Yasuda Emi, Nuri Takashi, Asaka Akinori, Hirose Yoshinobu, Osuga Keigo
Department of Pathology, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
Department of Plastic Surgery, Osaka Medical and Pharmaceutical University, Takatsuki City, Osaka, Japan.
Case Rep Pathol. 2025 Aug 19;2025:3818896. doi: 10.1155/crip/3818896. eCollection 2025.
Intraneural vascular anomalies are rarely encountered specimens as these are not commonly resected. To the best of our knowledge, this is the first report of the histologic findings in an arteriovenous malformation (AVM) within a digital nerve. We report a rare case of an 18-year-old man with a painful mass in the left hand and middle finger who was referred to our hospital for a treatment strategy consultation. According to Schobinger's clinical classification, the patient was diagnosed with Early-Stage 3 AVMs of the left hand and was followed up for approximately 1 year. Due to increasing pain and dark purple discoloration of the finger, the AVM on the left middle finger was removed en bloc, including the skin, subcutaneous fat, and digital nerve, leaving the tendon and the periosteum. Histology revealed the abnormal vasculature of the AVM within the digital nerve and adjacent subcutaneous fibroadipose tissue. Histologically, two patterns of nerve involvement were recognized: arterioles that pushed into the nerve fascicle in a non-destructive manner, compressing the perineurium, and numerous microvessels in the endoneurium surrounded by microvascular proliferation found on the outside of the perineurium. The presence of intraneural abnormal vessels suggested that one cause of AVM pain was neuropathic.
神经内血管异常是很少见的标本，因为这些病变通常不会被切除。据我们所知，这是关于指神经内动静脉畸形（AVM）组织学表现的首次报告。我们报告了一例罕见病例，一名18岁男性，左手和中指有疼痛性肿块，转诊至我院进行治疗策略咨询。根据Schobinger临床分类，该患者被诊断为左手3期早期AVM，并随访了约1年。由于手指疼痛加剧和出现深紫色变色，对左手中指的AVM进行了整块切除，包括皮肤、皮下脂肪和指神经，保留了肌腱和骨膜。组织学检查显示指神经和相邻皮下纤维脂肪组织内AVM的血管异常。在组织学上，识别出两种神经受累模式：小动脉以非破坏性方式挤入神经束，压迫神经束膜，以及神经内膜内有许多微血管，在神经束膜外侧发现微血管增生。神经内异常血管的存在表明AVM疼痛的一个原因是神经性的。
