Expert: Neha Dahiya MD - 7/10/2009

Question
I recently had a full excision of a growth on my forehead. The most recent
pathology report follows. Could you please help me understand what this
means? What may have caused this? Could it spread? I understand that I now
have to go back for further excision. On a previous punch biopsy report, the
diagnosis  was: Neuroma with areas of neurofibroma with focal moderate
cytologic atypia.

Site of specimen: Forehead
Clinical Impression: Re Exc
Gross Description 22X12X6 mm exc

At the center of the specimen, there is a recent scar and a foreign body
granuloma. At the periphery and base, there is a residual proliferation of
spindle-shaped cells arranged as fascicles, predominantly around small and
medium sized blood vessels. The cells have oval to slender nuclei with fine
chromatin pattern and scanty cytoplasm. There are deposits of connective
tissue mucin between the cells. Mitotic figures are not apparent in these
sections.

DIAGNOSIS: SCAR AND RESIDUAL SPINDLE-CELL NEOPLASM

Note: Immunostains for a panel of mesenchymal markers are being done to
better define the lesion. The neoplasm extends to the lateral margins of the
excision.

Answer
Hello Jerry:

Neurofibroma and neuroma are  benign tumors of the peripheral nerves.
These are composed of spindle shaped cells. The cell of origin or their cause of occurrence is not known.

Neurofibromas require complete excision. Even if few cells are left behind the lesion can recur. It does not spread to other locations. However if there is a genetic predisposition multiple neurofibromas can arise in different locations.

On the biopsy they are not able to characterize the specif tumor as there are many times of tumors of nerve origin.

However, by the report this is most likely a benign lesion.