Paredes I, Jimenez Roldán L, Ramos A, Lobato R D, Ricoy J R
Department of Neurosurgery, University Hospital 12 de Octubre, Avenida de Córdoba S/N, Neurocirugía, 28041 Madrid, Spain.
Clin Neurol Neurosurg. 2012 Jan;114(1):42-6. doi: 10.1016/j.clineuro.2011.07.003. Epub 2011 Aug 6.
Intraparenchymal schwannomas are very rare tumours. We present two young adult patients operated for this type of lesion who show no signs of recurrence 2 years after surgery. These tumours have a bimodal peak of presentation: most occur in young patients under 25 years, and the rest present in the elderly. Characteristically they show both Antoni A and Antoni B areas, intense inmunoreactivity to S-100 and Vimentin protein, and none to EMA or CD34. Electron microscopy is diagnostic when basal membrane is found around the cytoplasmatic processes. MRI spectroscopy depicts increased myoinositol, choline and lipids, and perfusion MR demonstrates high rCBV with a characteristic curve due to the total absence of blood brain barrier. An origin in the Schwann cells of the perivascular nervous plexus in the subarachnoid space is the most accepted theory for the histogenesis of these tumours. We propose to perform the characterization of a series of markers such as SOX-10 in every new case in order to prove that theory.
脑实质内神经鞘瘤是非常罕见的肿瘤。我们报告了两名接受此类病变手术的年轻成年患者,术后2年无复发迹象。这些肿瘤有两个发病高峰:大多数发生在25岁以下的年轻患者中,其余发生在老年人中。其特征是同时出现Antoni A区和Antoni B区,对S-100和波形蛋白呈强免疫反应,而对EMA或CD34无反应。当在细胞质突起周围发现基底膜时,电子显微镜检查具有诊断意义。磁共振波谱显示肌醇、胆碱和脂质增加,灌注磁共振显示由于完全没有血脑屏障,rCBV高且具有特征性曲线。这些肿瘤的组织发生最被接受的理论是起源于蛛网膜下腔血管周围神经丛的雪旺细胞。我们建议对每一个新病例进行一系列标志物(如SOX-10)的特征分析,以证明该理论。