Emma Children's Hospital, Amsterdam UMC, University of Amsterdam & Vrije Universiteit Amsterdam, Department of Pediatric Surgery, Amsterdam, The Netherlands.
Department of Neuropathology, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
J Pediatr Surg. 2020 Dec;55(12):2783-2786. doi: 10.1016/j.jpedsurg.2020.01.060. Epub 2020 Feb 22.
Anterior cutaneous nerve entrapment syndrome (ACNES) has been described as a possible cause for chronic pain in the pediatric population. However, the exact pathophysiology of ACNES is unknown. It may be caused by compression or traction of cutaneous nerve branches of intercostal nerves, or it may be the result of an infection. Therefore, we present histopathological evidence to determine the pathophysiology of ACNES.
A total of seven pediatric patients underwent a neurectomy for ACNES. All specimens were sent for histopathological evaluation, including immunohistochemical staining, to evaluate if there were any signs of infection, inflammation or compression.
Seven out of seven (100%) histopathological specimens showed non-specific nerve degeneration. Immunohistochemical evaluation showed there were several CD68-positive macrophages present in the specimens. Four out of seven (57%) specimens showed the presence of a few CD3-positive T-cells, however, this was not suggestive for inflammation or infection.
Our study supports the hypothesis that ACNES is caused by compression of the nerves rather than inflammation.
III.
前皮神经卡压综合征（ACNES）已被描述为小儿慢性疼痛的可能原因。然而，ACNES 的确切病理生理学尚不清楚。它可能是由肋间神经皮支的神经分支受压或牵拉引起的，也可能是感染的结果。因此，我们提出组织病理学证据来确定 ACNES 的病理生理学。
共有 7 名小儿患者因 ACNES 接受神经切除术。所有标本均进行组织病理学评估，包括免疫组织化学染色，以评估是否有任何感染、炎症或压迫的迹象。
7 例（100%）组织病理学标本均显示非特异性神经变性。免疫组织化学评估显示标本中存在多个 CD68 阳性巨噬细胞。7 例中有 4 例（57%）标本显示有少量 CD3 阳性 T 细胞，但这并不提示炎症或感染。
我们的研究支持 ACNES 是由神经受压而不是炎症引起的假设。
III 级。
