Zosteriform Palisaded Encapsulated Neuroma: An Unusual Presentation
A 30-year-old female patient presented to us with asymptomatic skin lesions on the face of 4 years duration. These lesions began as pinhead sized elevations and gradually grew in size to the present state. On examination, lesions were multiple, discrete, mostly multi-lobulated, flesh colored, soft to firm, papules, and nodules arranged in a curvilinear fashion on the face [] starting from tip of the nose and gradually deviating to the left along the nose, left eyebrow, and forehead region along the distribution of the ophthalmic division of the trigeminal nerve. There was no accompanying history of hearing defect or other neurological disorders. None of the family members were affected. On thorough cutaneous examination, there was no café au lait macules, axillary freckling or plexiform neurofibromas. Hair nails and mucous membranes were normal. On ophthalmological examination no signs of neurofibromatosis were detected. No other clinical sign suggestive of systemic neurofibromatosis was noted. Routine blood investigations, chest X-ray, ultrasonography of the whole abdomen were normal. Skin biopsy specimen showed a tan granular surface of the base and histopathological examination revealed a normal epidermis. In the dermis, there was a partially encapsulated, well-circumscribed nodule [] composed of fascicles of small spindle cells with wavy nuclei interlaced with small slits and clefts []. There was no nuclear pleiomorphism or mitoses. The tumor cells were positive for S-100 protein []. These findings and the clinical presentation were consistent with a diagnosis of PEN. We had sent the patient to the plastic surgery out patient departmentfor excision of the lesion.