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.     

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。     

头颈部腺样囊性癌38例临床分析

目的:探讨头颈部腺样囊性癌(ACC)的临床特点及治疗效果。方法:回顾性分析38例头颈部ACC患者的临床表现、治疗及随访结果。结果:38例患者中均行手术治疗,随访时间3～13年,失访6例,以生命表法统计,3年生存率为71.1%,5年生存率为63.2%。结论:头颈部ACC不易及时确诊,肿瘤生长缓慢,易复发和远处转移,手术应彻底。     

外耳道耵聍腺源性恶性肿瘤(附13例报告)

目的 探讨外耳道耵聍腺源性恶性肿瘤的临床特征和治疗效果。方法 对13例耵聍腺源性恶性肿瘤手术病例进行随访和回顾性分析。结果 随访5年以上11例，随访3年以上2例，其中失访4例，无瘤生存7例，复发死亡2例。结论 对耵聍腺源性的恶性肿瘤，应早期行局部扩大或根治手术。放疗可作为手术切除后的辅助治疗。对所有病例应进行长期随访。对腺样囊性癌病例，尤其应注意肺部随访。     

外耳道耵聍腺囊性腺样癌

外耳道盯聍腺囊性腺样癌是头颈部肿瘤中较为突起见的恶性肿瘤，本文就1976-1993年间收治的13例外耳道盯聍腺囊性腺样癌临床表现及治疗结果进行回顾，13例中男4例，女9例，年龄24-79岁，平均46.7岁，除1例拒绝治疗外，12例均接受了手术治疗，5例随访10年以上，6例随访2-4年，1例胡访1年，1例失访，随访10年的5例病人中3例死于癌转移，1例死于肺感染，1例存活；6例随访2-4年者均存活，无癌复发。结合文献息就外耳道盯聍腺囊性腺样癌的发病率、临床表现、病理特征、诊断、治疗及预后进行讨论。     

头颈部腺样囊性癌高级别转化临床特征分析

目的　分析头颈部腺样囊性癌高级别转化的临床特征及预后情况。方法　采用病例回顾性分析，收集北京同仁医院2017年1月~2018年12月就诊并且病理明确诊断为腺样囊性癌的患者101例。依据高级别转化组织学形态诊断标准，选出6例高级别转化病理类型，收集整理其临床特征并完善随访信息，比较复发及转移、无病生存期等预后情况。结果　6例腺样囊性癌高级别转化患者，随访时间为11~121个月，存活4例，死亡2例，平均无病生存期为29.8个月。6例中有5例均发生了局部复发及远处转移。结论　高级别转化类型腺样囊性癌预后较差，复发及远处转移速度较快。     

小涎腺肿瘤的外科治疗

目的:分析和探讨小涎腺肿瘤的临床特征和诊疗要点。方法:对我院1997～2004年收治的54例小涎腺肿瘤患者的临床特征和治疗效果作回顾性分析。结果:54例患者中失访16例,在随访到的38例患者中,因肿瘤复发死亡4例,其中2例鼻腔腺样囊性癌分别于术后2年和3年死于肿瘤复发,1例喉肌上皮癌术后3年死于肿瘤复发,1例鼻窦黏液表皮样癌术后1年5个月死于肿瘤复发;2例鼻窦腺样囊性癌术后复发,再次手术后无瘤生存;1例鼻腔腺样囊性癌术后11个月复发,行伽玛刀治疗及中药治疗带瘤生存;其余患者均无瘤生存。结论:小涎腺肿瘤分布广泛,病理类型繁多,本组病例以恶性肿瘤多见,占81.4%。不同部位的肿瘤和不同病理类型的肿瘤临床表现和治疗方案各不相同。对良性肿瘤多采用肿瘤摘除术。而对恶性肿瘤治疗,手术结合放疗是主要的治疗方案。成功的关键是完整地切除肿瘤和有足够的切缘。     

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，…     

颞骨次全切除术治疗外耳道腺样囊性癌的疗效分析

目的 探讨颞骨次全切除术在外耳道腺样囊性癌的临床应用效果。方法 回顾性分析2015—2019年收治的8例外耳道腺样囊性癌患者的临床资料，其中男2例，女6例；年龄33~76岁，平均年龄55.6岁。耳痛7例，外耳道肿块、耳溢液、听力下降各6例，面瘫1例；从最初出现症状到确诊平均为2.75年，5例曾被误诊，3例曾被误治手术；6例行颞骨次全切除+腮腺浅叶切除术，2例行颞骨次全切除+全腮腺切除术。结果 围手术期内1例患者出现局部切口感染，1例出现脑脊液漏。全部患者平均随访4.34年；6例患者无瘤存活；1例复发患者于我院二次手术后3年再次出现局部复发伴肺转移，接受放射治疗，目前带瘤生存；1例患者术后随访3.5年死于其他疾病。结论 外耳道腺样囊性癌早期症状不典型，容易误诊；确诊后应实施颞骨次全切除术以达到彻底切除肿瘤目的，术中应同时处理腮腺；术后放疗也是一种可选择的补充治疗手段。     

外耳道腺样囊性癌的远处转移及预后分析

目的 探讨外耳道腺样囊性癌远处转移的相关危险因素及其对预后的影响.方法 回顾性分析22例江苏省人民医院2007年6月至2019年3月行原发灶根治手术且病理确诊为外耳道腺样囊性癌患者的临床和随访信息,单因素及多因素回归分析远处转移的危险因素及其对预后的影响.结果 患者远处转移率为40.9％,其中肺转移发生率最高,达66....     

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。     

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.     

Cancer of the external auditory canal

OBJECTIVE: To evaluate the outcome of surgery for cancer of the external auditory canal and relate this to the Pittsburgh staging system used both on squamous cell carcinoma and non-squamous cell carcinoma. DESIGN: Retrospective case series of all patients who had surgery between 1979 and 2000. Median follow-up was 47 months (range, 2-148 months). Data on age, sex, symptoms, TNM status, histopathological diagnosis, surgery, adjunctive therapy, sequelae, recurrence, and status at follow-up were obtained. SETTING: An ear, nose, and throat department in an ambulatory and hospitalized care center. PATIENTS: Ten women and 10 men with previously untreated primary cancer. Median age at diagnosis was 67 years (range, 31-87 years). Survival data included 18 patients with at least 2 years of follow-up or recurrence. INTERVENTION: Local canal resection or partial temporal bone resection. MAIN OUTCOME MEASURE: Recurrence rate. RESULTS: Half of the patients had squamous cell carcinoma. Thirteen of the patients had stage I tumor (65%), 2 had stage II (10%), 2 had stage III (10%), and 3 had stage IV tumor (15%). Twelve patients were cured. All patients with stage I or II cancers were cured except 1 with adenoid cystic carcinoma. No patients with stage III or IV cancer were cured. All recurrences developed in patients with incompletely resected tumors. CONCLUSIONS: The outcome was related to the stage of disease, suggesting that the Pittsburgh staging system is useful also in patients with non-squamous cell carcinoma. Patients with early cancer benefited from a less aggressive surgical approach, while survival was poor in patients with advanced cancer with incompletely resected tumors despite adjuvant radiotherapy.     

Primary pleomorphic adenoma of the external ear canal. Report of a case and literature review

INTRODUCTION: Primary neoplasms of the external ear canal are rare, and 5% of these tumors are of glandular origin. Ceruminal glands are modified sweat glands of the skin of the external auditory meatus that may give rise to (a) benign tumors such as ceruminous adenoma, pleomorphic adenoma, and syringocystadenoma papilliferum, and (b) malignant tumors such as ceruminous adenocarcinoma, adenoid cystic carcinoma, and mucoepidermoid carcinoma. An alternative theory holds that pleomorphic adenomas may well arise from ectopic salivary tissue present in the external ear canal. These tumors are very rare and usually have a benign course. In this report, we describe an unusual case of pleomorphic adenoma of the external auditory canal associated with chronic infection of the middle ear. CASE REPORT: A 60-year-old woman presented with exacerbation of left otalgia over a 6-month period. She had been affected with chronic otitis media and aural polyps for the last 13 years, for which she had received medical treatment only. A canal-filling aural polyp was noted on clinical examination. Subsequent biopsy and histologic examination revealed pleomorphic adenoma of the external ear canal, possibly with malignant elements. Magnetic resonance imaging showed no intracranial extension or any association with the adjacent parotid gland. The patient underwent modified radical mastoidectomy and complete resection of the tumor and the entire skin of the external auditory canal. Final histology and immunohistochemistry confirmed the absence of malignancy, and no recurrence has been reported 1 year postoperatively. CONCLUSIONS: Pleomorphic adenoma is an extremely rare tumor arising from the ceruminal glands of the external ear canal. Nonspecific presentation and difficult histologic diagnosis characterize this benign neoplasm. Wide local excision is the mainstay of treatment.