Neuroma

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Neuroma Microchapters

Overview

Historical Perspective

Classification

Morton's neuroma
Acoustic neuroma
Ganglioneuroma

Pathophysiology

Causes

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Treatment

Differential Diagnosis

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [7]; Associate Editor(s)-in-Chief: Sara Mohsin, M.B.B.S.[8] Maria Fernanda Villarreal, M.D. [9]

Synonyms and Keywords: Traumatic neuroma; Morton neuroma; Amputation neuroma; Pseudoneuroma; Morton’s metatarsalgia; Plantar interdigital neuroma; Morton's intermetatarsal neuroma; Morton's entrapment; Morton's disease; Morton's neuropathy; Morton's neuralgia; Intermetatarsal neuroma; Intermetatarsal space neuroma; Intermetatarsal nerve entrapment; Interdigital neuroma; Interdigital nerve compression; Interdigital nerve enlargement; Joplin's neuroma; Plantar neuroma; Scar neuroma; Terminal neuroma; Stump neuroma

Overview

Neuroma (Neuro- is from the Greek for nerve) is defined as a benign tumor of a nerve. However, neuroma commonly refers to any tumor of cells of the nervous system. Neuromas form part of the peripheral nerve sheath tumors and belong to Reactive class of tumors. Neuroma was first described by Thomas Morton in 1876. Neuromas may be classified according to histopathological features into 3 groups: Morton's neuroma, traumatic neuroma, and neoplasic neuromas. The pathogenesis of neuroma is characterized by neural degeneration with epineural and endoneural vascular hyalinization, and perineural fibrosis. Neuroma is more commonly observed among patients aged between 15 to 50 years old. Neuroma is more commonly observed among middle aged adults. Females are more commonly affected with neuroma than males. The female to male ratio is approximately 5:1. Common risk factors in the development of neuroma include improper footwear and high impact sports (e.g., rock-climbing, ballet dancing). A major complication of neuroma is chronic neuropathic pain. On ultrasound, neuroma is characterized as a well-defined, hypoechoic lesion located in the intermetatarsal space proximal to the metatarsal head. Patients with neuroma usually appear with antalgic posture. Physical examination may be remarkable for tenderness to palpation and dysesthetic pain. Surgical excision is the treatment of choice for patients with neuroma; this surgical intervention is associated with a relatively favorable success rate, approximately 80%. The recurrence rate after surgery is as high as 50%.

Historical Perspective

  • The term neuroma originates from the following two Greek words:
  • In 1876, Neuroma was first described by Thomas Morton

Classification

Classification of neuroma
Types of neuroma Characteristic features Neoplastic nature
Morton's neuroma[5][6][7][8][9][10] Non-neoplastic
Traumatic neuroma[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27]
Palisaded encapsulated neuroma/solitary circumscribed neuroma
Mucosal neuroma[4][28]
Neoplasic neuroma Neoplastic
Acoustic neuroma [29]
Ganglioneuroma
Pacinian neuroma[30][31][32][33]

Pathophysiology

S-100 Immunostain of Palisaded and Encapsulated Neuroma Source: Ed Uthman at flickr
Histopathology of Palisaded and Encapsulated Neuroma Source: Ed Uthman at flickr
Histopathology of Palisaded and Encapsulated Neuroma [1]
Histopathology of Palisaded and Encapsulated Neuroma [2]

Histopathology of traumatic neuroma

Traumatic neuroma Source: Libre Pathology
Traumatic neuroma [3]
Traumatic neuroma [4]
Traumatic neuroma [5]
Traumatic neuroma [6]

Common sites of involvement by traumatic neuroma

Causes

Epidemiology and Demographics

Age

Gender

Race

  • There is no racial predilection for neuroma

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

Symptoms

Physical Examination

Laboratory Findings

Imaging Findings

MRI

Morton neuroma MRI Source: Radiopedia

Ultrasound

Treatment

Medical Therapy

Conservative therapy for Morton's neuroma

Non-conservative medical therapy

Surgery

Prevention

Differential Diagnosis

Differentiating neuroma from other causes of intermetatarsal pain
Disease/Condition Underlying Etiology Pathophysiology Clinical presentation Other associated features
Neuroma


Indirect nerve trauma

Metatarsal stress fracture (Neck of metatarsal bone)[101] Repeated extraordinary stress, overuse, or trauma to the bone caused by any of the following: Stress fracture can be prevented by following measures:
Rheumatoid arthritis[102][103][104][105][106][107] Common causes include: On gross pathology, following features may be noticed:

Microscopic histopathologicalanalysis shows:

Common symptoms of rheumatoid arthritis include: Conditions associated with rheumatoid arthritis include:

Patients with rheumatoid arthritis may have a positive history of:

Hammer toe[108][109][110][111][112][113][114][115][116] Can be caused by muscle, nerve, or joint damage due to any of the following: Also known as:
Neurofibroma[117][118][119][120][121][122][123][120][124][125][126][127] Can be sporadic or as a part of Neurofibromatosis 1 and 2

Neurofibroma with degenerativeatypia ("ancient change") has following microscopic features:

References

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