Mrak R E, Flanigan S, Collins C L
Department of Pathology, Department of Veterans Affairs Medical Center, Little Rock, AR.
Arch Pathol Lab Med. 1994 May;118(5):557-61.
An unusual pleomorphic tumor was resected from the cerebellopontine angle of a 40-year-old man with no stigmata of neurofibromatosis. The tumor showed multinucleated giant cells scattered amid smaller, slightly elongated cells. The tumor showed a rudimentary fascicular pattern containing some looser areas but no nuclear palisading. A diagnosis of Schwann cell tumor was made based on ultrastructural findings and on immunoreactivity for S100 protein. Malignancy was suggested by the extreme pleomorphism of the tumor, by the presence of tripolar mitotic figures, and by flow cytometric demonstration of aneuploidy and of a significant proportion of S-phase tetraploid nuclei (9%). Ten months after the first operation, the tumor had regrown to its original size, and was again resected. The histologic and ultrastructural appearances were similar to those of the first specimen, but flow cytometric analysis now showed a double aneuploid population of nuclei and showed 12% of the nuclei in tetraploid S phase. Within 11 months of the second operation, the tumor had regrown to an estimated size of 22 cm3. Four months of radiotherapy subsequently halted tumor growth, but additional lesions appeared in the cervical and high thoracic areas.
从一名40岁男性的桥小脑角切除了一个不寻常的多形性肿瘤，该患者无神经纤维瘤病体征。肿瘤显示多核巨细胞散在于较小的、略呈细长形的细胞之间。肿瘤呈现出一种基本的束状结构，包含一些较疏松的区域，但无核栅栏状排列。基于超微结构发现和S100蛋白免疫反应性做出了施万细胞瘤的诊断。肿瘤的极度多形性、三极有丝分裂象的存在以及流式细胞术显示的非整倍体和相当比例的S期四倍体核（9%）提示为恶性。首次手术后10个月，肿瘤复发至原来大小，再次进行了切除。组织学和超微结构表现与第一个标本相似，但流式细胞术分析现在显示有双非整倍体核群，且12%的核处于四倍体S期。第二次手术后11个月内，肿瘤复发至估计体积为22立方厘米。随后四个月的放疗使肿瘤生长停止，但颈部和上胸部区域出现了额外的病灶。
