咽鼓管圆枕淀粉样变性伴中耳积液1例并文献复习

doi:10.6040/j.issn.1673-3770.0.2023.330

摘要/Abstract

摘要： 目的探讨咽鼓管圆枕局部淀粉样变性的临床特征及诊疗。方法回顾分析1例咽鼓管圆枕淀粉样变性伴中耳积液的病例资料。总结病例特点、诊疗方法并复习相关文献。结果患者反复左侧中耳积液,保守治疗不佳。电子鼻咽镜检查发现双侧咽鼓管圆枕肥大,活检后提示淀粉样变性,排除系统性淀粉样变性,行经鼻内镜双侧咽鼓管圆枕病灶等离子射频消融术。术后随访1年,患者恢复良好,未见复发及进展为系统性淀粉样变性。结论淀粉样变性发生在咽鼓管圆枕比较罕见,对于其引起临床症状保守治疗不佳时可行手术治疗,排除其他系统累及可能尤为重要,且术后应密切随访。

关键词: 淀粉样变性, 咽鼓管圆枕, 中耳积液

Abstract: Objective The purpose of this study is to investigate the clinical characteristics and treatment of localized amyloidosis of torus tubalis. Methods We retrospectively analyzed the amyloidosis of torus tubalis with middle ear effusion, summarized the characteristics, performed diagnosis of the clinical case, and reviewed relevant literature. Results The patient had repeated hydrops in the left middle ear, and conservative treatment was poor for this case. Electronic nasopharynx examination showed bilateral torus tubalis hypertrophy, and amyloidosis was recommended after biopsy. The examination was completed to exclude systemic amyloidosis. Lesions of bilateral torus tubalis were removed through operation with low-temperature plasma radio-frequency ablation. After one year of follow-up, the patient recovered well, and no recurrence or progression to systemic amyloidosis was observed. Conclusion Amyloidosis is rare in the torus tubalis. Surgical treatment is feasible when the clinical symptoms are not treated conservatively. In particular, it is crucial to exclude systemic amyloidosis, and postoperative follow-up should be closely followed.

Key words: Amyloidosis, Torus tubalis, Middle ear effusion

中图分类号:

R766.3

林云仙,马玲国. 咽鼓管圆枕淀粉样变性伴中耳积液1例并文献复习[J]. 山东大学耳鼻喉眼学报, 2024, 38(4): 86-90.

LIN Yunxian, MA Lingguo. Amyloidosis of torus tubalis with middle ear effusion: a case report with literature review[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2024, 38(4): 86-90.

参考文献

[1] Vaxman I, Gertz M. When to suspect a diagnosis of amyloidosis[J]. Acta Haematol, 2020, 143(4): 304-311. doi:10.1159/000506617
[2] Gertz MA, Dispenzieri A. Systemic amyloidosis recognition, prognosis, and therapy: a systematic review[J]. JAMA, 2020, 324(1): 79-89. doi:10.1001/jama.2020.5493
[3] Kourelis TV, Kyle RA, Dingli D, et al. Presentation and outcomes of localized immunoglobulin light chain amyloidosis: the mayo clinic experience[J]. Mayo Clin Proc, 2017, 92(6): 908-917. doi:10.1016/j.mayocp.2017.02.016
[4] Al-Obaidy KI, Grignon DJ. Primary amyloidosis of the genitourinary tract[J]. Arch Pathol Lab Med, 2021, 145(6): 699-703. doi:10.5858/arpa.2020-0102-RA
[5] Celenk F, Durucu C, Baysal E, et al. Management of upper aerodigestive tract amyloidosis[J]. Ann Otol Rhinol Laryngol, 2013, 122(8): 535-540. doi:10.1177/000348941312200810
[6] Wahid NW, Abed T, Meghji S, et al. Localized sinonasal amyloidosis[J]. Allergy Rhinol, 2019, 10: 2152656719860821. doi:10.1177/2152656719860821
[7] George J, Khan H, Masood I, et al. Localized nasopharyngeal amyloidosis: a case report[J]. Radiol Case Rep, 2022, 17(12): 4506-4509. doi:10.1016/j.radcr.2022.08.070
[8] Takumi K, Staziaki PV, Hito R, et al. Amyloidosis in the head and neck: CT findings with clinicopathological correlation[J]. Eur J Radiol, 2020, 128: 109034. doi:10.1016/j.ejrad.2020.109034
[9] 刘雅琴, 张立庆, 张佳程, 等. 头颈部淀粉样变性23例临床分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(1): 72-77. doi:10.6040/j.issn.1673-3770.0.2019.464 LIU Yaqin, ZHANG Liqing, ZHANG Jiacheng, et al. Amyloidosis of the head and neck: a clinicopathological study of 23 cases[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2020, 34(1): 72-77. doi:10.6040/j.issn.1673-3770.0.2019.464
[10] 中国系统性轻链型淀粉样变性协作组, 国家肾脏疾病临床医学研究中心, 国家血液系统疾病临床医学研究中心, 等. 系统性轻链型淀粉样变性诊断和治疗指南(2021年修订)[J]. 中华医学杂志, 2021, 101(22): 1646-1656.
[11] Vrana JA, Gamez JD, Madden BJ, et al. Classification of amyloidosis by laser microdissection and mass spectrometry-based proteomic analysis in clinical biopsy specimens[J]. Blood, 2009, 114(24): 4957-4959. doi:10.1182/blood-2009-07-230722
[12] Nienhuis HLA, Bijzet J, Hazenberg BPC. The prevalence and management of systemic amyloidosis in western countries[J]. Kidney Dis, 2016, 2(1): 10-19. doi:10.1159/000444206
[13] Gertz MA. Immunoglobulin light chain amyloidosis: 2014 update on diagnosis, prognosis, and treatment[J]. Am J Hematol, 2014, 89(12): 1132-1140. doi:10.1002/ajh.23828
[14] Kumar SK, Callander NS, Adekola K, et al. Systemic light chain amyloidosis, version 2.2023, NCCN clinical practice guidelines in oncology[J]. J Natl Compr Canc Netw, 2023, 21(1): 67-81. doi:10.6004/jnccn.2023.0001
[15] Ehman EC, El-Sady MS, Kijewski MF, et al. Early detection of multiorgan light-chain amyloidosis by whole-body 18F-florbetapir PET/CT[J]. J Nucl Med, 2019, 60(9): 1234-1239. doi:10.2967/jnumed.118.221770[PubMed]
[16] Rubin J, Maurer MS. Cardiac amyloidosis: overlooked, underappreciated, and treatable[J]. Annu Rev Med, 2020, 71: 203-219. doi:10.1146/annurev-med-052918-020140
[17] Pearlman AN, Jeffe JS, Zynger DL, et al. Localized amyloidosis of the nasal and paranasal mucosa: a rare pathology[J]. Am J Otolaryngol, 2010, 31(2): 130-131. doi:10.1016/j.amjoto.2008.11.003
[18] Hall J, Rubinstein S, Lilly A, et al. Treatment of localized amyloid light chain amyloidosis with external beam radiation therapy[J]. Pract Radiat Oncol, 2022, 12(6): 504-510. doi:10.1016/j.prro.2022.03.011

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