Le Fèvre C, Castelli J, Perrin C, Hénaux P L, Noël G
Département universitaire de radiothérapie, centre Paul-Strauss, Unicancer, 3, rue de la Porte-de-l'Hôpital, 67065 Strasbourg cedex, France.
Département universitaire de radiothérapie, centre Eugène-Marquis, Unicancer, rue de la Bataille-Flandres-Dunkerque, 35042 Rennes cedex, France.
Cancer Radiother. 2016 Apr;20(2):119-32. doi: 10.1016/j.canrad.2015.07.157. Epub 2016 Feb 27.
Malignant peripheral nerve sheath tumours are extremely rare and can be associated with neurofibramatosis type 1. Their prognosis is poor and surgery remains the mainstay of therapy and should be the first line of treatment. Radiotherapy and chemotherapy are second line treatment and their effectiveness remains to demonstrate. The diagnosis is clinical, radiological, histological and immunohistochemical. Malignant peripheral nerve sheath tumours have a potential of local tumour recurrence very high and can metastasize. They often occur in extremity of the members but also rarely into brain. We report two cases of intracerebral nerve sheath tumour. The first was a 68-year-old woman who was admitted with progressive symptoms of headache and diplopia. A left frontotemporal malignant peripheral nerve sheath tumours was diagnosed and was treated by surgery and irradiation. Ten months later, she presented a local recurrence and spine bone's metastases were treated by vertebroplasty and irradiation. The patient died 15 months after the diagnosis. The second case was a 47-year-old woman who was referred because headache and vomiting symptoms. A right frontal malignant peripheral nerve sheath tumours was diagnosed and treated by surgery and irradiation. After that, the patient had three local recurrence operated and pulmonary and cranial bone's metastases. She was still alive after 20 months. We propose a literature review with 25 cases of intracerebral nerve sheath tumour identified, including the two current cases.
恶性外周神经鞘瘤极为罕见,可与1型神经纤维瘤病相关。其预后较差,手术仍是主要治疗手段,应作为一线治疗方法。放疗和化疗为二线治疗,其有效性尚待证实。诊断需结合临床、影像学、组织学和免疫组化检查。恶性外周神经鞘瘤局部肿瘤复发可能性很高,且可发生转移。它们常发生于肢体末端,但也很少发生于脑部。我们报告两例脑内神经鞘瘤病例。第一例是一名68岁女性,因进行性头痛和复视入院。诊断为左额颞部恶性外周神经鞘瘤,接受手术和放疗。10个月后,出现局部复发,脊柱骨转移,接受椎体成形术和放疗。患者在诊断后15个月死亡。第二例是一名47岁女性,因头痛和呕吐症状就诊。诊断为右额叶恶性外周神经鞘瘤,接受手术和放疗。此后,患者接受了三次局部复发手术以及肺部和颅骨转移灶的治疗。20个月后她仍存活。我们对已确诊的25例脑内神经鞘瘤病例进行文献综述,包括目前这两例。