Are preoperative complete blood count parameters in peripheral nerve sheath tumors useful diagnostic tools?

Objectives: This study aims to evaluate the diagnostic value of complete blood count (CBC) parameters in patients with peripheral nerve sheath tumors (PNSTs). Patients and methods: A total of 181 patients (83 males, 98 females; median age: 44 years; range, 15 to 83 years) who underwent surgical treatment for PNSTs in our tertiary oncology center between January 2010 and December 2019 were retrospectively analyzed. Eighty-two patients were diagnosed with a neurofibroma, 79 with a schwannoma, and 20 with a malignant PNST (MPNST). The patient group was evaluated as malignant (n=20) and benign (n=161). Age- and sex-matched patients admitted to our outpatient clinic of orthopedic and traumatology with non-specific symptoms other than tumor, infection, fracture, and rheumatological or hematological diseases were included as the control group (n=165). Data including age, sex, definitive histopathological diagnosis, and pre-treatment CBC values were obtained from the hospital records. Pre-treatment CBC values such as neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and lymphocyte-to-monocyte ratio (LMR) were calculated for both malignant and benign groups and control groups. Diagnostic values of NLR, PLR, and LMR between PNST groups were assessed using the receiver operating characteristic (ROC) curve analysis. Results: Neurofibroma, schwannoma, and MNPST groups had significantly higher median NLR, compared to the control group (p<0.001), while the median LMR was significantly lower in these groups (p<0.05). However, the median PLR was higher only in the MPNST group, compared to the control group (p<0.001). Post-hoc analyses revealed that median NLR, PLR, and LMR ratios were similar in PNST groups, compared to the control group. In addition, the median NLR, PLR, and LMR ratios were similar between malignant and benign patient groups. The highest area under the curve (AUC) was found for NLR (AUC=0.756) and LMR (AUC=0.716) in the MPNST group. Conclusion: Our study results suggest that NLR, PLR, and LMR may have an added value in the early diagnosis of PNSTs and are valuable for differentiating patients from healthy individuals, although their value in differential diagnosis is still unclear.

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Malignant Peripheral Nerve Sheath Tumor and Hypertrophic Osteopathy in a Bitch

Acta Scientiae Veterinariae ◽

10.22456/1679-9216.100522 ◽

2020 ◽

Vol 48 ◽

Author(s):

Amabile Arruda de Souza ◽

Rubia Avlade Guedes Sampaio ◽

Camila Pereira da Silva ◽

Rafael Lima de Oliveira ◽

Débora Monteiro Navarro Marques de Oliveira ◽

...

Keyword(s):

Peripheral Nerve ◽

Blood Count ◽

Complete Blood Count ◽

Clinical Signs ◽

Surgical Excision ◽

Nerve Sheath Tumor ◽

Peripheral Nerve Sheath Tumor ◽

Peripheral Nerve Sheath Tumors ◽

Mesenchymal Origin ◽

Nerve Sheath

Background: Malignant peripheral nerve sheath tumors (MPNSTs) are rare, aggressive, relapsing, metastatic cutaneous neoplasms of mesenchymal origin. So far, no account on the association of this disease with hypertrophic osteopathy (HO) in dogs is available in the literature. Current theories on the possible causes of HO suggest that this disease may be triggered by a primary neoplasm as well as by its metastasis. The objective of this work is to report the clinical, cytological, radiographic, histopathological, and immunohistochemical aspects of a dog affected by MPNST and HO.Case: A 13-year-old female mongrel dog was presented with a history of ulcerated nodular lesion on the skin of the flank. Several ulcerated and non-ulcerated tumors were observed on the thorax, neck, and head at the physical exam. Cytological examination of the nodules revealed presence of mesenchymal cells with a malignant aspect. Complete blood count revealed anemia. There were no alterations in the biochemical tests performed. Thoracic radiographs showed presence of a nodular interstitial pattern in the cranial, medial, and caudal lobes of the lungs. To improve quality of life of the patient, the veterinary team opted for surgical excision of the tumoral ulcerations. Slight claudication in the pelvic limbs was noticed prior to the surgery. Histopathological analyses of the excised nodules verified the existence of malignant mesenchymal neoplasia, which was categorized as peripheral nerve sheath tumor after immunohistochemical examination. Additional cutaneous tumors emerged after surgical excision, along with increased claudication, edema, and pain in the legs. Complete blood count revealed persistent anemia, lymphopenia, monocytosis, and neutrophilia. Radiographs showed an increase in the number and size of the nodules. Radiography of the limbs showed presence of palisading periosteal reaction, and increased radiopacity and volume in the adjacent soft tissues. Doxorubicin and vincristine were administered, but the patient died one week after commencement of the treatment.Discussion: Cytology suggested presence of a malignant neoplasm of mesenchymal origin, and the histopathological and immunohistochemical exams substantiated the diagnosis of malignant peripheral nerve sheath tumor. Macroscopic and histopathological examinations revealed characteristics similar to those described for MPNST in the literature. Positive immunohistochemical reactions for the markers NSE and CD56 determined the diagnosis of MPNST in spite of being negative for S-100, which could represent a consequence of variability in expression and cell differentiation. MPNST exhibits a variable distribution among breeds; it is more predominant in male and elder dogs. Animals exhibiting neoplastic lesions in the thorax, abdomen, head and neck show a high incidence of metastasis after surgical removal of these lesions. The clinical signs of MPNST were unspecific; the alterations observed in the four limbs were observed concomitantly with the diagnosis of hypertrophic osteopathy (HO), and could be due to this condition rather than MPNSC. Histopathological analysis of the pulmonary neoplasms was not possible. However, there is strong suspicion that the pulmonary lesions were a consequence of MPNSC metastasis, which could be the underlying cause of the reemergence of the cutaneous nodules. We believe that HO was caused by the thoracic tumors because the clinical signs became more intense after the increase in the nodules found in the lungs. The difficult diagnosis of MPNSC could be the reason for this type of tumor is rarely identified. MPNSC should always be included in the differential diagnosis for cutaneous tumors, and the possibility that HO represents a consequence of these tumors should be considered.

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