胃神经鞘瘤临床病理分析

Clinicopathologic study of 10 cases of gastric schwannoma

目的：探讨胃神经鞘瘤（gastric schwannoma）的临床病理学特点、免疫表型、诊断及鉴别诊断。方法：对8例胃神经鞘瘤的临床特点、组织形态学和免疫组织化学结果进行分析,并复习相关文献。结果：患者女性5例,男性3例,平均年龄61岁（30~81岁）。8例胃神经鞘瘤直径1.0~7.0 cm（平均3.0 cm）,无包膜,切面灰白色,镜下,瘤细胞短梭形,束状、栅栏状排列,肿瘤的边缘见淋巴细胞套。免疫组织化学染色：S-100全阳性,胶质纤维酸性蛋白（glial fibrillary acidic protein,GFAP）7例阳性,CD117、CD34、Dog1、a-平滑肌肌动蛋白（a-Smooth muscle actin,a-SMA）、结蛋白（Desmin）阴性。3例发现血小板衍化生长因子受体（platelet-derived growth factor receptor,PDGFR）阳性,但未发现c-kit和PDGFRα的基因突变。结论：胃神经鞘瘤是一种良性肿瘤,需与胃肠道间质瘤鉴别。

Objective：To determine the clinicopathologic feature,immunohistochemistry,diagnosis and differential diagnosis of gastric schwannoma.Methods：Clinical characteristics,pathological morphology and immunohistochemical staining in 8 cases of gastric schwannoma were analyzed,and literature was reviewed.Results：The patients included 5 females and 3 males.The age of patients ranged from 30 to 81 years（median=61 years）.The size of the tumors ranged from 1.0 to 7.0 cm in diameter（median=3.0 cm）.Gross examination showed that gastric schwannoma was white and without true fibrous capsule.The tumors were composed entirely or mainly of short spindle shaped cells which were described in a palisade manner or in bundles.All tumors showed a lymphocytic cuffing at the peripheral part.Immunohistochemistry results showed,the expression of S-100 was all positive,and glial fibrillary acidic protein（GFAP） was positive in 7 cases while CD117,CD34,Dog1,a-Smooth muscle actin （a-SMA） and Desmin were negative.Three cases showed positivity for PDGFR,but with no mutations found in c-kit and platelet-derived growth factor receptor α（PDGFRα）.Conclusion：Gastric schwannoma is a benign tumor and should be differentially diagnosed from the gastrointestinal stromal tumor.