犬周邊神經鞘膜瘤：病理學及免疫組織化學特徵之研究

Canine Peripheral Nerve Sheath Tumors: Studies on Pathological and Immunohistochemical Characterization

涂央昌(Yang-Chang Tu)

指導教授 ： 劉振軒

國立臺灣大學/生物資源暨農學院/獸醫學研究所/碩士(2005年)

https://doi.org/10.6342/NTU.2005.00997

摘要

收集犬周邊神經鞘膜瘤共36例，包括組織病理學診斷23例惡性及13例良性病例。以品種分析，好發品種為混種犬（mongrel）佔51.5％，年齡以7歲到14歲的發生率最高佔86.7％；就性別比較，雌犬（54.8％）的發生略高於雄犬（41.2％）；以發生部位統計，四肢的發生率最高（75.6%）。組織病理學特徵，周邊神經鞘膜瘤由梭形或S型的細胞，構成波浪狀、柵欄狀、束狀交織及旋渦狀的列，細胞間因腫瘤細胞的彎曲型，而有裂隙的產生。惡性周邊神經鞘膜瘤的腫瘤細胞，呈現肥胖梭形或圓形至類上皮形態，偶見多核巨大細胞出現，有2例惡性病例伴隨有軟骨細胞的化生，另有6例腫瘤區域出現嚴重的壞死，其中有3例伴隨廣泛血栓的形成。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例組織病理形態具有典型Antoni type A and B的特徵；神經纖維瘤的腫瘤細胞密度低且細胞間存在多量的膠原纖維。超顯微結構下腫瘤細胞膜上可見到雙層連續的basal lamina，細胞突起（processes）且互相交織（intertwining processes），細胞間存在大量的膠原纖維。免疫組織化學染色的結果，vimentin有100％，laminin有93.3％，S-100有87.8％，NGFR（nerve growth factor receptor）有84.8％，neurofilament有51.58％，NSE（neuron-specific enolase）有30.3％，α-SMA（α-smooth muscle actin）有6.1％，及desmin有3.0％，而cytokeratin，factorⅧ及GFAP （glial fibrillary acidic protein）均呈陰性。神經纖維瘤對neurofilament抗體染色，大部分呈陽性（4/5; 80.0%），而laminin對良性或惡性的許旺氏細胞瘤會呈陽性。雖然血管周細胞瘤對S-100有71.4％的陽性率，但血管周細胞瘤對α-SMA有71.4％的陽性率，但配合laminin及NGFR抗體染色，可進一步區別兩者。綜合研究結果，梭形細胞瘤於組織病理形態學下，即可初步推測其組織來源，配合免疫組織化學染色S-100，vimentin，α-SMA（＋），neurofilament，laminin，NGFR及NSE的結果，可將周邊神經鞘膜瘤與其他組織學類似的梭形細胞瘤區別。

關鍵字

犬 ； 周邊神經鞘膜瘤 ； 免疫組織化學染色

並列摘要

A total of 36 canine peripheral nerve sheath tumors (PNSTs), 23 malignant PNSTs (MPNSTs), and 13 benign PNSTs (BPNSTs) were diagnosed by histological features and immunohistochemical results. In this study, the affected dogs were 17 (54.8%) females and 14 (41.2%) males. The peak incidence of the PNSTs was between 7 to 14 years of age (26/30; 86.7%). Breed at the highest risk was mongrel dogs (17/33; 51.5%). The limbs were the most common site (25/33; 75.6%), followed by the trunk (5/33; 15.2%), genital (2/33; 6.1%), and head (1/33; 3.0%). Microscopically, PNSTs were 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 occasionally. 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 typical 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. Ultrastructurally, the tumor cells were long, thin, intertwining processes, a duplicated external basal lamina covering the cells, and long spacing collagen. Immunohistochemically, the expression of vimentin (100%), laminin (93.3%), S-100 (87.8%), nerve growth factor receptor (NGFR, 84.8%), neurofilament (51.58%), neuron-specific enolase (NSE, 30.3%), α-SMA (α-smooth muscle actin, 6.1%), and desmin (3.0%) were found in PNSTs. PNSTs failed to demonstrate expression of cytokeratin, factorⅧ, and glial fibrillary acidic protein (GFAP). On conclusion, PNSTs often occur in the skin soft tissue of dogs that share histological similarities with other spindle cell tumors. Comprehensive studies on microscopical findings and immunohistochemical characterization 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

參考文獻

劉振軒, 王綉真, 蘇豐振 and 傅千惠. (1997). 改良式免疫組織化學染色技術應用於福馬林液固定與石蠟包埋豬組織之研究. 23, 523-530.

LeCouteur, R. A. (2001). Small animal clinical oncology. WB Saunders, Philadelphia, PA., pp. 521-525.

Abraham, L. A., Mitten, R. W., Beck, C., Charles, J. A. and Holloway, S. A. (2003). Diagnosis of sciatic nerve tumour in two dogs by electromyography and magnetic resonance imaging. Aust Vet J, 81, 42-46.

Altmannsberger, M., Weber, K., Droste, R. and Osborn, M. (1985). Desmin is a specific marker for rhabdomyosarcomas of human and rat origin. Am J Pathol, 118, 85-95.

Anderson, G. M., Dallaire, A., Miller, L. M. and Miller, C. W. (1999). Peripheral nerve sheath tumor of the diaphragm with osseous differentiation in a one-year-old dog. J Am Anim Hosp Assoc, 35, 319-322.