消化道神经鞘瘤17例临床病理特征分析

Schwannomas of digestive tract:a clinicopathological analysis of 17 cases

目的探讨消化道神经鞘瘤临床病理、免疫组化特征及与其他间叶源性肿瘤鉴别要点。方法对17例消化道神经鞘瘤进行临床病理分析,并行S-100、vimentin、CD34、CD117、SMA和desmin检测,对10例作PAS与Masson染色。结果患者女性11例,男性6例,年龄38～73岁(中位年龄57岁),16例发生于胃,1例位于食管。巨检:肿瘤直径2～8 cm(平均4 cm),无包膜。8例界限较清,9例与周围组织界限欠清,均缺乏锐利边界,切面呈实性。镜检:瘤细胞梭形,呈小束状,多排列成编织状结构,均可见小束的两端及瘤细胞之间有粗细不等的胶原纤维形成。1例有小灶状上皮样结构,3例极少数肿瘤细胞胞质内可有黑色素颗粒。间质内均见有少数至弥漫淋巴细胞、浆细胞浸润,肿瘤周边均出现淋巴细胞反应带。免疫组化:vimentin和S-100强(+),3例有少数瘤细胞CD34灶状(+);10例PAS和Masson染色晶状体(-)。结论消化道神经鞘瘤有不同于软组织发生者的临床、大体及形态学特点,诊断依赖组织学及免疫组化检测。

Objective To explore the clinicopathological and immunohistochemical features of digestive tract schwannomas as well as the key points to distinguish it from other mesenchymal tumors.Methods We analysed the clinical pathology of 17 cases of digestive tract schwannomas and performed immunohistochemical staining for S-100,CD117,vimentin,CD34,SMA and desmin.PAS and Masson staining were conducted in 10 cases.Results The patients included 6 men and 11 women,whose ages ranged from 38 to 73 years（median 57 years）.16 tumors were located in the stomach,and 1 in the esophagus.Follow-up of 10 cases from 4 to 153 months showed no recurrences.Tumor size ranged from 2.0 to 8 cm in diameter（mean 4 cm） without capsule.8 cases had well circumscribed boundaries and 9 without unclear boundaries,or short of sharp edges.They showed solid cut surface and the tumor cells,in a shape of spindle,were mainly in small bundles or woven pattern.Collagen strands,different in thickness,were formed at both ends of the amph-bundle and between the tumor cells.1 case had small focal epithelioid structure,and 3 cases showed that an extremely small number of tumor cells had melanin particles in cytoplasm.In all cases,there was inflammatory cell infiltration composed of plasma cells and lymphocytes,and the tumor cells were surrounded by a characteristic peripheral lymphoid cuff.Immunohistochemically,the tumor cells were strongly positive for vimentin and S-100 protein,a few cells were focally positive for CD34 in 3 cases.10 cases with PAS and Masson staining found no crystalloid formation.Conclusions The digestive tract schwannomas have characteristic clinical,macroscopic and morphological features,which are different from their soft tissue counterparts.The diagnosis depends on the histologic analysis and immunohistochemical detection.