中外医疗
中外醫療
중외의료
CHINA FOREIGN MEDICAL TREATMENT
2014年
17期
34-36
,共3页
胃肠道神经鞘瘤%免疫组化%临床病理分析%鉴别诊断
胃腸道神經鞘瘤%免疫組化%臨床病理分析%鑒彆診斷
위장도신경초류%면역조화%림상병리분석%감별진단
Gastrointestinal schwannomas%Immunohistochemistry%Clinical pathology analysis%Differential diagnosis
目的：探讨胃肠道神经鞘瘤（GSs）临床病理特征、免疫表型、鉴别诊断。方法对4例GSs患者临床资料、病理形态、免疫表型进行观察，结合文献进行讨论分析。结果4例患者，平均年龄（61.3±9.9）岁，女3例，男1例。患者无特殊临床症状和体征。影像学瘤体表现为界清的稍低密度均质实体灶。大体观察肿瘤无包膜，界清，切面呈实性，有光泽感。镜下瘤组织外围均有丰富的淋巴细胞增生形成的淋巴细胞套，梭形瘤细胞呈交叉束状排列，局部区域细胞核呈不显著的栅栏状，局灶可有显著的核异型性，但核分裂罕见。肿瘤边缘局灶区域可见瘤细胞分隔、包裹胃壁平滑肌现象。免疫组化显示4例瘤细胞S-100、Vimentin呈弥漫强阳性，2例GFAP片灶性阳性，Ki-67阳性指数＜3%，Desmin、CD34、CD117、DOG-1均为阴性。术后随访均未见复发或转移。结论 GSs 是胃肠道罕见的间叶源性良性肿瘤，掌握其相对特征性病理学形态结合 S-100、CD117、CD34、DOG-1等标记物检测有助于诊断和鉴别诊断。
目的：探討胃腸道神經鞘瘤（GSs）臨床病理特徵、免疫錶型、鑒彆診斷。方法對4例GSs患者臨床資料、病理形態、免疫錶型進行觀察，結閤文獻進行討論分析。結果4例患者，平均年齡（61.3±9.9）歲，女3例，男1例。患者無特殊臨床癥狀和體徵。影像學瘤體錶現為界清的稍低密度均質實體竈。大體觀察腫瘤無包膜，界清，切麵呈實性，有光澤感。鏡下瘤組織外圍均有豐富的淋巴細胞增生形成的淋巴細胞套，梭形瘤細胞呈交扠束狀排列，跼部區域細胞覈呈不顯著的柵欄狀，跼竈可有顯著的覈異型性，但覈分裂罕見。腫瘤邊緣跼竈區域可見瘤細胞分隔、包裹胃壁平滑肌現象。免疫組化顯示4例瘤細胞S-100、Vimentin呈瀰漫彊暘性，2例GFAP片竈性暘性，Ki-67暘性指數＜3%，Desmin、CD34、CD117、DOG-1均為陰性。術後隨訪均未見複髮或轉移。結論 GSs 是胃腸道罕見的間葉源性良性腫瘤，掌握其相對特徵性病理學形態結閤 S-100、CD117、CD34、DOG-1等標記物檢測有助于診斷和鑒彆診斷。
목적：탐토위장도신경초류（GSs）림상병리특정、면역표형、감별진단。방법대4례GSs환자림상자료、병리형태、면역표형진행관찰，결합문헌진행토론분석。결과4례환자，평균년령（61.3±9.9）세，녀3례，남1례。환자무특수림상증상화체정。영상학류체표현위계청적초저밀도균질실체조。대체관찰종류무포막，계청，절면정실성，유광택감。경하류조직외위균유봉부적림파세포증생형성적림파세포투，사형류세포정교차속상배렬，국부구역세포핵정불현저적책란상，국조가유현저적핵이형성，단핵분렬한견。종류변연국조구역가견류세포분격、포과위벽평활기현상。면역조화현시4례류세포S-100、Vimentin정미만강양성，2례GFAP편조성양성，Ki-67양성지수＜3%，Desmin、CD34、CD117、DOG-1균위음성。술후수방균미견복발혹전이。결론 GSs 시위장도한견적간협원성량성종류，장악기상대특정성병이학형태결합 S-100、CD117、CD34、DOG-1등표기물검측유조우진단화감별진단。
Objective To explore the clinicopathological features, immune phenotype, the differential diagnosis of gastrointestinal schwannomas (GSs). Methods The clinical data, pathological morphology and immune phenotype of 4 cases of GSs were observed, discussed and analyzed by combining with literature. Results The 4 patients, included 3 women and 1 man, mean age (61.3±9.9) years, with no specific clinical signs and symptoms. Imaging tumor showed clear bounded slightly low density homogeneous entity foci. The tumor had no capsule, the boundary was clear, the cross section was solid, glossy via gross observation. Under the micro-scope, lymphocyte sets, spindle tumor cells formed by rich lymphocytes proliferation in periphery of tumor tissue arranged in cross-ing fascicles, the nuclei in local area were not significant palisade, could have a significant focal nuclear atypia, but mitotic rare. Focal region of the tumor margin showed the tumor cells separating, wrapping the stomach muscle phenomenon. Immunohisto-chemistry showed that 4 cases of tumor cells S-100, Vimentin showed diffuse strong positive, 2 cases of focal piece GFAP positive, Ki-67 positive index was less than 3%, Desmin, CD34, CD117, DOG-1 were negative. Postoperative follow-up showed no recur-rence or metastasis. Conclusion GSs is a rare gastrointestinal mesenchymal benign tumor, grasping the relative characteristic pathologic morphology combined with S-100, CD117, CD34, DOG-1 and other markers contribute to the diagnosis and differential diagnosis.
