腮腺内面神经鞘瘤的临床病理分析

doi:10.13591/j.cnki.kqyx.2022.05.009

摘要/Abstract

摘要： 目的探讨腮腺内面神经鞘瘤的临床特点及病理特征。方法收集2015—2020年江苏大学附属医院口腔颌面外科收治的5例腮腺内面神经鞘瘤病例,分析患者的临床资料、影像资料、病理资料、术前诊断、治疗方式及术后神经损伤情况等。结果 5例患者均为男性,年龄33~70岁。临床表现仅为境界清楚的无痛性腮腺区肿物,均不伴面神经瘫痪等症状。2例术前诊断为混合瘤,3例术前诊断为腺淋巴瘤。治疗方式为肿瘤合并神经切除后神经端端吻合术。术后随访4例患者面神经功能基本正常,仅一例患者存在H-BⅡ级面神经功能障碍症状,随访10~72个月未见复发病例及恶变。镜下肿瘤细胞呈长梭形,呈编织状排列。免疫组化示肿瘤细胞S-100蛋白在5例患者的细胞核和细胞质中呈弥漫性强阳性表达,Vimentin在5例患者胞质中均呈强阳性表达,Sox10在4例患者胞核中呈阳性表达,3例患者局灶表达CK7,细胞增殖能力标记物Ki-67阳性指数均小于3%,AE1、EMA、P63、SMA在全部病例中均呈阴性表达。结论腮腺内面神经鞘瘤的临床表现及辅助检查均无特异性,术前确诊较为困难,需要依赖病理诊断,S-100、Vimentin可辅助诊断腮腺内面神经鞘瘤。

关键词: 腮腺, 神经鞘瘤, 面神经, S-100, Vimentin

Abstract: Objective To investigate clinical and pathological features of intra-parotid facial nerve schwannoma. Methods A total of 5 cases of intra-parotid facial nerve schwannoma admitted to the Department of Oral and Maxillofacial Surgery, Affiliated Hospital of Jiangsu University from 2015 to 2020 were collected and reviewed. Patients’ clinical data, imaging data, pathological data, preoperative diagnosis, treatment and postoperative nerve injury were analyzed. Results All patients with intra-parotid facial nerve schwannoma were male (33-70 years old). Clinical manifestations were only painless parotid gland mass with clear boundary, without facial nerve paralysis and other symptoms. Two cases were diagnosed as mixed tumor and 3 cases were diagnosed as adenolymphoma before operation. The treatment method was tumor with involved facial nerve resection and anastomosis in which nerve was jointed end-to-end. Post-operative follow-up showed that the facial nerve function of 4 patients was basically normal, and only one patient had grade Ⅱ (House-Brackmann) facial nerve dysfunction. No recurrent cases and malignant changes were observed during follow-up for 10-72 months. Microscopically, tumor cells were long spindle-shaped and arranged in a braided pattern. Immunohistochemistry showed diffuse strong positive expression of S-100 protein in the nuclei and cytoplasm of 5 patients. Also Vimentin was strongly positive in cytoplasm in all 5 cases. Sox10 was positive in the nuclei of 4 cases. Focal expression of CK7 was found in 3 patients. The positive index of Ki-67, a marker of cell proliferation, was less than 3%, and AE1, EMA, P63 and SMA were negative in all cases. Conclusion Clinical manifestations and auxiliary examination of intra-parotid facial nerve schwannoma are non-specific. Preoperative diagnosis is difficult and depends on tissue pathological diagnosis. S-100 and Vimentin could assist the diagnosis of intra-parotid facial nerve schwannoma.

Key words: parotid gland, neurinoma, facial nerve, S-100, Vimentin

中图分类号:

R739.87

鞠玮, 史圆圆, 黄育萌, 许建辉, 严志新, 杨细虎. 腮腺内面神经鞘瘤的临床病理分析[J]. 口腔医学, 2022, 42(5): 431-436.

JU Wei, SHI Yuanyuan, HUANG Yumeng, XU Jianhui, YAN Zhixin, YANG Xihu. Clinical pathological analysis of intra-parotid facial nerve schwannoma[J]. Stomatology, 2022, 42(5): 431-436.

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