CAJ | 학술논문

目的探讨色素性神经鞘瘤( melanotic schwannoma, MS)的临床病理特征,以提高临床诊断水平. 方法回顾分析1例MS的临床资料,结合文献分析其临床病理特征. 结果本例男,27岁,因颈枕部疼痛伴四肢间隙性麻木不适2月余入院. 头颅及颈部MRI平扫示:上颈段寰、枢椎水平脊髓背侧占位性病变,考虑神经源性肿瘤可能性大. 全麻下行经后路椎管减压占位性病变摘除加寰枢椎植骨融合内固定术,术后瘤体组织学显示肿瘤细胞呈梭形及上皮样,呈束状、栅栏状或巢状排列,胞核大小较一致,异型性不明显,胞质内见较多黑色素,未见明显坏死;部分区域仍可见典型神经鞘瘤的组织构象:多细胞的AntoniA区和低密度的AntoniB,也可见Verocay小体;免疫组织化学染色示:瘤细胞S-100、Vimentin、HMB45、Melan-A均( +) ,Ki67阳性率<5%,EMA、GFAP、LCA、NSE、P-CK、CD117、MyoD1、SMA均( -). 结论 MS较罕见,临床医师应熟知其病理特征,注意与恶性黑色素瘤等鉴别. 本病确诊需依赖病理检查,免疫组织化学染色有助于其诊断及鉴别诊断.
목적 탐토색소성신경초류( melanotic schwannoma, MS)적림상병리특정,이제고림상진단수평. 방법 회고분석1례MS적림상자료,결합문헌분석기림상병리특정. 결과 본례남,27세,인경침부동통반사지간극성마목불괄2월여입원. 두로급경부MRI평소시:상경단환、추추수평척수배측점위성병변,고필신경원성종류가능성대. 전마하행경후로추관감압점위성병변적제가환추추식골융합내고정술,술후류체조직학현시종류세포정사형급상피양,정속상、책란상혹소상배렬,포핵대소교일치,이형성불명현,포질내견교다흑색소,미견명현배사;부분구역잉가견전형신경초류적조직구상:다세포적AntoniA구화저밀도적AntoniB,야가견Verocay소체;면역조직화학염색시:류세포S-100、Vimentin、HMB45、Melan-A균( +) ,Ki67양성솔<5%,EMA、GFAP、LCA、NSE、P-CK、CD117、MyoD1、SMA균( -). 결론 MS교한견,림상의사응숙지기병리특정,주의여악성흑색소류등감별. 본병학진수의뢰병리검사,면역조직화학염색유조우기진단급감별진단.
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of mel-anotic schwannoma ( MS) in order to improve the levels of diagnosis and treatment. Methods Clinical data of 1 patient with MS was retrospectively analyzed, and clinicopathological features were analyzed with related literature. Results The 27-year-old male Was admitted for occipital pain and intermittent numb limbs for 2 months. MRI scan for head and neck showed that an occupying lesion of dorsal spinal cord within C1-C2 level spinal canal was found, and the tumor was likely to be neurogenic tumors. Posterior decompression of vertebral canal for occupying lesion removal and atlantoaxial internal fixation and bone graft fusion was performed under general anesthesia. The postoperative histological results of tumor tissue was bland spindle-shaped and epithelioid with fascicular, palisade or nest arrangements. The nucelus sizes were similar atypia, and cells were not obvious, and a lot of melanins were in the cytoplasm without obvious necrosis. There were typical histopathological features were occasionally seen such as multicellular Antoni A and density Antoni B areas as well as Verocay body. Immunohistochemical results showed that the tumor cells were positive for S-100, Vimen-tin, HMB45 and Melan-A, and negative for EMA, GFAP, LCA, NSE, P-CK, CD117, MyoD1 and SMA. Ki67 prolifer-ative index was less than 5%. Conclusion Melanotic schwannoma is rare which needs to be distinguished with malig-nant melanoma. Pathological examination can confirm the diagnosis, and immunohistochemical examination contributes to the diagnosis and differential diagnosis.