nerve sheath tumor
Introduction
Introduction to sphincter tumors Neurogenic tumors are the most common mediastinal tumors in adults and children. The tumors are classified into benign tumors such as schwannomas, melanoma, Schwannoma, granulosa cell tumors and neurofibroma. Malignant tumors have malignant Schwannoma and neurogenic sources. Sarcoma. Tumors are classified into benign tumors such as schwannomas, melanin, Schwannoma, granulosa cell tumors and neurofibromas, of which malignant tumors have malignant Schwannoma and neurogenic sarcoma. Surgical treatment is the only method. After the malignant tumor, radiotherapy is needed to provide survival rate. basic knowledge The proportion of sickness: 0.002% - 0.008% Susceptible people: no special people Mode of infection: non-infectious Complications: multiple lung infections
Cause
The cause of sphincter-derived tumors
(1) Causes of the disease
Schwannoma:
The Schwann cells from the nerve sheath grow slowly. On the naked eye, the sphincter envelope is completely adhered to the originating nerve fibers. It is hard, grayish yellow or pink, and the cut surface is like an annual ring. It can be seen under the microscope. Two kinds of cells: Antoni A is a spindle-like cell, which is dense and avascular. It has a change of myxoma and multiple cystic areas. The vessel wall is thickened and hyaline degeneration. There are many electron microscopic observations of Antoni A cells. The small cytoplasmic processes emitted by the cell body, Antoni B cells lack these cytoplasmic processes, but are rich in cytoplasm and complex organelles. Schwann cell tumors containing melanin occur in the spinal canal in addition to the paraspinal sulcus, and granuloma is the origin of sphincter cells. Aisner et al. (1988) reported a simultaneous granulocyte in the paraspinal sulcus. tumor.
Neurofibroma:
Compared with schwannomas, neurofibromatosis is composed of nerve cells and nerve sheaths. It appears to have a capsule on the naked eye. The cut surface is gray and translucent, with small round or fusiform swelling, but no real connective tissue can be seen under the microscope. Boundary, histologically, the proliferating cell membrane sheath and many axons form a staggered network. The cells are not arranged in a grid. Under electron microscopy, the tumor is composed of elongated cells that protrude from a few large cytoplasmic processes. Occasionally, myelinated or unmyelinated axons are seen in the collagen matrix. The plexiform neurofibroma is a diffuse fusiform enlargement of the nerve and/or multiple masses distributed along the nerve. The sympathetic trunk of the paraspinal sulcus, the vagus nerve, and the phrenic nerve are all visible, but the left vagus nerve is near. The lateral ends, ie above the aortic arch or the level of the aortic arch are more common.
Neurogenic sarcoma (malignant Schwann cell tumor):
Less than 10% of adult neurogenic tumors are neurogenic sarcomas, and the tumors are mostly located in the posterior mediastinum, and can be seen in the anterior mediastinum; nearby structures are often violated and distant metastasis can occur, which can be seen under the microscope. The number of cells is abnormally increased, nuclear polymorphism and mitosis.
(two) pathogenesis
The schwannomas are derived from the nerve sheath cells, which occur in the posterior and intercostal nerves of the spinal nerves. They can also occur in the sympathetic and vagus nerves. The recurrent laryngeal nerves are similar in men and women. They occur in people 20 to 50 years old. The difference occurred in the upper part of the chest more than below, the size of the tumor is different, usually ranging from 3 to 15 cm in diameter (median value 5.0 cm), single hair more than multiple, benign nerve sheath tumor can be divided into two categories: nerve Schwannoma (benign Schwannoma) and neurofibromatosis, rare melanoma Schwannoma and granulosa cell tumor, malignant schwannomas or neurogenic sarcoma, schwannomas mostly located in the nerve trunk One side, wrapped in a nerve outer garment or clothing, makes the nerve trunk eccentric fusiform expansion, but the nerve does not penetrate into the tumor, so the operation is easy to remove without damaging the nerve.
Neurofibromas occur mostly in the 20 to 40 years old, and are mostly part of the neurofibromatosis Von Reckling-hausens disease. The main cellular component is also the nerve sheath cells, which are tumor-like masses formed by peripheral nerve fiber components or diffuse hyperplasia. The intrathoracic mediastinal neurofibromatosis is often single. The malignant rate of neurofibromatosis in these patients can be as high as 4% to 10%. The spinal nerve root and intercostal nerve scabbage tumor can expand and expand in the intervertebral foramen. Dumbbell-shaped, the tumor outside the intervertebral foramen is often larger than the inner part of the intervertebral foramen. Occasionally, two uncommon sphincter-derived tumors are seen in the mediastinum: melanoma schwannomas, granulocyte tumors, the latter is confirmed Originated from neuromembrane cells, it is a malignant lesion and is classified as malignant schwannomas. Neurogenic sarcoma (malignant Schwann cell tumor) accounts for less than 10% of adult neurogenic tumors, and is more common in young people aged 10 to 20 or In the elderly aged 60 to 70 years, the structure near the tumor is often violated, and distant metastasis can occur. Microscopically, the number of cells is abnormally increased, nuclear polymorphism and mitosis.
Prevention
Cerebral sheath tumor prevention
There is no effective preventive measure for this disease. Early detection and early diagnosis are the key to the prevention and treatment of this disease.
Complication
Neuroscleral tumor complications Complications multiple lung infections
Numbness in the limbs or trunk, lung infection.
Symptom
Symptoms of sphincter- derived tumors Common symptoms Brachial plexus involvement Pulmonary infection Chest tightness Tracheal transposition Spinal cord compression Dyspnea Neck sympathetic chain Suffering Acute pain Acute dyspnea
Nerve sheath-derived benign tumors, mostly asymptomatic, are often found on routine chest X-rays, while in a few patients the symptoms are often caused by mechanical causes, such as chest or back pain due to intercostal nerves, bone or chest wall Pressing or being infiltrated, coughing and difficulty breathing are caused by bronchial tree compression, Pancoast syndrome is involvement of brachial plexus, Horner syndrome is involved in cervical sympathetic chain, and hoarseness is tumor invasion of the recurrent laryngeal nerve.
3% to 10% of patients have tumors that protrude into the spine and expand in the shape of a dumbbell in the spinal canal. Symptoms of spinal cord compression, numbness of the lower extremities, and movement disorders, although 60% of patients with dumbbell-shaped tumors appear Symptoms related to spinal cord compression, but still partially asymptomatic. When the tumor grows hugely or malignantly, it can occupy one side of the chest cavity, causing the mediastinum to shift to the healthy side. The patient's lungs are completely compressed by the tumor without function, and gradually appear chest tightness and shortness of breath. Symptoms are aggravated after the activity, and can cause wheezing, partial atelectasis after lung compression, recurrent lung infection, cough, phlegm, fever, some may have acute dyspnea, and may cause tracheal displacement, affected side The breath sound disappears.
Blood gas analysis suggests hypoxemia, due to the displacement of the heart, tumor compression of the superior vena cava can occur in the superior vena cava syndrome, compression of the esophagus can occur dysphagia, generally from asymptomatic to symptomatic, for 3 months to 3 years not Etc., there are reports for up to 14 years, the mediastinal neurofibroma malignant is rare, malignant schwannomas due to rapid growth, symptoms often appear earlier and heavier, often due to tumor invasion of adjacent tissues and severe pain .
Examine
Examination of sphincter-derived tumors
1. Chest X-ray:
The neurogenic tumors seen were basically similar, and there were no significant differences between benign and malignant manifestations. The orthotopic X-ray showed a circular or elliptical density of uniform shadows in the thoracic cavity, occasionally triangular or lobulated, with the inner edge often located in the mediastinum. In the shadow, the lateral position shows that the tumor is located in the para-segmental area of the spine, the boundary is clear, and adjacent bones may also change. Such as: ribs and vertebral body erosion, increased intervertebral foramen, widened intercostal space, and valgus eversion, but often can not explain the nature of the tumor, because the tumor growth caused by local compression, pedicle flattened Even the pedicle transverse vertebral body is destroyed, accompanied by the expansion of the intervertebral foramen, which is a special X-ray sign of the posterior mediastinal dumbbell-shaped tumor. The upper digestive tract tincture tablet also shows the distortion of the esophagus.
2. CT scan shows:
The tumor is located in the posterior mediastinum, much closer to the paravertebral, with clear tumor boundaries, rounded, oval, and some cases of benign or malignant tumors may have lobes. In patients with multiple neurofibromatosis, the detection rate of CT scan is often higher than that of ordinary chest X-ray.
3. Magnetic resonance imaging (MRI):
Enhanced images of T1 and T2 can be seen: neurofibroma has a high-density characteristic peripheral zone and a medium-density central zone, while schwannomas are heterogeneous high-density zones, CT or MRI can be determined, tumor invasion into the spinal canal In the case of the latter, the latter can also be used to determine the extent of involvement. However, enhanced spinal X-ray examination is currently used to understand the tumor invasion, such as a giant neurogenic tumor on one side of the chest, X-ray films, and CT films. It shows that the huge tumor fills the entire thoracic cavity, the mediastinum shifts to the healthy side, the trachea is displaced, compressed or narrowed, the affected lung is compressed, and the common intrapulmonary effusion is common.
Diagnosis
Diagnosis and diagnosis of sphincter tumors
The age of onset of sphincter-derived tumors is 20-50 years old, occasionally seen in children. The incidence is similar between men and women, but neurogenic sarcoma tends to occur in patients with benign schwannomas at both ends, 10-20 Age and 60-70 years old age, after understanding the medical history, it is difficult to diagnose according to clinical manifestations. The diagnosis depends mainly on postoperative pathological examination.
Neurofibromatosis with intrathoracic neurofibromatosis must be differentiated from rare meningeal protrusions, which is not difficult to diagnose because of its peripheral neurofibromatosis.
