Kamiyoshihara Mitsuhiro, Igai Hitoshi, Ohsawa Fumi, Yoshikawa Ryohei, Yazawa Tomohiro
Department of General Thoracic Surgery, Japanese Red Cross Maebashi Hospital, Maebashi, Japan.
Respir Med Case Rep. 2018 Jun 4;25:18-21. doi: 10.1016/j.rmcr.2018.06.002. eCollection 2018.
Schwannomas commonly arise in the torso, extremities, and mediastinum. However, no interlobar lymph node (#11i) lesions have ever been reported. This is a thought-provoking case, because it involved a schwannoma arising in a lymph node mimicking metastatic pulmonary carcinoma. A 72-year-old man was diagnosed with primary pulmonary carcinoma, and 18F-fluorodeoxyglucose (FDG) positron emission tomography demonstrated high FDG uptake in the primary lesion and in #11i, which suggested metastasis (clinical stage IIA). A right lower lobectomy with lymph node dissection was performed. Fortunately, the enlarged #11i was a schwannoma and not metastasis. The take-home message is "a patient with multiple neuromatosis tends to have schwannomas throughout the body".
神经鞘瘤通常发生于躯干、四肢和纵隔。然而，此前从未有关于叶间淋巴结（#11i）病变的报道。这是一个发人深省的病例，因为它是一例起源于淋巴结的神经鞘瘤，酷似转移性肺癌。一名72岁男性被诊断为原发性肺癌，18F-氟脱氧葡萄糖（FDG）正电子发射断层扫描显示原发灶和#11i处FDG摄取增高，提示转移（临床分期IIA）。遂行右下肺叶切除术及淋巴结清扫术。幸运的是，增大的#11i是神经鞘瘤而非转移瘤。关键信息是“患有多发性神经瘤病的患者全身易于出现神经鞘瘤”。
