胃神经鞘瘤40例临床诊治分析

Analysis of gastric schwannoma on clinical diagnosis and treatment in 40 cases

目的探讨胃神经鞘瘤的临床病理特点、诊断、治疗和预后。方法回顾性分析中国医学科学院肿瘤医院2007年1月至2015年12月收治的40例胃神经鞘瘤患者的临床资料。结果所有患者中男14例,女26例,年龄(53.3±13.2)岁,肿瘤直径(36.660±22.864)mm,肿瘤位于胃体的比例达72.5%。9例行腹腔镜手术,30例行传统开腹手术,1例行内镜黏膜下剥离术。腹腔镜手术时间与开腹手术时间经比较差异无显著性(P=0.649);术后住院天数较开腹手术短,差异具有显著性(P=0.049)。肿瘤由梭形细胞组成,核分裂象≤5/50HPF,S100强阳性(100%),c-kit和PDGFRA基因无突变。随访无复发、转移。结论胃神经鞘瘤好发于女性,确诊需依据病理和免疫组化,可选择腹腔镜手术或内镜黏膜下剥离术等微创治疗方式。

Objective To explore the clinicopathological features, diagnosis, treatment and prognosis of gastric schwannoma. Method The clinical data of 40 patients diagnosed as gastric schwannoma in Cancer Hospital of Chinese Academy of Medical Sciences from January 2007 to December 2015 were retrospectively collected and analyzed. Result There were 14 men and 26 women. Mean ages were（53.3±13.2） years. The tumors＇ mean diameter was（36.660±22.864） mm. The most common location was gastric body（72.5%）. They were treated by laparoscopic surgery（n=9）, traditional open surgery（n=30） or endoscopic submucosal dissection（n=1）. There was no significant difference between the laparoscopic and open surgery with respect to operation time（P=0.649）. Postoperative hospital stay of the laparoscopic surgery patients was shorter than the open surgery（P=0.049）.The tumors were composed of spindle cells. Mitotic counts were not more than 5/50 high-power fields（HPF）. Immunohistochemically, all tumors were S100 protein positive strongly. No genetic mutations of c-kit and PDGFRA were detected. Postoperative follow-up did not reveal recurrences or metastases. Conclusion Gastric schwannoma occured more frequently in female. Definite diagnosis depended on pathological and immunohistochemical findings. Laparoscopic surgery or endoscopic submucosal dissection can be a minimally invasive choice.