超音波診斷復發之多發性正中神經鞘膜瘤：病例報告

Ultrasound Diagnosis of Recurrent Multiple Neurilemmomas of Median Nerve: A Case Report

姜義彬(Yi-Ping Chiang) ； 楊百嘉(Baii-Jia Yang) ； 劉士嘉(Shih-Chia Liu) ； 陳冠文(Kuan-Wen Chen)

《台灣復健醫學雜誌》 36卷1期 (2008/03) Pp. 53-58

https://doi.org/10.6315/2008.36(1)07

摘要

本病例爲一31歲女性，因左上肢出現多處隆起可觸及之無痛硬塊而至骨科就診，此患者於四年前曾因左腕部之神經鞘膜瘤接受切除手術。理學檢查發現手掌處及前臂遠端接近腕橫紋處各有一明顯隆起之腫塊，而肘前部亦有一不明顯之隆起。手部X光檢查並未發現任何不正常影像；核磁共振檢查之結果，則於手掌部發現一神經源性腫瘤。超音波檢查則於手掌、前臂遠端及肘前部之正中神經，分別發現血流增加之神經鞘膜瘤。神經傳導檢查發現，患者正中神經之運動神經遠端潛期延長，感覺神經傳導則無異常。經手術後，病理檢查證實三處腫瘤均爲神經鞘膜瘤，而術後正中神經之運動神經遠端潛期縮短爲正常範圍之內。單獨發生之神經鞘膜瘤並不少見，而多發性神經鞘膜瘤則甚爲少見，侷限於正中神經之多發性神經鞘膜瘤，於文獻報導則更爲罕見。本患者爲復發之多發性正中神經鞘膜瘤，並於術前之神經傳導檢查有疑似腕道症候群之表現，相同病歷並未出現於文獻記載中。根據本病例之經驗，超音波檢查對於檢測正中神經之神經鞘膜瘤是十分有效的工具；對於多發性之神經鞘膜瘤，超音波比核磁共振檢查更方便偵測臨床可觸及之多發病灶。

關鍵字

超音波 ； 神經鞘膜瘤

並列摘要

A 31-year-old lady complained of multiple painless masses on her left arm. Two masses were clearly visible in the left palm and distal forearm, and a smaller lump was also palpable in the left antecubital area. A neurogenic tumor in the left palm was diagnosed by magnetic resonance image (MRI). Sonography demonstrated highly vascular neurilemmomas along the median nerve in the palm, distal forearm, and antecubital area. A nerve conduction velocity study of the median nerve showed prolonged distal latency of the motor nerve portion but normal sensory function. The tumors were resected, and pathology examination confirmed the diagnosis of neurilemmoma at all three sites. The median nerve distal latency was normal one month after surgery. Solitary neurilemmomas are not uncommon, but multiple lesions are quite unusual. We were unable to find any other published reports of multiple neurilemmomas limited to the median nerve. Our experience in this case suggests that ultrasound may be even more useful than MRI in detecting and diagnosing neurilemmomas, particularly when there are multiple lesions in an unusual location.

並列關鍵字

ultrasound ； neurilemmoma