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食管神经鞘瘤:病例报告及流行病学、临床、手术和免疫病理学分析

Esophageal schwannoma: Case report and epidemiological, clinical, surgical and immunopathological analysis.

作者信息

Souza Luiz Carlos de Araújo, Pinto Thiago David Alves, Cavalcanti Hugo Oliveira de Figueiredo, Rezende Alexandre Rezende, Nicoletti Ana Luiza Alves, Leão Cinthia Mares, Cunha Vinícius Carvalhêdo

机构信息

Undergraduates of Medicine in the University Center of Brasilia (UniCEUB) and Researchers in the Department of Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil.

Physician Anatomopathologist of Diagnose laboratory and Cytopathology and Pathological Anatomy of the Base Institute of the Federal District (NUCAP-IHBDF), Brasilia, Brazil.

出版信息

Int J Surg Case Rep. 2019;55:69-75. doi: 10.1016/j.ijscr.2018.10.084. Epub 2019 Jan 10.

Abstract

INTRODUCTION

Schwannoma is a tumor of the peripheral nervous system originated in the Schwann cells of the neural sheath.

PRESENTATION OF CASE

A 43-years-old male complained of odynophagia, dysphagia and hemoptysis. The upper gastrointestinal endoscopy showed a smooth elevated lesion, 20 cm from the incisor teeth, occupying the entire lumen of the esophagus. The chest computed tomography (CT) scan showed a lesion of 7 cm and superior mediastinal, lower paraesophageal and cardiac enlarged lymph nodes. A posterolateral thoracotomy was performed with total esophagectomy without intraoperative complications. The anatomopathological analysis revealed fusocellular mesenchymal neoplasia of low malignancy potential. The immunohistochemical study showed positivity for S-100 protein and KI67 antibodies and absence of staining for CD117, CD34, ALK protein, SMA and Desmin. Thus, the morphological and immunohistochemical findings pointed to the diagnosis of esophageal Schwannoma.

DISCUSSION

Although rare and indolent, Schwannoma occurs in the peripheral nervous system, being uncommon in the esophagus.

CONCLUSION

The immunohistochemical study is essential for the diagnosis, which is based on the positivity for S-100 protein and absence of staining for CD34 and CD117.

摘要

引言

施万细胞瘤是起源于神经鞘雪旺细胞的周围神经系统肿瘤。

病例介绍

一名43岁男性主诉吞咽疼痛、吞咽困难和咯血。上消化道内镜检查显示距门齿20厘米处有一个光滑的隆起病变,占据食管整个管腔。胸部计算机断层扫描(CT)显示一个7厘米的病变以及上纵隔、食管下段旁和心脏周围肿大的淋巴结。进行了后外侧开胸手术并全食管切除术,术中无并发症。解剖病理学分析显示为低恶性潜能的梭形细胞间质性肿瘤。免疫组织化学研究显示S-100蛋白和KI67抗体呈阳性,而CD117、CD34、ALK蛋白、平滑肌肌动蛋白(SMA)和结蛋白均无染色。因此,形态学和免疫组织化学结果提示诊断为食管施万细胞瘤。

讨论

尽管施万细胞瘤罕见且生长缓慢,但它发生于周围神经系统,在食管中并不常见。

结论

免疫组织化学研究对诊断至关重要,诊断依据是S-100蛋白呈阳性以及CD34和CD117无染色。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/840d/6357786/889ebb3b3161/gr1.jpg

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