胃神经鞘瘤9例多层螺旋CT表现
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摘要
[目的]分析总结胃神经鞘瘤(gastric Schwannoma,GS) CT影像学特点,以提高对GS的认识及术前诊断准确率。[方法]回顾性分析我院2006年9月至2018年1月间收治的9例GS患者临床及影像、病理资料,并进行总结。[结果] 9例GS术前均行MSCT平扫+增强扫描(8例单发、1例多发,共11枚肿块),肿块位于胃体部4例,胃窦部3例,胃底部2例,呈圆形、类圆形或不规则形,最长径约2.0cm～8.3cm,腔内型5个,腔外型4个,混合型2个。11枚肿块平扫呈较均匀稍低密度,CT值16～45 HU,其中1枚肿块内伴出血,增强扫描10枚肿块呈轻中度渐进性强化,1例呈环形强化,术后病理证实为肿瘤坏死并脓肿形成,2例伴胃周多发肿大淋巴结。8例术前检查误诊,分别误诊为胃间质瘤7例,肝血管瘤1例,1例未明确诊断。9例均行手术治疗,术后病理均确诊为良性GS,免疫组化检查:S-100蛋白均为阳性,而CD117、CD34、SMA及Desmin均为阴性。[结论]胃神经鞘瘤CT影像学表现具有一定特征性,但亦可表现多样,且缺乏一定特异性,易与其他多种胃部肿瘤,尤其是GIST相混淆,临床医生应该准确识别GS的CT影像学表现并综合分析判断。
引文
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[11]Li ZS,Li GD,Liu M.Current research status of gastric neurilemmoma[J].Chinese Journal of Common Foundation and Clinical Science,2017,(12):1541-1545.[李忠生,李国东,刘明.胃神经鞘瘤的研究现状[J].中国普外基础与临床杂志,2017,(12):1541-1545.]
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[2]Hou YY,Tan YS,Xu JF,et al.Schwannoma of the gastrointestinal tract:a clinicopathological,immunohistochemical and ultrastructural study of 33 cases[J].Histopathology,2010,48(5):536-545.
[3]Voltaggi o L,Murray R,Lasota J,et al.Gastric schwannoma:a clinicopathologic study of 51 cases and critical review of the literature[J].Human Pathology,2012,43(5):650-659.
[4]Prévot S,Bienvenu L,Vaillant JC,et al.Benign Schwannoma of the digestive tract:a clinicopathologic and immunohistochemical study of five cases,including a case of esophageal tumor[J].American Journal of Surgical Pathology,1999,23(4):431-436.
[5]Feng YK,Hu GM,Jiang YH,et al.Clinicopathological analysis of 27 cases of gastrointestinal neurilemmoma[J].Journal of Clinical and Experimental Pathology,2018,34(10):1146-1148.[冯怡锟,胡桂明,蒋玉涵,等.胃肠道神经鞘瘤27例临床病理分析[J].临床与实验病理学杂志,2018,34(10):1146-1148.]
[6]Wu J,Wang JM,Meng FQ,et al.Clinicopathological characteristics of 16 cases of gastrointestinal neurilemmoma[J].Journal of Clinical and Experimental Pathology,2011,27(3):307-310.[伍健,王景美,孟凡青,等.胃肠道神经鞘瘤16例临床病理特征[J].临床与实验病理学杂志,2011,27(3):307-310.]
[7]Lasota J,Was Aogong B,Dansonkamieszkowska A,et al Evaluation of NF2 and NF1 tumor suppressor genes in distinctive gastrointestinal nerve sheath tumors traditionally diagnosed as benign schwannomas:a study of 20 cases[J].Laboratory Investigation,2003,83(9):1361-1371.
[8]Bai YJ,Li TF,He J,et al.CT,MRI findings of gastric neurilemmoma[J].Journal of Clinical Radiology,2018,37(5):817-821.[白延军,李铁丰,贺吉,等.胃神经鞘瘤CT、MRI表现[J].临床放射学杂志,2018,37(5):817-821.]
[9]Mo YK,Xie L,Huang JZ,et al.CT imaging analysis and review of gastric neurilemmoma[J].Chinese Journal of Clinical Imaging,2018,29(8):597-599.[莫泳康,谢磊,黄锦粧,等.胃神经鞘瘤的CT影像分析及复习[J].中国临床医学影像杂志,2018,29(8):597-599.]
[10]Wang J,Hu HJ.CT findings of gastric neurilemmoma[J].Journal of Clinical Radiology,2015,34(10):1602-1606[王健,胡红杰.胃神经鞘瘤的CT表现[J].临床放射学杂志,2015,34(10):1602-1606.]
[11]Li ZS,Li GD,Liu M.Current research status of gastric neurilemmoma[J].Chinese Journal of Common Foundation and Clinical Science,2017,(12):1541-1545.[李忠生,李国东,刘明.胃神经鞘瘤的研究现状[J].中国普外基础与临床杂志,2017,(12):1541-1545.]
[12]Ra CY,Se Hyung K,Sun-Ah K,et al.Differentiation of large(≥5cm)gastrointestinal stromal tumors from benign subepithelial tumors in the stomach:radiologists’performance using CT[J].European Journal of Radiology,2014,83(2):250-260.]