Perineural spread of tumour

Perineural spread of tumour is a form of local invasion in which primary tumours cells spread along the tissues of the nerve sheath.  It is a well-recognised phenomenon in head and neck cancers.

An important distinction has to be made between perineural invasion (PNI) and perineural spread (PNS). The former is a histological finding of tumour cell infiltration or associated with small nerves that cannot be radiologically imaged, while the latter is macroscopic tumour involvement along a nerve extending away from the primary tumour; this can be radiologically apparent. A third term, neurotropism, simply means that a tumour has an affinity for growth along nerves.

Perineural tumour spread is more frequently associated with 1,2,5:

Perineural tumour spread could be characterised as nerve thickening, widening of the neural foramen, loss of the fat surrounding the nerve and enhancement of the nerve following contrast administration. 

Radiation-induced neuritis is the main differential diagnosis in the appropriate clinical setting (i.e. following radiotherapy treatment) 7. PET-scan might be helpful as tumours are usually FDG avid whereas radiation-induced neuritis is not.

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Article information

rID: 33252
Tag: cases, cases
Synonyms or Alternate Spellings:
  • Perineural spread
  • Perineural tumor spread
  • Perineural tumour spread

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Cases and figures

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    Case 1: cutaneous SCC and infraorbital nerve
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    Case 2: SCC along branches of trigeminal and facial nerve
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    Case 3: along the infra-orbital nerve
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