Perineurioma...Explained by a Soft Tissue Pathologist

[@JMGardnerMD]

A complete organized library of all my videos, digital slides, pics, & sample pathology reports is available here: kikoxp.com/posts/5084 (dermpath) & kikoxp.com/posts/5083 (bone/soft tissue sarcoma pathology).

[@Jam-zg2co]

Very nice explanation with differential do.thank you so much

[@Narciarka12]

Love your lectures, the clarity of presentation. Thank you!

[@cristiserban9922]

To me, this tumor looks like Van Gogh's Starry Night :) Thank you for the explanation!

[@omsairam79]

Thank you for explaining why EMA is positive in the cytoplasmic processes of perineuroma. Will never forget this.

[@junudevi8065]

Very nice video on perineurioma

[@tinocasadeitherezo6063]

A beautiful and interesting explanation! Altino Therezo, from Brazil.

[@drdenisamar]

Thank you very much, Dr Gardner, for this excellent teaching video on perineurioma. Would you be able to do one on solitary fibrous tumour, please?

[@berryblu1014]

Thank you so much!

[@martinromocubero4114]

I am little obsessed/worried with this. I was diagnosed with this tumor almost two years ago. It was located in my inside a nerve of my mouth, right in front of my teeth (down-left section). At one point it was of the size of an Olive and it was growing quite fast. After removing it, I had to do some other checks as I still feel that I've got a lump inside. It's smaller than the other but about 3-4mm size. I have done a magnetic resonance to see if there's something bad there, but the results reflect that there aren't any pathological alterations, I should be "good"... more than a year has passed and the wound is more than closed, but I still feel pain from time to time in this zone, like if that lump got bigger or a sensation like if the fibrosis expands through the mouth's wall... medic says that it's the scar of the intervention that will make me feel like that and have that sensation that would not disappear never. I am really obsessed with the idea that this cause more problems in the future regarding the mouth :( Could this kill me or cause me any disease in the mouth/face in long term basis?

[@JMGardnerMD]

I’m sorry to hear of your worry. I can’t give you official medical advice since I’m not your doctor and you are not my patient. But I can tell you some general info for educational purposes. Perineurioma is a benign tumor. It may occasionally grow back but it does not spread or cause death to my knowledge. Surgery To remove any mass Will leave behind a scar and sometimes scars can be a bit lumpy. Also, surgery that involves or cut through a nerve may cause long term nerve related symptoms in that area like pain numbness or unusual sensation. Please be sure to discuss your concerns with your doctor. If you still feel concerned, you may also consider seeking a second opinion. Sometimes that can help put one’s mind at ease when multiple different doctors are saying the same thing. Best wishes to you for health and peace of mind.

[@martinromocubero4114]

@@JMGardnerMD Jerad, thanks a lot for your response. It's all about the lumpy scar and the strange sensations on the nerves, you nailed it. Probably I'm just scared and I shouldn't be like this. I'll have a check in some months, I'll ask my medic about all of this. Again, thanks! really appreciated.

[@truthrock4783]

Thanks a lot. Nice lecture

[@johnfazio2892]

Great discussion of perineurioma and differential dx

[@amandaireland7547]

Thank you very much for this! It is probably way too late now ( since this talk is 2 years old) but our local soft tissue specialist harps on about concentrated EMA for perimeurioma. Is that what you use?

[@JMGardnerMD]

I don’t know actually. I’ve never heard about this. Do you know what concentration he uses? Maybe that’s why I have trouble with getting EMA to stain perineurioma. I might need to revalidate a higher concentration of antibody specifically for perineurioma. Thanks for this tip! If you can get any details for me I’d appreciate it! 🙏🏻

[@orchidbonsai8360]

Jerad Gardner, MD oh yeah no problem I’ll ask him.

[@amandaireland7547]

Jerad Gardner, MD I have sent you a message on twitter as it is a bit of an essay! Hope this helps’

[@aliceroberts7437]

Fabulous Jerad!

[@goharrehman7710]

please say about the IHC in each case

[@JMGardnerMD]

The video explains immunostains for perineurioma. Also see the links in the video description for more info.

[@أحمديوسفجواد]

Thank you Dr jared gardner i really enjoyed, please can you make a video about trichoblastic tumours, thanks again

[@goharrehman7710]

how to use the condenser what is

[@znrsmsaa3655]

Great thanks 🙏🏻

[@laboratoriopatologiaestudi8886]

Excelent viewpoint for me

[@laboratoriopatologiaestudi8886]

From Mexico l send a big huge

[@rymahamoudi2692]

Thank you so much.

[@sarfraz151]

excellent Gerad!

[@arahmanabdelrahman6661]

Hello I wish if you can do a video on soft tissue tumors immunohistochemistry

[@JMGardnerMD]

I usually cover IHC findings for each soft tissue tumor in their respective videos. ie MPNST, synovial sarcoma, perineurioma etc.

[@rosalie3999]

I actuly was just diagnosed with this on my tongue.

[@khaled_osman]

got this on my peroneal nerve. it caused nerve damage, numbness & footdrop for a year & a half now, took me that long, 2 different hospitals in Germany and 2 surgeries to even diagnose it because I was hearing different things everytime I go to a doctor or do an MRI or ultrasound. I heard neuroma then after first surgery "fibrosis only, no evidence of tumor" then neurofibroma then schwannoma then finally Perineurioma after my second surgery 2 weeks ago. They said they can't dissect or take it out without damaging the nerve so they only did an "epineurotomy" and took out what they could.

[@goharrehman7710]

hi sir you work with Leica Please teach every in immunostain someone shown me a list of stains please on the Immuno stain

[@siavashghaderisohi7544]

Wonderful

[@tinocasadeitherezo6063]

Don't you think perineurioma is the "meningioma" of the skin? To me they are quite similar! Thank you.

[@arnabbiswas9461]

My Newrofribama problem any titmant please sir tell me please 😭

[@lal6996]

baklava🤤😂thank you for another awesome video!

[@LaurenLillianHaggerty]

I was a musician, and we found an Intraneural Perineurioma in my left median nerve. It's completely ruined my ability to play guitar, piano, drums, but thankfully I can still sing. It's just under my carpal tunnel, but more on the hand side. So in a extremely compact area. Inoperable. Nice to know my Perineurioma is considered 'beautiful' lol

[@JMGardnerMD]

I’m so very sorry to hear this. Usually these tumors are in soft tissue and have an excellent prognosis, but I can see how in very rare cases of intraneural perinerioma like yours they could cause great pain and suffering. I must honestly admit that I do find beauty in the patterns I see in tumors under the microscope and that I am fascinated with disease particularly rare tumors. I try to harness these emotions to help me learn more, teach more, and provide better care for my patients each day. But at the same time I hate that patients suffer from diseases and I wish we could prevent or cure all of them. Working with rare tumor patients has totally changed my life (my TED talk about working with rare cancer Facebook patient groups: kzbin.info/www/bejne/b5K0hKCuZaZqpsk ). I care very deeply for what patients endure with their disease and would never wish to trivialize their pain. Please forgive me if my words were hurtful. I did not intend them that way. My best wishes to you for health and healing.

[@LaurenLillianHaggerty]

@@JMGardnerMD No not at all! I never took offense at all. It is very pretty on the slides you've shown! I had a biopsy surgery in 2012 after a year of diagnostic testing, MRI's, Ultrasounds. Before it, I was asked to sign paperwork to allow photographs to be taken during as my surgeon hadn't seen it before. Every follow up appointment I had was a show and tell, lots of students taking a look and learning. I find it great. I love being able to use it as a way to teach. I also have a suspected connective tissue disorder, so I wonder if my slides would look different in any way from the ones you showed. Thank you for sharing your content. I find it absolutely fascinating to see what has been apart of me for a long time now. I wish I could've seen my scans etc. If it weren't from my circumstances over the years, I would've loved to have gone into the medical field, but if my body can be involved by being used as a teaching tool, that'll be more than enough for me. :)

[@JMGardnerMD]

I was feeling so crushed that I had offended a patient with my words. Your reply makes me feel so much better...thank you! Yes, perineurioma is rare but the intraneural form is even more so. I've only seen a few of the intraneural type and rare tumors are my specialty. By connective tissue disorder do you mean lupus erythematosus or something similar? If so, I doubt your tumor would look different under the microscope. Connective tissue diseases like lupus can show a variety of different changes in the skin as well as various internal organs. But I haven't noticed them causing any change in microscopic appearance of tumors that I can think of. Thank you so much for sharing your story. Patient stories teach me so much, give me greater empathy and compassion, fuel my drive to work harder and practice at the cutting edge of my ability, and remind me daily why I became a doctor in the first place. All my best wishes to you. Please let me know if I can be of any help now or in future. Jerad

[@LaurenLillianHaggerty]

@@JMGardnerMD Well, my diagnosis at the moment is Hypermobility type Ehlers-Danlos Syndrome, pending genetic testing. That's another reason why I struggle to deal play my instruments anymore. I have muscle atrophy in my hand where the tumor is which, when paired with the hypermobile joints causes my thumb to dislocate a lot. It's hard to know where some of the symptoms come from, such as the pins and needles, and the bloodflow issues. My thumb and index finger on that side are often very cold and I struggle to keep them warm. The body is an odd thing. Lol