上海交通大学学报（医学版）

›› 2012, Vol. 32 ›› Issue (10): 1343-.doi: 10.3969/j.issn.1674-8115.2012.10.014

• 论著（临床研究） • 上一篇    下一篇

12例胃神经鞘瘤的临床病理特征及预后

赫 超1, 沈艳莹2, 倪醒之1, 沈丹平1   

  1. 上海交通大学 医学院附属仁济医院 1.普外科, 2.病理科, 上海 200127
  • 出版日期:2012-10-28 发布日期:2012-11-05
  • 通讯作者: 倪醒之, 电子信箱: niyin@yahoo.com。
  • 作者简介:赫 超（1986—）, 男, 硕士生；电子信箱: hechao2005hechao@163.com。

Clinicopathological features and prognosis of 12 cases of gastric Schwannomas

HE Chao1, SHEN Yan-ying2, NI Xing-zhi1, SHEN Dan-ping1   

  1. 1.Department of Surgery, 2.Department of Pathology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200127, China
  • Online:2012-10-28 Published:2012-11-05

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摘要：

目的 探讨胃神经鞘瘤（GS）的临床病理表现、诊断与鉴别诊断要点、治疗方法和预后。方法 对12例GS患者的临床资料、病理学表现、免疫组织化学特征、手术及术后随访情况进行分析。结果 肿瘤位于胃窦部3例，胃体8例，胃底1例；7例肿瘤主要向腔内生长，5例向腔外生长。1例GS合并胃癌患者术前血CEA升高，另有1例GS患者血CEA和CA199升高。高倍镜下，肿瘤细胞呈长梭形。免疫组织化学检测结果显示所有病例GS细胞S-100蛋白和Vimentin呈阳性，2例CD34呈弱阳性。4例患者分子生物学检测结果显示：C-kit基因第9、11、13、17和PDGFRA基因第12、18外显子均为野生型，无基因突变。所获随访的9例GS患者中，除GS合并胃癌患者因胃癌复发死亡外，其余均无肿瘤复发和转移。结论 GS的确诊依赖于病理学检查及免疫组织化学检测，S-100是诊断GS的重要标志物，术前胃镜和CT检查能为该病的诊断提供线索。手术完整切除是治疗GS的关键,微创手术可作为首选术式。

关键词: 胃神经鞘瘤, 临床病理特征, 免疫组织化学, 预后

Abstract:

Objective To investigate the clinicopathologic features, diagnosis and differential diagnosis of gastric schwannoma (GS), and to summarize the treatment experience and prognosis. Methods The clinical data of 12 cases of GS were analysed. The pathological features, immunohistochemical characteristics,surgical management and follow-up data were evaluated. Results The tumors located in the gastric antrum in 3 cases, in the gastric body in 8 cases and in the gastric fundus in 1 case. The tumors grew to the cavity in 7 cases, and grew outside to the cavity in 5 cases. Serum CEA increased in 1 patient with GS and gastric cancer before operation, and serum CEA and CA199 increased in another patient with GS. All tumors cells were spindle under microscope. Immunohistochemical detection revealed that GS tumor cells were positive for S-100 protein and Vimentin protein in all cases, and were weakly positive for CD34 in 2 cases. Molecular biological detection in 4 patients indicated that exon 9,11,13 and 17 of C-kit gene and exon 12 and 18 of PDGFRA gene were wild type, with no gene mutations. No tumor recurrence or metastasis occurred in the 9 cases with follow-up except that one patient with GS and gastric cancer died of recurrence of gastric cancer. Conclusion The diagnosis of GS depends on pathological and immunohistochemical examinations. S-100 is an important marker for the diagnosis of GS. Preoperative gastroscopic and imaging CT examinations can provide clues to the diagnosis. Surgical en bloc resection is necessary for the treatment of GS, and minimally invasive surgery can be used as the first choice of operation for GS.

Key words: gastric Schwannoma, clinicopathological features, immunohistochenistry, prognosis