原发于喉部的非鳞状细胞癌11例并文献复习

doi:10.6040/j.issn.1673-3770.0.2014.302

摘要/Abstract

摘要： 目的探讨除鳞状细胞癌外其他特殊病理类型的喉恶性肿瘤的临床表现及病理特点,提高其诊断和治疗水平。方法回顾性分析366例原发性喉恶性肿瘤中11例非鳞状细胞癌患者的临床资料,采用HE染色和免疫组化法,观察其组织病理学改变及免疫表型,并复习有关文献。结果 11例中腺癌2例,腺样囊性癌1例,恶性淋巴瘤2例,神经内分泌癌1例,肉瘤样癌5例。其中声门区病变5例,声门上区病变4例,声门下区病变2例。均经活检或手术病理证实,活检 1 次即明确诊断者仅 2 例,其余病例经多次重复活检甚至最后手术切除方才确诊。确诊前的诊断多为慢性炎症、炎性息肉、增生性改变、坏死性肉芽肿、鳞癌等,除1例恶性淋巴瘤未行手术外,其余病例均首选手术治疗,部分联合放射治疗和(或)化学治疗。死亡2例,失访3例,其他患者均存活至今。结论该病的临床表现缺乏特征性,检查所见肿物形态不一,与常见的良、恶性喉肿瘤不易鉴别,病理检查、免疫组化检查有助于确诊,临床上应根据组织病理学特点选用手术切除、放射治疗、化学治疗或综合性治疗。

关键词: 综合性治疗, 非鳞状细胞癌, 喉肿瘤

Abstract: Objective To explore the clinical and pathological features of laryngeal non-squamous cell carcinoma to improve diagnosis and treatment. Method The clinical data of 11 non-squamous cell carcinoma cases, selected from 366 cases of primary malignant tumor of larynx, were reviewed. Results All the patients came from the E.N.T department of the Affiliated Drum-Tower Hospital of Nanjing University Medical School from Jan. 2000 to Dec. 2009. The histopathology and immunophenotype were observed by HE staining and immunohistochemistry, including 2 adenocarcinoma, 1 adenoid cystic carcinoma, 2 malignant lymphoma, 1 neuroendocrine carcinoma, and 5 sarcomatoid carcinoma. Among them, the tumor located in glottic (5 cases), supraglottic (4 cases) and infraglottic regions (2 cases). All cases were confirmed by biopsy or pathologic studies after operation. Except for 2 single biopsy, other cases were diagnosed by repeated biopsy or operation. Most pathological results were chronic inflammation, inflammatory polyps, hyperplastic change, necrotic granuloma, squamous cell carcinoma and so on. All the patients underwent primary surgery except for one malignant lymphoma. Some received consecutive radiotherapy and/or chemotherapy. During the follow up, 2 cases died, 3 cases lost, and others survived. Conclusion The clinical manifestations of primary laryngeal non-squamous cell carcinoma are indefinite. It is not easy to identify it with the common laryngeal tumors. Pathological study and immunohistochemistry are helpful for diagnosis. The choice of management (surgery, radiotherapy, chemotherapy or combined) depends on pathological diagnosis.

Key words: Laryngeal tumor, Non-squamous cell carcinoma, Combined therapy

中图分类号:

R739.65

王玉红, 王倩, 陈萍, 钱晓云. 原发于喉部的非鳞状细胞癌11例并文献复习[J]. 山东大学耳鼻喉眼学报, 2015, 29(1): 83-88.

WANG Yu-hong, WANG Qian, CHEN Ping, QIAN Xiao-yun. Clinical analysis of primary laryngeal non-squamous cell carcinoma (11 cases report)[J]. JOURNAL OF SHANDONG UNIVERSITY (OTOLARYNGOLOGY AND OPHTHALMOLOGY), 2015, 29(1): 83-88.

参考文献

[1] 黄选兆,汪吉宝.实用耳鼻咽喉科学[M].北京:人民卫生出版社,2005:503-504.
[2] 杨美琴,程杰.国内喉癌肉瘤报道情况及临床特点分析[J].中国耳鼻咽喉头颈外科,2013,20(5):230. YANG Meiqin, CHENG Jie. Analysis of reference and clinical characteristics of domestic laryngeal carcinosarcoma[J]. Chin Otolaryngol Otolaryngol Head Neck Surg, 2013, 20(5):230.
[3] 王延林,刘良发,李亚卓,等.11例头颈部头瘤样癌临床分析[J].中国耳鼻咽喉颅底外科杂志,2013,19(1):9-14. WANG Yanlin, LIU Liangfa, LI Yazhuo, et al. Sarcomatoid carcinoma of head and neck : A report of 1 1 cases[J]. Chin J Otorhinolaryngol Skull Base Surg, 2013, 19(1):9-14.
[4] Cao X, Liu J, Zheng Y, et al. Simultaneous squamous cell carcinoma with primary malignant fibrous histiocytoma of the larynx: a case report[J]. Mol Med Rep, 2012, 5:971-973.
[5] 吉庆家,李静娴,冯勇,等.鼻及喉部神经内分泌癌临床分析[J].临床耳鼻咽喉头颈外科杂志,2013,27(9):452. GU Qingjia, LI Jingxian, FENG Yong, et al. Clinical analysis of nasal and laryngeal neuroendocrine carcinoma[J]. Clin J Otorhinolarynol Head Neck Surg, 2013, 27(9):452.
[6] 李采,周梁,沈雁,等.喉神经内分泌癌[J].临床耳鼻喉头颈外科杂志,2009,23(21):970-972. LI Cai, ZHOU Liang, SHEN Yan, et al. Clinical analysis of laryngeal neuroendocrine carcinoma[J]. Clin J Otorhinolarynol Head Neck Surg, 2009, 23(21):970-972.
[7] 杨晶磊,徐欣.涎腺腺样囊性癌免疫组化表达的临床意义[J].山东大学学报:医学版,2012,50(6):114-118. YANG Jinglei, XU Xin. The clinical significance of immunohistochemical expression in salivary adenoid cystic carcinoma[J]. J Shandong Univ: Health Sci, 2012, 50(6):114-118
[8] 姜振华,贺德智,李力,等.喉腺样囊性癌1例及文献复习[J].山东大学耳鼻喉眼学报,2003,17(6):380. JIANG Zhenhua, HE Dezhi, LI Li, et al. Laryngeal adenoid cystic carcinoma of 1 cases and review of literature[J]. J Otolaryngol Ophthalmol Shandong Univ, 2003, 17(6):380.
[9] 何发尧,王跃建,陈伟雄,等.喉气管腺样囊性癌10例临床分析[J].山东大学耳鼻喉眼学报,2013,3(27):16-18. HE Fayao, WANG Yuejian, CHEN Weixiong, et al. Clinical analysis of adenoid cystic carcinoma of larynx and trachea (10 case report)[J]. J Otolaryngol Ophthalmol Shandong Univ, 2013, 3(27):16-18.
[10] Bayram I, Ugras S, Kiris M, et al. Adenocarcinoma of the larynx: a case report with histochemical and immunohistochemical studies[J]. Kulak Bur run Bogaz Ihtis Derg, 2004, 13(1-2):41- 45.
[11] Smith E, Rottscholl R, Brosch S, et al. Malignant Lymphoma in the larynx[J]. Laryngorhinootologie, 2013, 92(6):381-388.
[12] 许德斌,陈文宽,郭朱明,等.喉原发性恶性淋巴瘤13 例[J].广东医学,2011,32(15):1944. XU Debin, CHEN Wenkuan, GUO Zhuming, et al. Pimary laryngeal lymphoma of 13cases[J]. Guangdong Med, 2011, 32(15):1944.
[13] 田俊,王丹丹,皇甫辉,等.喉癌CT/MRI融合图像的建立及初步应用[J]. 山东大学耳鼻喉眼学报,2014,4(28):52-55. TIAN Jun, WANG Dandan, HUANG Fuhui, et al. Preliminary application of MR and CT image fusion in laryngocarcinoma[J]. J Otolaryngol Ophthalmol Shandong Univ, 2014,4(28):52-55.
[14] 卿菁,赵素萍.喉部非鳞状细胞癌的临床特征分析(附11例报告)[J].中国耳鼻咽喉颅底外科杂志,2010,16(2):112. QING jing, ZHAO Suping. Clinical features of laryngeal nonsquamous cell carcinoma (A report of11cases)[J]. Chin J Otorhinolaryngol Skull Base Surg, 2010, 16(2):112.

相关文章 15

[1]	文锋,张驰,扈希昊,董冰婉,秦永,赵恩民. 喉部腺样囊性癌4例并文献复习[J]. 山东大学耳鼻喉眼学报, 2023, 37(4): 119-125.
[2]	毛泽凡陈曦,程雷. 喉神经内分泌癌的研究进展[J]. 山东大学耳鼻喉眼学报, 2022, 36(4): 114-119.
[3]	李晓明. 喉癌治疗中喉功能保留的历史、现状和未来[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 1-5.
[4]	刘鸣. 早期声门癌的内镜治疗[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 6-9.
[5]	黄若飞,陈立晓,陈歆维,於子卫,金斌,祝江才,董频. 喉异期喉重复癌[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 36-39.
[6]	孙笑晗,李娜. 喉保留策略在喉癌治疗中的应用—美国临床肿瘤学会临床实践指南更新(2017)介绍[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 40-42.
[7]	丁洁,孙彦. 142例喉癌术后患者整体睡眠质量状况调查分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 76-81.
[8]	张小平,杨登权,王少新,黄小明. 连续性院外管理对喉癌患者术后生活质量的影响[J]. 山东大学耳鼻喉眼学报, 2019, 33(4): 169-174.
[9]	陈慧君,宋圣花,周涵,董伟达,乔明哲,陈曦,徐进,林子萍,邢光前. 血小板与淋巴细胞比值对喉癌复发的预测价值[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 106-110.
[10]	冯剑,周涵,董伟达. 喉癌内镜诊断技术研究进展[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 129-133.
[11]	姚慧,万文锦. 同伴支持教育在全喉切除术后患者延续护理中的应用效果分析[J]. 山东大学耳鼻喉眼学报, 2019, 33(3): 138-142.
[12]	邹良玉,李连贺,岳文慧,韩志鹏,张子惠. MIF、GSK-3β在喉鳞状细胞癌中表达的临床意义及相关性研究[J]. 山东大学耳鼻喉眼学报, 2019, 33(2): 76-80.
[13]	陈立晓,蒋锐,於子卫. 窄带成像技术在咽喉肿瘤诊治中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(6): 104-108.
[14]	张明德,张祖平,于学民,魏燕红,袁英. RASSF2A基因甲基化在喉癌组织中的表达及意义[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 64-67.
[15]	付玉贵,王海兰,孙德重,杨佩珍,陈彦林,陈志鹏. 保留部分环状软骨环的喉全切除术[J]. 山东大学耳鼻喉眼学报, 2017, 31(4): 73-75.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed