鼻腔鼻竇惡性神經鞘瘤－病例報告

Sinonasal Malignant Schwannoma – Case Report

謝勇上(Yung-Shang Hsieh) ； 周延隆(Yen-Long Jou) ； 王國榮(Kuo-Rong Wang) ； 彭玉文(Yue-Wen Peng) ； 周建聖(Jiann-Sheng Chou)

《中華民國耳鼻喉科醫學雜誌》 34卷5期 (1999/09) Pp. 408-412

https://doi.org/10.6286/1999.34.5.408

摘要

源於鼻腔或鼻竇的惡性神經鞘瘤在文獻上少有報告。本院在1998年3月經歷一個病例。病患為64歲女性，主訴為鼻塞6個多月，就診時在兩側鼻腔內發現有灰白色息肉狀的腫瘤。電腦斷顯示軟組織於兩側鼻腔及右側篩竇，經由鼻腔內視鏡手術取得的標本，右側組織在顯微鏡上顯示惡性梭狀細胞並對S-100蛋白的染色為陽性，因而證實為惡性神經鞘瘤。病患於是再接受廣泛的內視鏡清除手術，至今年1月尚未發現有復發的現象。回顧文獻，只有16例曾被報告過，特提出此罕見病例報告。

關鍵字

惡性神經鞘瘤

並列摘要

Malignant schwannomas are rare neoplasms that are seldom found in the sinonasal region. The literature search reveals only 16 previously reported cases. Herein, we report a case of sinonasal malignant schwannoma which was successfully treated with endoscopic tumor excision. In 1998, a 64-year-old woman visited us with the chief complaint of nasal obstruction for more than six months. Gray-whitish polyps in both nasal cavities were found by an anterior rhinoscopy. Computed tomography (CT) scan revealed soft tissue density in both nasal cavities and the right ethmoid sinus. Bilat-eral chronic paranasal sinusitis with polyps was the initial impression. Endo-scopic tumor excision was performed and the specimens were sent for pathologic examination. The reports revealed chronic inflammation and polyps on the left-side specimens. As for the right-side specimens, diffuse malignant spindle cells with wavy, comma shaped nuclei as well as immuno-histochemical positivity for S-100 protein and vimentin were found. Malig-nant schwannoma was diagnosed. Post-operative CT scan showed residual tumors in the right ethmoid sinus. The patient underwent endoscopic revi-sion procedure to remove the tumors in the ethmoid sinus. The patient recovered with no evidence of disease 9 months after surgery. We suggest that endoscopic excision can be a viable surgical option for selective cases of malignant schwannoma in sinonasal region.

並列關鍵字

malignant schwannoma