of familial dysautonomia (FD). At the age of 6 years, a paediatric dentist experienced with FD noticed a normal number and shape of tongue fungiform papillae, while expecting to find a smooth tongue lacking those structures. The presence of numerous submucosal neuromata initiated a meticulous neurological and endocrine work-up, which established the diagnosis of MEN 2B. This led to an early detection and appropriate treatment of asymptomatic medullary thyroid carcinoma (MTC). ( info) |
76/305. Painful traumatic neuroma after a finger stick. In this case report we present a patient with a painful traumatic neuroma after a finger stick by lancet. The patient benefited from surgical excision of the lesion, and her symptoms were completely abolished with additional sympathetic nerve blocks. ( info) |
77/305. abdominal wall neuroma pain after breast reconstruction with a transverse abdominal musculocutaneous flap: cause and treatment. breast reconstruction with either a pedicled or microvascular transfer of the transverse rectus abdominus musculocutaneous flap, whether with or without the muscle, is now the standard of care when patients choose an autologous form of reconstruction. Complications related to flap loss and abdominal wall weakness have been well described. Complications related to painful neuromas of the intercostal nerves, ilioinguinal and iliohypogastric nerves have not been described previously. The diagnosis and treatment of pain related to neuromas of the abdominal wall is discussed in this paper. ( info) |
78/305. Digital pacinian corpuscle neuroma eroding bone: a case report. A case of digital pacinian corpuscle neuroma leading to erosive changes in the adjacent proximal phalanx is reported. Characteristics and previous reports of this relatively uncommon hand tumor are discussed. ( info) |
79/305. Bilateral traumatic neuroma of the anterior cervical nerve root: case report. STUDY DESIGN: Case report. OBJECTIVES: A rare case of anterior cervical second root traumatic neuroma with no history of trauma is reported, and possible etiology is discussed. SUMMARY OF BACKGROUND DATA: Traumatic neuroma is the reactive, nonneoplastic proliferation in the injured nerve. Several atypical locations of traumatic neuroma have been reported. To date, only 4 cervical traumatic neuroma cases with no history of trauma have been reported, and, to our knowledge, there is no case of bilateral cervical traumatic neuroma published in the literature. methods: A patient with a history of neck and left upper extremity pain, who had hypoesthesia in left C2 dermatome on neurologic examination is presented. A left C2-C3 hemilaminectomy and tumor extirpation were performed. RESULTS: A histopathologic study revealed features of a typical traumatic neuroma. The patient had no deficits on her postoperative neurologic examination, and her neck and left arm pain improved. The unusual location of this lesion and possible etiology of such a traumatic neuroma are discussed. CONCLUSIONS: A rare case of anterior bilateral cervical second root traumatic neuroma with no history of trauma is reported. An unnoticed history of trauma may play an etiologic role in the development of these lesions. ( info) |
80/305. amputation neuromas after neck surgery. Traumatic or amputation neuromas are benign tumours formed by a proliferation of schwann cells, axons and connective tissue elements. They are secondary to the partial or total section of a nerve pathway due to an accidental or surgical trauma. They can form at any site and affect any type of nerve. The presence of amputation neuromas is very frequent in major surgery but rare in simple excisions of skin tumours. We report two cases with neuroma localized in the neck, one after lymph node dissection for melanoma metastasis and the other after excision of a cutaneous melanoma with 3-cm margin on lateral neck. In both cases, the presence of the neuroma mandated a surgical excision to rule out a possible recurrence of melanoma. ( info) |