胃神经鞘瘤31例临床病理学分析

doi:10.16150/j.1671-2870.2021.06.007

摘要/Abstract

摘要：

目的: 探讨胃神经鞘瘤（gastric schwannoma,GS）的临床病理学特征、诊断、鉴别诊断、治疗及预后。方法: 2014年1月至2020年3月间,中国科学技术大学附属第一医院经病理确诊为各种类型胃肿瘤的手术标本共有17 223例,其中GS有31例,约占0.18%,回顾性分析这31例GS患者的临床病理学特征和免疫表型,并复习相关文献,讨论GS的诊断、鉴别、治疗及预后。结果: 31例GS患者中,男性为12例,女性为19例,年龄为22~70岁,中位年龄为51岁。其中20例患者术前影像学检查提示为胃肠道间质瘤（gastrointestinal stromal tumor,GIST）。29例患者的肿瘤病灶位于胃黏膜层至浆膜层之间,2例病灶突破浆膜层。肉眼观察,GS的边界清晰,均无包膜。在光学显微镜下,可见肿瘤边界较清晰,周边常见淋巴细胞套;肿瘤主要由梭形细胞组成,呈束状、小簇状或杂乱排列,经典软组织神经鞘瘤常见的交错分布的Antoni A区和Antoni B区常不明显;细胞核可有一定异型性,但核分裂象罕见。免疫组织化学检测显示,肿瘤组织呈弥漫性S100、SOX10阳性。结论: GS是胃罕见的间叶源性肿瘤,为良性,术前易被误诊为GIST,诊断时需结合组织学特征及免疫表型,与GIST等肿瘤进行鉴别。

关键词: 胃, 神经鞘瘤, 鉴别诊断, 免疫组织化学

Abstract:

Objective: To investigate the clinicopathological characteristics of gastric schwannomas (GSs). Methods: The 31 GS cases, including 12 males and 19 females with a median age of 51 years (22-70), of 17 223 surgical procedures performed from January 2014 through March 2020 were retrieved for histological and immunological studies. The diagnosis, differentiation, treatment and prognosis were discussed with reference to relevant literatures. Results: The pre-operative imaging study suggested gastrointestinal stromal tumor(GIST) in 20 cases. Only two patients had the tumor breaking the serosa, and the tumor found on 29 patients was located between the muscularis propria and serosa of the stomach. Histological examination revealed well-circumscribed tumor with a prominent peripheral lymphoid cuff. The tumor was mainly composed with spindle cells, arranged in bundles and small clusters or in a haphazard fashion. The common features of soft tissue schwannoma, such as Antoni A zone and Antoni B zone, were absent or rarely found. Although the atypical nucleus could be identified, the mitosis was rare or absent. GS were diffusely positive for S100 and SOX10. Conclusions: GS is a rare benign mesenchymal tumor of the stomach, most of which are easy to be misdiagnosed as gastrointestinal stromal tumor. The diagnosis should be established based on histological features and immunophenotypes.

Key words: Gastric, Schwannoma, Differential diagnosis, Immunohistochemistry

中图分类号:

R541.7

王昭晖, 吴海波. 胃神经鞘瘤31例临床病理学分析[J]. 诊断学理论与实践, 2021, 20(06): 552-556.

WANG Zhaohui, WU Haibo. Clinicopathological analysis of 31 cases of gastric schwannoma[J]. Journal of Diagnostics Concepts & Practice, 2021, 20(06): 552-556.

图/表 3

表1

31例胃神经鞘瘤的临床病理学特点

序号	性别	年龄（岁）	部位	肿瘤直径（cm）	临床症状	术前诊断	治疗方式
1	女	43	胃体大弯	4.5	上腹部不适	胃间质瘤	手术
2	男	44	胃体大弯	6.0	上腹隐痛	恶性胃间质瘤	手术
3	男	48	胃体大弯	6.5	黑便	胃间质瘤	手术
4	女	70	胃体大弯	6.0	上腹部隐痛	胃间质瘤	手术
5	女	53	胃底	5.0	上腹部胀痛	胃间质瘤	手术
6	女	50	胃体大弯	3.8	体检	胃间质瘤	手术
7	女	51	胃体大弯	3.2	上腹部不适	胃间质瘤	手术
8	女	48	胃体大弯	3.0	体检	胃间质瘤	手术
9	女	60	贲门小弯	6.0	呕吐	胃占位	手术
10	女	50	胃角	4.5	上腹部胀痛	胃间质瘤	手术
11	女	66	胃体小弯	5.0	体检	胃间质瘤	手术
12	女	66	贲门小弯	1.7	上腹部隐痛	胃癌	手术
13	女	39	胃体前壁	2.0	上腹部阵痛	胃间质瘤	内镜
14	男	22	胃体大弯	2.0	腹胀	胃间质瘤（合并食管隆起病变）	内镜
15	男	28	胃角前壁	1.5	急性胃肠炎	胃黏膜病变	内镜
16	女	51	胃体大弯	2.5	体检	胃间质瘤	手术
17	男	41	胃体大弯	7.0	呕吐	胃间质瘤	手术
18	男	48	胃体大弯	6.5	上腹部不适	恶性胃间质瘤	手术
19	男	50	胃体小弯	4.0	上腹部不适	胃间质瘤	手术
20	女	49	胃体前壁	6.0	嗳气	胃间质瘤	手术
21	女	50	胃体小弯	4.5	体检	胃间质瘤	手术
22	女	53	胃体大弯	3.5	上腹部不适	胃间质瘤	手术
23	女	60	胃体小弯	4.0	腹痛	胃间质瘤	手术
24	男	56	胃体大弯	4.0	体检	胃肿物	手术
25	女	54	胃体大弯	3.0	上腹部不适	胃占位	手术
26	男	60	胃体大弯	0.4	合并食管癌	食管癌	手术
27	女	58	胃体小弯	2.0	上腹部隐痛	胃间质瘤	内镜
28	女	64	胃体后壁	4.0	上腹部不适	胃占位	手术
29	男	28	胃角前壁	2.2	急性胃肠炎	胃黏膜病变	内镜
30	女	54	胃体小弯	4.0	体检	胃间质瘤	手术
31	男	70	胃体大弯	2.0	大便带血	直肠癌	手术

表1

图1

图2

参考文献 13

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