Post-traumatic Neuroma Following Breast Surgery

Ashkar, Laila K.; Ömeroğlu, Atilla; Halwani, Fawaz; AlSharif, Shaza; Loutfi, A; Mesurolle, Benoı̂t

doi:10.1111/tbj.12186

Cited by 16 publications

(7 citation statements)

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“…If a traumatic neuroma occurs in the breast or chest wall after oncologic surgery (breast-conserving surgery or mastectomy), it is difficult to clinically and radiologically differentiate from recurrence of the tumor, and a core needle biopsy or an excisional biopsy must be performed to obtain a pathologic diagnosis. To our knowledge, the imaging findings of traumatic neuroma in the breast or chest wall after surgery have only been described in 21 cases: 20 cases in six reports written in English [2,4,6,8-10], and one case report involving a Korean patient [5]. The majority of the articles were individual case reports.…”

Section: Introductionmentioning

confidence: 99%

Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy

Sung

Kim

2017

Ultrasonography

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PurposeThe purpose of this study was to evaluate the ultrasonographic (US) features of traumatic neuromas in breast cancer patients after mastectomy.MethodsThis study was performed with approval from our Institutional Review Board, and the requirement for informed consent was waived. Six traumatic neuromas in five patients were included in this study. The US findings of traumatic neuromas were evaluated retrospectively by two radiologists according to the Breast Imaging-Reporting and Data System (BI-RADS) lexicon. The final assessment was also recorded.ResultsOn US, all six lesions presented as a mass within the pectoralis muscle layer (mean size, 4.8 mm; range, 3.9 to 5.5 mm). Of the six masses, four had an oval shape with a circumscribed margin, and two had an irregular shape and an indistinct margin. They were all hypoechoic. Two lesions showed a non-parallel orientation. On color Doppler examinations, two lesions showed internal vascularity. Strain elastography was performed for four neuromas, resulting in scores of 1 (n=1), 4 (n=2), and 5 (n=1). The final assessment categories were BI-RADS 3 (n=2), 4A (n=2), and 4B (n=2).ConclusionOn US, an oval shape, circumscribed margin, parallel orientation, and hypoechogenicity were the most frequent features of traumatic neuromas in breast cancer patients after mastectomy. Neuromas may show increased vascularity on color Doppler imaging and present as a hard mass on elastography.

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Section: Introductionmentioning

confidence: 99%

Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy

Sung

Kim

2017

Ultrasonography

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“…Clinically TBN may present as a palpable mass or may be identified incidentally (1,6,10). It is most commonly encountered in the upper outer quadrant of the breast (6,10).…”

Section: Discussionmentioning

confidence: 99%

“…Traumatic neuroma (TN) is a nonneoplastic reactive proliferation of the proximal end of a partially transected or severed nerve as a result of trauma or surgery (1,2). It is a disorganized tangled mass of axons, Schwann cells and perineural fibroblasts that is formed as a result of a failed attempt to reestablish axonal continuity following disruption of neuronal axons (3).…”

Section: Introductionmentioning

confidence: 99%

Traumatic neuroma as a rare cause of intractable neuropathic breast pain following cancer surgery: Management and review of the literature

Salemis¹

2018

IRDR

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Traumatic neuroma of the breast after cancer surgery is a very rare clinical entity with only a few cases having been reported to date. We herein present a very rare case of traumatic breast neuroma in a postmenopausal patient with a history of breast-conserving surgery, who presented with a four-month history of intractable neuropathic breast pain. Diagnostic evaluation and management are discussed along with a review of the literature. Traumatic breast neuromas are very rare benign lesions that have been reported mainly after mastectomy. Our literature review yielded only 35 cases of traumatic breast neuromas in 28 patients, reported so far. Although imaging features may be indicative of a benign lesion, surgical excision is necessary to obtain a definitive diagnosis and to rule out a recurrent breast cancer. Conservative treatment is feasible in properly selected cases with asymptomatic neuromas after an accurate tissue sampling. The case presented herein underlines the necessity to consider traumatic neuroma in the differential diagnosis in patients with a history of breast surgery presenting with refractory neuropathic breast pain. A high index of suspicion is required because the lesion may be too small and can be missed on imaging investigations.

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“…However, in cases of too long distance between two segments of the injured nerve, proximal axons will grow toward multiple directions around so as to find a way for growth; thus, the appearance generally overgrows in bulbous-end-like shape [8], and besides, as nerve tissues grow more slowly than surrounding soft tissues, they will be mixed with other kinds of cells, such as fibroblast and mastocyte [9]. The other one is spindle neuromas, which commonly occur in complete nerves and currently are considered as resulting from chronic stimulation and friction [10]. There is also a report indicating that facial nerve hemangioma also can lead to traumatic neuroma under the condition of no trauma or operation history and no chronic stimulation and compression [4].…”

Section: Reviewmentioning

confidence: 99%

“…Ultrasound image of traumatic neuroma is generally oval, low-echo enclosed mass, clear and irregular probable boundary, diameter being greater than that of nerve trunk, and continuity with nerve [8]. At histopathology, traumatic neuromas generally show in the following appearance: nonencapsulated tangled mass formed by Schwann cell, endoneurial cell, perineurial cell, and surrounding fibroblast [10]. …”

Section: Reviewmentioning

confidence: 99%

Traumatic neuroma of the superficial peroneal nerve in a patient: a case report and review of the literature

et al. 2016

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BackgroundTraumatic neuromas are rare benign tumors, which are common in trauma or post-operation and accompanied with obvious symptoms of pain. This study will show the superficial peroneal nerve neuroma occurring after resection of hemangioma.Case presentation A 44-year-old male had an operation of the right leg cavernous hemangioma resection in 1995. Half a year after the operation, pain around the wound appeared and gradually aggravated. The patient had the lesion exploration resection in 2013, and the pathological result showed traumatic neuroma. Within half a year of the second operation, severe pain showed up again, so neuroma resection proceeded in May 2015. The postoperative pathological and immunohistochemical results showed traumatic neuroma. According to the postoperative follow-up, there were no symptoms of pain appearing again.Literature reviewThe pain is obvious, and B ultrasonography is the most efficient way to find neuromas. Both conservative and operative therapy have their advantages and disadvantages.ConclusionsThere remain many unanswered questions in relation to the treatment of traumatic neuromas, and further research is required, although we have already had adequate understanding of traumatic neuromas.

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Post-traumatic Neuroma Following Breast Surgery

Cited by 16 publications

References 0 publications

Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy

Ultrasonographic features of traumatic neuromas in breast cancer patients after mastectomy

Traumatic neuroma as a rare cause of intractable neuropathic breast pain following cancer surgery: Management and review of the literature

Traumatic neuroma of the superficial peroneal nerve in a patient: a case report and review of the literature

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