上颌窦恶性蝾螈瘤1例并文献复习

目的 探讨恶性蝾螈瘤（malignant triton tumor,MTT）的临床表现、病理学特点及诊断和治疗方法,提高临床诊疗水平.方法 回顾性分析一例右侧上颌窦恶性蝾螈瘤患者的临床资料,结合文献对恶性蝾螈瘤的特点进行讨论.结果 1例患者右侧上颌窦占位,行扩大的上颌骨全切除术并眶内容物切除术,术后病理证实恶性蝾螈瘤.结论 恶性蝾螈瘤是含有横纹肌肉瘤成分的恶性神经鞘膜瘤,临床罕见,发生于上颌窦者更是少见.其恶性程度高,极具侵袭性,易复发和转移.肿瘤的根治性切除辅助局部放疗和全身化疗可延长术后生存时间。     

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。     

颌面肿瘤颞肌筋膜瓣修复腭部缺损一期重建

上颌骨或腭部肿瘤患者术中常不可避免地出现腭部缺损 ,术后发音和饮食困难。为提高其生存质量 ,总结安徽省立医院耳鼻咽喉与颌面外科从 1995年到 2 0 0 0年用颞肌筋膜瓣一期重建腭部 ,疗效满意 ,总结如下。一、资料与方法1 一般资料 :共 10例 ,其中 2例软腭肿瘤侵犯腭板 ,术中行整个软腭及上颌骨低位切除 ;其余患者中 ,4例行上颌骨次全切除术 ,3例行上颌骨全切术 ,1例上颌骨扩大术。男 6例 ,女 4例 ;年龄 3 7～ 68岁 ,平均 46岁。病变部位 :上颌窦恶性肿瘤 6例 ,其中鳞状上皮细胞癌 3例 ,上颌窦肉瘤 2例 ,腺样囊腺癌 1例 ;硬腭鳞状上皮细胞…     

鼻内镜下上颌骨内侧壁切除联合经鼻腔泪道置管治疗上颌窦内翻性乳头状瘤

目的 探讨鼻内镜下上颌骨内侧壁切除联合经鼻泪道置管,在上颌窦内翻性乳头状瘤手术中的应用价值。方法 回顾分析2006年1月至2010年10月采用鼻内镜下上颌骨内侧壁切除联合经鼻泪道置管治疗32例上颌窦内翻性乳头状瘤患者的临床资料。术中切除上颌骨内侧壁,彻底切除上颌窦肿瘤,经鼻泪道置入硅胶管,术后长期随访。结果 32例患者均为Krouse分期T₃期,全部彻底切除肿瘤,术后随访12~72个月,平均35个月,术腔上皮化良好,2例复发,复发率为6.3%,局部清除后随访未再复发,患者均无溢泪并发症。结论 鼻内镜下上颌骨内侧壁切除是治疗Krouse分期T₃期上颌窦内翻性乳头状瘤的良好术式,术中联合经鼻泪道置管可以预防泪道狭窄。     

鼻内镜手术治疗上颌骨囊肿的临床分析

目的 探讨鼻内镜下经鼻-上颌窦进路切除上颌骨囊肿的手术方法及临床效果。 方法 回顾性分析自2014年3月至2019年4月收治的上颌骨囊肿患者21例,均为囊壁突入上颌窦内者,根据影像学检查明确囊肿的大小、范围以及与上颌窦各壁的位置关系,内镜下经鼻腔行扩大上颌窦自然口或联合泪前隐窝进路并下鼻道开窗引流,尽可能切除突入上颌窦腔的囊肿囊壁,使囊肿壁与上颌窦壁融合成共腔,建立囊肿-上颌窦-鼻腔相通的引流通道。 结果 所有患者术后随访6~24个月,术腔黏膜均上皮化良好,鼻面部症状消失或明显缓解,囊腔与上颌窦引流通畅,无复发病例。 结论 经鼻-上颌窦进路切除或开放上颌骨囊肿联合下鼻道开窗引流,可以彻底切除病变或建立充分的引流通道。相对于传统手术进路刮除或开放囊肿,该进路损伤轻微、恢复快、复发率低,符合微创手术的理念,值得临床推广。     

以鼻出血为特征的上颌窦病变27例分析

目的:探讨以鼻出血为特征的上颌窦病变的诊断和治疗.方法:回顾分析1995年1月至1999年6月住院治疗27例患者的临床资料.结果:22例患者经手术切除窦内病变,病理证实为上颌窦息肉、出血坏死性息肉,血管瘤,乳头状瘤,曲霉菌性上颌窦炎等疾病.其中14例行上颌窦根治术,6例行上颌窦根治伴窦内筛窦开放或鼻内筛窦开放术,2例行功能性上颌窦手术.术后恢复良好,随访0.5～4年,除1例失访,无复发.结论:要提高对以鼻出血为特征的上颌窦病变的认识,鼻窦CT扫描有助于诊断,手术切除病灶效果良好.     

头颈部炎性肌纤维母细胞瘤

目的 炎性肌纤维母细胞瘤（inflammatory myofibroblastic tumor,IMT）是一种可发生于头颈部的罕见肿瘤,本文就其临床表现、病理组织学特征、治疗及预后进行探讨.方法 回顾性分析4例头颈部IMT患者的临床资料,并进行光镜检查及免疫组化染色.结果 IMT肿瘤组织学由具有平滑肌细胞和纤维母细胞特征的梭形肿瘤细胞、大量慢性炎性细胞及黏液血管样背景构成.免疫组化：平滑肌特异性肌动蛋白（smooth muscle actiVe,SMACTIN）、波形蛋白（Vimentin）呈强阳性表达.术后随访9～21月,2例声带IMT无复发,1例上颌窦IMT无复发,另1例上颌窦鼻腔IMT术后4个月再次复发.结论 IMT是兼有纤维母细胞及平滑肌细胞特征的肿瘤,具有局部复发倾向.治疗以根治性手术切除为主,术后放疗、化疗效果不确定.鼻窦I MT极易复发,具有局部浸润行为,手术切除须彻底.     

CT拟似恶性征象的上颌窦良性肿块4例分析报告

目的 探讨ＣＴ对上颌窦肿的诊断价值。方法 报告ＣＴ显示上颌窦骨壁垒破坏而拟似恶性肿瘤的上颌窦肿块４例。结果 ３例行上颌窦根治术,术后病理分别是上颌窦息肉、囊肿及修复性巨细胞肉芽肿。１例行上颌骨部分切切除术,病理为上颌血管瘤。结论 上颌窦肿块的定性诊断必须依靠病理检查,而ＣＴ仅作参考。     

鼻腔及上颌窦软骨肉瘤

鼻腔及上颌窦软骨肉瘤邱建新，沙群，郑红梅鼻腔和上颌窦软骨肉瘤较罕见，我科共收治２例报告如下。１病例报告例１男，４７岁。因右下颌肿块渐增大４年，伴右眼失明、胀痛入院。３０年前曾诊断鼻腔软骨肉瘤在外院行手术治疗，２０年后复发，再先后３次行右上颌骨切除肿瘤...     

经鼻内镜开窗治疗上颌骨囊肿

目的探讨上颌骨囊肿的的治疗方法。方法根据囊肿的大小、累及上颌窦范围和离上颌窦自然开口距离,采用扩大上颌窦自然口中鼻道开窗3例、下鼻道开窗或鼻底开窗4例、泪前隐窝入路+下鼻道开窗9例,手术切除完全囊肿囊壁或部分切除,囊肿与上颌窦有间隔的将间隔完全去除,使囊肿与上颌窦融合为一个腔,保证囊肿腔与上颌窦、鼻腔引流通畅。结果术后随访6～24个月,平均随访12个月,15例面部胀感消失,未出现面部隆起,定期复查鼻内镜及鼻窦CT,囊肿术腔黏膜均于术后2～3个月上皮化,囊肿均无复发,术腔、鼻窦腔引流通畅。1例因开窗口小致开窗口闭合,但囊肿较前明显缩小,半年后再次开窗后囊肿未见复发。结论经鼻内镜开窗治疗上颌骨囊肿简便、安全、创伤小、恢复快、疗效确切、复发率低,术后便于观察术腔情况,尤其适合侵犯鼻腔底或上颌窦的上颌骨囊肿。     

头颈部低度恶性肌纤维母细胞肉瘤二例分析

目的 探讨头颈部低度恶性肌纤维母细胞肉瘤(LGMS)的临床表现、影像学表现、病理表现、治疗方法及预后。 方法 回顾性分析2例头颈部LGMS患者的临床资料并复习相关文献,总结其临床表现、影像学表现、病理表现及治疗方法、预后情况。 结果 头颈部LGMS的临床表现取决于肿瘤的部位,声门区的LGMS以声音嘶哑为首发症状,随着肿瘤增大可出现呼吸困难,颈部的LGMS表现为无痛性肿块。肿瘤表面光滑,似有被膜,界不清,基底广泛,表面可有坏死。CT表现为均匀或不均匀的中等密度肿瘤,肿瘤内可见钙化,偶可破坏骨质,增强后呈现轻度均匀强化或环形强化。MRI扫描T₁W2呈低信号或等限号,T₂W1呈均匀或不均匀高信号,肿瘤内有条索信号影,增强后肿瘤实质呈周边明显强化表现。光镜下见肿瘤细胞由梭形细胞和小多角形细胞组成,呈束状、疏松状、编织状排列,弥漫性浸润性生长,可侵犯黏膜鳞状上皮、肌肉,肿瘤细胞界限不清,纺锤形,核为细长型,核增大、深染、不规则。免疫组化见Vimentin、SMA、desmin、actin等阳性表达,S-100等阴性表达。治疗方法以广泛手术切除为主,术后随访12~23个月,均无复发及转移。 结论 头颈部LGMS临床及影像学表现无特异性,病理诊断必须结合免疫组织化学检查,广泛手术切除是最有效的治疗方法,肿瘤对放化疗不敏感,肿瘤的复发与是否切除彻底有关。     

Low-grade myofibroblastic sarcoma of the palate

Low-grade myofibroblastic sarcoma(LGMS) is a rare,malignant tumor with myofibroblastic differentiation.Despite it being classified as a distinct entity by the World Health Organization,a few cases were reported in the oral and maxillofacial region.Here,a LGMS developed on the palate of a 73-year-old man who presented with a 1-cm tumor on the posterior border of the palate.Based on the histological and immunohistochemical features,a diagnosis of LGMS was established.The tumor was resected,and no recurrence was observed over 2 years.Although the tongue is the most preferred site for LGMS,it may occur in any region of the oral cavity.     

Inverting papilloma of the nose: analysis of 48 patients

Forty-eight cases of inverting papilloma of the nose and paranasal sinuses treated by a number of surgeons at the University of Toronto from the years 1976 to 1985 are presented. Age at diagnosis, duration of symptoms, male predominance, associated symptoms and location of tumor were found to be similar to previous studies. A 4% incidence of an associated nasal carcinoma was found while 2% progressed to papillary squamous carcinoma. A minimum five-year follow-up was obtained in 18 cases, demonstrating an overall recurrence rate of 39%. Polypectomy resulted in a 75% recurrence, compared to a 27% recurrence rate following lateral rhinotomy and medial maxillectomy. The average disease-free period was 4.1 years. Lateral rhinotomy and medial maxillectomy is suggested as the minimum procedure to control inverting papillomas of the lateral nasal wall. Lesions confined to the septum can be best managed by wide local excision. An extended period of follow-up is recommended in all of these patients.     

Basal cell adenocarcinoma of the parotid gland: Comparison with basal cell adenoma for preoperative diagnosis

ObjectiveTo summarize the diagnosis and treatment outcomes of basal cell adenocarcinoma (BCAC) of the parotid gland, a rare low-grade malignancy, at a single institution, and to investigate the treatment approach for this rare malignancy.MethodsWe conducted a retrospective analysis of 9 patients with BCAC during 20 years from September 1999 to December 2019. Forty-five patients with basal cell adenoma (BCA), who were treated during the same time period, were used for comparison. The clinical characteristics of BCAC, diagnostic imaging, the usefulness of fine-needle aspiration cytology (FNAC) and frozen section biopsy (FSB), histological assessment of malignancy, and treatment outcomes were investigated.ResultsThere were no marked differences in sex, age, tumor diameter, or tumor location between BCAC and BCA cases. Among the 9 patients with BCAC, one patient was noted with pain/tenderness, and two patients were observed with adhesion to the surrounding tissues. Only one patient was diagnosed as malignant based on MRI/US. FNAC for BCAC was suspicious for malignancy in 6 of the 9 cases, which included one patient with the correct grade of malignancy, one patient with malignancy only, and 4 patients suspicious for malignancy. FSB was suspicious for malignancy in 8 of the 9 cases. Malignancy grade was determined based on infiltration to the surrounding tissues and expression of Ki-67, p53, and bcl-2. One patient with infiltration to the surrounding tissue was diagnosed as intermediate-grade malignancy, while the remaining 8 patients were diagnosed as low-grade malignancy. The BCAC cases included 7 patients with T2 and 2 patients with T1. Conservative resection was performed for all patients, and all cases are surviving cancer-free.ConclusionThe malignancy of BCAC can be suspected before surgery based on symptoms/signs, diagnostic imaging, and FNAC. FSB enables the diagnosis of not only malignancy but also the grade of malignancy, which may help determine the appropriate surgical resection. Although all 9 patients with BCAC are surviving free from cancer, a long-term follow-up is warranted.     

Does evaluation of tumor volume or/both origination site better guide to optimal surgery for inverted papilloma?

IntroductionSinonasal inverted papilloma is noted for its high rate of recurrence. Staging systems aid to reduce recurrence and avoid excessive surgeries by guiding the selection of the optimal surgical approach.ObjectiveTo evaluate the effectiveness of different endoscopic approaches in inverted papilloma by assessing tumor origin site and tumor volume.MethodsKrouse classification system that is based on tumor volume was used for staging; furthermore, tumor origin sites were grouped as lateral nasal wall, medial wall and other walls of maxillary sinus. The main treatment method for all patients was endoscopic sinus surgery. Endoscopic extended middle meatal antrostomy, endoscopic Caldwell-Luc and endoscopic medial maxillectomy were the additional surgery types performed in different combinations.ResultsFifty-five patients (42 male) with a mean 54.9 ± 14.4 years of age were included. 37 patients were diagnosed with advanced stage inverted papilloma (67.2 %). Recurrence was observed in 12 patients (21.8 %). In early stage lateral nasal wall origination, no recurrence was observed in the simple tumor resection group (0/10). In early stage medial wall origination, no recurrence was observed in the extended middle meatal antrostomy group (0/8). In advanced stage medial wall origination, the recurrence rates of extended middle meatal antrostomy, extended middle meatal antrostomy + endoscopic Caldwell- Luc and endoscopic medial maxillectomy were 100.0 %, 53.8 % and 13.6 %, respectively (p  = 0.002). In advanced stage other walls of maxillary sinus origination, recurrence rates of extended middle meatal antrostomy + endoscopic Caldwell-Luc and endoscopic medial maxillectomy were 20 % and 16.6 %, respectively (p  = 0.887).ConclusionTumor origin site, tumor stage and surgery types show an impact on recurrence. Despite the fact that tumor origin site singly could lead to appropriate selection of the surgery type in most cases, tumor stage carries substantial importance in selection of surgery type for sinonasal-inverted papilloma. An operation plan regarding both tumor volume and tumor origin site may aid surgeons in selecting optimal endoscopic surgical method to avoid recurrence or excessive surgeries.     

Low-grade adenocarcinoma of the nasal cavity--an unusual presentation: case report and review of the literature

Low-grade nasal cavity adenocarcinoma is an unusual neoplasm. When it does occur, it often appears in conjunction with a history of epistaxis and nasal obstruction that spans a period of a few weeks to several months. Most of these tumors arise in patients who are middle-aged or older. We report a case of low-grade nasal cavity adenocarcinoma that was unusual in that it occurred in an adolescent boy and that the presenting symptoms of chronic nasal obstruction and recurrent epistaxis had persisted for 7 years. The occurrence of this uncommon but recognized entity in such a young patient widens the age range of possible patients with this tumor, and a finding of such an extended duration of symptoms should raise clinical suspicion and encourage a thorough investigation in order to make the diagnosis.     

Fibrosarcoma of the maxillary sinus

Fibrosarcoma arising in the sinonasal cavities are very rare. By the time of clinical diagnosis, they are usually advanced. Lack of adequate surgical margins predisposes these patients to tumor recurrences. Most common sites are the extremities, with only one percent of fibrosarcoma arising in the head and neck area. The imaging features of these tumors reflect their aggressive behavior. We report the case of a maxillary sinus fibrosarcoma in a 16 year-old male patient. Neoadjuvant chemotherapy, medial maxillectomy, adjuvant chemotherapy and subsequent external irradiation was perfomed.     

颞下窝-翼腭窝-咽旁间隙肿瘤手术进路探讨

目的：探讨如何选择最佳手术进路切除颞下窝-翼腭窝-咽旁间隙肿瘤，以提高疗效，减少并发症和后遗症。方法：回顾性分析66例颞下窝、翼腭窝、咽旁间隙肿瘤患者，包括组织学诊断、影像学检查及手术人路。结果：50例良性肿瘤患者术后随访2～5年，均无复发；16例恶性肿瘤患者，术后随访2～5年，生存期不足1年4例，2～4年8例，5年及以上4例。结论：扩大上颌骨切除术适于上颌窦原发恶性肿瘤侵及翼腭窝、颞下窝和（或）咽旁间隙的患者；面正中揭翻术适于鼻腔、鼻窦、鼻咽及翼腭窝良性肿瘤及局限的恶性肿瘤患者；颈侧高位切开下颌骨外旋人路术适于咽旁间隙肿瘤累及翼腭窝和（或）颞下窝的患者；颈颌径路-下颌骨截骨术适于咽旁间隙-颞下窝良、恶件肿瘤侵犯侧颅底及翼腭窝的患者。     

咽旁间隙恶性肿瘤的诊断与治疗

目的 探讨咽旁间隙恶性肿瘤的临床特征、诊断和治疗方法。方法 回顾性分析5例咽旁间隙恶性肿瘤患者的临床资料,均行颈部B超及CT扫描,3例行增强MRI检查;均行颈侧入路切除肿瘤,其中2例同期行同侧功能性颈淋巴结清扫术,3例术后行放射治疗;术中快速病理、术后常规病理及免疫组织化学检查,明确诊断。结果 5例中恶性神经纤维瘤1例,恶性神经鞘膜瘤1例,腮裂癌1例,未分化癌1例,滑膜肉瘤1例;术前B超、CT、增强MRI检查可以明确肿瘤的位置、大小、形态、边界及与周边结构的关系,有助于手术入路及手术方式的选择;5例术后随访,3例随访1年内无复发,1例随访3年后死亡,1例半年后失访。结论 咽旁间隙恶性肿瘤组织类型复杂多样,预后差,颈部B超、CT扫描、增强MRI检查对肿瘤的诊断有帮助,选择合适入路肿瘤切除术是首选的治疗方法,综合治疗对患者的预后很关键。