原发性膀胱神经鞘瘤一例报告并文献复习  

Primary bladder schwannoma： one case report and literature review

作　　者：田忠伟 侯四川[1] 赵海军[1] 苏道胜 李广旭 Tian Zhongwei, Hou Sichuan, Zhao Haijun, Su Daosheng, Li Guangxu.(Department of Urology, Municipal Hospital of Qingdao, Qingdao 271000, Chin)

机构地区：[1]青岛市市立医院泌尿外科,271000

出　　处：《中华泌尿外科杂志》2018年第3期183-186,共4页Chinese Journal of Urology

摘　　要：目的探讨原发性膀胱神经鞘瘤的病因、影像学及临床表现、病理学特点及治疗方式。 方法回顾性分析2016年10月收治的1例膀胱神经鞘瘤患者的临床病理资料，并复习相关文献。患者男，64岁。因无痛性肉眼血尿4个月于2016年10月5日入院。增强CT检查示膀胱左前壁占位病变，病变结节影轻度强化。术前诊断为膀胱肿瘤。行经尿道膀胱肿瘤切除术（TURBT），术中见膀胱左侧壁息肉状软组织凸向膀胱，表面光滑，广基，大小约3 cm×3 cm。术中顺利切除膀胱肿物。 结果手术顺利，术中出血量约100 ml，术后患者恢复可。术后病理检查：大量黏液样间质中见梭形细胞。免疫组化染色检查S-100（＋），考虑间叶组织来源神经鞘瘤。诊断为膀胱神经鞘瘤。随访3个月未见肿瘤复发。检索国内外文献，1993—2016年膀胱神经鞘瘤共报道17例。本病发病年龄为40～69岁，发病与性别无关。肿瘤单发，多见于膀胱顶部或侧壁，生长缓慢，极少发生恶变，临床表现和影像学检查特点与其他膀胱实体肿瘤不易鉴别。因有关于本病恶变的文献报道，故建议积极治疗。手术方式以膀胱部分切术或TURBT为主。病理检查是诊断的金标准，免疫组化染色检查S-100常为（＋）。 结论膀胱神经鞘瘤是极少见的膀胱良性肿瘤，易误诊，确诊依靠病理检查。因本病有恶变可能，建议积极治疗，治疗方式未明确规定，手术切除的效果良好。ObjectiveTo investigate the etiology, clinical manifestations, imaging finding, pathology and treatment of primary bladder schwannoma. MethodsA case of bladder schwannoma was reported and discussed in the literature. A 64-year-old male patient with painless gross hematuria for 4 months was admitted on October 5, 2016. Enhanced computed tomography （CT） showed left anterior bladder wall lesions with mildly enhancement. Preoperative diagnosis was bladder cancer. The patient underwent transurethral resection of bladder tumor （TURBT）. During surgery, a 3 cm×3 cm polypoid soft tissue was found in the left side of bladder, which convex to the bladder with smooth surface and wide base. ResultsThe bladder neoplasm was resected successfully. The intraoperative bleeding was about 100 ml. Postoperative pathology showed a large number of myloid spindle cells with immunohistochemical S-100（＋ ）, considering source of mesenchymal tissue. No recurrence was noticed during the 3 months’ follow-up. Retrieving domestic and foreign literature, we found 17 cases with bladder schwannoma from 1993 to 2016. Bladder schwannoma occurs in the age of 40-69 years old. There is no relationship with the agenda. It is often seen in the top or the side wall of the bladder with single growth and rare malignant.The clinical manifestations was mainly painless gross hematuria, CT and magnetic resonance imaging（MR） showed less specificity than other solid tumors of the bladder, which is difficult to identify. Partial cystectomy or TURBT is the main strategy. Postoperative pathology is the gold standard for diagnosis.The immunohistochemical stainings often showed S-100（＋ ）. ConclusionsBladder schwannoma is extremely rare in benign bladder tumor, and it could easily be misdiagnosed. The diagnosis should be performed by histopathological examination. Because it will become malignant, it is suggested that the positive treatment should be done. Treatment methods have not been clearly defined, and the effect of surgical re

关 键 词：膀胱神经鞘瘤 影像学表现 病理及免疫组化 治疗 

分 类 号：R737.14[医药卫生—肿瘤]