0
Journal Contents   |    
TUMORS OF THE NERVE SHEATHS OF THE EXTREMITIES NEUROGENIC SARCOMAS
EDGAR M. BICK
View Disclosures and Other Information
Hospital for Joint Diseases, New York City
J Bone Joint Surg Am, 1931 Jan 01;13(1):149-153
5 Recommendations (Recommend) | 3 Comments | Saved by 3 Users Save Case

Abstract

Four cases of tumors classified as neurogenic sarcomas or tumors of nerve trunks are presented to illustrate a study of these neoplasms. They are derived from the connective tissue of the peripheral nervous system,—i.e., the epineurium, perineurium, or endoneurium. The term "neurogenic" applied to these tumors is misleading, since, it implies an ectodermic origin which, by definition, is incompatible with sarcoma. Hence we prefer the more unwieldy term "fibrosarcoma of the nerve sheath", as expressing more accurately the pathological concept of these neoplasms.

Clinically these tumors are characterized by slow growth, often existing from childhood. They may remain symptomless for many years, and suddenly become painful following trauma of even slight degree. Usually increase in size accompanies the onset of pain. Often the pain follows the distribution of the involved or associated nerve, and in this event the symptom is a great aid in diagnosis. It may be piercing or burning in character, but never in our experience does it resemble the dull gnawing ache of the periosteal or osteosarcoma. These tumors may be superficial or deep. The latter are more liable to be multiple, but must be distinguished from the neurofibromatosis of von Recklinghausen.

These tumors are all potentially, if not actually, malignant. The apparent harmlessness of a very small skin growth, obviously superficial, too often invites minor consideration which results in the unpleasant sequence of recurrence, metatasis, death. While in its primary state the tumor is of low-grade malignancy, trauma may activate it to a remarkably high degree. That trauma should not be thoughtlessly inflicted by the surgeon without full appreciation of the danger involved.

Many of these growths, especially the deeper ones, are encapsulated. Although relative benignity is thus preserved, it is no guaranty against recurrence. Metastasis in these tumors has been reported, even when surgery has not been used.

Early and complete excision followed by properly conducted deep radiation is the treatment advocated at present. Such tumors are quite radioresistant, so that treatment must be prolonged. At the operation the tumor will seldom be found associated with a large nerve trunk. The smaller muscular or cutaneous branches are more frequently involved. When no nerve structure is defined in the gross specimen, one may still discover strands of fibers in microscopic study.

The small, superficial, harmless-appearing, cutaneous nodule must not be exempt from consideration. It may be of considerable malignancy. Multiplicity must always be borne in mind, and as much search made for nearby growths as is feasible.

Figures in this Article
    This article is only available in the PDF format. Download the PDF to view the article, as well as its associated figures and tables.
    Sign In to Your Personal ProfileSign In To Access Full Content
    Not a Subscriber?
    Get online access for 30 days for $35
    New to JBJS?
    Sign up for a full subscription to both the print and online editions
    Register for a FREE limited account to get full access to all CME activities, to comment on public articles, or to sign up for alerts.
    Register for a FREE limited account to get full access to all CME activities
    Have a subscription to the print edition?
    Current subscribers to The Journal of Bone & Joint Surgery in either the print or quarterly DVD formats receive free online access to JBJS.org.
    Forgot your password?
    Enter your username and email address. We'll send you a reminder to the email address on record.

     
    Forgot your username or need assistance? Please contact customer service at subs@jbjs.org. If your access is provided
    by your institution, please contact you librarian or administrator for username and password information. Institutional
    administrators, to reset your institution's master username or password, please contact subs@jbjs.org

    References

    Accreditation Statement
    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
    CME Activities Associated with This Article
    Submit a Comment
    Please read the other comments before you post yours. Contributors must reveal any conflict of interest.
    Comments are moderated and will appear on the site at the discretion of JBJS editorial staff.

    * = Required Field
    (if multiple authors, separate names by comma)
    Example: John Doe





    Related Content
    The Journal of Bone & Joint Surgery
    JBJS Case Connector
    Topic Collections
    Related Audio and Videos
    PubMed Articles
    Clinical Trials
    Readers of This Also Read...
    JBJS Jobs
    12/04/2013
    NY - Icahn School of Medicine at Mount Sinai
    04/02/2014
    WY - Memorial Hospital of Sweetwater County
    03/17/2014
    CT - Orthopaedic Foundation
    02/28/2014
    DC - Children's National Medical Center