Neuroma morphology: A macroscopic classification system

Introduction/Aims:

Neuromas come in different shapes and sizes; yet the correlationbetween neuroma morphology and symptomatology is unknown. Therefore, we aimto investigate macroscopic traits of excised human neuromas and assess the validityof a morphological classification system and its potential clinical implications.

Methods:

End-neuroma specimens were collected from prospectively enrolledpatients undergoing symptomatic neuroma surgery. Protocolized images of the speci-mens were obtained intraoperatively. Pain data (Numeric rating scale, 0-10) wereprospectively collected during preoperative interview, patient demographic andcomorbidity factors were collected from chart review. A morphological classificationis proposed, and the inter-rater reliability (IRR) was assessed. Distribution of neuromamorphology with patient factors, was described.

Results:

Forty-five terminal neuroma specimens from 27 patients were included.Residual limb patients comprised 93% of the population, of which 2 were upper(8.0%) and 23 (92.0%) were lower extremity residual limb patients. The proposedmorphological classification, consisting of three groups (bulbous, fusiform, atypical),demonstrated a strong IRR (Cohen's kappa=0.8). Atypical neuromas demonstratedhigher preoperative pain, compared with bulbous and fusiform. Atypical morphologywas more prevalent in patients with diabetes and peripheral vascular disease

Discussion:

A validated morphological classification of neuroma is introduced. Thesefindings may assist surgeons and researchers with better understanding of symptom-atic neuroma development and their clinical implications. The potential relationshipof neuroma morphology with the vascular and metabolic microenvironment requiresfurther investigation.