胃神经鞘瘤11例临床病理分析

目的：探讨胃神经鞘瘤的临床特征,免疫组化特征,病理诊断及间叶性肿瘤鉴别诊断,治疗方法及预后.方法：收集11例经手术确诊胃神经鞘瘤的临床资料,并行S-100、Vim、CD34、CD117、SMA和Des检测.光镜观察,结合文献进行回顾性分析.结果：所有11病例胃镜检查均考虑胃肠道间质瘤可能性大,术前诊断都不确定,经手术获取标本,术后经病理免疫组化进一步确诊.患者女性7例、男性4例,年龄49-61岁,中位年龄52岁,3例位于胃窦,一例为远端胃大弯侧浆膜面,6例位于胃体.巨检：肿瘤直径1-6cm,平均3.5cm,均无明显包膜,切面均实性.结论胃神经鞘瘤是一类发生于胃肠道的间叶性肿瘤大多为良性,预后良好,很少有恶变及复发,影像学检查及胃镜检查缺乏特异性,诊断主要依据病理检查,镜下形态主要由梭形细胞组成,呈小束状,多排列编织状结构,小束的两端及瘤细胞之间有粗细不等的胶原纤维,间质内均见少数弥漫淋巴细胞、浆细胞浸润,肿瘤周边可见淋巴细胞,＋反应带.免疫组化：vimetmin和S-100强（＋）,3例CD34少数瘤细胞灶状（＋）.结论：胃神经鞘瘤与发生于软组织部位的临床、巨检、及形态学有不同之处,镜下很难与胃肠道间质瘤、平滑肌肿瘤相鉴别,诊断主要借助免疫组化检测.手术切除是主要的治疗方式,术后注意随访.

Clinical and pathological analysis of 11 cases of gastric schwannoma

Objective：To investigate the clinical characteristics of gastric schwannoma, immunohistochemical fea- tures, differential diagnosis and pathological diagnosis of mesenchymal tumors, treatment method and prognosis. Meth- ods： Clinical data of 11 patients after operation were collected the diagnosis of gastric schwannoma, parallel S - 100, Vim, CD34, CD117, SMA, and Des detection,light microscope, were analyzed retrospectively. Results： All the 11 cases preoperative diagnosis were uncertain,postoperative pathology immunohistochemistry further confirmed. Patients age 49 -61 years old ,with an average of 52 years. 3 cases in the gastric antrum, a case of distal along the greater curvature of the stomach serosa, 6 cases in the body of stomach. Giant examination：tumor diameter 1 -6cm, aver- age 3.5cm, there were no obvious envelope, section of the solid. The prognosis was good, there were few malignant and recurred,imaging examination and gastroscopy are lack of specificity, diagnosed mainly based on pathological exami- nation, microscopic morphology is mainly composed of spindle cells, a small bundle, multiple alignment knitting struc- ture, a coarse and fine collagen fibers between the ends and the tumor cells of uniform, a diffuse lymphocyte, plasma cell infiltration was seen around the tumor stroma, visible lymphocyte, ＋ reaction zone. Immunohistochemistry：vimet- rain and S - 100（ ＋ ） ,3 cases of CD34 a few tumor cells of focal（ ＋ ）. Conclusion：Gastric schwannoma is different in clinical, on, and morphological occurrence in soft tissues. Surgical operation is the main treatment