腓肠肌内神经鞘瘤1例

2018-11-06 王军 赵雷 范影 中国临床医学影像杂志

周围神经鞘瘤影像报道多是发生于肌间隙内神经血管束走行区病变,骨骼肌内的神经鞘瘤少见。本文报道1例并进行文献复习,对其影像学表现探讨。

周围神经鞘瘤影像报道多是发生于肌间隙内神经血管束走行区病变,骨骼肌内的神经鞘瘤少见。本文报道1例并进行文献复习,对其影像学表现探讨。
 
男,43岁,自述3月前无意间发现左小腿包块,因包块较小,未引起重视,未作治疗,约一月前包块逐渐增大。查体:左小腿后侧可触及大小约2.0 cm×3.0 cm包块,质韧,边界清楚,触压痛阳性,活动度良好,皮肤静脉未见怒张,足背动脉搏动可及,皮肤感觉可,未及麻木感,甲床毛细血管反应良好,肌张力未见异常。
 
影像学检查:彩超探及左小腿肌层内一实性低回声结节,边界清晰,形态规则,直径约1.0 cm内部回声均匀。CDFI:结节周边见少许血流信号。MRI影像表现:左小腿腓肠肌内见类圆形异常信号,边缘清晰,大小约1.1 cm×1.0 cm×1.1 cm,T1WI为稍高信号,质子抑脂像病灶中心稍低信号,周边呈高信号,冠状位病灶边缘可见细血管穿行。
 
手术及病理:术中见肿块位于腓肠肌内侧头肌肉内,呈淡黄色,外敷包膜,与周围肌肉界限清晰,包块完整剥离;送检病理结果:神经鞘瘤,瘤细胞呈梭形,栅栏状、束状排列。
 








图1超声检查。图1a:肌层内一实性低回声结节。图1b:CDFI示结节周边少许血流信号。图2,3MRI检查,图2a,3a为冠状位,图2b,3b为横断位。图2:T1WI像腓肠肌内结节状稍高信号。图3:质子密度抑脂像病灶中心稍低信号,边缘呈高信号,冠状位可见病灶边缘有细血管穿过。图4病理学检查,瘤细胞呈梭形(HE染色)。
 
讨论
 
神经鞘瘤又称施万细胞瘤或神经膜细胞瘤,是起源于胚胎期神经嵴来源的神经膜细胞或施万细胞的良性肿瘤。神经鞘瘤是周围神经肿瘤中最常见的一种类型,90%多为单发,多见于20~50岁人群,无性别差异。四肢软组织的神经鞘瘤多发生于肢体及关节屈侧肌间隔神经血管束走行区内,下肢多于上肢。周围性神经鞘瘤生长的位置不同,瘤体外形差别较大,常沿神经纤维以外的非同心圆轴发展并被神经束膜所包饶,境界清楚,包膜完整,呈孤立生长。
 
超声探及表浅软组织内神经鞘瘤为低回声包块,能对其大小、位置、形态及相邻组织器官关系作出判断,较深组织内的肿块有时显示不佳。MRI对软组织具有高对比分辨率与多向、多层面成像,不仅可以显示肿块位置、大小、形状,还可以精确勾勒出肿块对周边血管神经的侵犯、包饶和推移情况,根据肿块内不同成分的信号特点判断肿瘤组织特性,其价值优越于超声和CT检查。结合本例患者及综合文献,骨骼肌内的神经鞘瘤一般较小(直径小于5 cm)、类圆形、包膜完整、无囊变。常规MRI序列检查,T1WI为等或少高信号,PDWI抑脂像病变中心低信号,周围高信号,呈“靶征”;“靶征”与神经鞘瘤组织学的两种构象:即AntoniA区(密集的梭形细胞),AntoniB区(黏液样成分)相关,具有一定的特征性。神经纤维瘤也有相同的“靶征”表现,神经纤维瘤多与神经关系密切,常多发,单发的多无包膜,这与神经鞘瘤鉴别有重要意义。
 
总之,骨骼肌内的神经鞘瘤凭借单一的影像学特点不易与其他软组织肿瘤鉴别。MRI对病理类型不同的神经鞘瘤鉴别诊断有一定的价值,结合临床资料分析,明确骨骼肌内的神经鞘瘤诊断,优化临床治疗方案有不可忽视的意义。
 
原始出处:

王军,赵雷,范影,谢玉海.腓肠肌内神经鞘瘤1例[J].中国临床医学影像杂志,2018(02):151-152.

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    2018-11-26 zwjnj2

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    2018-11-09 zwjnj2

    好好学习天天学习

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    2018-11-07 王秀

    学习了,涨知识了!

    0

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    2018-11-07 红色

    学习了

    0