Cervix
Benign / nonneoplastic epithelial lesions
Traumatic neuroma
Authors: Yang Hu, M.D., Ph.D., Xiaoming Zhang, M.D.
Editorial Board Member: David B. Chapel, M.D.
Deputy Editor-in-Chief: Gulisa Turashvili, M.D., Ph.D.
Last author update: 20 March 2025
Last staff update: 20 March 2025
Copyright: 2007-2025, PathologyOutlines.com, Inc.
PubMed Search: Traumatic neuroma
Table of Contents
Definition / general | Essential features | Terminology | ICD coding | Epidemiology | Sites | Pathophysiology | Etiology | Clinical features | Diagnosis | Prognostic factors | Case reports | Treatment | Gross description | Microscopic (histologic) description | Microscopic (histologic) images | Positive stains | Negative stains | Sample pathology report | Differential diagnosis | Additional references | Board review style question #1 | Board review style answer #1Cite this page: Hu Y, Zhang X. Traumatic neuroma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/cervixtraumaticneuroma.html. Accessed April 1st, 2025.
Definition / general
- Nonneoplastic, reparative proliferation of nerve components at a site of prior traumatic injury of the peripheral nerves
Essential features
- Disorganized proliferation of nerves due to the cell's inability to self repair in response to injury or surgery
- Often occurs after surgical interventions or childbirth
- Morphologically characterized by a haphazard proliferation of normal nerve components, including axons, Schwann cells and perineurial cells within a mature collagenous scar
Terminology
- Amputation neuroma
ICD coding
Epidemiology
- Rare complication occurring at the site of surgical interventions or childbirth
- Microneuromas present in 55% of hysterectomy patients in a study of 300 hysterectomy specimens and is correlated with childbirth (Histopathology 1996;28:153)
- Less likely in younger women without a history of childbirth or uterine surgery
Sites
- Occurs at injury or scar sites caused by surgical interventions or childbirth
- Examples include uterine cervix, vulva, perineum, clitoris and myometrium
Pathophysiology
- Interruption in continuity of nerve due to injury causes Wallerian degeneration (loss of axons in proximal stump and retraction of axons in distal segment), resulting in exuberant regeneration of nerve components including neurons, Schwann cells, axons and fibrous cells (Brain Pathol 1999;9:313)
Etiology
- Almost always limited to injury caused by surgical interventions, cone biopsy of uterine cervix, colporrhaphy, episiotomy and deep endometrial ablation for abnormal uterine bleeding or lacerations due to childbirth
- Generally arises between 1 and 12 months after nerve injury (J Minim Invasive Gynecol 2019;26:1219)
- Microneuromas can rarely occur without known injury (Histopathology 1996;28:153)
Clinical features
- Most reported cases present with burning pain and sometimes with an associated scar or nodule (Arch Pathol Lab Med 1989;113:945, Obstet Gynecol 2006;108:809, Geburtshilfe Frauenheilkd 1996;56:566, Hum Pathol 2017;67:211)
- Pain can be either intermittent or constant and is often worsened by anything that further compresses the nerves within the neuroma
- Pain can have a wide range of time to presentation, from 1 month to many years after initial injury
Diagnosis
- Direct visualization of scar / nodule at the site of injury during speculum assisted pelvic exam
- Painful scar site by digital exam (Obstet Gynecol 2006;108:809)
- Can be incidental due to laparoscopy for endometriosis (Journal of Endometriosis and Pelvic Pain Disorders 2019;11:49)
Prognostic factors
- Favorable prognosis and resolution of painful symptoms after surgical resection of scar / nodule
Case reports
- 32 year old woman with posterior colporrhaphy and vaginal pain after scar tissue formation (Obstet Gynecol 2006;108:809)
- 40 year old woman with previous conization for cervical squamous intraepithelial neoplasia (Arch Pathol Lab Med 1989;113:945)
- 42 year old woman with a chronic vulvar nodule 10 years following a Bartholin gland excision (Journal of Endometriosis and Pelvic Pain Disorders 2019;11:49)
- 43 year old woman with pain at scar site 24 years following mediolateral episiotomy (Geburtshilfe Frauenheilkd 1996;56:566)
- 47 year old woman with pain at scar site 5 years following endometrial ablation for abnormal uterine bleeding (Hum Pathol 2017;67:211)
Treatment
- Typically managed conservatively with topical anesthetics, local analgesic blocks, opioids or antidepressant medications (Obstet Gynecol 2006;108:809)
- Surgical management can be considered as an alternative if conservative management fails
Gross description
- Firm, gray, nodular or irregular lesion near margin or scar of surgical procedure, such as cone biopsy
- Typically < 1 - 2 cm
Microscopic (histologic) description
- Nonencapsulated, haphazard arrangement of small nerve fascicles containing axons, Schwann cells and an enveloping perineurium within a mature collagenous scar with entrapped smooth muscle
- May also present as a nerve proliferation surrounded by dense fibrocollagen tissue (Rom J Morphol Embryol 2005;46:239)
Microscopic (histologic) images
Contributed by Xiaoming Zhang, M.D.
Focal disordered proliferation of nerve twigs
Nonencapsulated nerve bundles
Haphazard arrangement
S100
EMA
CD34
Positive stains
- S100 / SOX10: positive in the Schwann cells (Am J Surg Pathol 2015;39:826)
- CD34: positive in the endoneurium (Ann Anat 2017;211:55)
- EMA and GLUT1: highlight the perineurium (Mod Pathol 2003;16:293)
- Neurofilament (NF): highlights the axons within the nerve fascicles (Brain 2020;143:1975)
Negative stains
Sample pathology report
- Cervix, biopsy:
- Consistent with traumatic neuroma (see comment)
- Comment: Histologic sections show fragments of squamous mucosa with focal disordered proliferation of nerve twigs of various sizes that are highlighted by an S100 stain. An EMA stain highlights associated perineurium. These findings are compatible with a traumatic neuroma in the appropriate clinical context. No dysplasia or malignancy is seen. Clinical correlation is required.
Differential diagnosis
- Neurofibroma:
- No history of surgery or childbirth
- More common in patients with neurofibromatosis type 1 (NF1) (Obstet Gynecol 1996;88:699)
- Bundles of monomorphic, comma shaped nuclei with interspersed collagen bundles
- Plexiform neurofibromas have been rarely reported in the uterine cervix and have encapsulated irregularly expanded nerve bundles with nodular appearance and include the presence of transformed Schwann cells
- Schwannoma:
- No history of surgery or childbirth
- Encapsulated, well circumscribed biphasic proliferation of spindle cells with extensive nuclear palisading; both Antoni A and Antoni B areas are commonly seen
- Scar / adhesion:
- Typically found with traumatic neuroma
- No neural tissue present
Additional references
Board review style question #1
A 45 year old woman with a remote history of cervical conization for high grade squamous intraepithelial neoplasia (HSIL) presents for biopsy of an 8 mm, painful, irregular lesion at the scar site of the previous procedure. Immunohistochemistry performed on sections of the lesion would most likely show positive staining of which of the following markers?
- Desmin and cytokeratins
- Desmin and SMA
- ER and CD10
- p63 and p16
- S100 and CD34
Board review style answer #1
E. S100 and CD34. The provided history is most consistent with a diagnosis of a traumatic neuroma (given the previous surgical history and small, painful lesion at the site of scar formation) and therefore involves the nerve. S100 will show cytoplasmic and nuclear staining of Schwann cells in the nerve while CD34 will show positive staining of the endoneurium. Answer D is incorrect because p63 and p16 are negative in nerves but would be positive in the patient's HSIL prior to resection. Answer C is incorrect because ER is negative in nerve but would be positive in endometrial glands and stroma of endometriosis, which can also cause pain clinically but is typically found in multiple locations and not limited to only one focus. Answer B is incorrect because desmin and SMA are both negative in nerve but would be positive in smooth muscle tumors like leiomyomata, which can also cause pain clinically but typically are found in the myometrium and are larger in size. Answer A is incorrect because desmin and cytokeratins are both negative in nerve but would be positive in cervical polyps, which are typically associated with abnormal uterine bleeding.
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Reference: Traumatic neuroma
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Reference: Traumatic neuroma
