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Imaging of non-neurogenic peripheral nerve malignancy—a case series and systematic review

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Abstract

Objective

To evaluate the frequency, clinico-pathologic and imaging features of malignant tumors in peripheral nerves which are of non-neurogenic origin (non-neurogenic peripheral nerve malignancy—PNM).

Materials and methods

We retrospectively reviewed our pathology database for malignant peripheral nerve tumors from 07/2014–07/2019 and performed a systematic review. Exclusion criteria were malignant peripheral nerve sheath tumor (MPNST). Clinico-pathologic and imaging features, apparent diffusion coefficient (ADCmin), and standard uptake values (SUVmax) are reported.

Results

After exclusion of all neurogenic tumors (benign = 196, MPNST = 57), our search yielded 19 non-neurogenic PNMs (7%, n = 19/272), due to primary intraneural malignancy (16%, n = 3/19) and secondary perineural invasion from an adjacent malignancy (16%, n = 3/19) or metastatic disease (63%, n = 12/19). Non-neurogenic PNMs were located in the lumbosacral plexus/sciatic nerves (47%, n = 9/19), brachial plexus (32%, n = 6/19), femoral nerve (5%, n = 1/19), tibial nerve (5%, n = 1/19), ulnar nerve (5%, n = 1/19), and radial nerve (5%, n = 1/19). On MRI (n = 14/19), non-neurogenic PNM tended to be small (< 5 cm, n = 10/14), isointense to muscle on T1-W (n = 14/14), hyperintense on T2-WI (n = 12/14), with enhancement (n = 12/12), low ADCmin (0.5–0.7 × 10–3 mm2/s), and variable metabolic activity (SUVmax range 2.1–13.1). A target sign was absent (n = 14/14) and fascicular sign was rarely present (n = 3/14). Systematic review revealed 89 cases of non-neurogenic PNM.

Conclusion

Non-neurogenic PNMs account for 7% of PNT in our series and occur due to metastases and primary intraneural malignancy. Although non-neurogenic PNMs exhibit a non-specific MRI appearance, they lack typical signs of neurogenic tumors such as the target sign. Quantitative imaging features identified by DWI (low ADC) and F18-FDG PET/CT (high SUV) may be helpful clues to the diagnosis.

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Authors and Affiliations

  1. The Russell H. Morgan Department of Radiology & Radiological Science, The Johns Hopkins Medical Institutions, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Rodrigo Luna, Laura M. Fayad & Shivani Ahlawat

  2. Division of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Laura M. Fayad

  3. Division of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Laura M. Fayad & Fausto J. Rodriguez

  4. Division of Ophthalmology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Fausto J. Rodriguez

  5. Division of Pathology - Neuropathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Fausto J. Rodriguez

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  1. Rodrigo Luna
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Correspondence to Shivani Ahlawat.

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Shivani Ahlawat has received support from Department of Defense 2018–2023 and Pfizer (2017–2018). Laura M. Fayad has received support from GERRAF 2008–-10 and Siemens 2011–12. There is no conflict of interest.

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Luna, R., Fayad, L.M., Rodriguez, F.J. et al. Imaging of non-neurogenic peripheral nerve malignancy—a case series and systematic review. Skeletal Radiol 50, 201–215 (2021). https://doi.org/10.1007/s00256-020-03556-z

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  • DOI: https://doi.org/10.1007/s00256-020-03556-z

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