Perineurioma

A.Prof Frank Gaillard et al.

Perineuriomas are rare tumours composed of neoplastic perineural cells. They are found either in the soft tissues, referred to as soft tissue perineurioma or extraneural perineurioma (where they are unassociated with nerves) or arising from peripheral nerves of the limbs or rarely the cranial nerves, in which case they are known as intraneural perineuriomas 1

The epidemiology of perineuriomas depends on their location. 

Soft tissue perineuriomas occur in adults and are more frequent in females (M:F 2:1)1

Intraneural perineuriomas are encountered in young adults and adolescents with no sex predilection 1,2

Typically patients with intraneural perineuriomas present with muscle weakness 1. Soft tissue perineuriomas present as deep masses, or in cases of malignant degeneration, metastatic disease or direct invasion, although this is uncommon 1

Soft tissue perineuriomas vary in grade from WHO grade I (benign) to WHO grade II to III (malignant), whereas intraneural perineuriomas are considered WHO grade I lesions 1

Malignant perineuriomas are considered variants of malignant peripheral nerve sheath tumours (MPNST) and are also known as MPNST with perineural differentiation 1

Soft tissue perineuriomas appear as well circumscribed rounded masses 1

Intraneural perineuriomas present as a fusiform expansion of a segment of peripheral nerve, ranging greatly in length, but typically longer than 10cm 1,2

Perineuriomas are composed of neoplastic perineural cells. 

Soft tissue perineuriomas demonstrate a whorled arrangement of neoplastic cells, within a collagen background 1

Intraneural perineuriomas demonstrate extension of neoplastic perineural cells around axons, largely contained by the endoneurium 1

Intraneural perineuriomas appear as fusiform enlargement of a nerve with increased T2 signal and contrast enhancement 2

Soft tissue perineuriomas can usually be cured with resection, although local recurrence and metastasis are described in malignant tumours 1

Intraneural perineuriomas can be treated conservatively following histological confirmation with biopsy 1. Alternatively, the mass can be resected with or without nerve grafting 2

The differential diagnosis for intraneural perineuriomas includes 2:

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Article information

rID: 52880
Synonyms or Alternate Spellings:
  • Malignant perineurioma

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