Suppr超能文献

子宫颈恶性神经鞘瘤:三例病例研究

Malignant schwannoma of the uterine cervix: a study of three cases.

作者信息

Keel S B, Clement P B, Prat J, Young R H

机构信息

James Homer Wright Pathology Laboratories, Massachusetts General Hospital, Boston 02114, USA.

出版信息

Int J Gynecol Pathol. 1998 Jul;17(3):223-30. doi: 10.1097/00004347-199807000-00005.

Abstract

Pure sarcomas of the uterine cervix are rare; most of those reported have been leiomyosarcomas or rhabdomyosarcomas. Minimal data exists on malignant nerve sheath tumors in this site; only one typical example and one melanocytic example have been reported. We report three additional examples here in three patients 25, 65, and 73 years of age. The two older patients had vaginal bleeding and underwent hysterectomy as initial treatment. The youngest patient initially underwent only polypectomy. The tumors were 1.3, 4.4, and 5.0 cm in greatest dimension. The tumors were red-grey to white: two were polypoid and the third was ulcerated. The dominant microscopic appearance was that of cellular fascicles of spindle cells with hyperchromatic nuclei and eosinophilic cytoplasm. However, hypocellular areas were striking in each case; the hypocellular areas were fibromatous in two tumors and two had areas with a myxoid stroma (prominent in one). One tumor focally had cellular aggregates with a swirling pattern within a hypocellular background. Epithelioid foci in which tumor cells were rounded with conspicuous eosinophilic cytoplasm were focally prominent in one case. Mitoses were readily identified in each case. All three tumors were positive for S-100 protein and vimentin and negative for cytokeratin. HMB-45, and desmin. One case is recent and one patient had multiple metastases in the abdomen 2 years after hysterectomy. The patient treated initially by polypectomy underwent repeat local excision, followed by cone biopsy with positive margins, and then hysterectomy. She is clinically free of disease 15 months after diagnosis. Although the diagnosis of malignant schwannoma was suggested by the histologic features of the tumors, other diagnoses were entertained and immunohistochemistry was crucial in confirming the diagnosis. These tumors should be distinguished from other malignant spindle cell tumors of the cervix, such as leiomyosarcoma, endocervical "stromal sarcoma," and spindle cell melanoma, so their features, behavior, and optimal therapy can be further delineated.

摘要

子宫颈纯肉瘤罕见;报道的大多数此类肿瘤为平滑肌肉瘤或横纹肌肉瘤。关于该部位恶性神经鞘瘤的数据极少;仅报道过1例典型病例和1例黑素细胞型病例。我们在此报告另外3例,患者年龄分别为25岁、65岁和73岁。两名老年患者有阴道出血,最初接受子宫切除术治疗。最年轻的患者最初仅接受了息肉切除术。肿瘤最大直径分别为1.3 cm、4.4 cm和5.0 cm。肿瘤颜色从红灰色到白色:2例为息肉样,第3例有溃疡。主要的显微镜下表现为梭形细胞的细胞束,细胞核深染,细胞质嗜酸性。然而,每例中细胞稀少区域都很显著;2个肿瘤的细胞稀少区域呈纤维瘤样,2个肿瘤有黏液样基质区域(其中1个很明显)。1个肿瘤在细胞稀少的背景中有局灶性的细胞聚集体,呈漩涡状。1例中,肿瘤细胞呈圆形、细胞质明显嗜酸性的上皮样灶局灶性突出。每例中均易于识别有丝分裂象。所有3个肿瘤S-100蛋白和波形蛋白呈阳性,细胞角蛋白、HMB-45和结蛋白呈阴性。1例为近期病例,1例患者子宫切除术后2年腹部出现多处转移。最初接受息肉切除术治疗的患者接受了再次局部切除,随后锥切切缘阳性,然后行子宫切除术。诊断后15个月她临床无疾病。尽管肿瘤的组织学特征提示为恶性神经鞘瘤,但也曾考虑过其他诊断,免疫组化对确诊至关重要。这些肿瘤应与子宫颈其他恶性梭形细胞肿瘤相鉴别,如平滑肌肉瘤、宫颈管“间质肉瘤”和梭形细胞黑色素瘤,以便进一步明确其特征、行为和最佳治疗方法。

文献检索

告别复杂PubMed语法,用中文像聊天一样搜索,搜遍4000万医学文献。AI智能推荐,让科研检索更轻松。

立即免费搜索

文件翻译

保留排版,准确专业,支持PDF/Word/PPT等文件格式,支持 12+语言互译。

免费翻译文档

深度研究

AI帮你快速写综述,25分钟生成高质量综述,智能提取关键信息,辅助科研写作。

立即免费体验