Perineurioma of the posterior interosseous nerve: surgical treatment

Perineurioma do nervo interósseo posterior: tratamento cirúrgico

Intraneural perineurioma is a benign tumor that occurs in less than 1% of peripheral nerve tumors; no more than 90 cases have been reported ^{1 , 2} . Tumorous lesions of the posterior interosseous nerve (PIN) have rarely been described ^3–5 .

An 18-year-old woman presented with a longstanding history of spontaneous progressive weakness in the PIN distribution ( Figure 1 ). Ultrasonography and MRI studies ( Figure 2 ) showed a nodular lesion in the PIN, measuring 1.0 cm at its greatest diameter. At surgical exploration a tumor ( Figure 3 ) involving all the nerve fascicles was entirely resected. The nerve was repaired by termino-terminal neurorrhaphy. Figure 4 shows the histological examination.

Figure 1
. Wrist extension partially preserved and deviation of the hand to the radial side. There was no finger extension.

Figure 2
. (A, B) MRI: heterogeneous oval lesion, with slight post-contrast enhancement, located in the PIN, measuring 1.0 cm at its greatest diameter; (C) Ultrasonography: nodule (N) located within the PIN.

Figure 3
. Intraoperative view of the tumor involving all the fascicles of the PIN. PIN: posterior interosseous nerve; RN: radial nerve; SB: superficial branch of the radial nerve; T: tumor.

Figure 4
. (A) Histological slide (H&E stain) showing diffuse pseudo-onion-bulb leaflets and thinly myelinated fibres at the centre of them; (B) Schwann cell preparation (S-100 protein) on immunohistochemistry demonstrates reactivity of the myelinated fibres at the centre, and absence of reactivity, of the surrounding pseudo-onion bulbs. Furthermore, epithelial membrane antigen (EMA) was positive, confirming perineurial origin. These findings, considered together, are diagnostic of perineurioma ⁵ .

References

• ¹
  Groeneweg AJM, Hartman EH, Fleischeuer R, Visser LH. An unusual location of ulnar nerve pathology: a perineurioma of the ulnar nerve in the upper arm. Muscle Nerve 2011;44:593-596.
• ²
  Heilbrun ME, Tsuruda JS, Townsend JJ, Heilbrun MP. Intraneural perineurioma of the common peroneal nerve. Case report and review of the literature. J Neurosurg 2011;94:811-815.
• ³
  Mauermann ML, Amrami KK, Kuntz NL, et al. Longitudinal study of intraneural perineurioma – a benign, focal hypertophic neuropathy of youth. Brain 2009;132:2265-2276.
• ⁴
  Lallemand RC, Weller RO. Intraneural neurofibromas involving the posterior interosseous nerve. J Neurol Neurosurg Psychiatry 1973;36:991-996.
• ⁵
  Sachanandani NS, Brown JM, Zaidman C, Brown SS, Mackinnon SE. Intraneural perineurioma of the median nerve: case report and literature review. Hand 2010;5:286-293.

Publication Dates

• Publication in this collection
  Nov 2013

History

• Received
  19 May 2013
• rev-received
  01 June 2013
• Accepted
  10 June 2013