鼻竇神經鞘瘤－－病例報告

Schwannoma of Sinonasal Tract-A Case Report

神經鞘瘤為源於許旺氏細胞的良性腫瘤，在任何年齡都可能發生，並且沒有種族、性別上的差異。頭頸部的神經鞘瘤並不多見，發生於鼻腔及鼻竇者更屬罕有。鼻竇的神經鞘瘤大多發生在篩竇或上頜竇，多具包膜，很少有惡性變化。本院於2002年底經歷一名59歲男性病人，因為長期鼻塞、鼻漏合併輕微鼻出血至本院門診就醫。經過鼻鏡檢查，發現左側鼻道有一蒼白息肉樣的腫塊，電腦斷層顯示有異常軟組織佔據左鼻腔並對左側上頜竇的內側壁造成壓迫。於是施以鼻竇內視鏡手術將其完全摘除，術中發現此腫瘤乃起源於前篩竇。其病理報告為良性神經鞘瘤。術後追蹤至今已4年，沒有任何併發症且無復發之現象。由於案例罕見，特此提出報告，並就過去之文獻，討論此病的成因、診斷及處置。

Schwannomas are benign tumors originating from Schwann cells without age, race and sex predilections. Schwannomas in the head and neck region are uncommon, especially from the sinonasal tract. Sinonasal tract schwannomas mostly originate from the ethmoid or maxillary sinus and are encapsulated with extremely rare incidence of malignant transformation. In 2002, we encountered a 59-year-old male in OPD with complaints of long-term nasal blockage, rhinorrhea and mild nasal bleeding. Rhinoscopic exam showed a pale, polypoid mass occupying the left nasal common meatus. Computer tomography (CT) revealed a homogenous soft tissue mass occupying the left nasal cavity compressing the medial wall of the maxillary sinus. The mass pediculated from anterior ethmoid sinus was completely excised by endoscopic sinus surgery and was proved benign schwannoma by pathology. No evidence of recurrence or postoperative complication was noted 4 years after surgery. Because of the rarity of the case, we review the literature and discuss the etiology, differential diagnosis and therapeutic options of sinonasal tract schwannoma.