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At least 307 records · Page 17Linked to original sources

Video-assisted thoracoscopic resection of intercostal neurofibroma.

BACKGROUND Video-assisted thoracoscopy (VAT) is being increasingly utilized by thoracic surgeons as an alternative to thoracotomy for several thoracic disorders. Neuroendoscopy is an exciting addition to the neurosurgical armamentarium. These procedures are attractive alternatives in the era of minimally invasive surgery and cost containment, while providing the highest quality medical care to patients. METHODS We report the application of this technology in a patient presenting with intractable thoracic radicular pain secondary to an intercostal neurofibroma. Complete excision of the intercostal neurofibroma was performed utilizing VAT. RESULTS The patient reported good relief of her preoperative thoracic radicular pain. She was ready for discharge from the hospital within 72 hours of surgery. CONCLUSIONS With the advent of improved instrumentation, video-assisted thoracoscopy offers a safe alternative to thoracotomy and the potential benefits of less postoperative discomfort and shorter hospital stays. The potential neurosurgical applications of VAT should not be overlooked.

Adult↗

Intrascrotal neurofibromas.

A solitary intrascrotal neurofibroma in a seventy-seven-year-old man is reported. This benign tumor of the nerve sheath arises from the Schwann cell and is rare in the external genitalia, especially in the absence of clinical and histopathologic stigmas of von Recklinghausen neurofibromatosis. The literature on intrascrotal neurofibromas is reviewed.

Aged↗

Neurofibroma of the ovary.

We report an unusual example of ovarian neurofibroma in a woman with neurofibromatosis (von Recklinghausen's disease). The neoplasm caused ovarian enlargement which surgically simulated malignant neoplasm. Ovarian neurofibromas are extremely rare and may arise from small myelinated nerves in the ovarian hilum.

Female↗

Solitary neurofibroma of the vagus nerve in the aortopulmonary window masquerading as a developmental cyst.

A rare case of solitary neurofibroma of the vagus nerve in the aortopulmonary window masquerading as a developmental cyst is reported. Its computed tomographic characteristics and magnetic resonance imaging are described and correlated with pathologic findings. Although the features of such imaging modalities are quite characteristic for a neurofibroma, its differentiation from "atypical" developmental cysts may be difficult.

Adult↗

Cytogenetic clones in a recurrent neurofibroma.

Chromosome studies were performed on a plexiform neurofibroma arising in a probable von Recklinghausen's disease patient, who also showed a de novo constitutional reciprocal translocation, t(1;22)(p32;q11). Banding analysis of the metaphases obtained from two primary cultures in vitro showed the presence of five cytogenetic clones, characterized by different chromosomal rearrangements. In addition to t(1;22), marker chromosomes involved pairs 1, 2, 3, 5, 8, 9, 10, 12, 16, and X. These findings suggest a possible polyclonal evolution in this neurofibroma.

Adult↗

Giant neurofibroma of the tongue.

Neurofibroma of the tongue arising from the hypoglossal nerve is rare [7], but a combined neurofibroma of the hypoglossal and lingual nerve is extremely rare in the English literature to our knowledge [4,6]. Here one such case is being presented for its rarity, peculiarity of its clinical presentation and the surgical approach to excise it.

Adolescent↗

A reciprocal t(4;9)(q31;p22) in a solitary neurofibroma.

Cytogenetic reports of solitary neurofibromas are rare and, to our knowledge, no clonal reciprocal translocations have been reported in these tumors. Reciprocal chromosome translocations have been identified in a number of solid tumors and can have both diagnostic and prognostic significance. We report the first case of a solitary circumscribed neurofibroma with a (4;9)(q31;p22) balanced reciprocal translocation as the sole cytogenetic abnormality.

Adult↗

Isolated neurofibromas of the conjunctiva.

We studied four histologically verified cases of isolated neurofibromas of the conjunctiva. The histologic pattern was diffuse in two patients, plexiform in one patient, and solitary in one patient. Simple excision was curative in all cases. We emphasize the importance of distinguishing neuromas (which may be associated with multiple endocrine neoplasia) from neurofibromas.

Adolescent↗

Massive plexiform neurofibroma with associated meningo-encephalocoele and occipital bone defect presenting as a cervical mass.

The commonest skull manifestations in neurofibromatosis involve the orbit, with very few reports about occipital defects. We report a rare case of a 54-year-old lady with a massive plexiform neurofibroma extending from the auricular region down her left neck and into her shoulder, with an associated large left occipital and left petrous bone defect and extensive cerebellar meningo-encephalocoele, which presented with a relatively asymptomatic cervical mass and was treated with resection of the neurofibroma and advancement and rotational skin flaps.

Encephalocele↗

Plexiform trigeminal neurofibroma.

Neurofibromas of the trigeminal nerve are uncommon tumours which usually present in patients in the third or fourth decade of life as a localised mass in the posterior or middle cranial fossa. A case is described of a plexiform neurofibroma of this nerve with unusual clinical and radiological features.

Adult↗

Mesenteric neurofibroma in von Recklinghausen's disease.

The authors report the case of a 6-year-old boy admitted for surgical removal of a 5- x 4-cm neurofibroma over the left wrist. On routine clinical examination a mobile firm, nodular, central abdominal mass was discovered. At laparotomy a tumor (measuring 7 x 5 x 3 cm) arising from the ileal mesentery was found. Complete excision of the mass together with a segment of ileum, followed by end-to-end bowel anastomosis was performed. Histological examination showed that the main elements of the mass consisted of wavy, long-spindled cells that crossed irregularly (pallisading negative). Special stains and immunocytochemistry for S-100 protein confirmed the mass to be a neurofibroma of the mesentery. The patient had an uneventful postoperative course and no signs of recurrence or fresh tumor have been recognized in the 4 years since his operation.

Anastomosis, Surgical↗

Prognostic signs in the surgical management of plexiform neurofibroma: the Children's Hospital of Philadelphia experience, 1974-1994.

OBJECTIVES: To estimate the rate of progression of plexiform neurofibroma after surgery and to identify prognostic factors that predict progression. STUDY DESIGN: A retrospective review of the inpatient and outpatient records of 121 patients, who had 302 procedures on 168 tumors over a 20-year period at a single large pediatric referral center. Data on age, location, indication for surgery, and extent of resection was analyzed for prognostic significance. RESULTS: The overall freedom from progression was 54%. Children < 10 years old had a shorter interval of tumor control than older children (p = 0.0004). Tumors of the head/neck/face fared worse than tumors of the extremities (p = 0.0003). Less extensive resection predicted shorter interval to progression (p < 0.0001). Indication for surgery was not of prognostic importance. In multivariable analysis older age and location in the extremities were predictors of a better outcome. CONCLUSIONS: Tumor progression is a serious problem for children with plexiform neurofibroma. Younger children, children with tumors of the head/neck/face, and tumors that cannot be nearly completely removed are at particular risk. These data may be useful in helping clinicians decide which patients and which tumors are most likely to benefit from surgical intervention.

Adolescent↗

Neurofibroma of the ureter.

We report a case of neurofibroma of the ureter without other clinical signs of von Recklinghausen's neurofibromatosis. The patient presented with flank pain, and excretory urography, retrograde urography and computerized abdominal tomography demonstrated a ureteral mass. The light and electron microscopic characteristics, as well as the histogenesis of ureteral neurofibroma, are discussed.

Adolescent↗

An isolated plexiform neurofibroma of the bladder.

Plexiform neurofibroma of the bladder is rare, and is considered an expression of the syndrome of neurofibromatosis (von Recklinghausen's disease). We report a case of a vesical plexiform neurofibroma with no other apparent stigmas of the syndrome. The variable natural course of the disease is demonstrated.

Adult↗

Plexiform neurofibroma involving the genitourinary tract in children: case reports and review of the literature.

We report extensive genitourinary neurofibroma in two children who presented with massive bilateral hydroureteronephrosis and a thick-walled bladder. The best radiologic technique to stage the disease and determine treatment is magnetic resonance imaging. Management of extensive genitourinary neurofibroma is controversial. Based upon our experience and a review of the literature, aggressive surgery should be approached cautiously.

Humans↗

Isolated episcleral neurofibroma.

A 22-year-old white woman presented with an epibulbar tumor of the right eye first noted seven years previously. Clinical examination showed a 6 x 8 mm lobulated yellowish white tumor rising 3-4 mm off the inferior bulbar surface. An excisional biopsy revealed the tumor to be free of conjunctival attachments and be firmly fixed to the sclera. Smaller nodules were noted away from the main tumor and posterior to the equator. The histopathologic evaluation revealed the tumor to be an isolated episcleral neurofibroma. Although rare, isolated episcleral neurofibromas should be thought of in the differential diagnosis of epibulbar tumors and treated conservatively.

Adult↗

Benign peripheral nerve sheath tumors (neurofibromas) of the lacrimal gland.

Two patients, a 43-year-old woman and a 62-year-old man, developed benign peripheral nerve sheath tumors (neurofibromas) of the lacrimal gland, in the former case of the deep orbital lobe, and in the latter of the palpebral lobe. A neurogenic tumor was not seriously considered clinically in either case, because of the paucity of previous reports on the occurrence of neural tumors in the lacrimal fossa region. Instead, in the first case a benign mixed tumor was considered the most likely clinical diagnosis, whereas in the second the coexistence of a swelling in the parotid gland raised the possibilities of a lymphoid tumor or a leukemia. Due to unusual light microscopic features, transmission electron microscopy was required to secure unequivocal diagnoses. In the orbital lobe tumor, an encapsulated spindle cell proliferation without nuclear palisading but with focal areas of myxoid change suggested either a cellular benign mixed tumor or a schwannoma. The palpebral lobe lesion displayed a myxoid spindle cell proliferation that had splayed apart the ducts and acinae of the lacrimal gland, to impart the overall appearance of a benign mixed tumor. The ducts, however, were multilaminar rather than possessing the usual double cellular layer seen in classical benign mixed tumors, and the glandular units contained zymogen granules, which are typically not seen in benign mixed tumors. Electron microscopy disclosed in both lesions the presence of interrupted basement membrane material partially surrounding the tumor cells, long spacing collagen (banded basement membrane material), and poorly developed desmosomes, features compatible with a neural tumor. Neither myofilaments, tonofilaments, nor ductal-type granules sometimes observed in benign mixed tumors were discovered. The tumor cells in these cases therefore failed to demonstrate clear-cut Schwann cell characteristics (eg, continuous basement membranes, pseudo-mesaxons, tangles of cell processes), and more closely resembled perineural cells that have been described in ultrastructural studies of peripheral nerve tumors including neurofibromas of other sites.

Adult↗