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头皮神经鞘瘤囊性变1例

2019-01-15 龚光辉 刘金辉 龚明 中国临床神经外科杂志

女性,61岁,因发现左侧耳后逐渐增大包块10年入院。10年前,发现左侧耳后包块,约黄豆大小,质地偏硬,无压痛,可活动,皮肤无红肿、破溃,无其他不适,未引起重视,未予诊治,但包块进行性增大,至就诊时约鸽蛋大小,有压痛,余无其他不适。既往体健,家族无类似病史。体格检查:左侧耳后见约3.5 cm×2 cm大小包块,质地稍硬,有压痛,边界清楚,可活动,局部皮肤无红肿、破溃,与四周无粘连。

1.病例资料
 
女性,61岁,因发现左侧耳后逐渐增大包块10年入院。10年前,发现左侧耳后包块,约黄豆大小,质地偏硬,无压痛,可活动,皮肤无红肿、破溃,无其他不适,未引起重视,未予诊治,但包块进行性增大,至就诊时约鸽蛋大小,有压痛,余无其他不适。既往体健,家族无类似病史。体格检查:左侧耳后见约3.5 cm×2 cm大小包块,质地稍硬,有压痛,边界清楚,可活动,局部皮肤无红肿、破溃,与四周无粘连。
 
超声检查示表皮样囊肿可能(图1A、1B)。胸部X线、心电图无异常。血常规、肝肾功能、电解质、凝血功能及大小便检查无异常。术前诊断:左侧耳后包块:表皮样囊肿可能?手术完整切除包块,术后病理结果示左侧颞部神经鞘瘤囊性变(图1C、1D)。术后随访6个月未复发。
 




图1 头皮神经鞘瘤囊性变术前影像及术后病理表现A.术前超声检查,示皮下软组织内探及一低回声结节,边界清,内回声均匀;B.术前超声CDFI,未见血流信号;C.术后病理,HE染色,×100;D.术后病理,HE染色,×200
 
2.讨论
 
神经鞘瘤男性发病略高于女性,是非遗传性疾病,各个年龄段都可发病,20~50岁多见。主要表现为散在的丘疹、结节、斑块,沿外周神经或颅神经走形分布,常见为单发皮下结节,可隆起于皮面,质地中等,界限清楚,部分触之有条索状改变,生长缓慢,属良性病变,恶变少见,一旦恶变常包含皮样的血管肉瘤改变。好发于四肢、额部、头皮及腹部,常无自觉症状,但累及周围神经组织时可伴有疼痛及压痛;累及中枢神经系统,对周围组织产生压迫时,可导感觉和运动障碍症状。
 
组织病理分致密型(AntoniA型)和网状型(AntoniB型)。致密型神经鞘细胞呈梭状,排列紧密,互相交织呈漩涡状或栅栏状,胞核呈杆状,多呈栅状排列,栅行之间隔以无核区,谓之Verocay小体,为该肿瘤常见特征。网状型,细胞较小,呈星状或多角状,排列疏松,无一定方向,间质有明显水肿,常形成微小囊腔,坏死常见,血管丰富。
 
本病常与神经纤维瘤病、皮样囊肿、脂肪瘤、皮脂腺腺瘤等疾病相鉴别。本病最有效的治疗方法为手术切除。
 
原始出处:

龚光辉,刘金辉,龚明,樊丹.头皮神经鞘瘤囊性变1例[J].中国临床神经外科杂志,2018(01):64.

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    2019-03-14 wolongzxh
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    2019-09-24 swallow
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    2019-01-15 一天没事干

    很好的学习机会

    0

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