下咽部巨大神经鞘瘤1例  

Giant neurilemmoma in hypopharynx: A case report

作　　者：李扬 谷彬[1] LI Yang;GU Bin(Department of Otolaryngology-Head and Neck Surgery,Tangshan Union Medical College Hospital,Tangshan Hebei 063000,China)

机构地区：[1]唐山市协和医院耳鼻咽喉-头颈外科,河北唐山063000

出　　处：《临床与病理杂志》2023年第7期1465-1468,共4页Journal of Clinical and Pathological Research

摘　　要：喉神经鞘瘤十分少见,多发生于杓会厌皱襞,常有室带、杓状软骨、声带、梨状隐窝的受累,发生于下咽部的神经鞘瘤少见。现报告1例位于下咽部后壁的神经鞘瘤。该患者起病隐匿,喉镜检查示喉咽后壁巨大肿物,表面光滑。在局部麻醉下行气管切开及全身麻醉下行内镜辅助等离子刀下咽部肿物摘除术,术中于30°内镜可见喉咽后壁偏左侧巨大表面光滑的新生物,肿物黏膜表面血管丰富,术中切开黏膜、黏膜下组织、肌肉层可见表面淡黄色肿物膨出,沿肿物周边剥离,肿物大小约5.0 cm×3.5 cm×2.8 cm。术后给予抗感染、糖皮质激素雾化吸入等综合治疗,1周后给予二期全身麻醉下鼻内窥镜下鼻中隔偏曲矫正术,2周后给予患者拔出气管套管,气管切开术用3-0可吸收线对位缝合,患者治愈出院。术后随访至今无复发。术后病理:喉咽后壁可见梭形肿瘤细胞,考虑神经鞘瘤。免疫组织化学染色:波形蛋白和S-100均为阳性,Bcl-2为部分阳性,细胞增殖的相关抗原Ki-67为小于5%阳性,平滑肌肌动蛋白和CD34均为血管阳性,甘露糖结合蛋白、NF、胶质细胞原纤维酸性蛋白、结蛋白和细胞角蛋白均为阴性。喉神经鞘瘤多为良性病变,手术为主要的治疗方法,经口入路喉显微手术和颈外入路手术是下咽神经鞘瘤的2种手术方式。应根据肿瘤大小、出血风险等选择合适的手术方式。Laryngeal schwannomas are extremely rare and most commonly originate from the aryepiglottic fold.They often involve the ventricular,arytenoid cartilage,vocal cords,and piriform fossa.Schwannomas occurring in the hypopharynx are uncommon.A case of schwannoma located in the posterior wall of the hypopharynx is reported.The patient presented with insidious onset and laryngoscopy revealed a large,smooth-surfaced mass in the posterior wall of the hypopharynx.A tracheotomy was performed under local anesthesia,and with general anesthesia,an endoscopic-assisted plasma knife pharyngectomy was performed to carry out the mass. Intraoperatively, a large, smooth surfaced neoplasm was observed on the left side of the posterior wall of the hypopharynx using a 30° endoscope. The surface of the mass mucosa exhibited rich vascularization. Upon dissecting the mucosa, submucosal tissue and muscle layer during the procedure, a faint yellowish mass protrusion was visible. The mass was dissected along its periphery, and its dimensions were approximately 5.0 cm×3.5 cm×2.8 cm. Postoperatively, the patient received comprehensive treatment including anti-infection measures and glucocorticoid atomization inhalation. One week later, corrective surgery for a deviated nasal septum was performed under second-phase general anesthesia using nasal endoscopy. Two weeks following that, the tracheal tube was removed, and the tracheotomy incision was sutured with 3-0 absorbable sutures. The patient achieved a full recovery and was discharged. Subsequent follow-ups have no recurrence to date. Postoperative pathology: fusiform tumor cells were visible in the posterior laryngeal wall, suggestive of schwannoma. Immunohistochemistry: vimentin and S-100 were positive, Bcl-2 was partially positive, the proliferation marker Ki-67 was positive in less than 5%, smooth muscle actin and CD34 were vascular positive, and mannose-binding protein, NF, glial fibrillary acidic protein, desmin, and cytokeratin were negative. Laryngeal schwannomas are mostly benign co

关 键 词：下咽 神经鞘瘤 睡眠呼吸暂停 气道 

分 类 号：R739.63[医药卫生—肿瘤]