目的 总结1例腹膜后神经鞘瘤合并胃神经鞘瘤的临床诊疗方法。 方法 2010年12月收治1例女性患者，因呕血行CT检查发现胃体前壁及右肾上腺区占位入院，行胃楔形切除术及右肾上腺肿瘤切除术治疗。 结果 术后病理证实为腹膜后神经鞘瘤合并胃神经鞘瘤，随访半年无复发。 结论 腹膜后神经鞘瘤合并胃神经鞘瘤病例罕见且诊断困难，影像学检查缺乏特异性，可依靠术后病理检查确诊；外科手术完整切除肿瘤是有效的治疗方法，预后较好。
摘要:目的: 探讨磁共振波谱(MRS)对鉴别桥小脑角神经鞘瘤与脑膜瘤的价值。 方法 :对8例神经鞘瘤和8例脑膜瘤病例进行MRI平扫和增强扫描,并采用点分辨波谱序列(PRESS,TR/TE=2000/136ms)进行单体素波谱分析。从事磁共振诊断专业的医师根据肿瘤的MRI及MRS表现特征进行鉴别诊断。 结果 :尽管多数神经鞘瘤(5/8)和脑膜瘤(6/8)具有典型的MRI表现特征并仅经MRI即可得到正确鉴别,但部分病例(5/16)为不典型表现者,如脑膜瘤呈长T1长T2信号并伴有囊变,以及神经鞘瘤呈等信号、均匀强化且不伴有囊变或内听道扩大者,鉴别诊断困难。MRS显示脑膜瘤的胆碱/肌酸比值(Cho/Cr)(2.74±1.47)略高于神经鞘瘤(2.70±1.21),但差异无统计学意义。丙氨酸(Ala)在脑膜瘤中的出现率(4/8)显著高于神经鞘瘤(0/8)(Plt;0.05),谷氨酸盐/谷氨酰胺(Glx)在脑膜瘤中的出现率(5/8)也高于神经鞘瘤(2/8);而肌醇(Ins)在神经鞘瘤中的出现率(4/8)高于脑膜瘤(2/8)。结合MRS表现,在MRI上尚难鉴别的病例可被明确诊断,并与最终病理结果相符。 结论 : MRI有助于多数桥小脑角神经鞘瘤与脑膜瘤的鉴别诊断,但对不典型病例有一定局限性;MRS对不典型病例的鉴别具有重要的参考价值。Abstract: Objective: To explore the value of magnetic resonance spectroscopy (MRS) in the differentiation of neurinoma and meningioma in the cerebellopontine angle. Methods : 16 cases, including 8 cases of meningiomas and 8 cases of neurinomas, underwent MRI (plan and gadoliniumenhanced scan) and singlevoxel proton MRS (PRESS series, TR/TE=2000/136ms). MRI and MRS results were reviewed and differential diagnoses were made by professional radiologists. Results : Although most cases (11/16) were typical and clearly classified on MRI, atypical cases were also observed, such as meningioma of long T1/T2 signal intensity with small cystic foci, and neurinoma of isointensity and homogenous enhancement without cystic change or enlargement of internal acoustic meatus. The choline to creatine ratio (Cho/Cr) of meningioma (2.74±1.47) was higher than that of neurinoma (2.70±1.21), however the difference was not significant (Pgt;0.05). Alanine was observed in 4/8 meningiomas but none of neurinomas (Plt;0.05), and glutamine/glutamate was more frequently visualized in meningiomas (5/8) than in neurinomas (2/8), whilemyoinositol was more frequently observed in neurinomas (4/8) than in meningiomas (2/8). With MRS, cases difficult to differentiate were clearly and correctly classified. Conclusion : Although most CPA neurinomas and meningiomas can be diagnosed by MRI, MRS is useful for the differential diagnosis of atypical cases.
ObjectiveTo investigate the sonographic characteristics and diagnostic value of color Doppler sonography for patients with renal schwannoma. MethodsTen patients with pathologically confirmed renal schwannoma dimensional ultrasonography treated between January 2008 and May 2014 were included in this study. We analyzed and summarized their color flow distribution characteristics. ResultsThe ultrasound of the 10 patients showed substantial hypoechoic mass with clear boundary and complete capsule; color Doppler flow imaging displayed mass within the probe and a small amount of dotted blood flow information or no obvious blood flow information. Four patients were suspected to have schwannoma before surgery by ultrasound diagnosis, while the remaining 6 cases only showed benign lesions without clear diagnosis. All the patients underwent surgery subsequently under laparoscope, and resection of the tumor was performed with the integrity of normal kidney tissue retained. Postoperative recovery was good, and follow-up did not detect any recurrence. ConclusionColor Doppler ultrasound has a certain specificity on the diagnosis of renal schwannoma. Combined with other examination methods, it can not only give the clinicians a good suggestion, but avoid laparotomy.
Objective To summarize the research progress of gastric schwannoma (GS). Methods GS related researches and case reports were collected to make a review on general clinical manifestations, pathology characteristics, auxiliary examinations, differential diagnosis, and treatment. Results GS is rare in clinical reports, and it is lack of tissue specificity. Diagnosis is rely mainly on the expressions of S-100 protein and glial fibrillary acidic protein (GFAP). All kinds of auxiliary examinations, such as gastrointestinal angiography, ultrasound, endoscope, CT, an so on, could not independently as a diagnostic basis. Identification between GS and other gastric tumors is difficult, and GS is not sensitive to radiation and chemotherapy, the main treatment is surgery. Conclusions GS is a kind of rare tumor which occurs in gastric mucosa, immunohistochemistry is the most main examination for the diagnosis of GS. The surgical excision is the main treatment for GS, but the safety and efficacy of combination therapy of laparoscopy and endoscopy remains to be study.
ObjectiveTo re-understand the nerve sheath tumors of the breast, to improve its diagnosis and cure rate.MethodSearched the relevant literatures of nerve sheath tumors of the breast, to analyze and summarize the origin, etiology, clinical manifestations, imaging characteristics, pathological characteristics, treatment, and prognosis of this disease.ResultsNerve sheath tumors of the breast was a very rare disease, which originated in the neuromembrane Snowwang cells. its specific cause was unknown and clinical manifestations were not specific, and other breast diseases were difficult to identify, such as leaf ybrilloma, mammary vascular epidermal cytoma, breast fibroids, and so on. Imaging data could provide some reference value, but the gold standard relied on pathology and immunohistochemical examination. Surgery could cure benign nerve sheath tumors of the breast, but there was a possibility of malignant changes that required follow-up after surgery. Malignant neuroblastoma was mainly surgically removed, supplemented by chemotherapy, which could effectively prevent the recurrence of tumor and distant metastasis. The prevention of nerve sheath tumors of the breast could be referred to breast cancer screening.ConclusionsDuring clinical practice, we need to understand the diagnosis and treatment of nerve sheath tumors of the breast to achieve early detection, early diagnosis, and early treatment, as well as improve the diagnosis rate and cure rate of the disease, in order to protect women’s physical and mental health.