기초 : 청신경초종의 면역조직화학 및 분자생물학적 분석 -기초연구-

이재원 ( Jae Won Lee ),김미현 ( Mi Hyun Kim ),안성기 ( Sung Ki Ahn ) 대한뇌종양학회 2005 대한뇌종양학회지 Vol.4 No.1

Objective￡ºIn generally, diagnosis of schwannoma is achieved by observation for tumor location, symptoms, radiological studies or surgical findings. However, it is reported that schwannoma can present a wide spectrum of histological patterns and show uncommon variants. The hypothesis of this study is that the tumor of a patient showing a second attack may show unexpected specific characteristics or phenotypic expression for genes associated with merlin or schwannomin. According to this hypothesis, the purpose of this study is to observe the progression state of vestibular schwannoma with molecular biological analysis. Methods￡ºHistological and molecular biological analysis using immunohistochemistry and reverse transcription-polymerase chain reaction(RT-PCR) method were carried out using collected tumor tissues from a patient with recurrent vestibular schwannoma. Results￡ºCollected tumor tissues showed a histologically typical schwannoma with spindle-shaped cells. Immunohistochemical study revealed that the tumor tissues were stained with S-100, vimentin, CD44, CD34 and desmin antibodies. However, glial fibrillary acidic protein(GFAP), HMB45 and cytokeratin antibodies were not reacted. In contrast, expression of GFAP was only examined in normal nerve tissue. Schwannoma related gene expression profiling was also examined. Neurofibromatosis type 2(NF2) and GFAP mRNA expressions in vestibular schwannoma were relatively lower than normal nerve tissues. Furthermore, the vestibular schwannoma expressed high level of FIR mRNA, which regulates neurite remodeling, compared to normal nerve tissues. Conclusion￡ºThese results provide evidence that benign vestibular schwannoma tissue may progress to malignant tumor and suggest that these diagnostic options for managing a vestibular schwannoma might be supported to make an appropriate diagnosis and best treatment.

수부의 신경초종: 감별진단과 미세수술의 중요성

탁관철,구현국,Tark, Kwan-Chul,Koo, Hyun-Kook 대한성형외과학회 2010 Archives of Plastic Surgery Vol.37 No.4

Purpose: The schwannoma is a benign peripheral nerve tumor arising from the Schwann cell of the nerve sheath. Only 2-8% of schwannomas arise in the hand and wrist. Misdiagnosis is frequent such as ganglion and neurofibroma. This article documents and clarifies the clinical features of schwannomas arising in the hand and wrist, and emphasizes importance of differential diagnosis and meticulous surgical extirpation under magnification. Methods: The author reviewed clinical features of 15 patients with pathologic final diagnosis of schwannoma developed in hand and wrist during the last 12 years from 1998 through 2009. The review included the sex, age of onset, duration, preoperative diagnosis, location, involved nerve, preoperative symptoms and. Postoperative sequelae after surgical extirpation of the lesion with magnification, or without magnification of the surgical fields. Results: The chief complaints were slow growing firm mass in all patients, and followed by pain in 40%, and paresthesia in 40% respectively. The lesions were developed solitarily in 14 patients (93%). The postoperative pathologic diagnosis and preoperative diagnosis were coincided with only in 6 patients (40%). Other preoperative diagnosis were soft tissue tumor in 4 patient (26.6%), and ganglion in 3 patients (20%), and neurofibroma in 2 patients (13%). In all patients who were undergone surgical excision under the fields of magnification, all symptoms were subsided without any sequelae. Meanwhile muscle weakness, paresthesia, hypoesthesia and /or accidental nerve resection developed after surgical excision with naked eye. Conclusion: Schwannoma in hand most commonly appears as a slow growing solitary mass with pain or paresthesia. The chance of preoperative misdiagnosis was 60% in this series. To provide good prognosis and less sequelae, careful and elaborate diagnostic efforts and meticulous surgical excision under the magnification are necessary in management of schwannoma.

An Intraosseous Schwannoma Combined with a Subchondral Fracture of the Femoral Head: a Case Report and Literature Review

Kim, Hyun Young,Ryu, Kyung Nam,Park, Yong Koo,Han, Jung Soo,Park, Ji Seon Korean Society of Magnetic Resonance in Medicine 2017 Investigative Magnetic Resonance Imaging Vol.21 No.3

Schwannomas are benign nerve sheath tumors that are typically located in soft tissue. Occasionally, schwannomas involve osseous structures. These intraosseous schwannomas are generally benign neoplasms that account for less than 0.2% of primary bone tumors. Schwannomas are very rarely observed in long bones. We present a case of a schwannoma affecting the proximal femur with a coincident subchondral fracture of the femoral head. A 38-year-old-male presented with left hip pain without deteriorating locomotor function. Plain film radiographs displayed a lobulating contoured lesion within the intertrochanteric portion of the femur. The magnetic resonance imaging (MRI) scans showed a tumor occupying the intertrochanteric region. Diffuse bone marrow edema, especially in the subchondral and head portions of the femur that was possibly due to the subchondral insufficiency fracture was also noted. The lesion was surgically excised and bone grafting was performed. Histologically, there was diffuse infiltrative growth of the elongated, wavy, and tapered cells with collagen fibers, which are findings that are characteristic of intraosseous schwannoma. Although very rare, intraosseous schwannoma should be included in the differential diagnosis of radiographically benign-appearing, non-aggressive lesions arising in the femur. The concomitant subchondral fracture of the femoral head confounded the correct diagnosis of intraosseous schwannoma in this case.

A Rare Duodenal Subepithelial Tumor: Duodenal Schwannoma

Dong Hwahn Kahng,김광하,Sang Gyu Park,So Jeong Lee,Do Youn Park 대한소화기내시경학회 2018 Clinical Endoscopy Vol.51 No.6

Schwannomas are uncommon neoplasms that arise from Schwann cells of the neural sheath. Gastrointestinal schwannomas are rareamong mesenchymal tumors of the gastrointestinal tract, and only a few cases have been reported to date. Duodenal schwannomas areusually discovered incidentally and achieving a preoperative diagnosis is difficult. Schwannomas can be distinguished from othersubepithelial tumors on endoscopic ultrasonography; however, any typical endosonographic features of duodenal schwannomas havenot been reported due to the rarity of these tumors. Immunohistochemistry is essential to distinguish schwannomas fromgastrointestinal stromal tumors and leiomyomas. We report a case of duodenal schwannoma found incidentally during a health checkupendoscopy. On endoscopic ultrasonography, this tumor was suspected as a gastrointestinal stromal tumor; therefore, the patientunderwent laparoscopic wedge resection of the tumor. Histopathology and immunohistochemistry confirmed that the duodenal lesionwas a benign schwannoma.

Schwannoma of the Ulnar Nerve in the Elbow

Doo-Sup Kim,Jung-Ho Rah,Hoe-Jeong Chung,John Junghun Shin,Kyung-Jin Hong 대한견주관절의학회 2014 대한견주관절학회지 Vol.17 No.4

Schwannomas are soft tissue sarcomas arising from neurilemma of Schwann cells in peripheral nerves, and is the most frequent type of benign tumor found in these nerves. We report a case of a Schwannoma of the ulnar nerve in the elbow joint, and along this report, give a review of the literature. A 46-year-old male patient was hospitalized with complaints of swelling and pain in the left elbow and a tingling sensation and hypoesthesia of the fourth and fifth fingers. Physical examination of the patient showed he was positive for Tinel’s sign, and magnetic resonance imaging results demonstrated the presence of a Schwannoma. Subsequent biopsy and excision of the Schwannoma was carried out. The suspected mass, which had a clear margin separating it from the healthy nerve of the medial left elbow, was removed along with its 2 × 2 × 3 cm capsule after a histological diagnosis of a Schwannoma was made. Pathophysiological results confirmed the excised mass as a Schwannoma. Schwannoma of the ulnar nerve within the elbow joint is rare and differential diagnosis is difficult. Therefore, treatment can only proceed after the presence of Schwannoma has been confirmed by physical and radiological examinations.

An Intraosseous Schwannoma Combined with a Subchondral Fracture of the Femoral Head: a Case Report and Literature Review

김현영,류경남,박용구,한정수,박지선 대한자기공명의과학회 2017 Investigative Magnetic Resonance Imaging Vol.21 No.3

Schwannomas are benign nerve sheath tumors that are typically located in soft tissue. Occasionally, schwannomas involve osseous structures. These intraosseous schwannomas are generally benign neoplasms that account for less than 0.2% of primary bone tumors. Schwannomas are very rarely observed in long bones. We present a case of a schwannoma affecting the proximal femur with a coincident subchondral fracture of the femoral head. A 38-year-old-male presented with left hip pain without deteriorating locomotor function. Plain film radiographs displayed a lobulating contoured lesion within the intertrochanteric portion of the femur. The magnetic resonance imaging (MRI) scans showed a tumor occupying the intertrochanteric region. Diffuse bone marrow edema, especially in the subchondral and head portions of the femur that was possibly due to the subchondral insufficiency fracture was also noted. The lesion was surgically excised and bone grafting was performed. Histologically, there was diffuse infiltrative growth of the elongated, wavy, and tapered cells with collagen fibers, which are findings that are characteristic of intraosseous schwannoma. Although very rare, intraosseous schwannoma should be included in the differential diagnosis of radiographically benign-appearing, nonaggressive lesions arising in the femur. The concomitant subchondral fracture of the femoral head confounded the correct diagnosis of intraosseous schwannoma in this case.

좌골신경에서 발생한 거대 신경초종의 치험례

박지훈,양호직,정태광,이혜경,김종환 대한성형외과학회 2009 Archives of Plastic Surgery Vol.36 No.6

Purpose: Schwannoma is one of common neoplasm in the central and peripheral nervous systems. However, schwannoma of sciatic nerve is rare, especially large schwannoma arising in sciatic nerve is extremely rare. This is a report of our experience with large schwannoma arising in sciatic nerve with minimal neurologic symptoms. Methods: A 65 - year - old man presented with palpable mass in middle portion of posterior thigh. No definitive neurologic deficits were detected on physical examinations. CT and sonography showed well - defined mass with large dimension. The mass was excised and confirmed histologically as a schwannoma. In postoperative period, NCS and EMG were followed. Results: The patient complained of difficulty in dorsiflexion of ipsilateral ankle joint postoperatively. NCS and EMG obtained immediately and showed sciatic neuropathy. After 2 months postoperatively, NCS and EMG were followed and abnormal findings of previous NCS and EMG were not found. Dorsiflexion of ankle joint was improved to normal range of motion. Conclusion: We report a rare case of large schwannoma arising in sciatic nerve with no definitive neurologic symptoms.

신경초종에 의한 표재요골신경의 압박

김현성,김철한,강상규,탁민성 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.4

Purpose: Schwannoma, a benign peripheral nerve tumor, is slow-growing, encapsulated neoplasm that originates from the Schwann cell of the nerve sheath. Schwannoma most frequently involves the major nerve. Schwannoma occurring in the superficial radial nerve rare. This is a report of our experience with schwannoma arising from the superficial radial nerve with neurologic symptom. Methods: A 55-year-old woman presented with eightmonth history of progressive numbness and paresthesia in dorsum of the thumb and index finger. Physical examination revealed a localized mass on the midforearm. Sonographic examination showed an ovoid, heterogenous, hypoechoic lesion, located eccentrically in related to the superficial radial nerve. The lesion was mobile in the transverse but not in the longitudinal axis of the nerve, which was thought to favour schwannoma rather than neurofibroma. At operation, a 20 × 15 mm ovoid, yellowish grey mass was seen arising from the superficial radial nerve. The tumor present as eccentric masses over which the nerve fibers are splayed. Using operating microscope, the tumor was removed, preserving the surrounding nerve. Results: Histology confirmed that the mass was a benign schwannoma. There were no postoperative complications. After two months the patient had no clinically demonstrable sensory deficit. Conclusion: An unsusual case of a schwannoma of the superficial radial nerve is presented. In case with neurologic symptom, prompt surgical decompression must be made to prevent further nerve damage and to restore nerve function early.

족부 신경초종의 치험례

송우진,김철한,강상규,탁민성,최인호 대한성형외과학회 2011 Archives of Plastic Surgery Vol.38 No.6

Purpose: Schwannoma is a slow-growing, encapsulated benign peripheral nerve tumor that originates from the Schwann cell of the nerve sheath. Schwannoma most frequently involves the major nerve. Schwannoma of the foot is rare. This is a report of our experience with a small,deep-seated, and non-palpable schwannoma occurring in the foot. Methods: A 42-year-old woman presented with the plantar pain of the right foot during 2 years. Physical examination did not identified a palpable mass. She made a clinical diagnosis of plantar fasciitis and was conservatively treated 2 years ago. Since her plantar foot pain was aggravated, she was recently visited again. For the evaluation of her plantar foot pain, sonographic examination of the whole right foot was performed, and it revealed a small hypoechoic hetergenous, deep-seated mass beneath the plantar aponeurosis. At operation, a 0.7 × 0.6 × 0.4 cm sized, ovoid, yellowish grey mass was removed. Results: Histology was confirmed that the mass was a benign schwannoma. There were no postoperative complications. Conclusion: Unsusual case of a schwannoma with the plantar foot pain during 2 years is presented. It should be recognized a small, deep-seated, non-palpable schwannoma as a possible cause of plantar foot pain.

슈반세포종 23예의 세침흡인 세포검사에 대한 세포소견

장선희,주미,김한성,Chang, Sun-Hee,Joo, Mee,Kim, Han-Seong 대한세포병리학회 2008 대한세포병리학회지 Vol.19 No.1

In an attempt to better define the cytologic characteristics of schwannomas, we have reviewed aspirates and corresponding histologic sections from 23 schwannomas. Of this number, the original cytologic diagnoses were: schwannoma in 14 cases (61%), benign soft tissue tumor in 2 cases (9%), and insufficient specimen in 7 cases (30%). The cytologic findings common to all cases of schwannoma included fragments of tightly cohesive fascicles with variable cellularity and corresponding Antoni type A area. The Antoni type B area, consisting of scattered spindle cells and some histiocytes and lymphocytes against a myxoid background, was seen in 14 cases. Fibrillary stroma was seen in 12 cases. The tumor cells had spindle- or ovalshaped nuclei, with pointed ends and indistinct cell borders. Nuclear palisading was seen in 10 cases, and distinctive Verocay bodies were seen in 5 cases. In ancient schwannomas, there were no Verocay bodies. Most schwannomas have distinct cytomorphologic features that allow correct diagnosis. The major problem with fine needle aspiration cytology of these tumors is the high frequency of poor cellularity, particularly in lesions with cystic degeneration. Of 7 cases with insufficient specimen, 4 showed marked cystic changes and 1 showed marked hyaline changes on histologic sections. In conclusion, we believe that if cytopathologist reminds the situation such as cystic degeneration or hyaline degeneration, the correct diagnosis of the schwannoma will be easily made.