巨大型恶性外周神经鞘瘤1例

A Case of Giant Peripheral Schwannoma

患者男,77岁。背部反复起肿物,先后多次手术切除15年余。皮肤科情况:左侧背部可见一约21cm×27cm大小的肤色肿物,突出皮肤,表面凹凸不平,质硬,无压痛,其上方可见一2cm×2cm大小的糜烂面,伴少许渗液。皮损组织病理示:镜下可见梭形细胞增生,细胞密集排列,部分细胞核呈异型性(大于正常3倍,核形不规则),核分裂相(1~4个/10HPF)。免疫组织化学结果:CD34(-)、SMA(-)、Desmin(-)、S-100(+)、Ki-67(5%~10%+)、EMA(-)、STAT6(+)、CD99(-)、CK(-)、Bcl-2(-)、p53(<1%+)。诊断:巨大型恶性外周神经鞘瘤。

A patient, male, 77 years old, got lumps on hisleft back recurrently, and had received resections quite a few times within the latest 15 years. Dermatology condition showed that the skin mass was 21cm×27cm large and protruded epidermis with uneven and hard surface, yet it was nontender. At the top of the lump, there was a 2cm＊2cm erosion with a little exudate. Histopathology of the skin lesions under microscope appeared as the proliferation of spindle cells, densely packed cells, partial atypical nucleus（3 times more normal, irregular nucleation）, and mitotic（1-4/10HPF）. Immunohistochemistry had the following results： CD34（-）, SMA（-）, Desmin（-）, S-100（＋）, Ki-67（5%-10%＋）, EMA（-）, STAT6（＋）, CD99（-）, CK（-）, Bcl-2（-）, p53（〈1%）. Diagnosis： Giant malignant peripheral schwannoma.