Hybrid tumors with perineurioma components: a systematic review of the literature and illustrative case

Acta Neurochir (Wien). 2023 Apr;165(4):935-945. doi: 10.1007/s00701-022-05413-5. Epub 2022 Nov 18.


Purpose: Hybrid peripheral nerve sheath tumors (HPNST) are a newly recognized class of peripheral nerve sheath tumor, composed of at least two areas characteristic of perineurioma, schwannoma, or neurofibroma. The literature consists only of case reports and small series; therefore, we present an illustrative case and an analysis of all reported cases of HPNST with a perineurioma component in the literature.

Methods: A systematic search of the literature was performed to identify all reported cases of hybrid perineurioma-schwannoma or perineurioma-neurofibroma in the world's literature. Individual cases were analyzed for demographics, clinical features, imaging, and outcomes.

Results: A total of 159 cases were identified across 41 studies. Hybrid tumors tended to present in mid-adulthood (median 38.5 years), predominantly affected females (57%, 89/156), as a painless (63%, 63/100) mass, or swelling. Ten patients (10/74, 14%) had a history of neurofibromatosis 1, and 2 patients a history of neurofibromatosis 2 (2/74, 3%). The majority (78%, 122/157) of cases occurred superficially, most commonly in the lower extremity (25%, 39/157). Perineurioma-schwannoma was the most reported (86%, 137/159) pathologic diagnosis, with 3 cases presenting with malignant features. Two cases reocurred after resection.

Conclusion: HPNST tend to occur in mid-adulthood and present as slowly progressive, painless, superficial masses, with a heterogeneous appearance on imaging. These entities pose a unique diagnostic challenge and likely remain under-recognized in the literature and current clinical practice. They pose low risk of recurrence or malignant transformation, and future work regarding the association with neurofibromatosis and genetic profiles is needed.

Keywords: Hybrid tumor; Neurofibroma; Perineurioma; Peripheral nerve sheath; Schwannoma.

Publication types

  • Systematic Review
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Humans
  • Nerve Sheath Neoplasms* / diagnostic imaging
  • Nerve Sheath Neoplasms* / surgery
  • Neurilemmoma* / diagnostic imaging
  • Neurilemmoma* / surgery
  • Neurofibroma* / diagnostic imaging
  • Neurofibroma* / surgery
  • Neurofibromatosis 1*
  • Neurofibromatosis 2*