Neurilemmoma

神经鞘瘤
  • 文章类型: Journal Article
    血管腔是神经鞘瘤等良性周围神经鞘瘤的极为罕见的位置。以前报告的病例不到10例。在这份报告中,我们介绍了一例68岁女性,她在体检时左腿小腿后部有一个软组织结节。完成手术切除后进行病理检查。患者在手术后接受了12个月的随访,没有复发或任何其他并发症的证据。这是第一例报道的血管内神经鞘瘤是静脉阻塞的原因。微观上,肿瘤由对S100蛋白和SOX10免疫反应的雪旺梭形细胞组成。该肿瘤被明确定义的血管平滑肌壁包围。需要前瞻性系列来提高对血管内神经鞘瘤发展的潜在机制的认识。
    The blood vessel lumen is an extremely rare location for a benign peripheral nerve sheath tumor like schwannoma. Less than 10 cases have been previously reported. In this report, we present a case of a 68-year-old woman who had a soft tissue nodule at the posterior calf of her left leg during a physical examination. Pathological examination was performed after complete surgical excision. The patient underwent follow-up for 12 months after surgery without evidence of recurrence or any other complication. This is the first case of intravascular schwannoma reported as a cause of vein obstruction. Microscopically, the tumor was composed of Schwann spindle cells that were immunoreactive for S100 protein and SOX10. This tumor was surrounded by a well-defined vascular smooth muscle wall. Prospective series are required to improve the knowledge on the underlying mechanisms of intravascular schwannoma development.
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  • 文章类型: Case Reports
    schwannomas are benign and common soft tissue tumors. They are usually asymptomatic and are discovered for other reasons.
    we present the case of an 82-year-old male patient with a recent diagnosis of moderately differentiated adenocarcinoma of the colon and a hypermetabolic periaortic nodule as an incidental finding.
    percutaneous biopsy of the periaortic nodule confirmed the diagnosis of schwannoma. At one year of follow-up, growth of the schwannoma has been demonstrated. There are no signs of progression of his oncological disease.
    schwannomas are benign tumors, rarely found in the retroperitoneum and can be sources of false-positive positron emission tomography results.
    los schwannomas son tumores benignos y frecuentes de las partes blandas. Habitualmente son asintomáticos y son descubiertos por otros motivos.
    presentamos el caso de un paciente masculino de 82 años con diagnóstico reciente de adenocarcinoma de colon moderadamente diferenciado y con un nódulo periaórtico hipermetabólico como hallazgo incidental.
    la biopsia percutánea del nódulo periaórtico confirmó el diagnóstico de schwannoma. Al año de seguimiento, se ha demostrado crecimiento del schwannoma. No hay signos de progresión de su enfermedad oncológica.
    los schwannomas son tumores benignos, infrecuentes en el retroperitoneo y pueden ser fuentes de resultados falsos positivos en tomografía por emisión de positrones.
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  • 文章类型: Journal Article
    Tumors occurring in the submandibular space are infrequent among pediatric patients, and benign peripheral nerve tumors in this region are exceptionally rare. This study describes the uncommon occurrence of a schwannoma in the submandibular space in a child and describes its management. A 7-year-old child presented with a gradually enlarging swelling over a 7-month period in the submandibular region, clinically resembling a salivary gland tumor. There were no associated marginal mandibular, lingual, or hypoglossal nerve palsy. The mass was excised completely, and histopathological examination revealed it to be a schwannoma. It is appropriate to consider benign peripheral nerve tumors, such as schwannoma, in the differential diagnosis of submandibular space tumors in children.
    Submandibular boşlukta meydana gelen tümörler pediatrik hastalar arasında sık görülmez ve bu bölgedeki benign periferik sinir tümörleri son derece nadirdir. Bu çalışmada, bir çocukta submandibular alanda nadir görülen bir schwannoma olgusu ve tedavisi anlatılmaktadır. Yedi yaşında bir çocuk, submandibular bölgede 7 aylık bir süre içinde giderek büyüyen ve klinik olarak tükürük bezi tümörüne benzeyen bir şişlik ile başvurdu. Kitle ile ilişkili marjinal mandibular, lingual veya hipoglossal sinir felci yoktu. Kitle tamamen eksize edildi ve histopatolojik incelemede schwannoma olduğu görüldü. Çocuklarda submandibular boşluk tümörlerinin ayırıcı tanısında schwannoma gibi benign periferik sinir tümörlerinin düşünülmesi gerekmektedir.
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  • 文章类型: Journal Article
    NF2相关神经鞘瘤病(NF2)是一种遗传综合征,其特征是神经系统良性肿瘤的生长,尤其是双侧前庭神经鞘瘤,脑膜瘤,和室管膜瘤.这篇综述巩固了目前关于NF2综合征的知识,强调与同名基因突变相关的分子病理学,NF2基因,以及其产品随后的功能障碍,Merlin蛋白.梅林,肿瘤抑制剂,整合了多个调节细胞接触的信号通路,扩散,和运动性,从而影响肿瘤生长。梅林的消失破坏了这些途径,导致肿瘤发生。我们讨论了另外两种可能与NF2缺乏症以及Merlin相关的蛋白质的作用:Yes相关蛋白1(YAP),这可能会促进肿瘤生长,和Raf激酶抑制蛋白(RKIP),这似乎抑制了肿瘤的发展。此外,这篇综述讨论了各种治疗方法的疗效,例如靶向特定途径或抑制NF2缺乏引起的新形态蛋白-蛋白相互作用的分子疗法。本概述不仅扩展了对NF2病理生理学的基本理解,而且还探讨了影响NF2综合征临床方法的新型治疗靶标的潜力。
    NF2-related schwannomatosis (NF2) is a genetic syndrome characterized by the growth of benign tumors in the nervous system, particularly bilateral vestibular schwannomas, meningiomas, and ependymomas. This review consolidates the current knowledge on NF2 syndrome, emphasizing the molecular pathology associated with the mutations in the gene of the same name, the NF2 gene, and the subsequent dysfunction of its product, the Merlin protein. Merlin, a tumor suppressor, integrates multiple signaling pathways that regulate cell contact, proliferation, and motility, thereby influencing tumor growth. The loss of Merlin disrupts these pathways, leading to tumorigenesis. We discuss the roles of another two proteins potentially associated with NF2 deficiency as well as Merlin: Yes-associated protein 1 (YAP), which may promote tumor growth, and Raf kinase inhibitory protein (RKIP), which appears to suppress tumor development. Additionally, this review discusses the efficacy of various treatments, such as molecular therapies that target specific pathways or inhibit neomorphic protein-protein interaction caused by NF2 deficiency. This overview not only expands on the fundamental understanding of NF2 pathophysiology but also explores the potential of novel therapeutic targets that affect the clinical approach to NF2 syndrome.
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  • 文章类型: Case Reports
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    文章类型: Case Reports
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  • 文章类型: Journal Article
    背景:NF2相关神经鞘瘤病(NF2-SWN,以前称为神经纤维瘤病2型)是一种肿瘤易感性综合征,表现为多发性前庭神经鞘瘤,非前庭神经鞘瘤,脑膜瘤,和室管膜瘤.这种情况无情地进展,没有批准的疗法。根据Brigatinib(多种酪氨酸激酶抑制剂)在NF2驱动的非前庭神经鞘瘤和脑膜瘤中的临床前活性,对于患有多种类型的进展性NF2-SWN肿瘤的患者,需要使用布格替尼的数据.
    方法:在带有篮子设计的第2阶段平台试验中,12岁或以上的NF2-SWN患者和进展性肿瘤患者接受每日180mg口服布格替尼治疗.中央审查委员会评估了每位患者的一个目标肿瘤和最多五个非目标肿瘤。主要结果是靶肿瘤的影像学反应。关键次要结果是安全性,所有肿瘤的反应率,听力反应,和患者报告的结果。
    结果:共有40名患者(中位年龄,26年)进行性靶肿瘤(10例前庭神经鞘瘤,8个非前庭神经鞘瘤,20个脑膜瘤,和2个室管膜瘤)接受布格替尼治疗。在中位随访10.4个月后,有影像学反应的肿瘤百分比为10%(95%置信区间[CI],目标肿瘤为3至24),所有肿瘤为23%(95%CI,16至30);脑膜瘤和非前庭神经鞘瘤的益处最大。治疗期间,所有肿瘤类型的年化增长率均降低。35%(95%CI,20至53)的合格耳朵听力改善。探索性分析表明,治疗期间自我报告的疼痛严重程度降低(每月-0.013单位;95%CI,-0.002至-0.029),评分从0(无疼痛)到3(严重疼痛)。未报告4级或5级治疗相关不良事件。
    结论:Brigatinib治疗导致多种肿瘤类型的影像学反应,并在NF2-SWN患者的大量预处理队列中获得临床益处。(由儿童肿瘤基金会等资助;INTUITT-NF2ClinicalTrials.gov编号,NCT04374305。).
    BACKGROUND: NF2-related schwannomatosis (NF2-SWN, formerly called neurofibromatosis type 2) is a tumor predisposition syndrome that is manifested by multiple vestibular schwannomas, nonvestibular schwannomas, meningiomas, and ependymomas. The condition is relentlessly progressive with no approved therapies. On the basis of preclinical activity of brigatinib (an inhibitor of multiple tyrosine kinases) in NF2-driven nonvestibular schwannoma and meningioma, data were needed on the use of brigatinib in patients with multiple types of progressive NF2-SWN tumors.
    METHODS: In this phase 2 platform trial with a basket design, patients who were 12 years of age or older with NF2-SWN and progressive tumors were treated with oral brigatinib at a dose of 180 mg daily. A central review committee evaluated one target tumor and up to five nontarget tumors in each patient. The primary outcome was radiographic response in target tumors. Key secondary outcomes were safety, response rate in all tumors, hearing response, and patient-reported outcomes.
    RESULTS: A total of 40 patients (median age, 26 years) with progressive target tumors (10 vestibular schwannomas, 8 nonvestibular schwannomas, 20 meningiomas, and 2 ependymomas) received treatment with brigatinib. After a median follow-up of 10.4 months, the percentage of tumors with a radiographic response was 10% (95% confidence interval [CI], 3 to 24) for target tumors and 23% (95% CI, 16 to 30) for all tumors; meningiomas and nonvestibular schwannomas had the greatest benefit. Annualized growth rates decreased for all tumor types during treatment. Hearing improvement occurred in 35% (95% CI, 20 to 53) of eligible ears. Exploratory analyses suggested a decrease in self-reported pain severity during treatment (-0.013 units per month; 95% CI, -0.002 to -0.029) on a scale from 0 (no pain) to 3 (severe pain). No grade 4 or 5 treatment-related adverse events were reported.
    CONCLUSIONS: Brigatinib treatment resulted in radiographic responses in multiple tumor types and clinical benefit in a heavily pretreated cohort of patients with NF2-SWN. (Funded by the Children\'s Tumor Foundation and others; INTUITT-NF2 ClinicalTrials.gov number, NCT04374305.).
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  • 文章类型: English Abstract
    OBJECTIVE: To identify the characteristics of pain syndrome in patients with schwannomas depending on genetic predisposition.
    METHODS: The study included 46 patients with peripheral, spinal and intracranial schwannomas, corresponding to the schwannomatosis phenotype according to the 2022 clinical criteria. All patients underwent sequencing of the LZRT1, Nf2 and SMARCB1 and a copy number study in the NF2.
    RESULTS: The most severe widespread pain was observed in patients with pathogenic LZRT1 variants, while patients with mosaic variants may not even have local tumor-related pain. Patients with SMARCB1variants may have no pain or have localized pain that responds well to surgical treatment.
    CONCLUSIONS: Further studies of the molecular features of schwannomatosis and driver mutations in the pathogenesis of pain are necessary to improve the effectiveness of pain therapy in this group of patients. Schwannomatosis is a disease from the group of neurofibromatosis, manifested by the development of multiple schwannomas. Neuropathic pain is one of the main symptoms characteristic of peripheral schwannomas, however, the severity and prevalence of the pain syndrome does not always correlate with the location of the tumors. According to modern concepts, the key factors influencing the characteristics of the pain syndrome are the target gene and the type of pathogenic variant. The most severe widespread pain is observed in patients with pathogenic variants in the LZRT1 gene, while patients with mosaic variants may not even have local pain associated with tumors. Patients with variants in SMARCB1 may have no pain or localized pain that responds well to surgical treatment.
    UNASSIGNED: Выявить особенности болевого синдрома у пациентов со шванномами в зависимости от генетической предрасположенности.
    UNASSIGNED: В исследование включены 46 пациентов с периферическими, спинальными и интракраниальными шванномами, соответствующие фенотипу шванноматозов согласно клиническим критериям 2022 г. Всем пациентам проводилось секвенирование генов LZRT1, Nf2 и SMARCB1 и исследование количества копий в гене NF2.
    UNASSIGNED: Наиболее тяжелая распространенная боль отмечалась у пациентов с патогенными вариантами в гене LZRT1, при этом у пациентов с мозаичными вариантами могло не быть даже локальной боли, связанной с новообразованиями. У пациентов с вариантами в SMARCB1 могло не быть боли или выявлялась локальная боль, хорошо реагирующая на хирургическое лечение.
    UNASSIGNED: Дальнейшие исследования молекулярных особенностей шванноматозов и драйверных мутаций в патогенезе боли необходимы для повышения эффективности терапии боли в данной группе пациентов.
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  • 文章类型: Case Reports
    背景:SamiiD型颈静脉孔神经鞘瘤(JFSs)由于解剖学的复杂性,对神经外科医生来说是最具挑战性的。已经描述了各种神经外科方法来获得JF。
    方法:我们介绍了一名女性,其附带诊断为D型JFS。通过颈动脉三角形入路实现了完全的根治性切除,而没有任何骨结构去除。患者无症状出院,没有新出现的神经功能缺损。
    结论:对于某些选定的D型JFSs病例,颈动脉三角是一种安全且合适的方法。然而,这种方法的具体适应症应该进一步探索和调查。
    BACKGROUND: Samii Type-D jugular foramen schwannomas (JFSs) are the most challenging for neurosurgeons because of anatomical complexity. Various neurosurgical approaches have been described to gain access to JF.
    METHODS: We present a female with incidental diagnosis of the Type-D JFS. Complete radical resection was achieved via the carotid triangle approach without any bony structure removal. And the patient was discharged asymptomatic and without new-developed neurological deficits.
    CONCLUSIONS: The carotid triangle is a secure and appropriate approach for some cases of selected Type-D JFSs. However, the specific indications of this approach should be further explored and investigated.
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  • 文章类型: Journal Article
    多种疾病可影响鼻前庭。由于鼻前庭的解剖特征,诊断和治疗鼻前庭肿瘤可能具有挑战性。神经鞘瘤是来源于神经鞘的许旺细胞的肿瘤。不到4%的肿瘤侵入鼻腔和鼻窦。鼻前庭神经鞘瘤很少见,当发现一个质量时,它经常被忽略。其诊断主要依据临床症状,鼻内窥镜检查,和成像,治疗的主要方法是完全切除手术。病理检查提供最终诊断。我们介绍了一名鼻前庭神经鞘瘤患者,该患者接受了成功的内窥镜手术,没有美容畸形,并讨论临床表现,组织学特征,成像特征,鉴别诊断,治疗方案,然后回顾了这种罕见良性病变的相关文献。
    A variety of diseases can affect the nasal vestibule. It might be challenging to diagnose and treat a nasal vestibular tumor due to the anatomical characteristics of the nasal vestibule. Neurilemmoma is a tumor derived from Schwann cells of the nerve sheath. Less than 4% of these tumors invade the nasal cavity and sinuses. Nasal vestibule neurilemmoma is rare, it is often overlooked when a mass discovered. The diagnosis of it is mainly based on clinical symptoms, nasal endoscopy, and imaging, The mainstay of treatment is complete resection surgery. Pathological examination provides the final diagnosis. We present a patient with nasal vestibule neurilemmoma who underwent a successful endoscopic surgery without cosmetic deformity, and discuss the clinical manifestations, histological features, imaging features, differential diagnosis, treatment options, then reviewed relevant literature of this rare benign lesion.
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