椎管内马尾终丝副神经节瘤二例

2019-03-12 任琦 程敬亮 张勇 临床放射学杂志

例1男,64岁。左下肢疼痛10年加重10天,大小便失禁2年,于2015年11月6日入院。行MRI检查示L2~3水平椎管内囊实性异常信号,病变实性部分呈等T1不均匀稍短T2信号(图1、2),T2脂肪抑制序列呈低信号(图3);病变囊性部分呈脑脊液样长T1、长T2信号(图1、2),长度约4.6 cm,T2脂肪抑制序列呈高信号(图4),邻近脊髓内可见斑片状长T2信号,脊髓圆锥消失,邻近马尾神经受压移位。增

例1男,64岁。左下肢疼痛10年加重10天,大小便失禁2年,于2015年11月6日入院。行MRI检查示L2~3水平椎管内囊实性异常信号,病变实性部分呈等T1不均匀稍短T2信号(图1、2),T2脂肪抑制序列呈低信号(图3);病变囊性部分呈脑脊液样长T1、长T2信号(图1、2),长度约4.6 cm,T2脂肪抑制序列呈高信号(图4),邻近脊髓内可见斑片状长T2信号,脊髓圆锥消失,邻近马尾神经受压移位。增强扫描示病变囊性部分未见明显强化,实性部分可见明显均匀强化(图5)。诊断:室管膜瘤。
 






图1 L2~3水平椎管内可见囊实性病灶,实性部分(白色箭头)呈等T1信号,囊性部分(黄色箭头)呈长T1信号;图2 病灶实性部分呈稍短T2信号,囊性部分呈脑脊液样长T2信号,脊髓圆锥消失,脊髓末端可见斑片状长T2信号;图3 T2脂肪抑制序列上病灶信号表现与图2一致;图4 L2~3水平轴位示病变囊性部分呈长T2信号(黄色箭头),终丝因受挤压而紧贴椎管(红色箭头);图5 冠状位增强扫描示病变实性部分(白色箭头)明显均匀强化,囊性部分未见强化
 
术中见病变为囊实性病变,切开后清亮液体流出,显露出实性病变有完整包膜,灰红色,质韧,呈膨胀性生长,血供丰富,整块切除肿瘤组织。术后病理见灰红椭圆形组织一块,大小约2.5 cm×2.2 cm×1.3 cm,切面灰红灰黄质软。免疫组织化学示CK、Vim、NSE、S-100、Syn均阳性,Ki-67(约1%+)。病理诊断:副神经节瘤(图6)。


图6 病理图片,显微镜下见肿瘤细胞呈巢状分布,核深染,核分裂像少见(HE×100)
 
例2男,50岁。无明显诱因出现持续腰痛3个月,于2016年3月3日入院。行MRI检查示L2水平椎管内硬膜下类圆形等T1不均匀稍长T2信号(图7、8),T2脂肪抑制序列呈高信号(图9),肿块内部见点状短T2信号,边缘可见环状短T2信号(图8),病灶边界清晰,相应部位神经根受压。增强扫描示病变呈明显均匀强化(图10)。诊断:脊膜瘤。



图7 L2水平椎管内可见椭圆形等T1信号肿块(白色箭头);图8 病灶呈稍长T2信号,边缘见短T2信号,肿块内部信号不均匀,局部可见点状短T2信号;图9 T2脂肪抑制序列上肿块信号表现与图8一致;图10 增强扫描病变呈明显均匀强化
 
术中在L2~3椎管水平正中腹侧发现肿瘤,有完整包膜,灰红色,质韧,呈膨胀性生长,硬脊膜完整,未见肿瘤组织侵犯,血供丰富。探查发现肿瘤与一脊神经根有粘连包裹,推测为肿瘤起源处,直视下小心对该神经根与周围瘤组织进行锐性分离,保全该神经根,并全切除肿瘤组织及其包膜。术后病理见灰红组织一块,大小约2.0 cm×1.5 cm×1.0 cm。免疫组织化学示CK、Vim、S-100、CD56、CD99、Syn均阳性,Ki-67(约5%+)。病理诊断:副神经节瘤(图11)。
 
图11 病理图片,显微镜下见肿瘤细胞呈片巢状分布,间质内可见明显血管成分(HE×100)
 
原始出处:

任琦,程敬亮,张勇,等.椎管内马尾终丝副神经节瘤二例[J].临床放射学杂志,2018,37(01):172-173.

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    2019-09-23 bugit
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    2019-03-26 zwjnj2

    学习学习

    0

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髓细胞肉瘤(myeloid sarcoma,MS)是一种发生在骨髓外的,由伴有或不伴有成熟迹象的髓系原始细胞构成的肿块。MS 可发生于身体任何位置,发生于椎管内的非常罕见。本文报道1例椎管内髓细胞肉瘤。

糖尿病合并椎管内马尾神经鞘瘤一例

患者男,65岁,因“双下肢麻木6个月,加重伴疼痛、乏力1个月”来我院。

自发性椎管内硬膜外血肿1例

患者,女,63岁,因突发双下肢麻木伴乏力14h余入院。主诉:在家弯腰洗衣服时突感胸腰背部疼痛,双下肢麻木、无力,不能站立及行走,无昏迷、恶心及低热、盗汗等伴随症状。急至当地医院行胸椎X线及CT检查,未见明显异常,予以局部康复理疗后未见好转,且症状逐渐加重。我院门诊以“不全瘫”收住我科。患病以来,患者精神尚可,大、小便未解。