摘要
目的
探讨肝门部神经纤维瘤的诊断与治疗方法,提高对罕见的肝门部神经纤维瘤的认识。
方法
对我院收治的1例肝门部神经纤维瘤病人临床资料及诊治过程结合国内外文献进行回顾性临床研究分析。
结果
肝门部神经纤维瘤好发于中年男性,临床表现缺乏特异性,实验室检查无明显异常,术前确诊较为困难,但B超,CT, MRI等影像学检查的联合应用有助于临床诊断,尤其是MRI检查具有重要诊断价值。手术完整切除肿瘤,术后效果满意。
结论
肝门部神经纤维瘤极为罕见,确诊主要依据组织病理学检查及免疫组化标记,手术切除是有效治疗手段,预后良好。
Object
To analyze the diagnosis and treatment of neurofibroma in the porta hepatis, and increase the understanding of this rare disease.
Methods
The clinical data of 1 case admitted in our hospital were analyzed retrospectively as well as domestic and foreign documents.
Results
Neurofibroma of the porta hepatis was more prevalent in middle-aged men and had no specific clinical feature. Laboratory examinations found no abnomal result. The preoperative diagnosis could be extremely difficult, but it would aid in clinical diagnosis when using B-Ultrasound, CT, MRI and other image analysis in combination, especially the use of MRI. The tumor was resected en bloc and the result after operation was satisfying.
Conclusion
Neurofibroma of the porta hepatis is especially rare. Its definitive diagnosis should mainly rely on histopathological and immunohistochemical findings. Complete excision is the main therapeutic method for it. The prognosis is well.
引文
1 同济医科大学病理学教研室,中山医科大学病理学教研室.外科病理学[M].第2版.武汉：湖北科学技术出版社,1999.1269-1273.
2 黄文清.神经肿瘤病理学[M].第2版.北京：军事医学科学出版社,2001.767-792.
3 谭郁彬,张乃鑫.外科诊断病理学[M].第1版.天津：天津科学出版社,2000.955-957.
4 Kleihues P, Cavenee WK. World Health Organization classification. Pathology and genetics of tumours of the nervous system. Lyon:IARC; 2000.
5 Reynolds RM, Browning GG, Nawroz I, et al. Von Recklinghausen's neurofibromatosis: neurofibromatosis type 1 [J]. Lancet,2003; 361:1552-1554.
6 Julius C. POON, Travis Ogilvie, and Elijah Dixon. Neurofibroma of the porta hepatic [J]. J Hepatobiliary Pancreat Surg,2008; 15:327-329.
7 牟洪超,刘永存.肝门部多发性神经纤维瘤1例报道[J].肝胆外科杂志,2005；13(6)：433.
8 徐爱民,程红岩,吴孟超等.肝门部多发神经纤维瘤一例[J].中华放射学杂志,2006；36(6)：575-576.
9 Takata M, Imai T, Hirone T. Factor-XIIIa-Positive cells in normal Peripheral nerves and cutaneous neurofibromas of type-1 neurofibromatosis [J]. Am J Dermatopathol,1994; 16: 37-43.
10 Chanoki M, Ishii M, Fukai K, et al. Immunohistochemical localization of type I,111, IV, V, and VI collagens and laminin in neurofibroma and neurofibrosareoma [J]. Am J Dermatopathol, 1991; 13:365-373.
11 周永昌,郭万学.超声医学[M].第3版.北京：科学技术文献出版社,2000.1303-1314.
12 Rosai J著.回允中译.阿克曼外科病理学[M].第8版.辽宁：辽宁教育出版社,1999.2041-2043.
13 刘复生,刘彤华.肿瘤病理学[M].北京：北京医科大学、中国协和医科大学联合出版社,1997.1975.
14 Beggs I. Imaging of peripheral nerve tumors [J]. Clinical Radiology,1997; 52:8.
15 HP Hu, QL Huang. Singnal intensity correlation of MRI with pathological findings in spinal neurinomas [J]. Neuroradiology,1992; 34:98.
16 M. Pilavaki, D. Chourmouzi, A. Kiziridou, et al. Imaging of peripheral nerve sheath tumors with pathologic correlation Pictorial review [J]. EJR,2004; 52:229-239.
17 Cerofolini E, Landi A, DeSantis G, et al. MR of benign peripheral nerve sheath tumors [J]. Comput Assist Tomogr,1991; 15(4):593.
18 National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement [J]. Arch Neuxol,1988; 45(5):575-578.
19 陈明祥,黄能贤,周人民.外生性肝癌的CT诊断(附7例报告)[J].实用外科杂志,1998；4(5)：282-283.
20 李选,山耘,谢敬霞.外生性肝癌[J].临床放射学杂志,1993；12：125.
21 Sadamoto Y, Higuchi K. Retroperitoneal castlrman's disease of the hyaline vascular type presenting arborizing calcification [J]. Inter Med,1998; 37(3):691.
1 同济医科大学病理学教研室,中山医科大学病理学教研室.外科病理学[M].第2版,武汉：湖北科学技术出版社,1999.1269-1273.
2 Kleihues P, Cavenee WK. World Health Organization classification. Pathology and genetics of tumors of the nervous system. Lyon:IARC; 2000.
3 同济医科大学病理学教研室,中山医科大学病理学教研室.外科病理学[M].第2版.武汉：湖北科学技术出版社,1999.1269-1273.
4 黄文清.神经肿瘤病理学[M].第2版.北京：军事医学科学出版社,2001.767-792.
5 谭郁彬,张乃鑫.外科诊断病理学[M].第1版.天津：天津科学出版社,2000.955-957.
6 Takata M, Imai T, Hirone T. Factor-XIIIa-Positive cells in normal Peripheral nerves and cutaneous neurofibromas of type-1 neurofibromatosis [J]. Am J Dermatopathol,1994; 16: 37-43.
7 Chanoki M, Ishii M, Fukai K, et al. Immunohistochemical localization of type I,错误!未找到引用源。,IV, Vand VI collagens and laminin in neurofibroma and neurofibrosareoma [J]. Am J Dermatopathol,1991; 13:365-373.
8 周永昌,郭万学.超声医学[M].第3版.北京：科学技术文献出版社,2000.1303-1314.
9 Rosai.J著.回允中译.阿克曼外科病理学[M].第8版.辽宁：辽宁教育出版社,1999.2041-2043.
10 Beggs I. Sonographic Appearances of Nerve [J]. Journal of Clinical Ultrasound,1999; 27(7): 363.
11 刘复生,刘彤华.肿瘤病理学[M].北京：北京医科大学,中国协和医科大学联合出版社,1997.1975.
12 Beggs I. Imaging of peripheral nerve tumors. Clinical Radiology,1997; 52:8.
13 Pierre MB, Jo-Aone OS, Elizabath M, et al. Plexiform neurofibromatosis of the mediastinum CT appearance [J]. AJR,1998; 151:461.
14 HP Hu, QL Huang. Singnal intensity correlation of MRI with pathological findings in spinal neurinomas [J]. Neuroradiology,1992; 34:98.
15 Chui MC, Bird BL, Rogers J. Extracranial and extraspinal nerve sheath tumors:computed tomographic evaluation [J]. Neuroradiology,1988; 30:47-53.
16 Resnick D, Niwayama G, Soft tissues. In:Resnick D, editor. Diagnosis of bone and joint disorders,3rd ed. Philadelphia (PA):Saunders,1995; 4552-4554.
17 Suh JS, Abenoza P, Galloway HR, et al. Peripheral (extracranial) nerve tumors:correlation of MR imaging and histologic findings [J]. Radiology 1992; 183(2):341-346.
18 M.Pilavaki, D.Chourmouzi, A. Kiziridou, et al. Imaging of peripheral nerve sheath tumors
with pathologic correlation Pictorial review [J]. EJR,2004; 52:229-239.
19 Murphey MD, Smith WS, Smith SE, et al. From the archives of the AFIP. Imaging of musculoskeletal neurogenic tumors:radiologic-pathologic correlation [J]. Radiographics 1999; 19(5):1253-1280.
20 郑九林,滑炎卿,黄忠泉.周围神经纤维瘤和神经鞘瘤的CT鉴别诊断[J].中国临床医学影像杂志,2004；15(12)：710-713.
21 王晓琪,张学林.神经纤维瘤,神经鞘瘤的临床与CT诊断[J].影像诊断与介入放射学,1998；7(4)：254-256.
22 Cerofolini E, Landi A, DeSantis G, et al. MR of benign peripheral nerve sheath tumors [J]. J Comput Assist Tomogr,1991; 15(4):593.
23 National Institutes of Health Consensus Development Conference. Neurofibromatosis conference statement [J]. Arch Neuxol,1988; 45(5):575-578.
24 解云川,杜文延,张亚华,等.应用显微外科技术治疗周围神经纤维瘤[J].中华显微外科杂志,2001；24：148-149.
25 王炜,林晓曦,祁佐良,等.面部神经纤维瘤的整形和显微外科治疗[J].上海医学.2000；23：387-389.
26 陈石海,周翔,彭福仁.头面部巨大神经纤维瘤的整形治疗[J].中华整形外科杂志,2001；17：187-188.
