此次手术后24个月后患者肿瘤再次复发增大，并且向深部发展侵袭了多根血管

Twenty-four months after the operation, the patient's tumor recurred and increased again, and deepened multiple blood vessels. We performed surgical resection again, and ligated the right superficial jugular vein and the right subclavian vein. <br>Fortunately, the patient has established a collateral circulation, and the function of the right arm has not been affected after the operation. <br>After the third surgery, the patient's tumor recurred again 6 months after surgery and underwent a fourth palliative resection (Figure 6). <br>Malignant peripheral nerve sheath tumors (MPNST) for short, account for 4%-10% of soft tissue sarcomas. <br>The incidence rate in the population is about 0.001%. <br>Malignant schwannomas originate from Schwann's sheath of peripheral nerves. They mostly occur in the head, neck, limbs, pelvis, etc., but rarely in the chest wall. Some people even reported malignant schwannomas that occurred in the heart, nose, and nasal septum. <br>Malignant peripheral nerve sheath tumor (MPNST) is an aggressive sarcoma. MPNST can be classified as: cases related to neurofibromatosis type 1 (NF1) (accounting for 50% of cases), sporadic (accounting for cases) 40% of cases) and radiation-induced cases (10% of cases. It <br>usually develops. <br>Malignant schwannomas not related to NF1 are called sporadic malignant schwannomas (sMPNST). <br>Malignant schwannomas tend to occur in Young, fast-growing, worse prognosis when associated with NF1, and easy to metastasize. <br>A comprehensive literature meta-analysis from 1963 to 2012 showed that patients with NF1 syndrome had significantly worse outcomes from MPNST compared with non-NF1 patients . <br>However, in recent years has increased the survival rate of patients with NF1, and the survival rate difference is narrowing. <br>compared with women, a higher proportion of men diagnosed with MPNST of (56% and 44%, respectively).<br>In a study of 95 MPNST patients, Hwang, I. K and others found that the median age of NF-MPNST patients was significantly lower (sMPNST was 32 years vs. 45 years, p=0.012). <br>In a study of MPNST of different races involving 1047 patients, Erin C. Peckham-Gregory et al. found that blacks had the highest incidence of MPNST compared with whites and other minority groups. <br>MPNST is associated with high mortality and there are few risk factors that can be changed, and the current staging system may not be able to fully predict survival. <br>As the primary tumor, the cause of malignant schwannoma is not clear. A case report by Nikhil K. Murthy et al. found that the first case of herpes zoster in the same nerve area as the peripheral nerve tumor was found Case. <br>This supports their hypothesis that the complex and little-known interaction between the VZV oncogene and the host immune system may be the cause of peripheral nerve tumors (benign and malignant). <br>The histological diagnosis of malignant schwannomas is difficult because it is similar to schwannomas and neurofibromas. <br>Malignant schwannomas are characterized by pale spindle cells usually arranged in fascicular cells with alternating cells and mucus-like stroma. <br>Typical immunohistochemical observations include S100 (calcium-binding motif as a Schwann cell marker), Ki-67 (nuclear non-histone protein marker for cell proliferation), TP53 (tumor suppressor marker for transformation) in situ antibody Research and CD34 (saliva albumin glycoprotein is a marker for non-specific endothelial cells and hematopoietic stem cells) and p16INK4a (a cell cycle inhibitory protein marker that is inactive in MPNST.

Twenty-four months after the operation, the patient's tumor relapsed and increased, and the development to the deep part struck many blood vessels, which we had again surgically removed and tied the shallow vein in the right neck and the under-the-bone vein in the right collarbone.<br>Fortunately, the patient has established a lateral branch circulation, and the right arm has not received functional effects after surgery.<br>After the third operation, the patient's tumor recured again six months after the operation and underwent a fourth palliative excision (Figure 6).<br>Malignant neuropathy ( MMST ) for short , accounts for 4% to 10% of soft tissue sarcoma .<br>The incidence rate in the population is about 0.001 per cent.<br>Malignant neuroblastoma originated in the peripheral nerve of Schwann's crucible, often in the head, neck, limbs, pelvis and so on, less in the chest wall, and even some people reported occurring in the heart, nose and nose in the nasal compartment of malignant neuroblastoma.<br>Malignant peripheral neuroblastoma (MPNST) is an invasive sarcoma, MPNST can be classified as: cases associated with neurofibromatosis type 1 (neurofibromatosis type 1, NF1), distributive (40% of cases) and radiation-induced cases (10% of cases).<br>Usually in development.<br>Malignant neuropathic tumors not related to NF1 are called emitted malignant neuropathy (sMPNST).<br>Malignant neuroblastoma is prone to occur in middle and young people, grows rapidly, and the prognosis associated with NF1 is worse and easily metastasized.<br>A comprehensive literature-gathering analysis from 1963 to 2012 showed that MPNST was significantly worse in patients with NF1 syndrome than in non-NF1 patients.<br>However, the survival rate of NF1 patients has improved in recent years, and the difference in survival rate is narrowing.<br>Men were diagnosed with MPNST at a higher rate (56 per cent and 44 per cent, respectively) than women.<br>In a study of 95 MPNST patients, Hwang, I. K et al. found significantly lower median age in NF-MPNST patients (sMPNST was 32 years vs. 45 years old, p-0.012).<br>In a study of 1,047 patients on different ethnic groups, Erin C. Peckham-Gregory and others found that blacks had the highest incidence of MPNST compared to whites and other minorities.<br>MPNST is associated with high mortality rates and has few variable risk factors, and the current staging system may not adequately predict survival rates.<br>The cause of malignant neuroblastoma as an primary tumor is not clear, and a case report by Nikhil K. Murthy et al. found the first case of shingles shingles shingles in the same neuroregion clinically shown in the same neuroregion as the peripheral neurotumor.<br>This supports their hypothesis that the complex and little-known interaction between the VZV cancer-causing gene and the host immune system may be the cause of peripheral neurotumors (benign and malignant).<br>Histological diagnosis of malignant neuropathy is difficult because it is similar to the tissue form of neuropathy and neurofibromatoma.<br>Malignant neuroblastomas are characterized by pale shuttle cells usually arranged in beam cells, with alternating cells and mucus-like substrates.<br>Typical immunohistized observations include S100 (calcium binding base sequence as a marker of serpentine cells), Ki-67 (nucleoprotein marker for cell proliferation), in situ antibody studies and CD34 (salivary albumin for non-specific endothelial cell and hematopoietic stem cell markers), and p16INK4a (cell cycle inhibitor markers in MPSTN.

24 months after the operation, the tumor recurred and enlarged again, and developed to the deep, invading multiple blood vessels. We resected the tumor again and ligated the right superficial jugular vein and the right subclavian vein.<br>Fortunately, the patient has established collateral circulation, and the right arm has not been affected.<br>After the third operation, the tumor recurred again 6 months after operation and a fourth palliative resection was performed (Fig. 6).<br>Malignant peripheral nerve sheath tumors (MPNST) account for 4% - 10% of soft tissue sarcomas.<br>The incidence rate is about 0.001% in the population.<br>Malignant schwannoma originated from Schwann's sheath of peripheral nerve, mostly in head, neck, limbs, pelvis and other places, rarely in chest wall. Some people even reported malignant schwannoma in heart, nose and nasal septum.<br>Malignant peripheral neurilemmoma (MPNST) is an aggressive sarcoma. MPNST can be classified into: cases associated with neurofibromatosis type 1 (NF1) (50%), sporadic (40%) and radiation-induced (10%).<br>It's usually developed.<br>Malignant schwannoma unrelated to NF1 is called sporadic malignant schwannoma (smpnst).<br>Malignant schwannoma is easy to occur in young and middle-aged people, and grows rapidly. When it is related to NF1, the prognosis is worse and it is easy to metastasize.<br>Meta analysis of the comprehensive literature from 1963 to 2012 showed that patients with NF1 syndrome had significantly poorer outcomes of MPNST than patients without NF1.<br>However, in recent years, the survival rate of NF1 patients has improved, and the difference in survival rate is narrowing.<br>Men were more likely to be diagnosed with MPNST than women (56% and 44%, respectively).<br>In a study of 95 patients with MPNST, Hwang, I. K. et al. Found that the median age of patients with nf-mpnst was significantly lower (32 years vs. 45 years, P = 0.012).<br>In a study of 1047 patients with MPNST of different races, Erin C. Peckham ‐ Gregory et al. Found that black people had the highest incidence of MPNST compared with whites and other minority groups.<br>MPNST is associated with high mortality, with few modifiable risk factors, and current staging systems may not adequately predict survival.<br>As a primary tumor, the cause of malignant schwannoma is not clear. In a case report by Nikhil K. Murthy et al., it was found that the first case showed herpes zoster and herpes zoster in the nerve region with the same clinical manifestations as peripheral nerve tumor.<br>This supports their hypothesis that the complex and unknown interaction between VZV oncogene and host immune system may be the cause of peripheral nerve tumors (benign and malignant).<br>The histological diagnosis of malignant schwannoma is difficult because it is similar to schwannoma and neurofibroma.<br>Malignant schwannoma is characterized by pale spindle cells, usually arranged in fascicular cells, with alternate cells and mucinous matrix.<br>Typical immunohistochemical observations include S100 (calcium binding motif as Schwann cell marker), Ki-67 (nuclear non histone protein marker for cell proliferation), TP53 (tumor suppressor marker for transformation), CD34 (salivary albumin glycoprotein is a nonspecific marker of endothelial cells and hematopoietic stem cells) and p16INK4a (cell cycle inhibition that is inactive in MPNST) Preparation of protein marker.