三十二例犬皮下軟組織周邊神經鞘膜瘤：病理學及免疫組織化學染色特徵之研究

Subcutaneous Peripheral Nerve Sheath Tumors in 32 Dogs: Studies on Pathological and Immunohistochemical Characterization

凃央昌(Yang-Chang Tu) ； 蕭正祥(Cheng-Hsiang Hsiao) ； 李進成(Chln-Chenq Lee) ； 龐飛(Victor Fei Pang) ； 鄭謙仁(Chian-Ren Jeng) ； 王汎熒(Fun-In Wang) ； 鄭穹翔(Chiung-Hsiang Cheng) ； 劉振軒(Chen-Hsuan Liu)

《臺灣獸醫學雜誌》 32卷2期 (2006/06) Pp. 101-115

https://doi.org/10.7009/TVJ.200606.0101

摘要

32例犬皮膚周邊神經鞘膜瘤，包括19例惡性及13例良性病例，其中以混種犬罹患比率最高，佔60.7%（17/28），年齡以7歲至14歲的發生率最高佔89.7%（26/29），就性別比較，雌犬（53.3%；16/30）的發生率略高於雄犬（46.7%；14/30），發生部位以四肢最常見（79.3%；23/29），其中以前肢的比率較高（69.6%；16/23）。患部肉眼可見凸起的堅實腫塊伴隨脫毛，潰痬灶少見，切面顏色白色至灰色，出血、壞死及囊腔樣形成常見於惡性病例。此外，亦可發現團塊表面有似神經束結節的多發小團塊凸出。組織病理學檢查，腫瘤細胞呈現紡鍾形或S型，形成波浪狀、棚欄狀、束狀交織或旋渦狀的排列，細胞間因腫瘤細胞的彎曲，而有裂隙的產生。惡性周邊神經鞘膜瘤的腫瘤細胞，除梭形外，亦有呈現肥胖梭形或圓形至類上皮形態，偶見多核巨細胞出現。2例惡性病例伴隨有軟骨細胞的化生，另有6例惡性腫瘤區域出現嚴重的壞死，其中有3例出現廣泛血栓的形成。此外，14例良性病例有9例許旺氏細胞瘤及5例神經纖維瘤，而9例許旺氏細胞瘤中，只有2例具有典型的Antoni type A and B的特徵；神經纖維瘤的細胞密度低且細胞間存在多量的膠原纖維。免疫組織化學染色的結果，vimentin有100%（32/32）、Iaminin 有96.9%（31/32）、S-100有87.5%（28/32）、NGFR有84.4%（27/32）、neurofilament有50.0%（16/32）、NSE有31.3%（10/32）、α-SMA有6.3%（2/32）、及desmin有3.0%（1/32）呈現陽性，而cytokeratin、factor VIII及GFAP均呈陰性。Neurofilament 抗體對PNSTs的標示，有特異性的反應，被標示的腫瘤細胞通常為單一細胞；血管周細胞瘤對α-SMA（71.4%；5/7）亦有特異性的反應，因此可用於區別這兩種腫瘤。Laminin抗體可用於犬PNSTs的應用，對良性或惡性的許旺氏細胞瘤會呈陽性，而GFAP抗體無法用於犬PNSTs診斷。而NGFR對犬PNSTs和其他梭形細胞瘤之間的區別，並無診斷上的價值。綜合研究結果，梭形細胞瘤於組織病理形態學下，可初步推測其組織來源，再配合免疫組織化學染色S-100，vimentin，α-SMA，neurofilament，laminin，NGFR及NSE的結果，可區別周邊神經鞘膜瘤與其他梭形細胞瘤。

關鍵字

犬 ； 免疫組織化學染色 ； 周邊神經鞘膜瘤 ； 皮下軟組織

並列摘要

A total of 32 canine peripheral nerve sheath tumors (PNSTs), 19 malignant PNSTs (MPNSTs), and 13 benign PNSTs (BPNSTs) were diagnosed by histological features and immunohistochemical results. In this study, the affected dogs were 16 (53.3%) females, 14 (46.7%) males and 2 unknown sexes. The peak incidence of the PNSTs was between 7 to 14 years of age (89.7%; 25/29). Breed at the highest risk was mongrel dogs (60.7%; 17/28). The limbs were the most frequent site (79.3%; 23/29) followed by the trunk (17.2%; 5/29) and head (3.4%; 1/29). Grossly, the tumor mass was found in the subcutaneous tissue with alopecia and occasional ulcerations. Tumors with the appearance of nodule-like neural bundles were also noted. Microscopically, PNSTs were mainly composed of spindle or S shape cells arranged in wavy bundles, palisading, storiform, and whorl fashions. The predominant tumor cells of MPNSTs were either plump spindle or round in shape with epithelioid characteristics, mixed with multinucleated giant cells occasionall y. There were two MPNSTs with cartilaginous metaplasia, and six MPNSTs presented with extensive necrotic foci accompanied with thrombosis in 3 of 6 cases. Regarding to 13 BPNSTs, all exhibited a typical feature of either schwannoma or neurofibroma. Only 2 of 9 schwannomas had Antoni type A and B features. The 4 neurofibromas presented with extensive collagen deposition likened to shredded carrots appearance, which tumor cells arranged in hypocellularity. Immunohistochemically, the expression of vimentin 100% (32/32), laminin 96.9% (31/32), S-100 87.5% (28/32), nerve growth factor receptor (NGFR) 84.4% (27/32), neurofilament 50.0% (16/32), NSE 31.3% (10/32), α-SMA 6.3% (2/32), and desmin 3.0% (1/32) were found in PNSTs. PNSTs failed to demonstrate expression of cytokeratin, factor VIII, and GFAP. On conclusion, PNSTs occur in the subcutaneous tissue of dogs, which share histological similarities with other spindle cell tumors. Comprehensive studies on microscopically findings and immunohistochemical characteri zed provide a useful and practical method to differentiate PNSTs from other spindle cell tumors.

並列關鍵字

Dog ； immunohistochemistry ； peripheral nerve sheath tumors ； subcutaneous