Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
Department of Pathology, First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
World J Gastroenterol. 2018 Jan 14;24(2):303-309. doi: 10.3748/wjg.v24.i2.303.
Primary benign schwannoma of the mesentery is extremely rare. To date, only 9 cases have been reported in the English literature, while mesenteric schwannoma with ossified degeneration has not been reported thus far. In the present study, we present the first giant ossified benign mesenteric schwannoma in a 58-year-old female. Ultrasound, computed tomography and magnetic resonance imaging were used, but it was still difficult to determine the definitive location and diagnose the mass. By laparotomy, a 10.0 cm × 9.0 cm × 9.0 cm giant mass was found in the mesentery and was then completely resected. Microscopically, the tumour located in the mesentery mainly consisted of spindle-shaped cells with a palisading arrangement. Some areas of the tumour were ossified, and a true metaplastic bone formation was observed, with the presence of bone lamellae and osteoblasts. Immunohistochemical investigation of the tumour located in the mesentery showed that the staining for the S-100 protein was strongly positive, while the stainings of SMA, CD34, CD117 and DOG-1 were negative. The cell proliferation index, measured with Ki67 staining, was less than 3%. Finally, a giant ossified benign mesenteric schwannoma was diagnosed. After surgery, the patient was followed up for a period of 43 mo, during which she remained well, with no evidence of tumour recurrence.
肠系膜原发性良性神经鞘瘤极为罕见。迄今为止,英文文献中仅报道了 9 例,而肠系膜伴有骨化变性的神经鞘瘤目前尚未见报道。本研究报道了首例 58 岁女性巨大骨化性良性肠系膜神经鞘瘤。超声、计算机断层扫描和磁共振成像均被应用,但仍难以确定肿瘤的确切位置和诊断。剖腹探查发现肠系膜有一 10.0 cm×9.0 cm×9.0 cm 的巨大肿块,然后将其完全切除。显微镜下,肿瘤主要位于肠系膜,由梭形细胞排列呈栅状。肿瘤的某些区域发生骨化,观察到真正的骨化生,存在骨板和成骨细胞。免疫组化研究显示,肠系膜肿瘤中 S-100 蛋白染色强阳性,而 SMA、CD34、CD117 和 DOG-1 染色均为阴性。Ki67 染色的细胞增殖指数小于 3%。最终诊断为巨大骨化性良性肠系膜神经鞘瘤。术后患者随访 43 个月,情况良好,无肿瘤复发迹象。