胃神经鞘瘤临床病理剖析.docVIP

胃神经鞘瘤临床病理剖析 　　[摘要] 目的 探讨胃神经鞘瘤的病理特点、诊断要点、免疫组化、鉴别诊断及临床特征。 方法 收集启东市人民医院2012年1月～2015年6月收治并经病理证实的2例胃神经鞘瘤，分析其临床表现、病理特征、免疫组化及鉴别诊断。 结果 2例均手术后病理证实，均为良性，术后随访36个月，无复发及转移，肿瘤大体上境界清楚，但无明显包膜，镜下主要由梭形细胞组成，排列成索条状、束带状结构，局灶细胞核呈栅栏状排列，栅行间为无核区，其余细胞形态各异，呈短梭形、星形或多边形，排列稀疏，细胞间间隙较大，呈水肿样或黏液样。免疫组化S-100阳性，Vimentin阳性，CD117阴性，CD34阴性，Desmin阴性，SMA阴性，AE1/AE3阴性。 结论 胃神经鞘瘤是良性梭形细胞肿瘤，诊断需结合大体表现、镜下特点及免疫组化，S-100阳性是确诊的有力依据，同时应作好鉴别诊断。 　　[关键词] 胃神经鞘瘤；病理；免疫组化；鉴别诊断；预后 　　[中图分类号] R735.2 [文献标识码] B [文章编号] 1673-9701（2015）29-0109-03 　　Clinical pathological analysis of gastric schwannoma 　　SUN Long 　　Department of Pathology， Qidong People’s Hospital in Jiangsu Province， Qidong 226200， China 　　[Abstract] Objective To discuss the pathological features， diagnostic key points， immunohistochemistry， differential diagnosis and clinical features of gastric schwannoma. Methods Two patients diagnosed with gastric schwannoma by pathology who were treated in Qidong People’s Hospital from January 2012 to June 2015 were collected and their clinical manifestations， pathological features， immunohistochemistry and differential diagnosis were analyzed. Results Both patients were confirmed by postoperative pathology with benign tumor. The patients were followed up for 36 months and no recurrence or metastasis occurred. The tumor borders were clear in general， without obvious envelop. The tumors were mainly constituted by fusiform cells under microscope， which arranged as strip-like and band-like structures. Focal cell nuclei presented paliform-like arrange and between the bars was nuclear-free zone. The other cells were in various shapes， presenting short spindle， star or polygon shape， sparse arrange， large intercellular interval， and edema-like or mucoid. Immunohistochemistry showed S-100 positive， Vimentin positive， CD117-negative， CD34-negative， Desmin negative， SMA negative and AE1/AE3 negative. Conclusion Gastric schwannoma is a benign spindle cell tumor， the diagnosis of which needs combining general manifestations， microsco