应用鼻内镜或鼻内镜辅助下鼻腔鼻窦低度恶性肿瘤手术探讨

目的 探讨应用鼻内镜或鼻内镜辅助下切除鼻腔鼻窦低度恶性肿瘤的治疗效果.方法 回顾分析28例鼻腔鼻窦低度恶性肿瘤临床资料,其中内翻性乳头状瘤恶变 16例,低度恶性骨肉瘤 1例,腺样囊性癌5例,低度间叶组织肿瘤2例,血管外皮瘤 3例,鼻腔混合瘤恶变1例.均在鼻内镜下或鼻内镜辅助下切除肿瘤.术后19例加放射治疗.结果 术后随访4年以上的24例无局部复发;1例低度间叶组织肿瘤,3例内翻性乳头状瘤恶变,1～2年后出现鼻腔复发,再次行同类手术,术后1例内翻性乳头状瘤恶变出现广泛脑膜侵犯死亡.结论 只要掌握好适应证,内镜或内镜辅助下可以切除部分鼻腔鼻窦恶性肿瘤,且创伤小,避免了颜面部瘢痕,提高了患者的生存质量.     

鼻内镜下前颅底肿瘤切除术

目的探讨鼻内镜下前颅底区域肿瘤切除术的可行性及疗效。方法回顾性总结鼻内镜下鼻腔、筛窦及前颅底肿瘤切除术病例19例,其中筛窦鳞状细胞癌3例,嗅神经母细胞瘤3例,肾透明细胞转移癌1例,恶性黑色素瘤3例,浆细胞瘤1例,筛窦腺癌2例,腺样囊性癌4例,脑膜瘤2例。结果根据内镜下所见及术后影像学检查证实18例瘤全部切除,1例大部切除。3例恶性黑色素瘤患者中,1例术后1年死于脑转移,1例术后8个月后出现局部复发。1例腺样囊性癌患者术后17个月后复发,其余16例肿瘤患者随访12个月～3年未发现复发。结论对于局限于鼻腔、筛窦的恶性肿瘤,以及瘤体大部在鼻及鼻窦内的前颅底良性肿瘤,鼻内镜手术可以将其完整切除,对于恶性肿瘤应慎重选择病例,术后应辅以放疗。     

鼻腔鼻窦腺样囊性癌18例病例分析

目的：探讨鼻腔鼻窦腺样囊性癌的治疗方法及可能影响预后的因素。方法：回顾性分析18例患者的临床病理资料,其中4例放弃治疗,5例单纯行手术治疗,9例行手术治疗联合术后放化疗。结果：2年生存率为50．0％,其中3例因肿瘤侵犯颅内死亡,2例患者死于远处转移。结论：发生于鼻腔鼻窦的腺样囊性癌,应积极采取以手术为主的综合治疗,可提高患者的生存率。该肿瘤的预后主要取决于早发现、早治疗,越早诊治,疗效越好。     

鼻腔鼻窦腺样囊性癌40例临床分析

目的 总结鼻腔鼻窦腺样囊性癌的临床特点及治疗方法,对其预后及影响因素进行分析.方法 回顾性分析中国医学科学院肿瘤医院1994-2003年40例鼻腔鼻窦腺样囊性癌患者临床资料,采用Kaplan-Meier法和Log-rank检验分析其生存率、复发及远处转移特点.结果 鼻腔鼻窦腺样囊性癌原发于上颌窦者最多见,占80%.全部患者5年及10年生存率分别为76.9%和61.6%;5年和10年的无瘤生存率分别为44.2%和23.0%.5年复发率及远处转移率分别为45.0%和23.0%.肺转移是远处转移的主要方式,远处转移的出现和生存率下降密切相关(χ2=7.26,P=0.007).术前放疗患者远处转移发生率(18.2%)低于术后放疗者(38.9%),但差异无统计学意义(χ2=1.37,P=0.24).对复发患者采取以手术治疗为主的综合治疗,复发后5年生存率为60.0%.结论 远处转移可能是影响患者预后的重要因素;手术+放疗的综合治疗是治疗腺样囊性癌的主要治疗方式,放疗在鼻腔鼻窦腺样囊性癌的治疗中有重要作用;积极采取以手术为主的综合治疗方式,可有效延长复发患者的生存期,提高生存率.     

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,201...     

鼻腔鼻窦腺样囊性癌误诊1例

鼻腔和鼻窦恶性肿瘤罕见，在全部恶性肿瘤中仅占0．2％，在头颈部肿瘤占3％。其中鳞癌占80％，腺样囊性癌仅占5％。腺样囊性癌主要依靠组织学诊断，鼻腔和鼻窦腺样囊性癌因临床解剖复杂，无典型临床症状和特异性影象学特征，早期诊断较为困难，容易造成误诊、漏诊。我科近期收治1例鼻腔鼻窦腺样囊性癌，报告如下。     

鼻腔鼻窦腺样囊性癌88例临床分析

目的 总结鼻腔鼻窦腺样囊性癌的临床特征和治疗方法,探讨影响鼻腔鼻窦腺样囊性癌患者预后的因素.方法 总结中山大学肿瘤防治中心头颈外科1975年11月至2003年8月收治的88例原发于鼻腔鼻窦的腺样囊性癌患者的临床及病理资料,回顾性分析单纯手术、单纯放疗与放疗结合手术、化疗等治疗方式的疗效.对其治疗与预后进行统计分析.生存分析采用Kaplan-Meier法,组间比较采用Log-rank检验,多因素分析采用Cox比例风险模型.结果 就诊时56例鼻腔鼻窦腺样囊性癌患者为Ⅲ、Ⅳ期病变,治疗多采用手术+放疗.全组患者的5年、10年、15年生存率分别为0.640、0.341、0.190;Ⅲ期患者的5年、10年生存率分别为0.833、0.221;Ⅳ期患者的5年、10年生存率分别为0.323、0.145.手术+放疗组、单纯手术组及单纯放疗组的5年、10年生存率分别为0.761、0.415,0.750、0.367,0.286、0.143.结论 鼻腔鼻窦腺样囊性癌的治疗应以综合治疗为主,临床分期及治疗方式是影响鼻腔鼻窦腺样囊性癌患者预后的独立因素.     

鼻内镜或鼻内镜辅助下鼻腔鼻窦恶性肿瘤切除术的初步分析

目的：探讨鼻内镜或鼻内镜辅助下切除鼻腔鼻窦恶性肿瘤的可行性和疗效。方法：回顾性分析我院收治的40例鼻腔鼻窦恶性肿瘤患者的临床资料。病理类型为内翻性乳头状瘤恶变5例,上颌窦癌2例,筛窦癌3例,恶性黑色素瘤11例,嗅神经母细胞瘤7例,神经内分泌癌2例,肌上皮癌4例,鼻腔软骨肉瘤2例,腺样囊性癌3例,恶性血管外皮细胞瘤1例。所有患者均行鼻内镜或鼻内镜辅助下肿瘤切除术,其中32例术后采用放化疗。结果：所有患者随访1～5年,其中22例随访1～3年,随访3年以上者18例。4例患者术后6个月～2年症状复发,再次行鼻内镜手术后疗效满意;3例术后出现颈淋巴结转移,其中2例行颈淋巴结清扫术,1例因无手术指征而行放、化疗;4例出现远处转移;8例死亡;其余21例在随访期间未见复发及转移。结论：鼻内镜或鼻内镜辅助下手术切除鼻腔鼻窦恶性肿瘤切实可行,但必须严格选择适应证,辅以术后综合治疗,可取得满意的疗效。     

鼻内镜下鼻腔鼻窦低度恶性肿瘤切除术

目的 探讨鼻内镜下鼻腔鼻窦低度恶性肿瘤切除术的可行性及疗效.方法 回顾性总结鼻内镜下鼻腔鼻窦恶性肿瘤切除术病例12例,其中筛窦高分化鳞状细胞癌3例、嗅神经母细胞瘤3例、鼻中隔乳头状腺癌1例、鼻中隔黏液表皮样癌1例、腺样囊性癌4例.结果 根据内镜下所见及术后影像学检查证实12例肿瘤全部切除.所有病例随访1 5～52个月(...     

耵聍腺肿瘤临床分析 (附18例分析)

目的提高临床对耵聍腺肿瘤的认识。方法回顾分析18例耵聍腺肿瘤的临床资料,其中耵聍腺 腺瘤14例,多形性腺瘤1例,耵聍腺癌2例,腺样囊性癌1例。结果治疗首选手术切除。3例复发,其中2 例术后约10个月复发,再次手术随访3年未见复发,耵聍腺癌1例术后3年死于复发。结论耵聍腺肿瘤的 治疗应以手术为主,手术应有足够的安全界限。     

Malignant minor salivary gland tumors of the larynx

OBJECTIVE: To report our experience in treating patients with malignant minor salivary gland tumors of the larynx. DESIGN: Thirty-three-year retrospective study. SETTING: Tertiary referral center specializing in head and neck surgery. PATIENTS: Twelve patients with malignant minor salivary gland tumors of the larynx were identified from a search of the institutional databases and pathology records at Memorial Sloan-Kettering Cancer Center, New York, NY, between the years 1970 and 2003. All slides were independently reviewed by 2 pathologists (R.G. and D.C.). Details on patient and tumor characteristics, as well as treatment and surgical outcome, were recorded. RESULTS: Ten patients (83%) had adenoid cystic carcinoma and 2 (17%) had myoepithelial carcinoma. Five (42%) were located in the supraglottis and 7 (58%) in the subglottis. Ten (83%) had surgery (6 with adjuvant radiotherapy) and 2 (17%) were treated with radiotherapy alone. Of the 10 patients who had surgery, total laryngectomy was required in 6 (60%), supraglottic horizontal laryngectomy in 2 (20%), and cricotracheal resection in 2 (20%). With a median follow-up of 55 months (range, 1-194 months), 10 patients are alive, 6 of whom have no evidence of disease. Seven patients (58%) developed recurrent disease, 2 of whom had local recurrence alone, 1 had regional recurrence alone, 3 had distant recurrence alone, and 1 had local and distant recurrence. CONCLUSIONS: Up to 60% of patients with malignant minor salivary gland tumors of the larynx will develop recurrent disease locally, regionally, or at distant sites. In adenoid cystic carcinoma, regional recurrence is rare, but distant recurrence is common and may occur up to 10 years after the index therapy. For both adenoid cystic and myoepithelial carcinoma, partial surgery is possible in selected cases, but because of the high propensity for submucosal spread and perineural and lymphovascular invasion, total laryngectomy is usually recommended.     

Das adenoidcystische Carcinom — Erfahrungen mit 70 Fällen im Kopf-Hals-Bereich

Summary Owing to its high incidence of recurrence and its painfulness, the adenoid cystic carcinoma is one of the most adverse tumors in the head and neck region. The tumor is encountered predominantly in the region of the major salivary glands. The prognosis as to complete healing is poor even after radical surgical removal, and also when the paranasal sinus is involved. The course of the tumor disease seems to be more favorable when it originates from the minor salivary glands although this statement has to be made with considerable reservation due to the smaller number of cases. The histologic type of the adenoid cystic carcinoma possibly determines whether or not radiation, besides operation, will improve the prognosis or will at least lower the incidence of recurrence.     

Distant metastases from salivary glands cancer.

Patients who present with malignant salivary glands should at their initial assessment have an X-ray of the chest to exclude the possibility of distant metastases. Patients who have other symptoms, bone pain etc., should be appropriately investigated. The likelihood of patients developing distant metastases is associated with high-grade tumors, most commonly adenoid cystic carcinoma, high-grade mucoepidermoid carcinoma, salivary duct carcinoma and tumors sited in the submandibular gland, posterior tongue and pharyngeal tumors. Patients who have had a high-grade tumor treated and survived without locoregional recurrence have the same risk of developing distant metastases as those patients who have locoregional recurrence. Other histological types of salivary tumors are associated with a lower risk of developing distant metastases but a real risk remains lifelong. It is recommended that all patients who have a malignant salivary gland tumor treated, any histology, should be followed up and clinically assessed at least once every 12 months for life.     

喉小涎腺癌15例临床分析

目的 探讨喉小涎腺癌的临床特点、治疗及预后.方法 回顾性分析中国医学科学院肿瘤医院头颈外科1959至2005年收治的15例喉小涎腺癌患者的临床资料.11例(73.3%)病变位于声门上区,4例(26.7%)病变位于声门下区.其中腺样囊性癌10例,腺癌2例,黏液表皮样癌、恶性混合瘤、基底细胞腺癌各1例.单独手术7例;手术+放疗7例,其中6例患者行术后放疗,1例行术前放疗;1例行放疗+化疗.治疗后4例局部复发患者行手术挽救,其中l例肺转移后行转移灶切除;1例治疗后颈转移患者行放疗.结果 随访时间2～16年,中位数为8年.治疗后局部复发4例次,颈淋巴转移1例次,远处转移5例次,其中局部复发伴远处转移3例.7例患者存活3～16年,其中5例为无瘤生存,1例行单纯手术治疗,4例行手术+放疗;4例远处转移于治疗2～10年后死亡;其余4例随访2～16年后失访.结论 喉小涎腺癌很少见,其易发生局部复发和远处转移,远处转移是最主要的死亡原因.外科手术是喉小涎腺癌的主要治疗方法 ,手术结合放疗可望提高肿瘤局部控制率.     

Minor salivary gland tumors of the lip and buccal mucosa

Between 1944 and 1985, 50 patients with minor salivary gland tumors of the lip and buccal mucosa were treated at M.D. Anderson Cancer Center: 19 with lip and 31 with buccal mucosa tumors. The male-to-female ratios were 2.8:1 for lip and 1:2.9 for the buccal mucosa tumors. Patient age at presentation ranged from 18 to 98 years with a median of 55 years. Treatment consisted of surgery alone for 28 patients, radiotherapy in 9 patients, and combined therapy for 13. Adenoid cystic carcinoma was the predominant histologic type, accounting for 21 (42%) tumors. Risk for recurrence was influenced by histology, the presence of perineural invasion, and the location of the primary tumor. Six patients developed recurrent disease; all six had adenoid cystic carcinoma. The therapeutic approach and the rationale for combined treatment of these neoplasms are discussed.     

Clinicopathologic analysis of 2736 salivary gland cases over a 11-year period in Southwest China

Objective: To investigate the epidemiological and clinicopathological characteristics of salivary gland tumors in southwest China in order to provide data for clinical diagnosis and other similar research.

Methods: Between March 2007 and December 2017, 2736 patients with salivary gland tumors were recruited, the clinical and pathological data were retrospectively analyzed.

Results: A total of 2736 patients had a ratio of males to females of about 1.02:1. The ratio of benign to malignant tumors was 3.46:1. Pleomorphic adenoma and adenoid cystic carcinoma had 50.8% and 7.2%, respectively. About 65.4% tumors occurred in the parotid gland. There was no significant difference between the tumor in the left or right parotid and the use of cell phones. There were significant differences between gender and both the characteristics and locations of salivary gland tumors (p?p?Conclusions: The salivary gland benign and malignant tumors were more common in pleomorphic adenoma and adenoid cystic carcinoma, most occurred in the parotid gland. The minor gland tumors are lower than other parts of China. The incidence of parotid gland tumors is not related to the use of cell phones.     

Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity: a 40-year review of 35 cases

We retrospectively reviewed 35 cases of adenoid cystic carcinoma that had originated in the minor salivary glands of the paranasal sinuses or nasal cavity. All patients had been seen at two tertiary-care referral centers in western New York State between 1960 and 2000. Twenty patients had been treated with surgery and adjuvant radiotherapy, 10 patients with surgery alone, three with radiotherapy alone, and two with concurrent radiotherapy and chemotherapy. During the study, 22 patients developed recurrent disease--11 locally; three distantly; seven locally and distantly; and one locally, regionally, and distantly. At the conclusion of the study, 14 patients were alive and disease-free, and eight were alive with disease; 10 patients had died with disease, and three had died of other causes with no evidence of disease. Adenoid cystic carcinoma of the paranasal sinuses or nasal cavity is an aggressive neoplasm that results in a high incidence of both local recurrence and distant metastasis, regardless of treatment modality. Most cases are ultimately fatal, although long disease-free intervals have been observed. A combination of surgery and radiotherapy offers these patients the best chance for disease control.     

Minor salivary gland tumors of the palate: Clinical and pathologic correlates of outcome

Minor salivary gland tumors of the palate are rare and may pose a diagnostic and therapeutic dilemma for the head and neck surgeon. The authors reviewed their 46 years of experience with minor salivary gland tumors of the palate to determine the factors that influence outcome and their implications for treatment. Malignant tumors were seen in 116 patients (78%) and benign tumors were found in 33 patients (22%). Adenoid cystic carcinoma was the most common malignant tumor, occurring in 43 patients, and pleomorphic adenoma was the most common benign tumor, occurring in 30 patients. Univariate analysis on the malignant lesions showed that grade 3 tumor histology (P<.001), tumor size greater than 3 cm (P<.001), perineural invasion (P=.031), bone invasion (P=.012), positive surgical margins (P<.001), and positive initial but negative final margins (P=.004) were all associated with decreased survival. With multivariate analysis, tumor size, margin status, and grade were shown to be independently associated with decreased survival (P<.05). The recurrence rate at the primary site was significantly higher for adenoid cystic carcinoma than for other histologies (P=.0059). The 2-, 5-, and 10-year disease-specific survival rates for patients with malignant disease were 96%, 87%, and 80%, respectively. Wide surgical excision with adequate margins is essential for a favorable outcome in patients with malignant minor salivary gland tumors. Postoperative radiotherapy is reserved for patients with grade 3 tumor histology, large primary lesions, perineural invasion, bone invasion, cervical lymph node metastasis, and positive margins, although a clear-cut survival advantage has not been proven. Recurrence, especially regional and distant metastasis, portends an extremely poor prognosis. Laryngoscope, 105:1155-1160, 1995     

Adenoid cystic carcinoma secondary to heterotopic salivary gland tissue of the cervical lymph nodes

BACKGROUND: The presence of heterotopic salivary gland tissue in intra-, periparotideal and cervical lymph nodes is not an uncommen finding. In some rare cases the salivary gland inclusions in lymph nodes may undergo neoplastic transformation. PATIENT AND METHODS: An isolated and indolent tumor was detected in level III in the right cervical area in a 60 year-old male patient. The histological assessment of the extirpated node seemed to indicate lymph node metastasis of an adenoid cystic carcinoma. The radiological and endoscopic findings did not reveal a primary tumor. RESULTS: Due to the fact of missing of a primary tumor, the diagnosis of an adenoid cystic carcinoma in heterotopic salivary gland tissue of the cervical lymph node was established after long-term observation. CONCLUSION: After exclusion of an occult carcinoma of the salivary glands, the possibility of malignant transformation of heterotopic intranodal salivary gland inclusions should be considered in patients suffering from salivary gland carcinoma in the area of the cervical lymph nodes.