恶性神经鞘瘤25例临床分析

目的:对恶性神经鞘瘤的临床特征进行分析,以期提高对该病的认识。方法:对我院1993年1月~2006年2月收治的25例患者的临床表现、治疗模式及转移复发情况进行回顾性分析。结果:全组男性14例(56%),女性11例(44%),平均发病年龄53.7岁。表现为体表肿物16例(64%),腹腔及盆腔肿物7例(28%),腰背痛、下肢乏力1例(4%),体检发现肺转移结节1例(4%)。病理类型均为梭形细胞恶性肿瘤,S-100阳性者24例(96%),S-100阴性1例(4%)。23例给予手术完整或部分切除,1例未行手术,1例行剖腹探查发现广泛转移而无法切除。6例予术后放疗,2例行术前导管化疗。25例随访时间为7个月~5年,随访期内,4例(16%)发生肺转移,2例(8%)淋巴结转移,7例(28%)局部复发,2例失访,余10例(40%)未见复发及转移。结论:恶性神经鞘瘤可发生于全身各部位,体表肿块为常见症状,确诊依赖病理组织学检查。肿瘤易复发及转移,手术切除是最有效的治疗方法。

Clinical analysis of 25 patients with malignant neurilemoma

Objective:To analyse the clinical characteristics of malignant neurilenoma to improve our knowledge of this disorder. Methods:Twenty-five patients were retrospectively reviewed with malignant neurilemoma admitted to our hospital from Jan 1993 to Feb 2006. Results:The patient group included 14 (56%) males and 11 (44%) females with a mean age of 53.7 years (range, 20-84 years). Sixteen(64%) cases presented with body surface masses, 7 (28%) cases with abdominal cavity or pelvic cavity masses, 1 case with backache and low limb weakness, 1 case found lung nodules on health examination. Histologically all the specimens were composed of spindle cells, 24 (96%) cases were immunohistochemically positive for S-100 protein, and 1 (4%) case negative. Twenty-three(92%) cases underwent tumor resection totally or partially, 1 case had no operation, 1 case underwent exploratory laparotomy to find extend metastasis impossible for resection. Six cases were given radiotherapy post operation, 2 cases given transcatheter arterial chemotherapy pre-operation. Twenty-five cases were followed-up from 7 months to 5 years, 4 (16%) cases had lung metastasis, 2 (8%) cases had lymphonode metastasis, 7 (28%) cases had recurrence, 10 (40%) cases had not been found metastasis or recurrence. Conclusion:Malignant neurilemoma may occur all over the body, most often on body surface. Last diagnosis depends on pathologic examination. The tumor is apt to recurrence and metastasis, and surgery is the most effective therapy for it.