胃神经鞘瘤(附26例分析)

The gastric neurilemmoma

目的 通过对 2 6例胃神经鞘瘤的回顾性分析 ,提高对这一罕见疾病的认识。方法 对胃神经鞘瘤临床资料 ,X线、胃镜表现 ,病理资料 ,治疗方法并依据现代肿瘤学、外科病理学对其进行分析。结果 胃神经鞘瘤临床上以黑便、贫血貌、腹痛多见 ,可有腹部包块。该病病史体征无特异性 ,X线、胃镜、B超、CT检查均无特殊征象。术前常误诊为胃平滑肌 (肉 )瘤、胃溃疡、胃癌。光镜下该肿瘤由雪旺 (Schwann)氏细胞构成 ,免疫组化S -10 0多呈阳性。 2 6例全部手术。结论 胃神经鞘瘤是由胃壁间质中雪旺氏细胞形成的肿瘤 ,临床罕见。良性多于恶性 ,男性多发 ,40岁以上多发。好发于胃体、底 ,窦部少见。良恶性在发病年龄上无明显差异。良性包膜完整 ,无核分裂象 ,无浸润性 ;恶性无完整包膜 ,异形性明显 ,有核分裂象 ,有浸润性。该病病史、症状、体征特异性不明显 ,影像学检查均无特殊征象 ,术前诊断困难 ,误诊率高。手术为首选疗方法 ,确诊依赖术后病理 ,免疫组化和电镜检查对明确具体来源和鉴别诊断有很大帮助。

Objective To improve the understanding of the diagnosis and treatment of infrequent disease-neurilemmoma of the stomach, we did retrospective study of 26 case with such disease. Methods Twenty-six patients with neurilemmoma of the stomach were reviewed and analysed clinically, histologically and immunohistochemically. Results Gastrointestinal bleeding or melena and epigastric pain were the most common presenting symptoms. The disease history? symptoms? signs and checking-up of neurilemmoma of the stomach is without characteristic. It is misdiagnosised to leiomyosarcoma of stomach and carcinoma of stomach or gastric ulcer easily before the operation. Histologically, all tumours were composed of spindle cells with vague nuclear palisading and variably myxoid stroma. Immunohistochemically, the tumour cells were positive for S-100 protein .All twenty-six patients underwent gastrectomy Conclusion The gastric neurilemmoma are derived from the Schwann cells of nerves of th gastric wall and are usually benign. The gastric schwannoma is more common in males than in females. Most cases occur in after age 40 years. Benign schwannomas can only be distinguished from the malignant ones on the basis of histological and immunohistochemical criteria. These tumors are usually asymptomatic. Its treatment requires only surgery. Neurilemmoma of the stomach is diagnosised very difficulty before operation. The definitive and differentiating diagnosis are made on the histopathological or electronmicroscopy appearance and immunohistochemical profile in postoperation.