Perineural spread of tumor

Dr Yusra Sheikh and Dr Bruno Di Muzio et al.

Perineural spread of tumor is a form of local invasion in which primary tumors cells spread along the tissues of the nerve sheath.  It is a well-recognized 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 tumor cell infiltration or associated with small nerves that cannot be radiologically imaged, while the latter is macroscopic tumor involvement along a nerve extending away from the primary tumor; this can be radiologically apparent. A third term, neurotropism, simply means that a tumor has an affinity for growth along nerves.

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

Signs on MRI suggesting perineural tumor spread are:

  • nerve thickening
  • widening of the neural foramen
  • loss of the fat surrounding the nerve
  • abnormal perineural contrast enhancement

Article information

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

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Cases and figures

  • 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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  • Case 4: Meckel cave/cavernous sinus meningioma with perineural spread
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  • Case 5
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