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Skeletal Radiology
Published in: Skeletal Radiology 1/2021

01-01-2021 | Lymphoma | Scientific Article

Imaging of non-neurogenic peripheral nerve malignancy—a case series and systematic review

Authors: Rodrigo Luna, Laura M. Fayad, Fausto J. Rodriguez, Shivani Ahlawat

Published in: Skeletal Radiology | Issue 1/2021

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Abstract

Objective

To evaluate the frequency, clinico-pathologic and imaging features of malignant tumors in peripheral nerves which are of non-neurogenic origin (non-neurogenic peripheral nerve malignancy—PNM).

Materials and methods

We retrospectively reviewed our pathology database for malignant peripheral nerve tumors from 07/2014–07/2019 and performed a systematic review. Exclusion criteria were malignant peripheral nerve sheath tumor (MPNST). Clinico-pathologic and imaging features, apparent diffusion coefficient (ADCmin), and standard uptake values (SUVmax) are reported.

Results

After exclusion of all neurogenic tumors (benign = 196, MPNST = 57), our search yielded 19 non-neurogenic PNMs (7%, n = 19/272), due to primary intraneural malignancy (16%, n = 3/19) and secondary perineural invasion from an adjacent malignancy (16%, n = 3/19) or metastatic disease (63%, n = 12/19). Non-neurogenic PNMs were located in the lumbosacral plexus/sciatic nerves (47%, n = 9/19), brachial plexus (32%, n = 6/19), femoral nerve (5%, n = 1/19), tibial nerve (5%, n = 1/19), ulnar nerve (5%, n = 1/19), and radial nerve (5%, n = 1/19). On MRI (n = 14/19), non-neurogenic PNM tended to be small (< 5 cm, n = 10/14), isointense to muscle on T1-W (n = 14/14), hyperintense on T2-WI (n = 12/14), with enhancement (n = 12/12), low ADCmin (0.5–0.7 × 10–3 mm2/s), and variable metabolic activity (SUVmax range 2.1–13.1). A target sign was absent (n = 14/14) and fascicular sign was rarely present (n = 3/14). Systematic review revealed 89 cases of non-neurogenic PNM.

Conclusion

Non-neurogenic PNMs account for 7% of PNT in our series and occur due to metastases and primary intraneural malignancy. Although non-neurogenic PNMs exhibit a non-specific MRI appearance, they lack typical signs of neurogenic tumors such as the target sign. Quantitative imaging features identified by DWI (low ADC) and F18-FDG PET/CT (high SUV) may be helpful clues to the diagnosis.
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Metadata
Title
Imaging of non-neurogenic peripheral nerve malignancy—a case series and systematic review
Authors
Rodrigo Luna
Laura M. Fayad
Fausto J. Rodriguez
Shivani Ahlawat
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
Skeletal Radiology / Issue 1/2021
Print ISSN: 0364-2348
Electronic ISSN: 1432-2161
DOI
https://doi.org/10.1007/s00256-020-03556-z

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