头颈部色素性神经鞘瘤1例

目的:探讨头颈部色素性神经鞘瘤(melanotic schwannoma,MS)的临床表现、鉴别诊断及预后,以提高对该疾病的认识及治疗水平.方法:徐州市中心医院口腔科2019年5月收治了1例头颈部MS患者,总结其临床表现、影像学资料及病理资料,并分析国内外相关文献.结果:患者因发现右颈部肿物10 d入院就诊.颈部CTA示:病灶周围血管及软组织受压、推移,神经源性肿瘤可能.外科手术切除.免疫组织化学结果:HMB45(+)、KI67(10％,+)、CD34(+)、S100(+).病理诊断:(右颈部)色素性神经鞘瘤.结论:色素性神经鞘瘤来自神经嵴具有双向分化潜能的细胞,鉴于其潜在恶性,患者术后须长期随访.     

下颌骨骨内神经鞘瘤:1例报告及文献复习

神经鞘瘤是来源于神经髓鞘的良性肿瘤,多见于头颈部软组织.骨内神经鞘瘤较为罕见,但以下颌骨相对常见.本文报告1例首发表现为下颌下肿块的下颌骨多发性骨内神经鞘瘤,详细描述其临床特征、影像学表现、手术所见、病理结果以及术后随访情况,并回顾国内外文献将其好发因素、临床表现、影像学表现、组织病理学表现以及治疗情况和预后作了系统性总结和分析.大多数骨内神经鞘瘤临床表现一般为进行性无症状性下颌骨膨胀,也可表现为颌面畸形,牙移位或拥挤.     

口腔颌面部恶性神经鞘瘤的影像学和病理学分析

目的:系统分析口腔颌面部恶性神经鞘瘤的影像学和病理学特征,提高对该疾病的认识。方法 :收集2005—2013年我院收治并经病理检查确诊的8例口腔颌面部恶性神经鞘瘤的病历资料,系统分析其CT和MRI影像学表现,以及组织病理学特征。结果:颌骨内恶性神经鞘瘤的CT检查表现出骨质破坏、牙根吸收等恶性肿瘤特征。而软组织恶性神经鞘瘤的MRI检查表现为边界不清,T1WI呈等信号、T2WI压脂像呈高信号,信号不均匀,有不均匀强化等特点。病理学上,Vimentin免疫组织化学染色在所有病例的恶性神经鞘瘤细胞中为强阳性,S-100和Ki-67表现为部分肿瘤细胞表达阳性。CD34在7例患者肿瘤细胞中表达为阴性。结论:CT和MRI影像学检查可帮助确定颌面部恶性神经鞘瘤的性质、范围、形态和破坏程度及与周围组织的关系。Vimentin、S-100和Ki-67免疫组织化学染色可用于肿瘤术后的确诊。     

颌骨神经鞘瘤的诊断与鉴别

颌骨神经鞘瘤是一种少见的来源于神经鞘细胞的良性肿瘤,临床上易造成误诊。其鉴别诊断对于选择正确的手术方式具有重要意义。加深对颌骨神经鞘瘤临床表现和影像学、病理、免疫组化各项检查的了解,有助于提高其诊治水平。本文就颌骨神经鞘瘤的临床特征及与成釉细胞瘤、神经纤维瘤、颌骨囊肿等的鉴别诊断作一综述。     

婴儿黑色素性神经外胚瘤1例及临床病理特点分析

婴儿黑色素性神经外胚瘤是发生于婴儿的一种少见肿瘤,临床易误诊.笔者接诊婴儿上颌黑色素性神经外胚瘤1例,局部完整切除肿瘤后随访6个月,未见转移和复发.本文结合文献探讨婴儿黑色素性神经外胚瘤的临床、病理特点.婴儿黑色素性神经外胚瘤病理表现具有特征性,肿瘤由含棕黑色色素的上皮样瘤细胞和呈巢片状分布的神经母细胞样细胞组成,临床表现为蓝黑色肿物,应进行免疫组织化学病理检查确诊,治疗选择局部完整切除.     

颌骨内神经鞘瘤:1例报告及文献复习

神经鞘瘤是来源于神经鞘膜的肿瘤,多见于软组织,骨内神经鞘瘤并不常见。本文报告1例以下颌骨肿大为主要表现的骨内神经鞘瘤,通过该患者的临床表现、影像学检查、术中所见、病理诊断和术后随访情况。结合相关文献将该病的病因、临床表现、影像学表现、组织病理学特点、治疗方法及预后进行系统性的分析和总结,旨在为临床早期诊断、早期治疗该病时提供参考。     

腮腺脂肪瘤样多形性腺瘤的诊断与治疗分析

目的 探讨腮腺脂肪瘤样多形性腺瘤的病理特点、免疫组织化学特点、诊断标准和有效治疗手段.方法 腮腺脂肪瘤样多形性腺瘤患者2例,行瘤体加瘤周5 mm部分腺体摘除术,术后肿物标本行常规病理学和免疫组织化学检查;患者术后随诊26 ～ 36个月,观察预后情况.结果 常规病理镜下见肿瘤组织包膜完整,肿瘤实质由黏液软骨样基质、脂肪组织及肌上皮细胞构成;脂肪组织弥漫均匀分布于瘤组织内,呈蜂窝状结构.免疫组织化学检查发现肿瘤组织发现,胶质纤维酸性蛋白(glial fibrillary acidic protein,GFAP)在肌上皮细胞胞浆阳性表达;S-100蛋白表达阳性,主要在脂肪细胞表达;上皮膜抗原(epithelial membrane antigen,EMA)阳性,胞膜表达,主要在内层导管细胞表达;细胞角蛋白AE1/AE3阳性;细胞核增殖抗原Ki-67在细胞核的阳性表达率1％;患者术后随诊期内未见肿物复发.结论 病理和免疫组织化学检查是确诊腮腺脂肪瘤样多形性腺瘤的依据,手术是治疗本病的有效手段.     

颈鞘内神经鞘瘤的诊治分析

目的:探讨颈鞘内神经鞘瘤的诊断与治疗方法。方法:回顾性分析2005～2010年收治的23例颈鞘内神经鞘瘤患者的临床资料。结果:彩超和CT-血管造影(CT-angiography,CTA)检查后对23例患者进行手术治疗,术后经病理检查确诊为神经鞘瘤,术后随访,无严重并发症发生,无复发病例。结论:术前CTA检查是诊断颈鞘内神经鞘瘤的有效方法,手术切除务求彻底,术中尽可能保存来源神经的完整性是治愈该病的关键。     

以颈部肿块为主要临床表现的颈段椎管内外交通性神经鞘瘤的诊断与治疗

目的:发生于颈段椎管的神经鞘瘤可沿椎间孔向外生长,表现为颈椎内外交通性肿块,但多因早期出现脊髓压迫症状而就诊于神经外科。本文报告2例以颈部肿块为主要临床表现而就诊于口腔颌面外科的颈椎内外交通性神经鞘瘤,旨在提高临床医师对本病的诊断与治疗水平。方法:对中南大学湘雅医院口腔颌面外科近期收治的2例以颈部肿块为主要临床表现的颈椎内外交通性神经鞘瘤患者的临床资料进行总结与随访,并结合相关文献,探讨其临床病理特征、手术方式与预后。结果:2例患者均以颈上部肿块为主要症状就诊,术前影像学检查显示颈椎内外交通性哑铃型肿块,采用颈后正中和颈外侧联合入路切除肿瘤并重建脊柱的稳定性,随访1a未见复发。结论:发生于颈椎的神经鞘瘤可表现为颈部肿块而脊髓压迫症状并不明显,详细的体格检查与影像学检查可以明确诊断,手术切除具有一定难度。     

多发性神经鞘瘤一例报告

患者,女,26岁。五年前先后发现左面颊部,左腕臂、左大腿内侧,后枕部各长一肿物(左侧大腿内脚物已在当地医院切除)。近二年感到左面颊部肿物逐渐增大。同时伴面部麻木感。检查:各系统检查未发现异常。左侧腕臂处有一约3×3.5×3cm大小的肿物,质硬,上下不能活动,强行活动时伴有手指麻木感。左右活动度较大,且无手指麻木感。后枕部有一约2×1.5×1.5cm大小的肿物,性质同上,呈圆形,活动度小。左侧腮腺长一肿物,质硬,活动轻微,约有3×4×3.5cm大小,呈卵圆形,压之有轻微的放射性疼痛,张口度正常。处理:术中除左腕臂处及后枕部肿物可见神经干在肿物包膜外面,左腮腺肿物可见有面神经穿其于肿物内,术中保留面神经,将瘤体及腮腺完整摘除后送病理检查。病理报告多发性神经鞘瘤。术后一周拆线,伤口Ⅰ期愈合。     

Tongue schwannoma: clinicopathological findings

Schwannomas are peripheral nerve sheath tumors. Approximately 25% of extracranial schwannomas are located in the head and neck district, but only 1% shows an intraoral origin. We report a case of a 28-year-old patient with a tongue schwannoma. Morphologic analysis and immunohistochemical findings strongly support the diagnosis. Surgical treatment is discussed.     

Cyst-like schwannoma on the eyelid margin

Schwannomas are benign tumors originating from Schwann cells. We describe a rare case of solitary schwannoma on the eyelid margin. To our knowledge, this is the first clinical report of such a lesion on the eyelid margin, confirmed by both extensive immunohistochemical analysis and its distinctive morphology. Although schwannomas seldom undergo malignant change, they should be considered in the differential diagnosis of palpebral lesions.     

Systemic amyloidosis manifesting as localized, severe periodontitis

BACKGROUND: Amyloidosis comprises a heterogenous group of disorders characterized by amyloid deposition in various organs. The authors document a case in which amyloidosis manifested as a localized, severe, periodontal disease. CASE DESCRIPTION: A 73-year-old woman visited her dentist because of pain and increased mobility of her mandibular bridge. Radiographic examination revealed severe vertical bone loss associated with tooth no. 27. One of the authors extracted the tooth, removed tissue with a curet from this site and submitted it for pathological examination. He made a diagnosis of amyloidosis on the basis of histological and immunohistochemical findings. CLINICAL IMPLICATIONS: Clinicians should consider periodontal involvement in amyloidosis as a possible cause of severe, localized, periodontal disease, particularly in patients with chronic inflammatory disorders or a history of amyloidosis.     

Tuberculosis of jaw bones

The authors report three cases of isolated tuberculous foci of jaw bones and stress the increase in the prevalence of tuberculosis in last years. The process had a protracted course and was associated with isolated or multiple pus-discharging fistulae. In all cases the final diagnosis was based on the histological examination of scrapings from the pathological lesions. In one case establishing of correct diagnosis was very difficult since the initial laboratory investigations and microscopic examination of cells from the pus and sputum failed to demonstrate specific changes. Only later histological examination during repeated exacerbations demonstrated tuberculosis. The treatment with tuberculostatic agents made possible achieving of improvement.     

Intraosseus plexiform schwannoma of the mandible: immunohistochemical differential diagnosis

Schwannomas and neurofibromas are the most common benign tumors derived from peripheral nerves, and whereas the head and neck region is the most common location for the occurrence of benign neural sheath neoplasms, origin within the oral cavity is uncommon, and occurrence centrally in the jaws is most unusual. Plexiform (multinodular) schwannoma is an anatomically unique variant of schwannoma characterized grossly and/or microscopically by intraneural plexiform and often multinodular growth. In current report, we present the first reported case of intraosseous plexiform schwannoma of the mandible, an extremely rare benign neurogenic tumor, diagnosed by optical and immunohistochemical procedures, showing the importance of differential diagnosis of these unusual intraosseous mandibular tumors.     

A benign isolated schwannoma of the orbit

Schwannomas are benign encapsulated tumors, originating from Schwann cells of the peripheral nerves. Schwannomas accounts for approximately 1% of all orbital tumors. Most schwannomas originate from branches of the oculomotor, trochlear, trigeminal, and abducens nerves and from sympathetic and parasympathetic fibers. The progressive growth may cause compression of the optic nerve with papilledema or optic atrophy. Prompt diagnosis and early treatment are necessary to avoid important ocular consequences. We report a successful surgical treatment of orbital schwannoma in a 75-year-old woman.     

Glomus tumor of the lower lip. A case report

A glomus tumor is a benign neoplasm originating from the modified smooth muscle cells of the vascular glomus. This neoplasm was firstly considered by Masson in 1924, and generally it has a solitary lesions but in some cases multiple lesions were described. Differential diagnosis is usually made with Kaposi sarcoma and hemangiopericytoma. The histopathologic examination is essential together with the immunohistochemical study. The clinical case of a 65-year-old man with a glomus tumor of the lower lip is described.     

Extraosseous schwannoma of the mental nerve clinically simulating intraosseous

We report a case of a benign neurilemmoma arising from the right mental nerve. Schwannomas are rare neurogenic tumours that originate from Schwann cells of the peripheral nervous system. Frequent locations are the head and neck region. Most of the tumours occur in the soft tissue whereas intraosseous schwannomas are rare. This case report deals with a young patient who was referred to our hospital with an unidentified fast-growing tumour located mainly in the premolar region of the right mandible. The tumour presented as an expansive, unilocular, well defined, radiolucent lesion on orthopantomography. No expansion of the mandibular canal could be seen. Computerized tomography scans of the mandible helped to identify the solid nature of the tumour. A biopsy was necessary to make the final diagnosis and the tumour was then excised surgically. Postoperative magnetic resonance imaging scans and a histological examination of the surgical specimen showed no signs of neurofibromatosis type 2.     

直肠腺癌转移至牙龈1例报告及文献复习

直肠腺癌转移至牙龈非常罕见。本文报道1例81岁女性患者,结肠癌切除2年后出现直肠腺癌,并转移至牙龈。通过组织病理学检查、免疫组织化学染色确诊。口腔转移很少发生,并且通常易被误诊为更常见的良性病变,因此应将其视为鉴别诊断中的一种可能性。完善的临床检查以及多学科诊疗非常必要。     

颌面部嗜酸性淋巴肉芽肿15例临床病理分析

目的:探讨嗜酸性淋巴肉芽肿临床和病理特征,以利于正确诊治.方法:对我院19年来治疗的15例颌面部嗜酸性淋巴肉芽肿患者的临床资料进行分析.结果:5例术前正确诊断者中4例都有嗜酸细胞增高,1例有病理诊断;误诊以多形性腺瘤最多见,达6例.结论:末梢血嗜酸粒细胞增高对诊断本病有较高的参考价值,确诊靠病理检查,皮肤瘙痒则有一定参考作用;单靠临床检查易误诊.