Exogastric neurilemmoma presenting as acute abdomen: Role of computed tomography in diagnosis

A case of subserosal gastric neurilemmoma is hereby presented. This reported case is unique in its clinical presentation including the appearance of acute abdomen and fever subsequent to unremarkable and uneventful upper gastrointestinal endoscopy. The tendency of neurilemmoma to cause mucosal ulceration with fistula formation probably led to this clinical presentation. The role of computed tomography in establishing diagnosis of exogastric tumor is emphasized.     

臂丛神经鞘瘤的MRI诊断

目的 探讨磁共振成像（magnetic resonance imaging，MRI）在臂丛神经鞘瘤诊断中的应用价值。方法 分析36例经手术和病理证实的臂丛神经鞘瘤术前MRI表现。观察内容包括病变部位、肿块大小、边界、信号、强化特征及范围。结果 MRI能清晰显示臂丛神经的根、干及分支，表现为线状低信号影。36例臂丛神经鞘瘤平均直径为4．9cm，均表现为沿臂丛神经根生长的肿块，其中30例表现为边界清楚的纺锤形或长圆形肿块。MRI显示．16例表现为均匀的T1WI低或等信号（与肌肉相比），T2WI高信号，增强后中等度强化；20例T1WI呈低信号，T2WI呈不均匀高信号，内见低信号区，所谓的“靶征”，增强后明显强化。结论 臂丛神经鞘瘤具有特征性的发生部位、形态学表现及MRI信号特点，对本病能提供准确的诊断依据。     

寰椎后弓半切除在高位上颈椎哑铃状神经鞘瘤手术的应用

目的:探讨寰椎后弓半切除在高位上颈椎哑铃状神经鞘瘤手术的可行性及临床疗效。方法:回顾性分析2005年1月至2018年12月高位上颈椎哑铃状神经鞘瘤患者13例,男10例,女3例;年龄19~67岁;枕骨大孔至C1平面4例,C1,2平面9例。进行寰椎后弓半切除摘除肿瘤,未内固定,临床疗效采用疼痛视觉模拟评分(visual analogue scale,VAS),日本骨科协会(Japanese Orthopaedic Association,JOA)评分及美国脊髓损伤学会(American Spinal Injury Association,ASIA)分级等进行比较。结果:13例均顺利完成手术,术中均未出现椎动脉损伤及脊髓损伤。13例均随访12个月以上,未发现局部复发,VAS评分及JOA评分均较术前改善。术前ASIA分级:C级1例,D级6例,E级6例;末次随访D级3例,E级10例。结论:寰椎后弓半切除可Ⅰ期切除高位上颈椎哑铃状神经鞘瘤,短期临床疗效好,无颈椎不稳等并发症。     

CT在三叉神经瘤诊断中的价值

目的探讨CT在三叉神经瘤诊断中的价值。方法搜集经手术和病理学证实的三叉神经瘤12例,行CT平扫及静脉注射60％泛影葡胺或优维显增强扫描。结果12例中表现为特征性哑铃形3例,类哑铃形6例,类圆形3例。肿瘤呈混杂密度、均匀密度或等密度,均无钙化及水肿。结论CT对三叉神经瘤的定位、定性及岩骨和颅底骨的异常改变具有重要的诊断价值。     

Intraoperative ultrasonography of extramedullary spinal tumours

Summary Intraoperative spinal sonography (IOSS) was performed in 28 patients with extramedullary spinal tumours. Images were obtained of 31 tumours, because 2 patients had multiple tumours. There were 17 neurilemmomas, 9 meningiomas and 2 dermoid, cysts. All tumours appeared well-defined and highly echogenic. There was no difficulty differentiating extramedullary spinal tumours from intramedullary nasses excepting case, a big neurilemmoma at the conus medullaris. All images were assessed with reference to the surface of the lesions, the existence of cysts, and movement. Neurilemmomas had smooth surfaces, some cysts, and exhibited a floating movement. Meningiomas had irregular surfaces, were more highly echogenic than neurilemmomas, and adhered tightly to the dura mater. However, some neurilemmomas and meningiomas did not have these, and it was not always possible to differentiate them. Although, IOSS has limitations of resolution, it gave useful information about the size of the tumours, the degree of displacement of the spinal cord, and even about the type of tumour in some cases. It was extremely helpful to the surgeon.     

面神经管裂缺处面神经组织学观察

目的探讨先天性面神经管裂处神经外膜缺陷可能引起的病理学改变。方法采用光学显微镜对美国明尼苏达大学颞骨病理实验室１５２６具颞骨连续切片的面神经颞骨全程进行组织病理学观察。结果发现先天性面神经管裂者８８５耳，其中４８耳在管裂处神经外膜缺损，其中４０耳面神经从管裂处疝出，有１３耳在管裂处形成外生性面神经鞘瘤。３耳在管裂处面神经受炎性细胞浸润。而管裂处有神经外膜覆盖的８３７耳均未见此类病变。结论面神经管裂处神经外膜的缺损是此处面神经疝出、外生性神经鞘瘤形成和面神经易于受炎症浸润的组织解剖学原因。     

颞骨内微型面神经鞘瘤病理研究

目的探讨颞骨内微型面神经鞘瘤的原发部位和病理行为。方法用光镜对８１５人（１５２６侧）颞骨连续切片进行面神经颞骨内全程组织病理学观察。结果发现未诊断的无症状微型ＡｎｔｏｎｉＡ型面神经鞘瘤１５人（１７耳），占１．８４％。依其病理行为特征分为外生性（１３耳，起自面神经管裂处神经束膜，并向管外生长）和内生性（４耳，起自面神经主干）两种类型。肿瘤起自迷路段者２耳，水平段１２耳，第二膝段１耳，垂直段２耳。结论将颞骨内面神经鞘瘤分为内生性和外生性两种类型有重要的病理和临床意义，有助于手术目的的确定和手术方法的设计     

Neurilemmoma of cervical sympathetic chain

Neurilemmoma of the cervical sympathetic chain is a rare nerve tumour. Less than 40 confirmed cases have been reported in the literature.1 2 Sometimes they can he mistaken as carotid body tumour but usual presentation of these lesions is an asymptomatic neck mass. Because of the rarity of the tumour we report another case of neurilemmoma arising from cervical sympathetic chain in a 19 years old male.     

上消化道间叶源性肿瘤临床病理特征46例

目的:观察上消化道间叶源性肿瘤(GIMTs)的临床病理及免疫组化特征,探讨其临床诊断及处置策略.方法:46例内镜超声检查拟诊为上消化道间质瘤的病例,采用光镜观察其手术或黏膜切除术(EMR)标本的病理特征,免疫组化检测其CD117,CD34,平滑肌抗体(SMA)和S-100的表达状况,并分析其病理诊断与临床的关系.结果:46例GIMTs中食管肿瘤占24例,其中间质瘤5例(20.8%),平滑肌瘤19例(79.2%);22例胃GIMTs中间质瘤20例(90.9%),平滑肌瘤1例,神经鞘瘤1例.25例上消化道间质瘤中CD117阳性21例(84%)、CD34阳性24例(96%).而平滑肌瘤与神经鞘瘤分别仅表达SMA和S-100.结论:上消化道间叶源性肿瘤光镜下病理特征相似,联合检测CD117,CD34,SMA和S-100等免疫组化标记物可区别上消化道GIMTs.在食管以平滑肌瘤多见;而在胃则以间质瘤多见,平滑肌瘤与神经鞘瘤非常少见.