The Spread of Soft-Tissue Sarcomata of the Extremities Along Peripheral-Nerve Trunks

¹ Sections of Orthopaedic Surgery and Surgical Pathology, Mayo Clinic and Mayo Foundation, Rochester

In thirty-eight of ninety-eight amputated extremities, the following evidence of a pathological relationship between sarcomata and peripheral nerves was found: adherence of the nerve to the tumor, thirteen cases; displacement of the nerve by the tumor, four cases; passage of the nerve through the tumor, eleven cases; and invasion of the nerve by the tumor, ten cases. Microscopic study revealed that the tumor had infiltrated the epineurium in seven extremities and that it had infiltrated the epineurium and spread along the nerve in the epineural connective tissue for varying distances in four extremities. Thus, in eleven of ninety-eight extremities the tumor had invaded peripheral nerves. Metastasis to the regional lymph nodes had occurred in twelve of the extremities (as evidenced by the case records alone).

Fifty of the ninety-eight patients had complained of neurological symptoms, such as pain or numbness, but in only twenty-three instances was it possible to explain these complaints on the basis of gross and microscopic findings.

The results of this study suggest the following conclusions:

1. Invasion of peripheral nerves by soft-tissue sarcomata of the extremities is fairly commous.

2. Invasion of peripheral nerves by soft-tissue sarcomata seems to be confined mainly to the epineural connective tissue; the nerve bundles and the perineurium apparently resist invasion.

3. Soft-tissue sarcomata that invade the epineural connective tissue of peripheral nerves may spread along this tissue.

4. In cases in which there is pathological involvement of the peripheral nerve by a soft-tissue sarcoma, there may or may not be associated symptoms and signs.

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