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1/19. Cutaneous sclerosing perineurioma with cryptic NF2 gene deletion.

    Sclerosing perineurioma is a recently described variant of perineurioma that characteristically occurs in the fingers and palms of young adults. We report a cutaneous sclerosing perineurioma with preservation of the axons and schwann cells in the center of the whorls of perineurial cells, a feature that previously was reported to be typically absent in these lesions. Additionally, clonal chromosomal abnormalities of chromosome 10 and a cryptic deletion of the 5'BCR and NF2 loci on chromosome 22 were present. These findings further support the hypothesis that a gene on chromosome 22 may play a role in the pathogenesis of perineurioma. The NF2 gene is a logical candidate because of its involvement in other nerve sheath tumors.
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2/19. Fibrolipoma of the median nerve: a case report and review of the literature.

    A 38 year-old patient presented with right median nerve distribution paresthesias. Electrodiagnostic studies confirmed severe carpal tunnel syndrome. A palmar mass prompted a magnetic resonance imaging scan, which suggested a fibrolipoma of the median nerve. Carpal tunnel release resulted in resolution of preoperative pain and paresthesias. We review the literature dealing with this primary nerve tumor.
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3/19. Pacinian corpuscle neuroma of digital nerves.

    Symptoms and incapacitation due to abnormal aggregations of pacinian corpuscles are uncommon. Indeed, only three reports have been found in the scientific literature. A case is presented in which the patient's chief complaint was pain and localized tenderness in the hand which interfered with normal activity. Surgical exploration of the palm showed abnormalities of pacinian corpuscles attached to the median digital nerve in the form of a grape-like cluster and a single enlarged corpuscle beneath the epineurium; the abnormality attached to the ulnar digital nerve appeared as an offshoot of hyperplastic corpuscles lying in tandem. The abnormal corpuscles were excised. The symptoms have not recurred to date. These abnormalities in size, position, and number of pacinian corpuscles are compared to the findings of the few other reports in the literature. The neuroma formation found attached to this ulnar nerve has not been cited previously.
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4/19. Multiple neurilemmomas of the median and ulnar nerves with a communicating branch in the same upper extremity.

    A 30-year-old woman presented with multiple neurilemmomas in the same upper extremity. One originated from the main trunk of the ulnar nerve and two others from the sensory branch of the median nerve. A communicating branch in the palm from the ulnar nerve to the median nerve was confirmed. All the tumours were successfully enucleated and she made a satisfactory recovery.
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5/19. A very large Schwannoma originating from the median nerve in carpal tunnel.

    Schwannomas are common benign nerve tumors occurring in the peripheral nerves. A very large schwannoma of more than 5 years duration, originating from the median nerve in the carpal tunnel in a 38-year-old woman, is reported. There was a painful mass, 60 mm in length and 42 mm in diameter, on the palm without signs of sensory disturbance or atrophy on the thenar muscles. Surgical removal was performed under high-power magnification by separating the sensory and motor fascicles from the tumor. Histological examination resulted in a Schwannoma. At 4-year follow-up, the patient was asymptomatic with excellent relief of symptoms. The tumor did not recur. Although cases have been reported in the literature, this is one of the largest ever described without any neurologic deficit.
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6/19. Iatrogenic Horner's syndrome.

    PURPOSE: To report two cases of Horner's syndrome. One presented after the ablation of a schwannoma of the cervical sympathetic chain, the second after upper thorascopic sympathectomy for primary palmar hyperhidrosis. methods: A 42-year-old man underwent excision of a left neck mass found during routine physical examination. A 20-year-old girl with axillary and palmar hyperhidrosis was treated with cervical sympathectomy. RESULTS: In the early postoperative days, miosis, ptosis, anhidrosis, and enophthalmos were observed. CONCLUSIONS: In the ablation of a schwannoma, postoperative Horner's syndrome is associated with the relationship between nerves and the tumor mass, which makes it impossible to separate them surgically in most cases. In thorascopic sympathectomy, patients should be warned of this complication.
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7/19. Flexor tendon rupture 55 years following a wrist laceration.

    Flexor tendon rupture at the wrist or palm is rare. We present a case of index flexor digitorum profundus rupture at the level of the wrist associated with the site of a laceration 55 years earlier. Associated pathology included a large neuroma-in-continuity of the median nerve and adhesions involving the flexor digitorum superficialis tendons. The rupture was treated by tenodesis to the relatively unaffected flexor digitorum profundus to the adjacent long finger.
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8/19. granular cell tumor of the palmar cutaneous branch of the median nerve.

    granular cell tumor rarely occurs in the hand. A patient with this tumor involving the palmar cutaneous branch of the median nerve, and twelve-month follow-up is discussed. This lesion, similar to neurofibromas, can infiltrate peripheral nerves and cannot be dissected from them. The lesion is probably of Schwann cell origin.
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9/19. Digital schwannoma in a skeletally immature child.

    soft tissue neoplasms of the hand are rare in general and even more uncommon in children. The most commonly considered diagnoses include ganglion, inclusion cyst, lipoma, subcutaneous foreign body granuloma, and tendon sheath xanthoma. Aside from pressure sensitivity, masses on the palmar aspect of the hand are often asymptomatic. The case reported here identifies a primary neural neoplasm (neurilemmoma) that involves a small peripheral nerve in the hand of a twelve-year-old child. The patient had no neurologic symptoms and illustrates the need to include neurilemmomas in the differential diagnosis of hand masses in children.
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10/19. A case of neurofibroma of the palmar cutaneous branch of the median nerve.

    This case report describes a previously unreported entity, a neurofibroma of the palmar cutaneous branch of the median nerve. The lesion presented as a palmar mass with an overlying abnormality of the skin. Treatment consisted of excision of the lesion. Infiltration of the terminal branches of the nerve by the tumour prevented nerve reconstruction but provided a previously unknown diagnostic clue: fibrosis of an area of skin innervated by the involved nerve, which had the appearance of a callosity.
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