恶性外周神经鞘瘤误诊为糖尿病足二例报告  

Malignant Peripheral Nerve Sheath Tumor Misdiagnosed as Diabetic Foot: a Report of 2 Cases

作　　者：王璐宁[1] 杨彩哲[1] 吴石白[1] WANG Lu-ning YANG Cai-zhe WU Shi-bai(Department of Endocrinology, General Hospital of PLA Air Force, Beijing 100142, China)

机构地区：[1]解放军空军总医院内分泌科,北京100142

出　　处：《临床误诊误治》2016年第12期45-48,共4页Clinical Misdiagnosis & Mistherapy

摘　　要：目的提高临床医生对恶性外周神经鞘瘤(MPNST)的认识,减少误诊误治。方法对我院收治并误诊为糖尿病足的MPNST 2例的临床资料进行回顾性分析,并复习相关文献。结果本文2例均因足部溃烂,发现血糖升高入院。最初在外院分别按足部皮肤软组织感染、甲沟炎治疗,效果差,后发现血糖高,予降糖治疗,但创面仍迁延不愈。入院后行下肢血管彩色多普勒超声(彩超)、肌电图及心电图等检查发现患者无明显糖尿病周围血管及神经病变,血糖控制良好,后行创面活体组织病理检查(活检)示S-100(+),确诊为MPNST。1例拒绝进一步检查及治疗,要求出院,后失访;1例经浅表淋巴结及腹部、盆腔超声、胸部及颅脑CT和全身骨扫描均未见异常,行截趾术切除病灶,后创面愈合出院。随访1年未诉不适。结论足部MPNST临床少见,提高对该病的认识,尽早行活检,争取早诊断、早治疗,对避免或减少误诊甚至误治尤为重要。Objective To improve understanding of clinicians about malignant peripheral nerve sheath tumor （ MPNST） in order to reduce misdiagnosis and mistreatment. Methods Clinical data of 2 MPNST patients misdiagnosed as having diabetic foot was retrospectively analyzed, and related literature was reviewed. Results The 2 patients were admitted for foot ulcerate and elevated level of blood sugar. The 2 patients were treated as soft-tissue infection of foot skin and paronych-ia with poor effectiveness in other hospitals, and elevated level of blood sugar were found, but protracted course of disease in wound surface was found after hypoglycemic therapy. Medical examinations such as vascular ultrasound for lower extremity, electromyogram and electrocardiogram showed that no obviously lesions of diabetic peripheral vasculopathy and nerves, and blood-glucose level was controlled well. The histopathological examination for wound surface tissues showed S-100（ ＋）, and then MPNST was confirmed. One patient refused further treatment and discharged with losing follow-up; no abnormal was found in another patient by ultrasound for surface lymph nodes, abdomen and pelvic cavity, cranial computed tomography and total body of bone scanning, and toe amputation was performed, and then the patient was discharged after wound healing. No indisposition was told during 1 year of follow-up. Conclusion MPNST in foot is rare, and therefore clinicians should improve awareness and take histopathologic examinations as early as possible to confirm diagnosis and treatment so as to avoid or de-crease misdiagnosis and mistreatment.

关 键 词：神经鞘肿瘤 误诊 糖尿病足 

分 类 号：R739.4[医药卫生—肿瘤]