外耳道腺样囊性癌临床分析[论著]

目的　探讨外耳道腺样囊性癌的临床特点、诊断和治疗方法。方法　回顾性分析2008年1月至2020年12月在扬州大学附属苏北人民医院收治的6例外耳道腺样囊性癌患者临床资料,分析其临床症状、治疗及随访结果。2例行乳突扩大切除术,3例行颞骨次全切+腮腺浅叶切除+颞肌修复术,1例行颞骨次全切+腮腺浅叶切除、深叶部分去除术+颞肌修复术。结果　6例患者术后随访2~8年,随访5年以上者5例,术后复发1例。结论　外耳道腺样囊性癌不易及时确诊,肿瘤生长缓慢,容易复发和发生肺部转移。手术治疗结合术后辅以放疗可延长患者生存期、降低复发,是治疗外耳道腺样囊性癌的有效方法。     

外耳道腺样囊性癌8例临床分析

目的 探讨外耳道腺样囊性癌的临床病理特点，总结疗效。方法 回顾性分析1985-2001年收治的8例外耳道腺样囊性癌患者的临床资料。结果 8例患者中行局部肿瘤切除2例；行外耳道袖状切除加腮腺浅叶切除2例；行肿瘤切除加扩大乳突根治3例（1例手术5次，最后1次行颞骨次全切除术）；行耳廓全切除加颞骨次全切除术1例。后4例术后辅以放疗。随访5～15年，2例健在，2例6年后肺转移带瘤生存，2例8年后死于肺转移，2例失访。结论 外耳道腺样囊性癌早期确诊和彻底手术是延长患者生命的关键。肿瘤易发生肺转移，远期预后不佳，提倡综合治疗。     

外耳道腺样囊性癌24例临床分析

目的探讨外耳道腺样囊性癌的临床诊断和治疗策略。方法回顾性分析解放军总医院1996—2007年经治的24例外耳道腺样囊性癌患者的临床资料,并用Kaplan-Meier法计算生存率。结果全组24例患者中,行局限性外耳道肿物切除术3例,行部分骨性外耳道和软骨切除加乳突根治术11例,行颞骨次全切除术9例,颞骨全切除术1例。4例晚期患者腮腺因受侵而切除。23例患者术后加用辅助放疗。全组总的5年累计生存率为71-4％．10年累计生存率为38．1％;临床误诊的患者与未被误诊患者的10年生存率分别为21．9％和59-3％（P=0．012）。结论外耳道腺样囊性癌生长缓慢,但长期效果差,对肿瘤的扩大切除可能提高生存率、降低复发,手术加放疗是有效的综合治疗策略。     

外耳道腺样囊性癌6例

目的：探讨外耳道腺样囊性癌的临床及病理特点，以提高诊断和治疗水平。方法：回顾性分析6例外耳道腺样囊性癌患者的临床表现、治疗及随访结果，其中5例行颞骨次全切除术（含外耳道全切除），1例行外耳道后下壁广泛切除及鼓室成形术。结果：全部患者术后随访8～21个月无复发。结论：外耳道腺样囊性癌生长缓慢，可长期带瘤生存，但远期预后不佳，首次治疗应该采用扩大根治性手术以提高治愈率。     

外耳道囊性腺样癌12例临床分析

目的总结手术治疗外耳道囊性腺样癌的疗效。方法回顾分析1978至1995年收治的外耳道囊性腺癌12例的临床资料。结果4例术前病理诊断为耵聍腺瘤,行单纯肿瘤切除术,术后2～8年复发,分别行2～4次手术(乳突根治、下颌骨切除、颞骨次全切除术),术后病理诊断为囊性腺样癌,术后随访2～8年,1例死亡。6例术前诊断为囊性腺样癌,其中2例行乳突根治术,1例行乳突根治加腮腺切除术,3例行颞骨次全切术,随访2～10年,2例死亡。2例术前未行病理检查,行单纯肿瘤切除术,2～3年后复发再行乳突根治术,术后病理诊断为囊性腺样瘤,随访5年无复发。结论早期就诊和彻底手术是治疗外耳道囊性腺样癌延长患者生命的关键。     

耳部恶性肿瘤12例临床分析

目的 探讨耳部恶性肿瘤的治疗策略。方法 回顾性分析2014年3月—2020年12月收治的12例耳部恶性肿瘤患者的临床资料,其中鳞状细胞癌6例,腺样囊性癌6例;10例为初诊患者,根据改良匹兹堡分期标准,10例初诊患者中T1者1例,T3者3例,T4者6例,2例复发患者无法分期;4例手术切除,8例综合治疗(手术+放/化疗)。手术方式包括颞骨外侧切除术1例,颞骨次全切除术10例,颞下窝B型入路1例。利用生命表法计算生存率和Log-rank检验比较患者的生存差异。结果 随访8~53个月,3年生存率73%;单因素分析提示切缘阳性(P=0.033)与不良预后相关。结论 耳部恶性肿瘤发病率低且病程隐匿,手术切除结合术后放疗是有效的治疗方法。     

鼻腔鼻窦腺样囊性癌放疗后诱发未分化多形性肉瘤1例报道

目的 总结鼻腔鼻窦腺样囊性癌放疗后诱发未分化多形性肉瘤（UPS）的诊疗经验。方法 回顾性分析1例鼻腔鼻窦腺样囊性癌术后4年放疗诱发未分化多形性肉瘤患者的临床资料,并结合文献进行分析。结果 患者于2015年1月行鼻侧切开上颌骨大部分切除术,术中完整切除肿瘤,术后病检结果提示为左侧上颌窦腺样囊性癌,术后规律行放化疗,2018年12月患者考虑肿瘤复发,行鼻侧切开左侧上颌骨次全切除术及鼻腔鼻窦肿瘤切除术,完整切除肿瘤,术后病理结果提示为UPS。结论 UPS是一种罕见的异质性实体肿瘤,其发病率低,恶性程度高,预后差,手术完整切除肿瘤仍然是目前最有效的治疗方法,多学科综合治疗对其预后有积极作用。     

外耳道完整切除术治疗早期外耳道癌的临床研究

目的：提高早期外耳道癌诊断和手术治疗效果，介绍外耳道完整切除的手术方法。方法：回顾性分析12例早期外耳道癌的临床表现，所有患者均采用外耳道完整切除、颞骨侧切除和腮腺浅叶切除，随访1～3年。结果：男7例，女5例；年龄28～75岁，其中T1 4例，T2 8例。8例患者术前耳部疼痛或胀痛。6例患者术前有耳流水，其中3例患者有血性分泌物。查体外耳道可见大小不等的新生物，6例患者术前活检而被诊断，另6例以外耳道新生物为主诉，行外耳道肿块切除后病理确诊。术后病理诊断：腺样囊性癌6例，鳞状细胞癌5例，耵聍腺癌1例。腮腺组织和腮腺表面淋巴中未见有肿瘤累及，外切缘足够，向内未突破鼓膜。5例鳞状细胞癌，1例耵聍腺癌和3例腺样囊性癌患者术后接受放射治疗。所有患者在随访期间无瘤存活。有6例患者术后出现术侧不完全性面瘫，House—Brackmann评分为3～4级，均在术后1～3个月内完全恢复。12例患者术前平均听阈（500，1000，2000 Hz）为38dB，术后平均听阈（500，1000，2000 Hz）为65dB，均为传导性听力下降。1例患者术后出现腮腺涎漏，经加压包扎后痊愈。结论：及时的病理活检是诊断早期外耳道癌的关键。具有安全边缘的外耳道的完整切除是提高手术效果的有效途径。     

外耳道腺样囊性癌（附13例报告）

腺样囊性癌常发生于涎腺和呼吸道粘膜腺体，发生于外耳道者罕见。笔者总结了1985年至1996年间收治的22例外耳道腺源性肿瘤，其中腺样囊性癌13例，现就其临床和病理特性做一回顾性分析。临床资料13例外耳道腺样囊性癌，男6例，女7例，年龄31～60岁，平均45．6岁，病史1～20年，平均5．8年，其中7例为手术后复发来诊，1例曾先后4次手术。所有患者均有较长时间耳痛史，检查除1例肿瘤位于耳廓上部，耳甲艇及三角窝外，其余12例肿瘤均位于外耳道软骨部，肿物质硬，触痛明显。治疗行扩大乳突根治术或颞骨次全切除术。随诊1例术后2年全身性骨转移，…     

腮腺腺泡细胞癌临床诊治

目的研究腮腺腺泡细胞癌临床诊治方法。方法回顾性分析我院1g85～2007年收治的19例腮腺腺泡细胞癌诊治经过,4例行腮腺浅叶切除,3例行腮腺浅叶加部分深叶切除,5例行腮腺全切除术,6例行腮腺全切除术加颈清术,其中8例行术后放疗。1例外院活检术后仅行根治性放疗。术后随访1～20年。结果无1例死亡,有5N术后复发,复发率26．3％（5／19）。结论彻底的手术切除和术后放疗是腮腺腺泡细胞癌的主要治疗方法。     

外耳道腺样囊性癌临床分析

目的 探讨外耳道腺样囊性癌的治疗方法与影响预后的相关因素.方法 对解放军总医院耳鼻咽喉头颈外科医院1988--2004年收治的19例外耳道腺样囊性癌患者的临床资料进行分析.依据Pittsburgh外耳道癌分类法,T1期5例,T2期2例,T3期6例,T4期6例.T1和,12期病例行局部切除,T3和T4期病例行乳突根治术或颞骨切除术.术后予以足量放疗.复发病例伴远处转移单灶者行手术治疗,远处多灶转移者行放疗.结果 19例病例术后随访时间6个月～19年,随访时间中位数44个月,随访5年以上者8例.12例复发,7例远处转移,4例死亡.初次切缘肿瘤细胞阳性的4例患者足量放疗后全部复发.复发患者有9例进行了2次以上手术治疗,8例进行了3次以上手术治疗,4例进行了4次手术治疗.结论 外耳道腺样囊性癌起病隐匿,易复发,可长期带瘤生存.首次手术应扩大切除范围,确保切缘肿瘤细胞阴性.术后辅以足量放疗.复发病例可多次手术治疗,延长生存期.多次局部复发后易发生远处转移.远处转移是主要死亡原因.     

Diagnosis and treatment of carcinoma in external auditory canal

ObjectivesTo evaluate outcomes in treating carcinoma of external auditory canal (EAC) and to analysis factors which effect the prognosis of this disease.MethodsA retrospectively review of 16 patients treated for carcinoma of EAC at our department between April 2000 and April 2014 was conducted. All patients underwent surgical treatment and the diagnosis confirmed by pathological examination.ResultsThere were adenoid cystic carcinoma (ACC) in 8 patients, squamous cell carcinoma (SCC) in 5 patients, adenocarcinoma (AC) in 2 patients, and verrucous carcinoma (VC) in 1 patient. The tumors were classified as Stage I in 4 cases, Stage II in 2 cases, Stage III in 3 cases, and Stage IV in 7 cases. Five patients underwent extensive tumor resection (ETR), 2 patients underwent lateral temporal bone resection (LTBR), 5 patients underwent modified LTBR, 2 patients underwent subtotal temporal bone resection (STBR), and 2 patients underwent only open biopsy. Besides, adjunctive procedures, including neck dissection, parotidectomy and pinna resection were performed when indicated. Ten patients received postoperative radiotherapy. By the end of follow up, two patients had died of their disease, 2 lost to follow up, 2 survived with the disease, and the rest survived disease-free. The median follow-up period was 24 months.ConclusionComplete tumor resection appears to be an effective treatment for carcinoma of the EAC. Patients with SCC seem to have worse prognosis than those with ACC. Radiation therapy seems less effective for the disease than surgical treatment.     

A retrospective analysis of surgical operations on malignancies of the ear]

In the past 20 years from 1970 to 1990, 21 patients with malignancies of the ear were treated at Cancer Institute Hospital. The primary sites were the auricle and cartilaginous external auditory canal (group 1: n = 8), the bony external auditory canal (group 2: n = 6) and the middle ear (group 3:n = 7). In group 1, pathological types were squamous cell carcinoma in four patients and basal cell carcinoma in the other four patients. Seven patients were treated by surgery alone, and the remaining patient was treated by interstitial implant radiotherapy. No recurrence have been noted up to today in this group. In group 2, pathological types were squamous cell carcinoma in four patients and adenoid cystic carcinoma in the other two patients. All of the six patients underwent external canal resection or subtotal temporal resection. Two patients received postoperative radiotherapy. A five year survival rate of group 2 was 60%. In group 3, pathological types were squamous cell carcinoma in six patients and undifferentiated carcinoma in the remaining patient. Most of them underwent radical mastoidectomy followed by irradiation. However, all the patients died within two years after treatment. In group 2 and 3, cytodiagnosis was useful for early discovery. In group 2, temporomandibular joint seemed to be a key point in surgical treatment. In group 3, the combination of conservative surgery with radiotherapy was not a radical treatment. This suggested it necessary to perform subtotal temporal resection to treat malignancy of the middle ear.     

Adenoid cystic carcinoma of the parotid gland with temporal bone invasion

OBJECTIVE: To present our series of 16 patients with adenoid cystic carcinoma (ACC) of the parotid gland with temporal bone invasion. PATIENTS: All patients treated at our institution between July 1988 and July 2004 with parotid gland ACC with temporal bone invasion. INTERVENTIONS: Preoperative radiographic assessment with combined surgical and radiation therapy treatment. MAIN OUTCOME MEASURES: Postoperative- or radiation-related complications and overall 2-, 5-, and 10-year survival. RESULTS: The most common surgically related complications were new-onset cranial nerve deficits, whereas osteoradionecrosis of the bony external auditory canal was the most frequently noted complication associated with radiation therapy. The overall survival rates at 2, 5, and 10 years were 94, 75, and 60%, respectively. CONCLUSION: Lateral cranial base access should be used in the extirpation of ACC of the parotid gland with temporal bone involvement.     

Adenoid cystic carcinoma of the external auditory canal

Adenoid cystic carcinoma of the external auditory canal is much less common than squamous cell carcinoma and basal cell carcinoma. Signs and symptoms of the case presented here consisted of a longstanding discharging ear, a progressive hearing loss, and the presence of a circumferential subcutaneous induration in the distal third of the external auditory canal. No dizziness, tinnitus, or facial weakness was present. Computed tomography showed a soft tissue mass in the external auditory canal and middle ear with no lytic areas of the mastoid or the temporal region. A biopsy specimen was interpreted as an adenoid cystic carcinoma. Treatment consisted of radical excision of the external auditory canal via a modified temporal bone resection. This radical approach resulted in the local eradication of the lesion.     

Bilateral primary carcinoma of the external auditory meatus]

We report an extremely rare case of bilateral primary carcinoma of the external auditory meatus. A 50-year-old man suffered 1 month from left-ear discharge and otalgia. Examination revealed a tumor of the left ear canal and a biopsy showed well-differentiated squamous cell carcinoma. The patient underwent 60 Gy radiotherapy and left subtotal temporal bone resection. A tumor with irregular swelling of the right external canal was found 8 months after the first diagnosis. Biopsy of the right external canal confirmed the same squamous cell carcinoma. Genetic examination that the carcinoma of the right ear was probably not a metastatic from the carcinoma of the left ear.     

Malignancies of the external ear canal and temporal bone: surgical techniques and results

A combined therapy approach to malignancies of the external auditory canal and middle ear has been developed. A technique of external canal resection and gross tumor removal from the middle ear, parotid gland, and superior cervical lymph nodes is followed by postoperative full-therapy irradiation. This combined approach has been used in 30 patients with malignancies involving the external auditory canal and temporal bone. The preoperative evaluation and surgical technique, including the intraoperative decision-making process, is described. Twenty-four patients had squamous cell carcinoma of the external auditory canal, and two patients had basal cell carcinoma. There was one patient each with adenocystic carcinoma, acinic cell carcinoma, high grade mucoepidermoid carcinoma, and a giant cell tumor of bone. This group of patients was broken down into three groups based on the extent of disease as determined at surgery. Overall control of disease, both locally and distant, for the 30 patients was 66%. There were 12 patients with disease limited to the ear canal. These patients had a 91% survival of this disease process. Seven patients were determined to have limited extension beyond the ear canal. These were treated with combined therapy with an overall control of disease of 72%. Eleven patients had extensive disease outside of middle ear into the carotid jugular spine, stylomastoid foramen, and skull base, with a survival rate of 45%. It is concluded that a step-wise removal of all gross tumor, as opposed to an en bloc dissection of the temporal bone and skull base, followed by full-therapy irradiation gives equally as good, or even better, long-term survival for this malignancy of the external auditory canal and middle ear.