The immunohistochemical demonstration of early perineurial change in the development of localized hypertrophic neuropathy.

A case of localized hypertrophic mononeuropathy was studied by electron microscopy and immunohistochemistry for S100 protein, epitopes recognized by the Leu-7 monoclonal antibody, 200 kD neurofilament polypeptide, and the epithelial membrane antigen (EMA). The primary role of perineurial cell proliferation without the participation of Schwann cells in this process was directly demonstrated by EMA immunohistochemistry. Focal delamination of the EMA-positive perineurium, increased fibrosis between its layers, and compartmentalization of the fascicles by EMA-positive septae were the first recognizable changes. In practice, recognition of these early changes by EMA immunocytochemistry may be important for the clear definition of functionally unimpaired segmental margins for excision and graft implantation, and also for the future study of the process responsible for aberrant perineurial proliferation.