中国全科医学
中國全科醫學
중국전과의학
Chinese General Practice
2015年
30期
3741-3744
,共4页
神经鞘瘤%黑色素%腹膜后肿瘤%诊断%免疫组织化学%预后
神經鞘瘤%黑色素%腹膜後腫瘤%診斷%免疫組織化學%預後
신경초류%흑색소%복막후종류%진단%면역조직화학%예후
Neurilemmoma%Melani%Retroperitoneal neoplasms%Diagnosis%Immunohistochemistry%Prognosis
目的：探讨腹膜后囊性黑色素性神经鞘瘤的临床病理特征，以提高对该肿瘤的诊治水平。方法赣南医学院第一附属医院肿瘤外科2014－03－17收治1例腹膜后囊性黑色素性神经鞘瘤患者，总结其临床资料、影像学表现、病理特征，并结合国内外文献进行综合分析。结果患者，男，47岁，因左侧后腰部疼痛就诊，增强CT扫描发现左侧腰大肌旁肿瘤，与左侧肾脏关系密切，外科手术切除；巨检：肿瘤为囊性，大小15.0 cm ×10.0 cm ×10.0 cm，其内见大量咖啡样黏稠液体，囊壁厚1.0 cm，部分外壁与左侧肾脏周围组织粘连；镜下：囊壁内肿瘤细胞较少，被纤维组织分隔成结节状，肿瘤细胞呈梭形及上皮样，胞质内见大量黑色素沉积。免疫组织化学标记： HMB45、 Melan－A、S100、 CD57、波形蛋白（ Vimentin）均为（＋），细胞外胶原基膜Ⅳ型胶原（ CollagenⅣ）（＋）， Ki－67约4％（＋）。病理诊断：（腹膜后）囊性黑色素性神经鞘瘤（经典型）。结论囊性黑色素性神经鞘瘤是少见的具有神经鞘细胞特征及黑色素细胞分化的软组织肿瘤，囊性者罕见，有潜在恶性生物学行为，需长期随访。
目的：探討腹膜後囊性黑色素性神經鞘瘤的臨床病理特徵，以提高對該腫瘤的診治水平。方法贛南醫學院第一附屬醫院腫瘤外科2014－03－17收治1例腹膜後囊性黑色素性神經鞘瘤患者，總結其臨床資料、影像學錶現、病理特徵，併結閤國內外文獻進行綜閤分析。結果患者，男，47歲，因左側後腰部疼痛就診，增彊CT掃描髮現左側腰大肌徬腫瘤，與左側腎髒關繫密切，外科手術切除；巨檢：腫瘤為囊性，大小15.0 cm ×10.0 cm ×10.0 cm，其內見大量咖啡樣黏稠液體，囊壁厚1.0 cm，部分外壁與左側腎髒週圍組織粘連；鏡下：囊壁內腫瘤細胞較少，被纖維組織分隔成結節狀，腫瘤細胞呈梭形及上皮樣，胞質內見大量黑色素沉積。免疫組織化學標記： HMB45、 Melan－A、S100、 CD57、波形蛋白（ Vimentin）均為（＋），細胞外膠原基膜Ⅳ型膠原（ CollagenⅣ）（＋）， Ki－67約4％（＋）。病理診斷：（腹膜後）囊性黑色素性神經鞘瘤（經典型）。結論囊性黑色素性神經鞘瘤是少見的具有神經鞘細胞特徵及黑色素細胞分化的軟組織腫瘤，囊性者罕見，有潛在噁性生物學行為，需長期隨訪。
목적：탐토복막후낭성흑색소성신경초류적림상병리특정，이제고대해종류적진치수평。방법공남의학원제일부속의원종류외과2014－03－17수치1례복막후낭성흑색소성신경초류환자，총결기림상자료、영상학표현、병리특정，병결합국내외문헌진행종합분석。결과환자，남，47세，인좌측후요부동통취진，증강CT소묘발현좌측요대기방종류，여좌측신장관계밀절，외과수술절제；거검：종류위낭성，대소15.0 cm ×10.0 cm ×10.0 cm，기내견대량가배양점주액체，낭벽후1.0 cm，부분외벽여좌측신장주위조직점련；경하：낭벽내종류세포교소，피섬유조직분격성결절상，종류세포정사형급상피양，포질내견대량흑색소침적。면역조직화학표기： HMB45、 Melan－A、S100、 CD57、파형단백（ Vimentin）균위（＋），세포외효원기막Ⅳ형효원（ CollagenⅣ）（＋）， Ki－67약4％（＋）。병리진단：（복막후）낭성흑색소성신경초류（경전형）。결론낭성흑색소성신경초류시소견적구유신경초세포특정급흑색소세포분화적연조직종류，낭성자한견，유잠재악성생물학행위，수장기수방。
Objective To investigate the clinicopathologic features of retroperitoneal cystic melanotic schwannoma in order to improve the level of diagnosis and treatment of such tumor.Methods Selected one patient with retroperitoneal cystic melanotic schwannoma who were admitted into the Department of Oncological Surgery of the First Affiliated Hospital of Gannan Medical University on March 17, 2014.We made a review about clinical data , imaging findings, pathological features and treatment methods , and we conducted a general analysis combining with domestic and overseas literatures .Results Due to the pain in the left rear waist , this 47-year-old male went to see a doctor.A tumor was found beside the psoas muscle of left side by enhanced CT scan , which was closely related to the left kidney.And it was removed by surgical operation.Macroexamination:this tumor was cystic with the size 15.0 cm ×10.0 cm ×10.0 cm, within which much sticky liquid like coffee can be seen.And the capsule wall was 1.0 cm thick, part of which was adhered to peripheral tissues of the left kidney.Examination by optical microscope: cyst wall included few tumor cells , and they were divided into nodular shape by fiber tissues; the tumor cells were fusiform and epithelioid, and much melanin deposition can be seen in the cytoplast.Immunohistochemistry: HMB45, Melan-A, S100, CD57 , Vimmentin and CollagenⅣ were ( +) .Ki -67 was 4% ( +) .Pathological diagnosis: it was a typical Retroperitonea cystic melanotic schwannoma.Conclusion Melanotic schwannoma is a rare soft tissue tumor with the features of neurilemma cells and melanocytes differentiation.Cystic melanotic schwannoma is rare and contains potential malignant biological behavior.And such patients need long -term follow-up.
