NEUROMA

Synonyms.—Nerve tumor; Fr., Névrome; Ger., Neurom; Nervenschwamm.

Definition.—Neuroma of the skin is characterized by the for­
mation of variously sized, usually numerous, firm, immovable, and
elastic fibrous tubercles containing new nerve-elements, and accom­
panied by violent paroxysmal pain. It is an exceedingly rare disease,
and up to the present time but few cases in which the skin was primarily
affected have been reported; one of these was by Duhring¹ and another
by Kosinski.² According to Duhring, the subcutaneous nodule of Wood,
resembling neuroma closely, differs in being situated in the subcutaneous
tissue, is always freely movable under the skin, and is solitary. This and
other cases of subcutaneous neuromatous tumors are not, strictly speak­
ing, cutaneous growths, although they are usually so considered in the de­
scription of the disease. Nor is Rump’s case,³ sometimes quoted, a clear
example of the malady, consisting essentially of a fibroid tumor of the
nerve (false neuroma of Virchow), and was not accompanied by pain.

In Duhring’s case, a man of seventy, the disease began at the age
of sixty in the form of small, rounded nodules or tubercles upon the
shoulder. For a period of four years they continued to appear in in­
creasing numbers, the arm and shoulder becoming fairly well covered
with them. The lesions consisted of numerous small, firm, flat tubercles,
the size of a split pea, situated on the left scapular region, shoulder,
and outer surface of the arm to the elbow. The color of the tubercles
was purplish or pinkish, and they were irregularly distributed, apparently
without regard to the course of the nerve. Over the shoulder and arm
they were closely packed together and firmly imbedded in the skin.
The integument covering the growths was slightly scaly. The skin
between the tubercles was normal. The color of the affected area
varied, however, according to the position of the limb and the presence
or absence of pain, becoming hot and violaceous when painful. The
tumors did not give rise to any discomfort until several years after the
beginning of the affection, after which pain then became a troublesome
symptom, and occurred in paroxysms, and was of a violent character,
radiating down the arm, across the chest, and up the side of the neck and
head. The paroxysms generally lasted for an hour, and were aggravated
by exposure to cold air, mental emotion, or movements. In Kosinski’s
case, a male aged thirty, the disease appeared when sixteen years of age.

¹ Duhring, “Case of Painful Neuroma of the Skin,” Amer. Jour. Med. Sci., Oct.,
1873, and Oct., 1881.

² Kosinski, “Neuroma Multiplex,” Centralbl. f. Chirurgie, No. 16, 1874, p. 241.

³ Rump, Arch. Path. Anat., 1880, vol. lxxx, part i, p. 177.

RHINOSCLEROMA

705

The lesions were situated on the posterior and external aspect of the
right thigh and a portion of the buttock, and numbered about one hun­
dred. Pain was quite marked, and the lesions were exceedingly sensitive
when subjected to pressure.

Etiology and Pathology.—As already stated, true cutaneous
neuroma is rare, and in the broadest application of the term the malady
is not common. It usually develops in adult life. The cause is unknown.
It is not improbable that traumatism and irritation play a rôle in its
production. Virchow believes that tuberculous patients are more prone
to them. A family tendency has been noted. Histologically the growth
is found seated in the corium, extending into the deeper structures. Upon
examination it is seen to be made up of firm connective tissue containing
non-medullated nerve-fibers, running up as high as the papillary layer
of the corium, blood-vessels, and lymphoid cells, constituting true
neuroma amyelinicum (Virchow) of the skin. They are in reality fibro-
neuromata. In the diagnosis the aid of the microscope in determin­
ing the exact nature of the growth may have to be resorted to, as it bears
a close clinical resemblance to myomata, and this is especially so in some
cases of the latter, as Hardaway’s.¹

The treatment is purely surgical, consisting of excision of a portion
of the nerve-supply. In Duhring’s case resection of a part of the brachial
plexus relieved the pain markedly and the growths diminished in size.
In Kosinski’s case removal of a portion of the small sciatic nerve was
followed by immediate cessation of pain and almost entire disappearance
of the tumors.

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