Skidmore R A, Woosley J T, Tomsick R S
Department of Dermatology, University of North Carolina, Chapel Hill 27599, USA.
Dermatol Surg. 1996 Nov;22(11):969-71.
Mohs micrographic surgery maximizes the potential for complete tumor removal with normal tissue preservation through the histologic examination of all tissue margins. One component of the histologic examination is the evaluation of excised nerves for the presence of tumor infiltration. During such an evaluation, a subperineurial structure was noted.
Further investigation displayed a discrete, loosely textured, cell-sparse, whorled, subperineurial structure that invaginated into the peripheral nerve. Inflammation was absent and the nuclei were monomorphous. These findings are those seen with Renaut bodies.
Renaut bodies are found at sites of nerve compression. Mechanical factors are thought to play a major role in pathogenesis. Cells comprising the Renaut body are fibroblasts of perineurial origin with the extracellular matrix comprised of collagen fibrils, basal lamina material, and oxytalan filaments. Renaut bodies are important insofar as the surgeon must recognize that they are benign. Histologic characteristics that differentiate Renaut bodies from malignant neurotropic infiltration are: (a) a cell-sparse mass, (b) absence of nuclear atypia, (c) less than expected inflammatory infiltrate, and (d) well-defined borders.
莫氏显微外科手术通过对所有组织边缘进行组织学检查，最大限度地提高了完整切除肿瘤并保留正常组织的可能性。组织学检查的一个组成部分是评估切除的神经是否存在肿瘤浸润。在这样的评估过程中，发现了一种神经束膜下结构。
进一步研究显示，有一种离散的、质地疏松、细胞稀疏、呈漩涡状的神经束膜下结构，它向周围神经内凹陷。无炎症，细胞核形态单一。这些发现符合勒诺体所见。
勒诺体见于神经受压部位。机械因素被认为在发病机制中起主要作用。构成勒诺体的细胞是神经束膜来源的成纤维细胞，细胞外基质由胶原纤维、基膜物质和弹力纤维丝组成。勒诺体很重要，因为外科医生必须认识到它们是良性的。将勒诺体与恶性亲神经浸润区分开来的组织学特征有：（a）细胞稀疏团块；（b）无核异型性；（c）炎症浸润少于预期；（d）边界清晰。
