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==Overview==
==Overview==
A '''neurofibroma''' is a benign [[nerve sheath tumor]] in the [[peripheral nervous system]].
Neurofibroma is a benign [[nerve sheath tumor]] in the [[peripheral nervous system]].


==Classification==
==Classification==

Revision as of 21:20, 16 November 2015

Neurofibroma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Shanshan Cen, M.D. [2]

Overview

Neurofibroma is a benign nerve sheath tumor in the peripheral nervous system.

Classification

Neurofibroma may be classified into 3 subtypes: localised neurofibroma, diffuse neurofibroma, and plexiform neurofibroma.[1]

Pathophysiology

On gross pathology, a nonencapsulated superficial mass is the characteristic finding of localised or diffuse neurofibroma; whereas the "bag of worms" appearance is the characteristic finding of plexiform neurofibroma.[2] On microscopic histopathological analysis, spindle cells with wavy nuclei without pleomorphism, wire-like collagen, moderate increase of cellularity vis-a-vis normal dermis, and mast cells are characteristic findings of neurofibroma.[3][4]

Causes

Plexiform neurofibroma may be caused by the bi-allelic inactivation of the neurofibromatosis type I tumor suppressor gene.[1][5]

Differential Diagnosis

Neurofibroma must be differentiated from schwannoma, dermatofibrosarcoma protuberans (DFSP), ganglioneuroma, and melanocytic nevus.[1]

Epidemiology and Demographics

Neurofibroma usually affects individuals between 20 and 30 years of age.[6] Neurofibroma affects men and women equally.[1]

Risk Factors

There are no established risk factors for neurofibroma.

Screening

According to the the U.S. Preventive Service Task Force (USPSTF), there is insufficient evidence to recommend routine screening for neurofibroma.[7]

Prognosis

Prognosis of neurofibroma is generally excellent. If left untreated, 10% of patients with plexiform neurofibromas may progress to develop malignant peripheral nerve sheath tumor (MPNST).[8]

Staging

There is no established system for the staging of neurofibroma.

Diagnosis

Symptoms

Symptoms of neurofibroma include soft masses, transient itching, and transient pain.

Physical Examination

Physical examination of patients with neurofibroma is usually remarkable for soft masses (internal or superficial).

Laboratory Findings

There are no laboratory findings associated with neurofibroma.

X Ray

There are no X-ray findings associated with neurofibroma.

CT Scan

CT scan may be helpful in the diagnosis of neurofibroma.

MRI

MRI may be helpful in the diagnosis of neurofibroma.

Ultrasound

There are no ultrasound findings associated with neurofibroma.

Other Imaging Findings

There are no other imaging findings associated with neurofibroma.

Other Diagnostic Studies

There are no other diagnostic study findings associated with neurofibroma.

Biopsy

Biopsy is helpful in the diagnosis of neurofibroma.

Treatment

Medical Therapy

The predominant therapy for neurofibroma is surgical resection. Adjunctive chemotherapy and medications may be required.

Surgery

Surgery is the mainstay of treatment for neurofibroma.

Primary Prevention

There is no established method for prevention of neurofibroma.

Secondary Prevention

There are no secondary preventive measures available for neurofibroma.

References

  1. 1.0 1.1 1.2 1.3 Neurofibroma. Dr Bruno Di Muzio and Dr Maxime St-Amant et al. Radiopaedia.org 2015. http://radiopaedia.org/articles/neurofibroma
  2. Wilkinson LM, Manson D, Smith CR (2004). "Best cases from the AFIP: plexiform neurofibroma of the bladder". Radiographics : a Review Publication of the Radiological Society of North America, Inc. 24 Suppl 1: S237–42. doi:10.1148/rg.24si035170. PMID 15486243. Retrieved 2015-11-13.
  3. Bernthal, NM.; Jones, KB.; Monument, MJ.; Liu, T.; Viskochil, D.; Randall, RL. (2013). "Lost in translation: ambiguity in nerve sheath tumor nomenclature and its resultant treatment effect". Cancers (Basel). 5 (2): 519–28. doi:10.3390/cancers5020519. PMID 24216989.
  4. Staser, K.; Yang, FC.; Clapp, DW. (2010). "Mast cells and the neurofibroma microenvironment". Blood. 116 (2): 157–64. doi:10.1182/blood-2009-09-242875. PMID 20233971. Unknown parameter |month= ignored (help)
  5. Colman SD, Williams CA, Wallace MR (1995). "Benign neurofibromas in type 1 neurofibromatosis (NF1) show somatic deletions of the NF1 gene". Nature Genetics. 11 (1): 90–2. doi:10.1038/ng0995-90. PMID 7550323. Retrieved 2015-11-16.
  6. Pilavaki M, Chourmouzi D, Kiziridou A, Skordalaki A, Zarampoukas T, Drevelengas A (2004). "Imaging of peripheral nerve sheath tumors with pathologic correlation: pictorial review". European Journal of Radiology. 52 (3): 229–39. doi:10.1016/j.ejrad.2003.12.001. PMID 15544900. Retrieved 2015-11-13.
  7. Neurofibroma. U.S. Preventive Service Task Force (USPSTF) 2015. http://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=neurofibroma
  8. Mautner VF, Friedrich RE, von Deimling A, Hagel C, Korf B, Knöfel MT, Wenzel R, Fünsterer C. (2003). "Malignant peripheral nerve sheath tumours in neurofibromatosis type 1: MRI supports the diagnosis of malignant plexiform neurofibroma". American Journal of Pathology. 45 (9): 618–25. doi:10.1007/s00234-003-0964-6. PMID 12898075.


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