John Hunter's MSK Teaching File
Interesting MRI Cases from University of Washington Department of Radiology

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Case 22c Discussion

Neurilemoma. The proximity to the joint would raise the possibility of a ganglion on the non-contrast images, even though the increased signal intensity on the T2 weighted images is inhomogeneous. Debris in a cystic mass could give this appearance. The post-gadolinium images confirm that this is a solid mass and rules out the diagnosis of a fluid filled mass.

Neurilemoma is a benign peripheral nerve sheath tumor that arises from the nerve sheath. It is also known as a schwannoma or neurinoma. They tend to occur in the flexor aspect of the extremities. Unlike a neurofibroma, it tends to have two well defined zones: a central zone of compact spindle cells (Antoni A area) and a peripheral loose myxoid area (Antoni B area). On T2 or STIR MR images, the relatively hypointense central area and the more hyperintense peripheral area may reflect these zones.

Case 22c: Another Neurilemoma