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目的探讨病理学除能确诊颈部副神经节(副节)瘤外,是否还能提示或支持迷走神经来源。方法结合手术前后病史、体征,术中所见和术前CT或(及)MRI表现,应用光镜及免疫组织化学方法对4例颈部迷走神经副节瘤进行临床病理学分析。结果患者均为女性,年龄30~50岁。表现为上颈部肿块并伴有声音嘶哑、声带麻痹或进食时呛咳、按压肿块引起咳嗽等迷走神经受累症状和体征。影像学显示颈动脉分叉以上颈内动静脉之间占位。大体检查在肿瘤一端可见切断的神经残端及其分散混入肿瘤浅面的神经纤维束。镜下观察肿瘤均由特征性的器官样排列的细胞巢构成,间隔为窦样毛细血管。肿瘤周围的纤维包膜内及肿瘤实质内存在多个粗大神经纤维束,甚至肿瘤细胞在神经内生长。免疫组织化学显示主细胞嗜铬粒素A、神经元特异性烯醇化酶、突触素阳性,细胞角蛋白阴性,支持细胞及神经纤维S-100阳性、神经微丝阳性。结论病理学家除能确诊颈部副节瘤外,还能向临床提示或支持其迷走神经来源。
Objective To explore whether pathology can prompt or support the source of vagus nerve in addition to the diagnosis of cervical accessory ganglion (adjacent node) tumors. Methods Clinical pathology analysis of 4 cases of cervical vagal paraganglioma was performed using light microscopy and immunohistochemical methods combined with history and physical signs before and after surgery, intraoperative findings and preoperative CT or (and) MRI findings. The results were all women, aged 30 to 50 years old. It manifested as upper neck mass with hoarseness, paralysis of vocal cords, coughing when eating, and pressing lumps causing cough and other signs and symptoms of vagal nerve involvement. Imaging studies showed that there was a space between the carotid artery bifurcation and the internal carotid artery and vein. A gross examination revealed that at the end of the tumor, the severed nerve stumps and the bundles of nerve fibers dispersed and mixed into the shallow surface of the tumor. Microscopic observations of the tumors consisted of characteristic organ-like nests of cells, separated by sinusoidal capillaries. There are multiple bundles of coarse nerve fibers in the fibrous capsule surrounding the tumor and in the tumor parenchyma, and even the tumor cells grow in the nerve. Immunohistochemistry showed that the main cell chromogranin A, neuron specific enolase, synaptophysin positive, cytokeratin negative, support cells and nerve fiber S-100 positive, positive neurofilament. Conclusion In addition to confirming the diagnosis of cervical accessory tumors, pathologists can also provide clinical evidence for or support the source of vagus nerve.