恶性外周神经鞘瘤误诊为糖尿病足二例报告

发布时间：2018-05-13 01:30

  本文选题：神经鞘肿瘤 + 误诊　； 参考：《临床误诊误治》2016年12期

【摘要】：目的提高临床医生对恶性外周神经鞘瘤(MPNST)的认识,减少误诊误治。方法对我院收治并误诊为糖尿病足的MPNST 2例的临床资料进行回顾性分析,并复习相关文献。结果本文2例均因足部溃烂,发现血糖升高入院。最初在外院分别按足部皮肤软组织感染、甲沟炎治疗,效果差,后发现血糖高,予降糖治疗,但创面仍迁延不愈。入院后行下肢血管彩色多普勒超声(彩超)、肌电图及心电图等检查发现患者无明显糖尿病周围血管及神经病变,血糖控制良好,后行创面活体组织病理检查(活检)示S-100(+),确诊为MPNST。1例拒绝进一步检查及治疗,要求出院,后失访;1例经浅表淋巴结及腹部、盆腔超声、胸部及颅脑CT和全身骨扫描均未见异常,行截趾术切除病灶,后创面愈合出院。随访1年未诉不适。结论足部MPNST临床少见,提高对该病的认识,尽早行活检,争取早诊断、早治疗,对避免或减少误诊甚至误治尤为重要。
[Abstract]:Objective to improve the understanding of malignant peripheral neurilemmoma (MPNST) by clinicians and to reduce misdiagnosis and mistreatment. Methods the clinical data of 2 cases of MPNST, which were misdiagnosed as diabetic foot, were reviewed and reviewed, and the results were reviewed in this paper. The results showed that the blood glucose increased in 2 cases due to foot ulceration. The effect of skin soft tissue infection and trench inflammation was poor, and the blood glucose was high and the blood sugar was found, but the wound still remained. After admission, the blood vessel color Doppler ultrasound (color Doppler ultrasound), electromyography and electrocardiogram found that the patients had no obvious diabetic peripheral vascular and deity lesions, the blood sugar was well controlled, and then the wound living tissue pathological examination was performed. Examination (biopsy) showed S-100 (+), confirmed MPNST.1 cases refused further examination and treatment, required discharge, and then lost visit. 1 cases of superficial lymph node and abdomen, pelvic ultrasound, chest and craniocerebral CT and bone scan were not abnormal, and the focus of the chest was removed, and the wound healed after 1 years. Conclusion foot MPNST is rare and improved. Conclusion foot MPNST is rare and improve clinical Early diagnosis, early diagnosis and early treatment are especially important for avoiding or reducing misdiagnosis and mistreatment.

【作者单位】： 解放军空军总医院内分泌科;
【分类号】：R739.4

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