头颈部横纹肌肉瘤8例报告

目的 :提高临床对头颈部横纹肌肉瘤 (RMS)的诊疗水平。方法 :报告经病理确诊的 8例头颈部 RMS的临床资料。 8例均经手术治疗 ,其中手术加放疗 5例 ,加化疗 1例。结果 :7例获随访 ,3例分别于术后 4个月、16个月、2年死亡 ,4例生存≥ 5年。结论 :对发生在耳鼻咽喉 -头颈部的无痛性或痛性肿块 ,应注意 RMS的可能。根据影像学检查、病理活检及免疫组化标志等确诊 ;采用手术加化疗或放疗 ,可以提高 RMS患者的生存率。     

头颈部横纹肌肉瘤（附8例报告）

目的 探讨头颈部横纹肌肉瘤的临床表现、病理类型、诊断、治疗及预后。方法 回顾性分析8例头颈部横纹肌肉瘤的病史资料并复习文献。结果 8例除加化疗加放疗5例，手术切除加化疗1例；乳突探查术1例；化疗加放疗1例。手术切除6例中，5年生存率为62．5％（5／8）。结论 采用手术与放疗和化疗的综合治疗方案能明显提高生存率。     

颈部横纹肌肉瘤1例

患儿,女,6岁。因发现颈前无痛性肿物10d,于2004年7月12日入院。体检:全身情况良好,颈部正中甲状软骨、环状软骨前可触及一大小约3cm×2cm×2cm肿物,表面光滑,质硬,界限清,与皮肤无粘连,随吞咽上下移动,舌骨下方未触及条索状物,甲状腺不大,颈部两侧未触及肿大淋巴结。彩色超声检查示:颈部实性肿物,被膜完整、规则,与甲状腺峡部关系密切,甲状腺左右叶大小、回声正常。颈部CT检查示:颈前实性肿物,周围脂肪间隙清晰,肿物与左侧甲状腺分界不清。入院诊断为颈部肿物,于入院第2天在全身麻醉下行颈部肿物切除术。术中见肿物位于带状肌深面,包膜完整…     

头颈部横纹肌肉瘤的治疗

目的 探讨头颈部横纹肌肉瘤的临床表现和病理类型、治疗与预后的关系.方法 回顾性分析天津医科大学附属肿瘤医院28例横纹肌肉瘤的临床及随访资料.结果 28例中10例行手术加化疗、放疗,6例手术加化疗,2例手术加放疗,2例化疗加放疗,4例单纯化疗,2例单纯放疗,2例姑息性手术切除.总生存率3年为57.14%,5年为28.57%,其中有2例生存超过10年,均为胚胎型,属于Ⅰ期病例,采用了广泛切除术加化疗.8例生存超过5年的病例中,胚胎型6例,腺泡型1例,多形型1例.结论 采用手术与放疗和化疗综合治疗方案能明显提高患者,特别是早期患者的生存率.     

儿童头颈部横纹肌肉瘤诊治进展[综述]

横纹肌肉瘤是儿童期最常见的软组织肉瘤,原发部位以头颈部最为常见,国内多学科联合诊治起步相对较晚,在诊治等多方面尚存不足。最近关于横纹肌肉瘤的基础和临床研究报道了有希望的治疗靶点和新的治疗方法,并对既往的各分类系统进行了改进。本文对儿童头颈部横纹肌肉瘤的分类及治疗方面的研究进展做一综述。     

小儿中耳横纹肌肉瘤1例

横纹肌肉瘤好发于四肢 ,发生在耳部鲜见。现报告 1例。患者 ,女 ,6岁。因右耳流血水、听力差 3个月 ,口角歪斜 1个月 ,曾按“慢性化脓性中耳炎”治疗无效 ,于 1 999年 1 1月 2 3日入院。检查 :右眼睑闭合不全 ,右侧鼻唇沟变浅 ,口角向左歪斜。右外耳道内充满淡红色肉芽样组织 ,质脆 ,易出血 ,可擦出血性分泌物 ,味臭。X线片示右乳突蜂房消失 ,密度增高。左上肺有一 2 cm× 1 cm阴影。由外耳道内取活组织检查 ,病理诊断 :葡萄簇肉瘤。临床诊断 :右侧中耳横纹肌肉瘤 (葡萄簇型 ) ,并发周围性面瘫、左肺转移瘤。 1 1月 2 5日转院行放射治疗。…     

头颈部横纹肌肉瘤（附3例报告）

横纹肌肉瘤（Rhabdomyosarcoma，RMS）是一种少见、恶性程度很高的肿瘤，源自向横纹肌分化的原始间叶细胞，由不同分化程度的横纹肌母细胞组成，可发生于任何部位，其中以头颈部较为常见。由于早期临床症状不明显，瘤体细胞形态多变，分化不良，故其误诊率较高，愈后较差。     

小儿咽部横纹肌肉瘤1例

小儿咽部横纹肌肉瘤鲜见报道。我科在 1 995年诊治 1例原发于咽喉部的横纹肌肉瘤 ,现报道如下。患儿 ,女 ,2个月。因渐进性呼吸困难、喘鸣 1个月余 ,于 1 995年 4月 1 3日入院。患儿出生后不久即出现呼吸困难、喘鸣 ,在外地医院多次就医 ,均无效 ,且呼吸困难逐渐加剧。检查 :患儿烦躁 ,唇轻度紫绀 , ～ 度呼吸困难。心肺未见明显异常。咽后壁偏右可见 2 .5cm× 3.5cm大小肿块 ,粘膜色泽正常。 CT显示右咽后有一约 4.0 cm× 2 .5cm肿块 ,界清 ,上达鼻咽 ,下至喉咽。入院第 3天在气管切开插管全麻下行肿块切除术。经口进路 ,于咽部作纵行粘…     

头颈部滑膜肉瘤3例报告

报告头颈部滑膜肉瘤３例的临床资料，复习文献，总结头颈部滑膜肉瘤的临床特点，并就其外科治疗价值等有关问题进行讨论，认为避免术前激惹肉瘤和扩大切除术，是减少其术后复发和转移的关键，放疗对本瘤不敏感。     

小儿中耳横纹肌肉瘤3例报告

例1 男,4岁.左耳疼痛,伴有血性耳漏,家长否认有中耳炎病史,于1995年11月以左外耳道息肉收入院.体检:神志清,面色稍苍白,全身表浅淋巴结未触及,左外耳道有粉红色、表面较光滑赘生物堵塞.     

Radiotherapy in N0 head and neck cancer patients

Summary The efficacy of elective radiotherapy in N0 cancer of the oropharynx, hypopharynx and supraglottic larynx was assessed retrospectively in a large series of head and neck cancer patients treated at the Institut Curie between 1958 and 1976. Despite a significant incidence of false-negative cases accompanied by extracapsular tumor spread, radiation tissue doses of 4500–5500 cGy were highly successful in preventing nodal disease in clinically negative necks. Isolated node failure occurred in only 2% of 611 cases of oropharyngeal and pharyngolaryngeal cancer from a total group of 1646 patients and 2% of 237 N0 cases of supraglottic vestibular cancer taken from a series of 340 patients. The impact of neck status on survival and disease-free survival is discussed. Present findings show that elective irradiation of the neck is easily integrated into the radiation management of primary pharyngeal and supraglottic laryngeal cancers and results in no additional morbidity to patients so treated.Presented at the International Symposium: Diagnosis and treatment of the N0 neck of carcinomas of the upper aero-digestive tract, 18 September 1992, Göttingen, Germany     

Extracranial head and neck schwannomas--a 10-year review

OBJECTIVES: To present our experience in managing a large case series of extracranial schwannomas highlighting presenting features, diagnostic difficulties, and outcomes associated with surgical treatment of these tumours. METHOD: A retrospective case note study of 31 patients with a diagnosis of extracranial schwannoma seen in the Department of Otolaryngology, Head and Neck Surgery at Southmead Hospital, a tertiary referral centre and University hospital between 1 June 1993 and 30 May 2003. RESULTS: The commonest anatomical location was in the neck (42%) and an isolated neck lump was the commonest presentation (77%). Pressure symptoms were the next most common mode of presentation, and were often a helpful indicator of the nerve of origin. The nerve of origin was identified in 47% of patients who underwent surgery. Immunohistochemistry was a useful tool in the diagnosis of these tumours and magnetic resonance imaging was the preferred imaging technique to delineate their extent. The most significant postoperative morbidity was associated with the schwannomas of the vagus nerve, sympathetic chain, hypoglossal nerve, glossopharyngeal nerve and the facial nerve. CONCLUSION: Schwannomas can present in a wide variety of sites within the head and neck region and therefore it is important that otolaryngologists and head-neck surgeons are familiar with the more common sites of presentation and the potential difficulties associated with the diagnosis and management of these tumours. Adequate imaging should be carried out preoperatively to gain as much information as possible about the individual tumour and allow informed patient counseling regarding to potential risks and morbidity of surgical intervention.     

Inflammatory pseudotumor in head and neck

Background

Inflammatory pseudotumor (IPT) is a tumefactive lesion characterized by fibroblastic proliferations and a prominent inflammatory component. It behaves as a locally benign or aggressive lesion, clinically and radiologically mimicking a neoplastic process. Numerous entities can be diagnosed as IPT, from reactive lesions to true neoplasms. The diagnosis of IPT requires further elaboration, and IPT should be distinguished from other similar entities such as inflammatory myofibroblastic tumor and IgG4-related sclerosing disease.

Case summary

We report two cases of IPT arising from the head and neck region. One occurred at the orbit and the other at the parapharyngeal space. Histologically, they showed aggregates of myofibroblasts and inflammatory cells. Immunohistochemically, the number of IgG4-positive cells was less than 40% of the number of IgG positive cells, and the myofibroblastic cells were negative for anaplastic lymphoma kinase. The diagnosis was IPT/not otherwise specified. One patient was treated by systemic administration of corticosteroid and had good response. The other, who was treated by local administration of corticosteroid, partially responded and is currently stable with limited disease.

Discussion

IPT has been reported to occur in various anatomical sites, most commonly in the lungs. The incidence in the head and neck area is extremely rare. Treatment of IPT is controversial and may involve corticosteroids or surgical resection, or both. Other chemotherapeutic agents and radiotherapy may be considered in steroid-resistant patients. The pathological subtype, safety of resection, and safety of corticosteroid use must be included in the decision-making process for treatment.     

头颈肿瘤术后并发肺栓塞

目的　提高对头颈肿瘤术后并发肺栓塞的诊断意识。方法　回顾性分析中国医学科学院中国协和医科大学肿瘤医院头颈外科 1993～ 1999年头颈肿瘤手术后发生的 5例严重急性肺栓塞患者的临床资料。结果　同期共行头颈肿瘤手术 5 80 1例 ,手术后死亡 39例 ,发生严重急性肺栓塞 5例 ,其中 4例因漏诊、误诊未能给予及时正确的治疗 ,于 2h内死亡 ,占同期术后死亡的 10 3% (4/39) ;仅 1例得到正确诊断 ,经积极溶栓治疗存活。结论　急性肺栓塞是头颈肿瘤术后导致死亡的严重并发症 ;及时正确诊断与治疗可以挽救患者生命     

头颈部髓外浆细胞瘤临床分析

目的:总结头颈部髓外浆细胞瘤(EMP)的临床特征、诊断和治疗经验,提高治疗效果。方法:回顾性分析8例头颈部髓外浆细胞瘤的临床资料。发生于鼻腔3例、上颌窦2例、鼻咽部2例、口咽后壁1例。结果:8例均病理学确诊为浆细胞瘤,全部接受手术治疗,其中4例术后追行放疗。4例无瘤生存者分别已超过1年、5年、10年、12年;3例死亡,其中1例在出院2年后死于局部复发,1例3年后死于多发性骨髓瘤,1例2年后死于心脏病;失访1例。结论:头颈部髓外浆细胞瘤属于低度恶性肿瘤,诊断主要依靠临床表现和病理,手术和放疗是其主要治疗手段。     

头颈部隆突性皮肤纤维肉瘤诊治分析

目的探讨头颈部隆突性皮肤纤维肉瘤（dermatofibrosarcoma protuberans，DFSP）的不同治疗方式对患者预后的影响。方法对1982年至2005年中国医学科学院肿瘤医院头颈外科收治的28例头颈部DFSP进行回顾性分析，其中11例行扩大切除（切除边界≥2．0cm），17例行局部切除（切除边界〈2．0cm）；24例行单纯手术切除，4例行术前或术后放疗，放疗剂量为40—65Gy，同期行缺损修复的共18例。结果总体局部复发率为21．4％（6／28），11例行扩大切除的术后局部复发率为0（0／11），17例行局部切除的术后复发率35．3％（6／17），二者差异有统计学意义（P：0．033）；行术前或术后放疗的局部复发率为0（0／4），单纯手术的局部复发率25．0％（6／24），二者差异无统计学意义（P=0．357）。总体5年生存率为88．9％；行扩大切除的5年无复发生存率为100％，行局部切除的5年无复发生存率为59．6％，二者差异有统计学意义（X2=3．933，P：0．047）。结论扩大切除可以降低头颈部DFSP术后的复发率，对于切缘不充分或切缘不净的DFSP，行局部放疗可能有效。手术缺损较大时应行同期修复。