食管雪旺细胞瘤的诊断与治疗

目的探讨食管雪旺细胞瘤的临床表现、诊断及预后,以提高食管恶性雪旺细胞瘤的诊疗水平。方法回顾性分析我院1例恶性食管恶性雪旺细胞瘤患者的临床资料。使用PubMed检索系统,检索关键词为esophageal schwannoma或nerve sheath tumor,复习英语发表的临床资料完整的个案报道。结果患者为恶性食管雪旺细胞瘤（核分裂相6个/每50个高倍视野）,经肿块剜除术后随访6年无复发。复习临床资料完整的雪旺细胞瘤25例,其中恶性者4例。根据病灶切除后组织学诊断,临床表现主要是吞咽困难（64.0%）。食管良性和恶性雪旺细胞瘤的年龄、性别、生长方式、生长部位、病变长度、临床表现和手术方式差异均无统计学意义（P〉0.05）。病灶剜除术是主要的手术方式。随访中仅1例良性食管雪旺细胞瘤复发;恶性雪旺细胞瘤最长随访72个月无复发。结论食管黏膜下肿瘤的鉴别诊断中需考虑雪旺细胞瘤的可能,食管雪旺细胞瘤的诊断依赖于病理检查。对部分有选择的恶性雪旺细胞瘤患者,外科手术病灶剜除不失为替代食管切除的手术方式选择。

Diagnosis and treatment of esophageal schwannoma: report of one case with literature review

Objectives To review the clinical manifestation,diagnosis,treatment and prognosis of esophageal schwannoma.Methods Clinical data of one case with malignant esophageal schwannoma was reviewed retrospectively.Literatures were researched in PUBMED system with esophageal schwannoma or esophageal nerve sheath tumor as the key words.Results The patient was diagnosed as malignant esophageal schwannoma(number of mitosis:6/50 high power fields) and was treated by surgical enucleation and had survived for 6 years without any adjunctive treatment so far.Twenty five cases of esophageal schwannoma with complete data were reviewed,among whom 4 were malignant.The main symptom was dysphagia(64%).The diagnosis relied mainly on histopathological examination.There were no significant differences between benign and malignant esophageal schwannoma in age,sex,tumor growth pattern,tumor site,tumor dimension,symptoms and operational methods(P >0.05).Surgical enucleation was the main therapy with reported recurrence in only 1 benign case and no reported recurrence in malignant cases during the follow-up period of 72 months.Conclusion Schwannomas should be taken into account in differential diagnosis of esophageal submucosal tumors.