腹膜后良性神经鞘瘤的CT特征及鉴别诊断

摘要

Objective:To improve the preoperative diagnostic accuracy of rare retroperitoneal benign schwannoma,the CT features,clinical manifestations,pathology and differential diagnosis of patients.Methods:Retrospectively analysis for the clinical and imaging data of retroperitoneal schwannoma confirmed pathologically in 11 patients has been made to summarize the main points of diagnosis and treatment by combined with literatures.Results:In 11 cases,5 cases were found in physical examination owing to unconspicuous clinical symptoms of patients,6 cases with nonspecific clinical symptoms.9 cases lesions with large size of 5~15cm,and other 2 cases with size of 2~3cm.All of tumors were cystic-solid with clear boundary and complete capsule and multiple punctate calcification in CT scan images of 2 cases.CT contrast enhanced images of 6 cases showed slight or moderate gradual enhancement of strips and flocculent in substantial part and without enhancement in cystic part,the wall and capsule is mildly enhanced,some with strip and flocculent enhanced.All of lesions are confirmed pathologically as retroperitoneal benign schwannoma and no recurrence after complete resection surgery during follow-up.Conclusion:Retroperitoneal benign schwannoma was rare and lack of specific clinical characteristics.When CT scan and contrast enhanced images demonstrates mismatching of huge retroperitoneal cystic-solid mass with hidden clinical performance,benign schwannoma%目的:对少见腹膜后良性神经鞘瘤的CT特征、临床表现、病理及鉴别诊断进行分析以提高其术前诊断正确率.方法:回顾性分析经病理证实的11例腹膜后良性神经鞘瘤的临床及影像资料,结合文献总结其诊治要点.结果:11例病例中,5例因患者无明显临床症状而在体检时发现,其余6例的临床症状缺乏特异性.9例病变体积较大,最大径约5~15cm,其余2例最大径约2~3cm.CT平扫肿瘤均呈囊实性,边界清晰,包膜完整,其中2例可见多发斑点状钙化.增强扫描6例病变实性部分呈条絮状轻中度渐进性强化,囊性部分无强化,囊壁及包膜轻度强化.病理证实11例病变均为腹膜后良性神经鞘瘤,经手术完整切除后随访期内未见复发.结论:腹膜后良性神经鞘瘤极少见,临床特征缺乏特异性,CT平扫结合增强检查显示腹膜后巨大囊实性肿块与隐匿的临床表现不匹配时需考虑到良性神经鞘瘤的可能,在与腹膜后其他常见肿瘤仔细甄别后方可做出正确诊断.