双镜联合治疗胃神经鞘瘤4例临床分析

目的:探讨腹腔镜联合胃镜治疗胃神经鞘瘤的临床应用。方法:回顾分析4例胃神经鞘瘤患者临床及诊疗资料。结果:4例患者术前均行胃镜及腹部CT检查(肿瘤直径均<3 cm),仅1例诊断为胃神经鞘瘤;联合腹腔镜及胃镜切除肿瘤,术中快速病理报告均诊为胃间质瘤;手术均顺利完成,手术平均时间(83±15)min;术中平均出血量(43±10)m L;无出血、狭窄等并发症;随访未出现复发及转移。术后病理诊断均为胃神经鞘瘤。结论:腹腔镜联合胃镜对直径<3 cm的胃神经鞘瘤是安全可行的,但术前诊断率仍有待提高。     

胃神经鞘瘤

目的 总结胃神经鞘瘤的临床特点及治疗方法。方法 收集经我院诊治的10例胃神经鞘瘤患的资料,对其诊断及治疗作分析总结。结果 胃神经鞘瘤主要表现为腹痛、腹部肿块、黑便、上消化道出血亲休克。可通过胃镜、X线、B超等辅助检查协助诊断,确诊靠病理检查。治疗以手术为主。结论 胃神经鞘瘤无特殊临床表现,诊断困难,术前确诊率低,误诊率高。     

胃神经鞘瘤四例诊治体会

目的　探讨胃神经鞘瘤的诊断及治疗。方法　总结我院 4例胃神经鞘瘤病例 ,其中男 1例 ,女 3例 ;年龄 5 2～ 6 1岁 ,3例以急性上消化道大出血 ,急诊剖腹手术 ,1例术前胃镜拟诊淋巴瘤。临床表现无特异性。结果　 3例病灶位于胃底 ,1例于胃窦部 ;3例肿瘤附近并胃粘膜溃疡出血 ,1例溃疡已并发穿孔 ;肿瘤直径最小 3cm ,最大 7cm ;4例均行胃大部切除术治愈 ;4例病理检查结果均为胃神经鞘瘤。结论　胃神经鞘瘤多为良性 ,临床常并发溃疡大出血。肿瘤对胃壁的机械性刺激及局部压迫 ,胃粘膜血运障碍以及来自迷走神经本身的肿瘤诱发的迷走功能亢进等因素 ,可能是导致溃疡及出血的原因。本病易误诊 ,常靠术后病理诊断。手术切除病灶或胃大部切除对本病有确切疗效     

腹膜后神经鞘瘤1例报告并文献复习

目的报告1例腹膜后神经鞘瘤,并复习相关文献,分析其临床诊治现状。方法通过对1例腹膜后神经鞘瘤的诊断、治疗方法及术后病理、随访的回顾,结合国内外有关文献报道,综合分析腹膜后神经鞘瘤的诊断及治疗状况。结果本例行手术治疗,术后病理证实为腹膜后神经鞘瘤,随访半年无复发。结论腹膜后神经鞘瘤诊断困难,影像学检查无特异性,确诊依靠病理检查,理想的治疗方法是通过外科手术完整切除肿瘤,其预后良好,早期复发率低。     

35例胃间质瘤临床诊疗分析

目的:探讨胃间质瘤的临床表现、辅助检查特征、诊断及治疗方法。方法:回顾分析35例胃间质瘤患者的临床资料,统计和分析相关因素。结果:男女比例为1∶0.9,平均年龄(59.6±11.4)岁,肿瘤平均直径(4.5±4.4)cm;病理CD117阳性率91.40%,CD34阳性率88.60%;随访31例,中位存活时间(28.6±9.4)月。结论:胃间质瘤无特异性临床表现,超声内镜检查对诊断有重要的意义,确诊需要病理检查和免疫组化检查;CD117和CD34是胃间质瘤最重要的标记物;完整切除是首选治疗方式,靶向Z治疗药物伊马替尼可改善预后。     

胃神经鞘瘤一例报道及文献回顾

目的介绍胃神经鞘瘤的临床表现、病理特点及其诊治。方法报道1例58岁的女性病人,因"上腹部不适2年余"在徐州医科大学附属医院接受腹腔镜胃部分切除术,术后病理学及免疫组化证实为胃神经鞘瘤。结合既往文献,分析该病的临床表现、影像学表现、病理学特点、治疗和预后的相关情况。结果该病起源于雪旺细胞,临床表现无特异性,内镜及CT检查可辅助发现及定位病灶,光镜下肿瘤细胞呈梭形,核分裂象罕见,肿瘤周围淋巴细胞套形成,免疫组化:S-100(++),CD117(-),CD34(-),DOG-1(-)。手术切除是目前有效的治疗方法。结论胃神经鞘瘤是临床少见的良性肿瘤,恶性胃神经鞘瘤更为罕见,确诊需免疫组化检测,手术切除是最佳的治疗方法。     

胃间质瘤的早期诊断及微创治疗

目的探讨胃镜、超声内镜、腹腔镜联合应用在小的胃间质瘤(直径5cm)诊断和治疗中的作用和价值。方法自2004年8月至2009年12月,对胃镜发现的胃黏膜下隆起性病变43例,进行超声内镜检查,初步诊断胃间质瘤29例(直径0.89~3.85cm,平均1.78cm)。随后在胃镜辅助定位下,行腹腔镜胃部分切除术。术后长期随访有无局部复发及远处转移。结果手术全部成功,手术时间35~90min,平均55min,无术后并发症及死亡病例。术后胃肠功能恢复时间18~36h,平均28h。住院时间3~5d,平均3.6d。术后病理诊断间质瘤者28例,神经鞘瘤1例,术前诊断符合率96.5%。28例胃间质瘤患者术后随访2~64个月,平均30个月,未发现肿瘤局部复发和转移。结论胃镜联合超声内镜有助于发现和诊断小的胃间质瘤,并可在术前初步判定其可切除性。在胃镜辅助定位下,行腹腔镜胃部分切除术治疗小的胃间质瘤安全、有效、预后良好。     

泌尿生殖系神经鞘瘤(附7例报告)

目的:探讨泌尿生殖系神经鞘瘤的临床、影像学及病理特点。方法:回顾性分析1994～2004年7例泌尿生殖系神经鞘瘤患者的临床资料,包括肾上腺、膀胱、前列腺、精索、阴囊及阴茎的神经鞘瘤,结合文献分析其特点。结果:患者平均年龄42岁,均为偶然发现或体检时发现,通过病理检查确诊。随访2～6年,7例患者肿瘤均经手术切除,病理证实6例良性,无复发;1例恶性睾丸神经鞘瘤,2年后死于肿瘤复发转移。结论:手术切除是目前治疗泌尿生殖系统神经鞘瘤的方法,由于泌尿生殖系神经鞘瘤缺乏典型的临床表现,临床诊断困难,确诊需经病理学诊断。肿瘤特异性标志物S100,Leu7及MBP有助于该病的诊断。     

阴茎多发性神经鞘瘤的临床特征(附1例报告并文献复习)

目的:探讨阴茎多发性神经鞘瘤的临床特征。方法:报告1例阴茎多发性神经鞘瘤患者的临床资料,结合复习相关文献。结果:术前拟诊为阴茎多发性脂肪瘤,行肿瘤切除术,手术治疗后恢复良好。病理报告为阴茎多发性神经鞘瘤。免疫组化:S-100( ),SMA(-)。随访半年无复发。结论:阴茎多发性神经鞘瘤缺乏典型的临床表现,临床诊断困难,需经病理学检查,免疫组化检测肿瘤特异性标志物S-100、SMA有助于确诊。手术切除是治疗本病的主要方法。     

胃神经鞘瘤:附9例报告

目的 分析胃神经鞘瘤的临床特点、诊断和治疗方法。方法 回顾分析笔者近15年来收治的9例胃神经鞘瘤的临床资料。结果 临床主要表现是上腹部隐痛(9例)、腹部肿块(5例)和上消化道出血(3例)。9例均手术治疗，但无1例术前确诊。1例恶性胃神经鞘瘤术后只生存了8个月，良性的手术效果良好。结论 胃神经鞘瘤无特异性临床表现，术前确诊困难，误诊率高，一经确诊，应及早手术治疗。     

Benign nerve sheath tumor of stomach

Gastrointestinal mesenchymal tumors are a group of tumors, which originate from the mesenchymal stem cells of the gastrointestinal tract. Gastric schwannoma is a very rare gastrointestinal mesenchymal tumor, which represents only 0.2% of all gastric tumors and 4% of all benign gastric neoplasms. We report a 55 years old lady who suffered from pain epigastrium, vomiting, occasionally with blood, loss of appetite and weight loss. Endoscopic examination showed a round submucosal tumor with a central ulceration along the greater curvature of the stomach. The pathological examination revealed a picture of spindle cell tumor. Immunohistochemical stain was strongly positive for S-100 protein stain, and non-reactive for CD34, CD117, consistent with benign nerve sheath tumor of stomach i.e. gastric schwannoma.     

Laparoscopic treatment of a series of rare tumors,gastric schwannoma with chronic iron deficiency anemia: A case report

Introduction and importanceGastric schwannoma is a rare and slow-growing gastrointestinal mesenchymal tumor. Gastric neurilemmoma accounts for less than 1% of all gastric tumors. Without specific clinical manifestations, it is easy to be misdiagnosed before the operation, and rupture and bleeding will lead to persistent anemia in patients. The diagnosis can only be confirmed by pathological examination.Case presentationA 55-year-old woman was admitted to The Second Hospital of Lanzhou University due to abdominal distension, pain, acid regurgitation, and belching. The tumor was completely removed by laparoscopy. The postoperative specimens were diagnosed as gastric neurilemmoma by pathological examination.Clinical discussionSchwannoma is a benign neurogenic tumor. Complete surgical resection with a negative cutting edge is an effective method for the treatment of gastric schwannoma. Because the lesion is benign, the prognosis of the patient is good.ConclusionLaparoscopic tumor resection is a choice for the treatment of gastric schwannoma, and the therapeutic effect is good.     

胃间质瘤临床病理及预后分析

目的探讨胃间质瘤临床病理特征及与预后相关的因素。方法收集中国医学科学院肿瘤医院1986年3月至2001年12月收治的98例有完整资料的位于胃的间质瘤、平滑肌瘤、平滑肌肉瘤、平滑肌母细胞瘤、许旺细胞瘤和神经纤维瘤患者的临床和病理资料.复阅切片(苏木精-伊红染色)、重新诊断,肿瘤两点取材构建组织微阵列;免疫组织化学染色检测CD117、CD34、平滑肌肌动蛋白(SMA)、desmin、S-100及Ki-67蛋白等6种抗体的表达;单因素及多因素分析各变量与患者预后的关系。结果确诊间质瘤91例(92.9%)。随访率91.0%,中位随访时间54个月,患者1、5、10年生存率分别为88.8%、79.6%和63.7%。单因素分析显示,患者的预后与肿瘤大小、核分裂像数目、肿瘤坏死、核异型、细胞类型、细胞密集程度、手术类型、黏膜侵犯、年龄及Ki-67标记指数(5%为界)等因素有关(P<0.05,P<0.01);多因素分析显示,肿瘤大小、核分裂像数目、肿瘤坏死及黏膜受侵是影响预后的重要因素(P<0.05,P<0.01)。结论肿瘤直径大于10cm、核分裂像数目超过10个/50HPF、肿瘤有坏死,黏膜受侵常提示胃间质瘤恶性度较高。     

A Case of Benign Schwannoma of the Ascending Colon Treated With Laparoscopic-Assisted Wedge Resection

Isolated colonic schwannomas are rare gastrointestinal mesenchymal tumors. Only a small number of cases have been reported. Occurrence of these tumors is more common in the stomach than in the large intestine. These spindle cell lesions are distinct from leiomyoma, leiomyosarcoma, and gastrointestinal stromal tumors because the tumor cells have a distinct immunophenotype, with strong diffuse positivity for S-100 and vimentin, as well as corroborative negative staining of CD117 and smooth muscle markers. We present a case of colonic schwannoma in a 70-year-old woman who had no specific symptoms. The patient was diagnosed with a submucosal tumor in the ascending colon on colonoscopy and abdominal computed tomography. Laparoscopic-assisted wedge resection of colon was performed. The very rare pathologic diagnosis of ascending schwannoma was made postoperatively. This case is interesting because schwannomas of the colon and rectum are extremely rare and are treated by laparoscopic-assisted wedge resection.     

Intraparotid facial nerve schwannoma: diagnosis and management.

OBJECTIVE: Facial nerve schwannomas are rare neoplasms that present a challenge in diagnosis and management. We sought to gain insight into the clinical presentation and its implications in management. STUDY DESIGN AND SETTING: A group of patients diagnosed with schwannoma was reviewed, with focus on tumor arising in the intraparotid region of the facial nerve. The patient population consisted of 3722 patients evaluated retrospectively over 38 years at the Shadyside Facial Paralysis Center, a tertiary referral center. From this population, 29 patients (18 women and 11 men) with the diagnosis of schwannoma were selected for review. RESULTS: Twenty-nine patients had facial nerve schwannoma. The average age at diagnosis was 44 years (range, 7 to 78 years). Eight patients had intraparotid involvement, with 5 having a palpable mass in the parotid. The duration of symptoms averaged 8.4 years overall, with intraparotid involvement averaging 10.9 years. The 8 intraparotid schwannomas had a mean House-Brackmann grade of 1.5/6 at initial presentation. Postoperative facial nerve function was only 4.4/6 for resected intraparotid schwannomas. CONCLUSIONS: Intraparotid facial nerve schwannomas are slow growing tumors, which are usually asymptomatic but can be painful. Schwannoma should be suspected if the facial nerve cannot be found intraoperatively or if the tumor is intimately associated with the facial nerve. In cases where schwannoma is suspected, biopsy is recommended, while complete resection is postponed to obtain imaging studies to evaluate the extent of disease and to discuss possible outcomes with the patient. SIGNIFICANCE: This article provides guidance for the appropriate management of intraparotid facial nerve schwannoma.     

99例胃肠道间质瘤临床分析

目的：分析胃肠道间质瘤（GIST）的临床特征与诊断。方法：回顾性分析经手术和病理确诊的99例GIST病例资米斗。结果：1）GIST好发年龄在40岁以上,以60岁以上最多见,男性发病率多于女性。2）胃间质瘤好发于胃底和胃体。3）术前胃镜、上腹CT、超声内镜等有助于提示诊断,但最终确诊需靠术后病理及免疫组化,其中DOG-1、CDl17是目前诊断特异性较高的指标,其他CD34、SMA、S-100等可协助鉴别诊断,CEA对胃间质瘤的诊治无价值。4）手术仍是目前胃间质瘤的主要治疗方法,对于较小的肿瘤可局部切除,手术切缘距肿瘤3cm已足够;对较大的肿瘤可行胃大部切除,必要时行全胃切除;若侵及其他脏器,应争取-并切除;因淋巴结转移极少见,故不常规行淋巴结清扫。结论：GIST术前诊断较困难,确诊依赖于病理学及免疫组化检查。手术是主要治疗方法。     

Malignant tumors of the gastrointestinal autonomic nervous system (GAN tumors or plexosarcomas). Report of a case

The plexosarcomas or gastrointestinal autonomic nerve tumors (GAN tumors) are very rare neoplasms originating from the gastrointestinal autonomic nervous system. They have been differentiated from the other gastrointestinal stromal tumors due to ultrastructural features showed by electronic microscopy. Their mesenteric localization rare than the gastric and intestinal localization, and it gives a very poor and specific clinical symptomatology. It's very difficult to make a correct diagnosis. The most important prognostic factors influencing the survival seem to be the tumor size and the mitotic activity. The authors describe a case of multiple Plexosarcomas occurred in a young patient one year after a surgical intervention for ileal resection to remove a benign schwannoma. This patient wasn't a carrier of multiple Neurofibromatosis. The diagnostic difficulties before surgical operation are stressed and the importance of surgery as the only diagnostic and therapeutic choice is underlined, even if local recurrences occurred in more than 50% of the treated cases.     

Abducens nerve schwannoma: a case report and review of the literature

BACKGROUND: Schwannomas of the abducens nerve are extremely rare tumors; only 10 cases have been reported so far. The tumor may be located within the cavernous sinus (CS) or more commonly at the prepontine region. Patients usually present with VIth cranial nerve paresis. CASE DESCRIPTION: We report a case of a 42-year-old male patient who presented with headache, vertigo, and hearing deficit, but no symptoms or signs related to a VIth cranial nerve impairment. Computed tomography and magnetic resonance imaging showed a large mass with a ring-like contrast enhancement in the prepontine area. Surgical treatment, via a simple retrosigmoid suboccipital approach, revealed a schwannoma originating from the VIth cranial nerve at its prepontine portion. Postoperative histological examination confirmed the diagnosis of schwannoma, and the patient had only a VIth cranial nerve palsy, which resolved during long-term follow-up. CONCLUSIONS: Abducens schwannomas are rare tumors, representing less than 1% of all intracranial schwannomas in our clinic and about 13% of oculomotor nerve schwannomas reported in the literature. These lesions can be mainly divided into tumors originating from the intracavernous portion of the VIth cranial nerve or more commonly from the cisternal part of the nerve, leading to a lesion in the prepontine region. In such cases, with no invasion of the cavernous sinus, radical tumor resection with preservation of the abducens nerve can be performed via a simple suboccipital retrosigmoid approach.     

Laparoscopic wedge resection of a gastric leiomyoma

Gastric stromal tumors represent a small percentage of gastric neoplasms. Establishing a diagnosis when these lesions are encountered usually is not possible with limited biopsies. Benign and malignant gastric stromal tumors require only local excision for definitive treatment. However, most lesions are not amenable to endoscopic excision. As a result, laparoscopic local excision offers the ideal method to establish a diagnosis and to treat patients with gastric smooth muscle tumors. We present a minimally invasive local excision of a gastric stromal tumor. We also review the previously published management of gastric stromal tumors and show how it is being influenced by laparoscopy.     

Benign Gastric Schwannoma: How Long Should We Follow Up to Monitor the Recurrence? A Case Report and Comprehensive Review of Literature of 137 Cases

We aimed to explore the optimal follow-up time for benign gastric Schwannoma. Benign gastric Schwannoma is an uncommon type of gastric neoplasias. Most of the studies are case reports and case series. Although it is generally considered to be benign, the optimal follow-up time and the chance of recurrence have not yet been investigated fully. We presented a case of benign gastric Schwannoma and systematically reviewed published case series with follow-up data. Eight studies were included, totaling 137 patients (44 male and 93 female) with the median follow-up time ranging from 22–132 months across different studies. No recurrence had been recorded during the follow-up period. Benign gastric Schwannoma rarely recurs after complete surgical resection. Long-term survival will be expected in most patients.Key words: Schwannoma, Stomach, Survival, Follow-upGastrointestinal mesenchymal tumors are spindle-shaped tumors, originating from the gastrointestinal mesenchymal stem cells. Three major types are gastrointestinal stromal tumors (GIST), smooth muscle tumor (leiomyomas or leiomyosarcomas), and nerve sheath tumor (Schwannomas).¹ Gastric Schwannoma is a type of nerve sheath tumor that originates from the Schwann cells of peripheral nerves. The definite diagnosis of Schwannoma is based on postoperative immunohistochemical stain, which is usually S–100 positive. Surgical interventions are the mainstay for gastric Schwannoma and complete removal of the tumors could prevent recurrence. Here we present a case of gastric Schwannoma located in the lower segment of stomach and we discuss the issue of postoperative recurrence.