椎管内神经鞘瘤的临床及病理学特征分析  

Clinical and pathological features of intraspinal schwannoma

作　　者：李殿炜[1] 刘劲松[1] 李梅[1] 李娟[1] 代键 LI Dian-wei;LIU Jin-song;LI Mei;LI Juan;DAI Jian(Lu'anPeople's Hospital,Lu'an,Anhui 237000,China)

机构地区：[1]六安市人民医院,安徽六安237000

出　　处：《颈腰痛杂志》2022年第4期538-541,共4页The Journal of Cervicodynia and Lumbodynia

基　　金：六安市人民医院院内课题(编号:2021kykt17)。

摘　　要：目的探讨椎管内神经鞘瘤患者的临床和病理学特征,为其临床诊治提供参考借鉴。方法回顾性分析我院2016年1月~2021年12月收治的21例椎管内神经鞘瘤患者,均接受后路显微镜下肿瘤全切术。统计分析其临床资料和病理学特征,随访观察其术后转归情况。结果本组患者男女比例为10:11,无明显的性别倾向;年龄34~72岁之间,但未见高峰发病年龄;临床表现以疼痛为最(18例,占比85.7%),其次为感觉障碍(9例,占比42.9%)和运动障碍(6例,占比28.6%);发病位置:颈段5例,胸段6例,胸腰段3例,腰段7例,无明显的集中部位;其病程较长,最短为2个月,最长47个月,未见急性起病者;MRI检查见肿瘤多数为单发,且边界清晰、以圆形和类圆形结节灶多见。病理学方面,瘤体多为圆形或卵圆形,多数包膜完整,切面灰白色为主,镜下肿瘤细胞可呈梭形或短梭形,见交错状、栅栏状或旋涡状排列;免疫组化:Vimentin(+)9例,SOX-10(+)5例,S-100(+)13例,SMA血管壁(+)2例,散在Ki-67(+)13例(均为1%~10%之间,仅1例20%)。所有患者临床诊断均为良性肿瘤,术后疼痛、感觉障碍和运动障碍均显著减轻或消失。结论椎管内神经鞘瘤无明显的性别倾向和高峰发病年龄,椎管内无明显的集中发病部位,患者病程较长,肿瘤边界清晰,多为圆形或类圆形;病理学方面,瘤体多为圆形或卵圆形,切面灰白色为主,镜下肿瘤细胞可呈梭形或短梭形,见交错状、栅栏状或旋涡状排列;免疫组化可呈Vimentin、SOX-10、S-100(+),同时可散在低指数的Ki-67(+)。由于椎管内神经鞘瘤多为良性肿瘤,予以后路显微镜下肿瘤全切后,一般预后良好,可显著改善临床症状和脊髓神经功能。Objective To investigate the clinical and pathological characteristics of patients with intraspinal schwannoma,and to provide reference for clinical diagnosis and treatment.Methods From January 2016 to December 2021,21 patients with intraspinal schwannoma treated in our hospital were analyzed retrospectively.All patients underwent total tumor resection under posterior microscope.The clinical data and pathological characteristics were statistically analyzed,and the postoperative outcome was observed.Results The ratio of male to female in this group was 10:11,and there was no obvious gender tendency.The age ranged from 34 to 72 years old,but there was no peak age of onset.Pain was the most common clinical manifestation(18 cases,accounting for 85.7%),followed by sensory impairment(9 cases,accounting for 42.9%)and motor impairment(6 cases,accounting for 28.6%).Location of the disease:cervical segment in 5 cases,thoracic segment in 6 cases,thoracolumbar segment in 3 cases,lumbar segment in 7 cases,without obvious concentration.The course of disease was long,the shortest was 2 months,the longest was 47 months,and there was no acute onset.MRI showed that most of the tumors were single,with clear boundary,and round and quasi round nodules were more common.In terms of pathology,most of the tumor bodies were round or oval,most of them had complete capsule,and the section was mainly gray white.Under microscope,the tumor cells could be spindle or short spindle,with staggered,palisade or vortex arrangement.Immunohistochemistry stainning results:vimentin(+)9 cases,Sox-10(+)5 cases,S-100(+)13 cases,SMA vascular wall(+)2 cases,scattered Ki-67(+)13 cases(all between 1%-10%,only 1 case with 20%).All patients were clinically diagnosed as benign tumors,and postoperative pain,sensory and motor disorders were significantly reduced or disappeared.Conclusion s There is no obvious gender tendency and peak age of onset of schwannoma in the spinal canal,there is no obvious concentrated site of onset in the spinal canal,the patients have a

关 键 词：椎管内肿瘤 神经鞘瘤 病理学特征 免疫组化 

分 类 号：R739.4[医药卫生—肿瘤]