Takeda Shin-Ichi, Miyoshi Shinichiro, Minami Masato, Matsuda Hikaru
Department of Surgery Course of Interventional Medicine (E1), Graduate School of Medicine, Osaka University, Yamada-oka 2-2, Suita City, Osaka 565-0871, Japan.
Eur J Cardiothorac Surg. 2004 Oct;26(4):807-12. doi: 10.1016/j.ejcts.2004.07.014.
Intrathoracic neurogenic tumors are relatively uncommon, and there have been few reports regarding their entire clinical characteristics in the Asian population.
We retrospectively reviewed our Japanese institutional experience of intrathoracic neurogenic tumors, with emphasis on the clinical spectrum.
We analyzed the records of 146 patients with intrathoracic neurogenic tumors who were treated over the past 50 years. There were 60 pediatric and 86 adult patients (74 males and 72 females).
There were 51 ganglioneuromas, 37 schwannomas, 30 neurofibromas, 18 neuroblstomas, 5 gangliobastomas, and 5 others, of which 136 cases were located in the posterior mediastinum, 9 in the chest wall, and 1 in the lung parenchyma. Neurogenic tumors were most commonly seen as a pediatric mediastinal tumor (46.2%), as compared to 11.2% in the adult population (P<0.001). Eighty-four percent of adult patients and 60% of pediatric patients were asymptomatic. In thirteen patients (8.9%), the tumor showed an intraspinal extension, the so-called dumbbell-type. Overall, 20.5% of the neoplasms were malignant, occurring predominantly in the first 5 years of life. Complete resection was performed in 95.7% cases for benign tumors and 63.3% for malignant tumors, including a laminectomy for six cases of the dumbbell-type. There were no operative deaths and minimal morbidity.
Age seemed to be the most important clinical parameter for distinguishing between histological type and rate of malignancy for neurogenic tumors. Recognition of this clinical spectrum will lead to the immediate and appropriate surgical intervention.
胸内神经源性肿瘤相对少见，关于其在亚洲人群中的完整临床特征的报道较少。
我们回顾性分析了我院日本患者胸内神经源性肿瘤的治疗经验，重点关注其临床谱。
我们分析了过去50年中接受治疗的146例胸内神经源性肿瘤患者的记录。其中儿童患者60例，成人患者86例（男性74例，女性72例）。
神经节细胞瘤51例，神经鞘瘤37例，神经纤维瘤30例，神经母细胞瘤18例，神经节母细胞瘤5例，其他5例。其中136例位于后纵隔，9例位于胸壁，1例位于肺实质。神经源性肿瘤最常见于儿童纵隔肿瘤（46.2%），而成人患者中仅占11.2%（P<0.001）。84%的成人患者和60%的儿童患者无症状。13例患者（8.9%）肿瘤呈椎管内延伸，即所谓的哑铃型。总体而言，20.5%的肿瘤为恶性，主要发生在生命的前5年。95.7%的良性肿瘤和63.3%的恶性肿瘤进行了完整切除，其中6例哑铃型肿瘤行椎板切除术。无手术死亡，发病率极低。
年龄似乎是区分神经源性肿瘤组织学类型和恶性率的最重要临床参数。认识这一临床谱将有助于立即进行适当的手术干预。
