Yue John K, Chen Jia-Shu, Elguindy Mahmoud M, Tang Vivian, Tripathy Ryan, Bond Allison R, Aabedi Alexander A, Shah Vinil N, Perry Arie, Bollen Andrew W, Lee Dong Heun, Jacques Line G
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, United States.
Department of Pathology, University of California, San Francisco, San Francisco, California, United States.
J Brachial Plex Peripher Nerve Inj. 2025 Aug 19;20(1):e59-e65. doi: 10.1055/a-2667-7286. eCollection 2025 Jan.
Peripheral nerve masses have a wide differential diagnosis; however, there is no established diagnostic framework for evaluating non-neoplastic etiologies, such as inflammatory or infectious lesions. Here, we present a rare case of an ulnar nerve granuloma that initially mimicked a peripheral nerve sheath tumor (PNST) on imaging and clinical presentation to elucidate the relevant medical history, imaging, and histology that aid in distinguishing inflammatory, infectious, and neoplastic peripheral nerve lesions. An 85-year-old man with melanoma and multiple prior right elbow surgeries presented with right-hand weakness and a rapidly enlarging gadolinium-enhancing ulnar nerve mass suggestive of a PNST that warranted surgical resection. Surgical histology showed a necrotizing granulomatous lesion that then became most concerning for a parasitic infection. However, broad serum and histologic testing by the Centers for Disease Control and Prevention were all ultimately negative. The final diagnosis was an inflammatory reaction to a retained foreign body from his prior elbow surgeries. In summary, surgery and comprehensive histologic workup are required for diagnosing granulomatous peripheral nerve lesions that mimic PNSTs on imaging and infection on histology.
周围神经肿物的鉴别诊断范围广泛；然而，对于评估非肿瘤性病因，如炎症性或感染性病变，尚无既定的诊断框架。在此，我们报告一例罕见的尺神经肉芽肿病例，该病例在影像学和临床表现上最初酷似周围神经鞘瘤（PNST），以阐明有助于区分炎症性、感染性和肿瘤性周围神经病变的相关病史、影像学及组织学特征。一名85岁男性，有黑色素瘤病史且之前多次接受右肘手术，现出现右手无力，以及一个快速增大的、钆增强的尺神经肿物，提示为PNST，需行手术切除。手术组织学检查显示为坏死性肉芽肿性病变，当时最怀疑为寄生虫感染。然而，疾病控制与预防中心进行的广泛血清学和组织学检测最终均为阴性。最终诊断为对其既往肘部手术中残留异物的炎症反应。总之，对于在影像学上酷似PNST且在组织学上疑似感染的肉芽肿性周围神经病变，需要通过手术及全面的组织学检查来进行诊断。
