PMC4899878_01
18-year-old female with intraneural perineurioma. T1W image (A) demonstrates an elongated mass lesion (black arrow) superior to the subclavian artery (white arrow) in the location of the right brachial plexus divisions. STIR image (B) shows increased signal along a segmentally enlarged brachial plexus component (white arrow).
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T2 signal (Fig. 1), and diffuse enhancement (Fig. 2) of the lower trunk of the right brachial plexus extending to the divisions (Fig. 3). The patient underwent a supraclavicular brachial plexus exposure that revealed an enlarged and fibrotic lower trunk (Fig. 4).
18-year-old female with intraneural perineurioma. Sagittal T1-W image (A) at the level of the divisions of the plexus (arrowheads) shows the lesion (black arrow) superior to the subclavian artery (white arrow) and posterior to the subclavian vein (asterisk) involving the lower trunk. Gadolinium-enhanced coregistered T1-W image (B) shows that the lesion is enhancing (arrow). Schematic drawing of the brachial plexus with selected musculoskeletal landmarks (C). The plexus is highlighted in yellow, and the tumor is in highlighted in red. The black arrows indicate the following plexus components: R- the roots forming the plexus (C5-T1), T- the three trunks (upper, middle and lower) found on MRI at the level of the interscalene triangle (between the anterior and middle scalene muscles highlighted in brown), D - divisions (anterior and posterior) found on MRI at the lateral margins of the firs rib (R), C- cords (lateral, posterior and medial) found on MRI at The level of the coracoid process (CO) and B - branches at the level of the axilla. A- acromion, CO- coracoid process, H-humerus.
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T2 signal (Fig. 1), and diffuse enhancement (Fig. 2) of the lower trunk of the right brachial plexus extending to the divisions (Fig. 3). The patient underwent a supraclavicular brachial plexus exposure that revealed an enlarged and fibrotic lower trunk (Fig. 4).
18-year-old female with intraneural perineurioma. Intraoperative image shows an enlarged and fibrotic lower trunk of the brachial plexus (arrowheads) and the normal divisions of the upper trunk (arrow) located deep to the clavicle (asterisk) with the subclavian artery retracted inferomedially.
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T2 signal (Fig. 1), and diffuse enhancement (Fig. 2) of the lower trunk of the right brachial plexus extending to the divisions (Fig. 3). The patient underwent a supraclavicular brachial plexus exposure that revealed an enlarged and fibrotic lower trunk (Fig. 4).
18-year-old female with intraneural perineurioma. Hematoxylin-eosin (H&E) stain displays foci of hypercellularity arranged in a whorl-like formation (onion bulbs).
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The tumor displayed foci of hypercellularity arranged in an "onion-bulb" configuration (Fig. 5).
18-year-old female with intraneural perineurioma. The lesion stains for epithelial membrane antigen (EMA), especially in the onion-bulb formations (arrows).
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Immunohistochemistry of the lesion showed prominent staining for epithelial membrane antigen (EMA), especially within the onion-bulb components (Fig. 6).