Nonose Ronaldo, Lahan Alberto Youssef, Santos Valenciano Juliana, Martinez Carlos Augusto Real
Assistant Professor in General Surgery, Medical Course, São Francisco University, Bragança Paulista, Brazil.
Case Rep Gastroenterol. 2009 Sep 22;3(3):293-299. doi: 10.1159/000237736.
Schwannomas are neoplasms originating from Schwann cells, which are the cells forming nerve sheaths. These neoplasms generally involve peripheral nerves. They rarely affect the gastrointestinal tract and primary colon involvement is extremely rare. The objective of the present paper was to present a case of primary schwannoma of the sigmoid colon, unassociated with von Recklinghausen disease, that was histopathologically confirmed by means of an immunohistochemical panel. The patient was a 71-year-old woman who had had rectal bleeding when evacuating, with pain and tenesmus, for 4 months. She underwent colonoscopy, which identified a raised submucous lesion of 2.8 cm in diameter, located in the sigmoid colon, 30 cm from the anal margin. During examination, loop polypectomy with lesion excision was performed. Histopathological evaluation showed that this was a tumor of stromal origin. Its resection margins were compromised by neoplasia, and colon resection by means of videolaparoscopy was indicated. Conventional histopathological examination using the hematoxylin-eosin technique suggested that the neoplasm was of mesenchymal origin. An immunohistochemical panel was run for etiological confirmation, using anti-CD34 antibodies, desmin, cytokeratins (AE1/AE3), cKit, chromogranin and S-100 protein. The panel showed intense immunoexpression of S-100 protein. Investigation of the proliferative activity rate using Ki-67 antibodies showed that there was a low rate of mitotic activity, thus confirming the diagnosis of primary benign schwannoma of the colon. The patient's postoperative evolution was uneventful and she remains in good health, without signs of tumor recurrence, 15 months after surgical excision.
施万细胞瘤是起源于施万细胞的肿瘤,施万细胞是形成神经鞘的细胞。这些肿瘤通常累及周围神经。它们很少影响胃肠道,原发性结肠受累极为罕见。本文的目的是报告一例乙状结肠原发性施万细胞瘤,该病例与冯雷克林霍增氏病无关,通过免疫组织化学检测进行了组织病理学确诊。患者为一名71岁女性,排便时出现直肠出血、疼痛和里急后重4个月。她接受了结肠镜检查,发现直径2.8 cm的隆起性黏膜下病变,位于距肛缘30 cm的乙状结肠。检查期间,进行了带病变切除的圈套息肉切除术。组织病理学评估显示这是一种间质性起源的肿瘤。其切除边缘有肿瘤组织侵犯,因此建议通过视频腹腔镜进行结肠切除术。苏木精-伊红染色的传统组织病理学检查提示该肿瘤起源于间叶组织。为进行病因确诊,使用抗CD34抗体、结蛋白、细胞角蛋白(AE1/AE3)、cKit、嗜铬粒蛋白和S-100蛋白进行了免疫组织化学检测。检测显示S-100蛋白呈强免疫表达。使用Ki-67抗体检测增殖活性率显示有丝分裂活性低,从而确诊为结肠原发性良性施万细胞瘤。患者术后恢复顺利,手术切除15个月后仍健康良好,无肿瘤复发迹象。