腹部不典型神经鞘瘤的CT表现与病理对照  

CT Manifestations of Atypical Abdominal Neurilemmomas:Comparison with Pathological Findings

作　　者：田彤彤[1] 胡晓华[1] 杨国美[1] 眭未凡 吴晶涛[1] 

机构地区：[1]大学临床医学院、江苏省苏北人民医院医学影像科,扬州225001

出　　处：《临床放射学杂志》2014年第10期1555-1559,共5页Journal of Clinical Radiology

摘　　要：目的探讨腹部不典型神经鞘瘤的CT表现与病理特征,提高对该病的诊断水平。方法回顾性分析经手术病理证实的19例不典型神经鞘瘤的CT、病理表现。分析肿瘤的部位、数目、大小、形态、边界、密度、强化方式及转移。不典型表现包括少见部位、肿瘤多发、完全囊变、厚壁囊变、钙化、强化及转移,并分析CT不典型征象的病理基础。结果 19例中,胃部3例,肠系膜根部4例,胰腺颈部1例,肾上腺1例,腹膜后10例;其中单发17例,多发2例;良性16例,恶性3例。19例中完全囊变8例,厚壁囊变4例,肿瘤供血血管强化3例;钙化2例;3例恶性神经鞘瘤中,1例出现肺转移。病理表现:19例神经鞘瘤镜下均由Antoni A区和Antoni B区构成,Antoni A区含有较丰富束状排列肿瘤细胞,Antoni B区瘤细胞稀疏,组织内伴有囊变或黏液样变性;3例肿瘤内可见少量细胞核分裂象和不典型细胞。结论腹部不典型神经鞘瘤的定性诊断较难,充分认识此类病变的影像及病理特点,可提高对此类肿瘤的认识及诊断水平。Objective To investigate CT findings and pathological features of atypical abdominal neurilemmoma,known also as Schwannoma,in order to improve the diagnosis of this tumor.Methods A total of 19 patients with pathologicallyproved atypical abdominal neurilemmoma were enrolled in this study.CT findings and pathological features were retrospectively analyzed,focusing on the location, number, size, shape, margin, density, enhancement pattern of the lesion and metastasis.The atypical manifestations included unusual site, multiple lesions,complete cystic degeneration or thickenedwall cystic degeneration,calcification,abnormal enhancement pattern and metastasis.CT manifestations of atypical neurilemmomas were compared with pathological findings.Results The lesions were located at the stomach（3 /19）,the mesenteric root（4 /19）,the pancreatic neck（1 /19）,the adrenal gland（1 /19） and the retroperitoneal region（10 /19）.Among the 19 cases,the lesion was solitary in 17 and multiple in 2.The lesion was benign in 16 cases and malignant in 3cases.Of the 19 patients,complete cystic degeneration was seen in 8,thickened-wall cystic degeneration in 4,enhancement of tumor-feeding artery in 3,calcification in 2.In three patients with malignant neurilemmomas pulmonary metastasis was detected in one.Pathologically,all tumors were composed of Antoni A areas and Antoni B areas.Antoni A areas contained abundant cord-like arranged tumor cells,while in Antoni B areas the tumor cells were few and scattered and the lesions showed cystic or myxoid degeneration.A few atypical mitotic cells and nuclear mitotic were seen in three cases.Conclusion It is rather difficult to make a qualitative diagnosis of atypical abdominal neurilemmoma.A full knowledge of its imaging and pathologic characteristics can improve the recognition as well as the diagnosis of this tumor.

关 键 词：神经鞘瘤 非典型 体层摄影术 X线计算机 病理 

分 类 号：R739.4[医药卫生—肿瘤]