【摘要】 目的 :探讨黑色素性神经鞘瘤组织发生、鉴别诊断及预后。方法 :3例患者年龄 ,分别为 4、17、2 8岁。黑色素性神经鞘瘤用组织学 (HE)、免疫组化 (ABC法 )和电镜技术进行检测。结果 :肿瘤直径为 2、4、8cm。组织学 :由黑色素性梭形细胞和黑色素性多边形细胞组成。梭形细胞呈束状、交织状、小区呈栅状排列 ,多边形细胞呈疏松片状或网状。退色素后可见核呈卵圆形 ,核仁明显 ,核分裂相可见 ,部分细胞有异型。 2例有小区浸润。免疫组化 :S 10 0蛋白、HMB4 5、Vim、Leu 7、NSE等阳性。电镜观察见肿瘤胞质内大量Ⅱ—Ⅳ期黑色素小体及细胞膜外少量基膜。结论 :①黑色素性神经鞘瘤好发于青年人 ,多数为良性或潜在恶性 ,少数为恶性 ,需要随访。②黑色素性神经鞘瘤来自神经嵴具有双向分化潜能的细胞更多还原

【Abstract】 Purpose:To study the histogenesis,the differential diagnosis and the prognosis of melanotic schwannoma.Methods:The age of the patients was 4,17,28 years old, respectively.Three cases of melanotic schwannoma were examined using histologic (HE), immunohistochemical (ABC method) and electron microscopic techniques. Results: The diameter of tumor was 2,4,8, respectively. Histological examination showed pigmented spindle cells arranged in interlacing fascicles and occasional nuclear palisading. The pigmented polygonal cells were loosely arranged in sheets. After bleaching, the nuclei were oval and some showed slight pleomoprohism with prominent nucleoli, and nuclear mitoses were found. There was local invasion in two cases. Immunohistochemical stains for S 100 protein, HMB45, Vim, Leu 7, NSE were positive. Ultrastructrual examinations showed a lot of melanosomes in all stages of development and seldom basal lamina. Conclusions:①Melanotic schwannoma usually occurs in young adults. Most of the tumors are benign or only potentially malignant. Malignant MS is rare,and require follow up. ②MS originate from neural crest with a proliferation of the bipotential cell.更多还原