皮肤微囊/网状型神经鞘瘤临床病理特征

Clinicopathologic features of cutaneous microcystic/reticular schwannoma

目的探讨皮肤微囊/网状型神经鞘瘤的临床病理特征及鉴别诊断。方法对1例皮肤微囊/网状型神经鞘瘤进行形态学观察和免疫组化检测,并复习相关文献。结果患者男性,28岁。因左眼上睑部肿块就诊。大体检查显示肿块为位于真皮的境界清楚、无完整包膜的结节,最大直径0.5 cm。镜下显示2种形态:细胞稀疏区由梭形、圆形/卵圆形肿瘤细胞形成网状、微囊状结构,间质明显黏液变性;细胞丰富区域梭形细胞束状、隐约旋涡状排列,间质透明变性。免疫组化:两种区域的肿瘤细胞S-100和GFAP强(+),CK、Cam5.2和CEA(-)。结论皮肤微囊/网状型神经鞘瘤是神经鞘瘤的一种罕见特殊亚型,应与皮肤混合瘤、神经束膜瘤等肿瘤鉴别。

Objective To study the clinicopathological features of cutaneous microcyst/reticular schwannoma.Methods The histological manifestations of a case of cutaneous microcyst/reticular schwannoma were analyzed and the immunohistochemical staining was performed. The relevant literature was reviewed. Results A 28-year-old male presented with a lump in the left upper eyelid. Gross examination showed that it was a well circumscribed,unencapsulated nodule in dermis,measuring 0. 5 cm in greatest diameter. Microscopically,the tumor consisted of two kind of morphology.Hypocellular areas consisted of spindle,round/oval tumor cells arranged in microcystic/reticular pattern with prominent myxoid matrix. Hypercellular area was composed of spindle tumor cells arranged in fasicles,vaguely swirling pattern with hyaline matrix. Immunostains showed that S-100 and GFAP were strongly positive in the tumor cells of both areas while CK,Cam5. 2,and CEA were all negative. Conclusions Cutaneous microcystic/reticular schwannoma is a rare distinct variant of schwannoma that needs to be differentiated from multiple tumors such as mixed tumor of the skin and perineurioma.