耳鼻咽喉头颈部216例结外非霍奇金淋巴瘤的临床病理分析

目的：探讨耳鼻咽喉头颈部原发性结外非霍奇金淋巴瘤（NHL）的临床病理学特征。方法：回顾性分析216例头颈部NHL患者的临床病理学资料。结果：本组样本年龄分布有2个高发段,分别为31～60岁和71～80岁;最常见的原发部位为鼻腔95例（44．0％）,其次为扁桃体47例（21．8％）;最常见的组织学类型为NK／T细胞淋巴瘤107例（49．5％）,其次为弥漫性大B细胞淋巴瘤58例（26．7％）。按部位统计发病率最高的组织学类型分别为：鼻腔为NK／T细胞淋巴瘤74例（77．9％）,鼻窦为弥漫性大B细胞淋巴瘤6例（50．0％）,扁桃体为弥漫性大B细胞淋巴瘤27例（57．4％）,鼻咽口咽为NK／T细胞淋巴瘤17例（44．7％）,舌根为弥漫大B细胞淋巴瘤5例（45．4％）。结论：耳鼻咽喉头颈部原发性NHL是一类比较常见的疾病,其在发病年龄、原发部位和组织学类型上都具有明显的临床病理学特征,对临床病理诊断有较大的帮助。     

头颈部恶性淋巴瘤临床分析

头颈部恶性淋巴瘤在耳鼻咽喉科临床并非少见。该肿瘤临床特征常不典型,专科医生对此病又缺乏认识,易出现漏诊、误诊现象。现就本科近20年来收治的23例头颈部恶性淋巴瘤作一临床分析,报告如下。1资料与方法1．1临床资料本组23例,男17例,女6例;年龄11～67（平均47．3）岁。23例均经病理证实。非霍奇金淋巴瘤22例,霍奇金淋巴瘤1例。T细胞淋巴瘤12例,B细胞淋巴瘤8例,未报告淋巴细胞来源3例（均为80年代初病例,当时本院病理科尚未开展免疫组化检查,未注明细胞来源）。病变部位：扁桃体5例,扁桃体、颈淋巴结6例,鼻腔2例,鼻腔、鼻窦…     

头颈部恶性淋巴瘤17例报告

头颈部恶性淋巴瘤（malignantlymphoma，ML）临床少见，症状缺乏特征性，常规病理诊断有一定困难，故易发生漏诊及误诊。1986年2月～1995年4月，我院收治17例头颈部ML患者。为加深对本病的认识，现报告如下。1临床资料本组17例，男10例，女7例；年龄12～80岁，平均38．6岁。病程21d～2年，4个月以上者11例。病变部位为颈淋巴结4例，鼻腔4例，鼻腔鼻窦2例，鼻咽2例，鼻咽、咽腭弓、扁桃体1例，鼻腔、鼻咽、口咽、扁桃体2例，扁桃体1例，鼻翼1例。17例均经病理证实，非霍奇金淋巴瘤（NHL）15例，霍奇金病（HD）1例，ML未分类1例。T细胞淋…     

原发性头颈部非霍奇金淋巴瘤62例临床分析

目的 :探讨原发性头颈部非霍奇金淋巴瘤 (NHL)的临床特征。方法 :分析 6 2例头颈部NHL的临床资料。结果 :腭扁桃体 (2 5 .8% )、颈淋巴结 (19.4 % )、鼻腔及鼻窦 (12 .9% )为NHL的好发部位 ;临床分期ⅠE期和ⅡE期分别为 38.7%、2 4 .2 %。病理分型高度恶性为 75 .8%。CR率 75 .8% ,PR率 14 .5 % ,有效率 90 .3% ;部分患者无瘤长期生存。结论 :头颈部NHL一般恶性度高 ,多发于结外组织且易发生淋巴结转移 ,准确的取材活检结合免疫组化有利于早期确诊 ,治疗上应采用化疗、放疗或结合手术的综合治疗方案。     

原发性头颈部非霍奇金淋巴瘤临床分析

目的 探讨原发于头颈部的非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)的临床及病理特点,为早期诊断提供经验,从而降低误诊率及漏诊率.方法 对51例原发于头颈部,经病理确诊为NHL患者的临床资料进行回顾性分析.结果 原发部位,鼻腔、鼻窦1 9例(37.3%),腭扁桃体14例(27.5%),颈淋巴结8例(15.7%),鼻咽部6例(11.8%).误诊为炎症7例(13.7%),鼻咽癌2例(3.9%),总误诊率17.6%.结论 头颈部NHL恶性程度高,多好发于鼻腔及鼻窦,其次为扁桃体.该病误诊率高,准确的取材活检及免疫组化检查至关重要.     

头颈部原发性淋巴结外非霍奇金氏淋巴瘤临床和细胞免疫学表型分析

目的：报告原发于头颈部淋巴结外非霍奇金氏淋巴瘤的临床及细胞免疫学表型特点,方法：回顾近十年来经病理学确诊的,原发于头颈部淋巴结外的非奇金氏淋巴瘤115例,对其临床和细胞免疫表型特征进行分析。结果;本组头颈部淋巴结外非霍奇金氏淋巴瘤发病高峰年龄段为21－40岁,原发部位鼻腔最多,其次为鼻咽,扁桃体和口腔,而口咽,下咽和喉较少,临床表现以原发器官症关为主,体征以结节状或菜花状肿块型最多,其次为肿块伴溃烂型,单纯溃烂型较少,细胞免疫学表型结果显示,来源于T细胞者占51．2％,来源于B细胞者占48．8％,其中鼻腔以T细胞淋巴瘤为主,鼻咽则T,B细胞淋巴瘤约占各一半,扁桃体和口腔则以B细胞淋巴瘤为多。结论：头颈部淋巴结外霍奇金氏淋巴瘤最常原发于鼻腔,其次为鼻咽,扁桃体和口腔,临床表现缺乏特征性,易与原发器官的其他恶性肿瘤相混淆,易造成误诊,因此必须依据病理学和免疫组化染色进行鉴别和确诊。     

头颈部结外恶性淋巴瘤误诊分析(附13例报告)

恶性淋巴瘤是原发于淋巴系统及网织内皮系统的恶性肿瘤,按病理和临床特点可分为霍奇金淋巴瘤(HL)和非霍奇金淋巴瘤(NHL)两大类,而头颈部恶性淋巴瘤约占头颈部恶性肿瘤的3%,多数以浅表淋巴结肿大为首发症状,而发生结外的恶性淋巴瘤中约1/5～1/4发生在头颈部[1].     

原发于头颈部的结外型非霍奇金淋巴瘤42例临床分析

目的：探讨原发于头颈部的结外型非霍奇金淋巴瘤（NHL）的临床和病理特点,为该病的早期诊断提供经验。方法：对42例原发于头颈部,经病理证实为结外型NHL的患者的临床资料进行回顾性分析。结果：按照发生部位将病例分为3组,发生于扁桃体的病变与发生于鼻腔的病变之间的确诊时间差异有统计学意义（P〈0．05）;发生于扁桃体的病变与发生于鼻窦的病变之间的确诊时间差异有统计学意义（P〈0．05）;发生于鼻腔与鼻窦病变之间的确诊时间差异无统计学意义（P〉0．05）;按照有无全身症状将病例分为2组,其确诊时间之间差异无统计学意义（P〉0．05）。结论：原发于头颈部的结外型NHL病理类型恶性程度高,临床症状无特异性,其中发生于扁桃体的病变更容易被早期发现,是否伴有全身症状与确诊时间不具有相关性,对于发生于耳鼻咽喉部的单侧病变,要严密观察,必要时进行活检。     

头颈部非霍奇金淋巴瘤25例临床分析

目的：探讨25例头颈部非霍奇金淋巴瘤(NHL)的临床表现、分期、分型及治疗方法。方法：对我院2000年3月-2004年4月间治疗的25例头颈部NHL进行回顾性分析。结果：25例中,首犯咽淋巴环11例,鼻腔8例,鼻窦1例,颈淋巴结4例,腮腺1例。鼻腔、鼻窦已有3例死亡。结论：根据头颈部NHL的首犯部位、肿瘤分期、组织学分型进行恰当的治疗,可提高治愈率。     

头颈部非霍奇金淋巴瘤的临床特点

目的探讨头颈部非霍奇金淋巴瘤临床特点.方法结合相关文献的复习,回顾18例头颈部非霍奇金淋巴瘤的临床表现、诊断过程及部分CT影像.结果位于咽淋巴环多见,其次为鼻腔鼻窦;发病年龄在16～71岁之间;男女比为2∶1;18例中有11例曾被诊断为慢性炎症;CT检查均未明确提示恶性病变;从发病至确诊时间在12～500天不等.结论头颈部NHL的临床表现缺乏特异性,容易误诊;短期内进行性单侧扁桃体肿大、外观可疑者应考虑本病可能;准确的活检取材有助于最终明确诊断.     

84例原发头颈部淋巴瘤临床及病理特征分析

目的 探讨原发头颈部淋巴瘤的临床及病理特征。 方法 回顾性分析84例原发头颈部淋巴瘤患者的病历资料,对其年龄、性别、肿瘤部位、临床表现和病理类型及预后等进行分析。 结果 84例患者中,男性45例(53.6%),女性39例(46.4%),男女比为1.15∶1,年龄19~80岁。病理类型以非霍奇金淋巴瘤为主, 有80例(95.2%),霍奇金淋巴瘤4例(4.8%);非霍奇金淋巴瘤中弥漫大B细胞淋巴瘤39例(48.7%),NK/T淋巴瘤21例(26.3%)。发病部位广泛,依次为:颈部28例(33.3%),鼻腔鼻窦26例(30.9%),扁桃体14例(16.7%),舌根7例(8.3%)。原发于颈部淋巴结及Waldeyer 淋巴环以弥漫大B细胞淋巴瘤为主,原发于鼻腔鼻窦以NK/T细胞淋巴瘤为主。头颈部NK-T细胞淋巴瘤1年生存率为90%, 5年生存率47.6%;头颈部弥漫大B淋巴瘤1年生存率为97.3%,5年生存率58.3%。 结论 原发头颈部淋巴瘤发病率高,临床及影像学无特异性,需及早行组织病理检查,减少漏诊及误诊。     

Extranodal involvement of diffuse large B-cell lymphoma in the head and neck: An indicator of good prognosis

Objective

In this study, we analyzed clinicopathological characteristics and survival outcomes according to extranodal involvement of diffuse large B-cell lymphoma (DLBCL) in the head and neck.

Extracranial head and neck schwannomas: a clinical analysis of 33 patients

OBJECTIVE: To study the clinical features, diagnosis, and management of the extracranial head and neck schwannomas. STUDY DESIGN: Retrospective study. METHODS: The clinical data of 33 patients with schwannoma of the head and neck from 1996 to 2006 were studied retrospectively. RESULTS: Extracranial head and neck schwannomas usually presented as solitary and well-demarcated lesions with insidious course. Although benign, the lesion can cause secondary symptoms, such as nasal obstruction, dysphasia, and hoarseness, relevant to location of the lesion. Fine needle aspiration cytology, computed tomography scans, and magnetic resonance imaging may provide limited implications in the diagnosis of schwannomas, whereas postoperative pathologic examination establishes the final diagnosis. CONCLUSIONS: Complete surgical excisions with appropriate approaches have proven to be efficient and successful in the treatment of head and neck schwannomas.     

头颈部非霍奇金淋巴瘤临床特征和治疗及预后因素分析

目的:探讨原发于头颈部的非霍奇金淋巴瘤(NHL)的临床特征、治疗和预后影响因素。方法:回顾性分析107例头颈部NHL患者的临床资料。结果:本研究样本的中位年龄为54岁;最常见的原发部位为扁桃体29例(27.10%),其次为鼻腔28例(26.17%);最常见的组织学类型为弥漫性大B细胞淋巴瘤46例(42.99%),其次为NK/T淋巴瘤24例(22.43%)。化疗联合应用美罗华可以有效提高生存率;IPI和组织学类型是影响预后的危险因素,且IPI是比组织学类型影响更强的危险因素。结论:原发于头颈部的NHL是一种常见的恶性疾病,其在发病年龄、原发部位、组织学类型、治疗方法和影响预后的因素存在一定特征。     

11例头颈部肉瘤样癌临床分析

目的探讨头颈部肉瘤样癌的临床与病理学特点,以提高对肉瘤样癌的诊断、治疗及判断其预后的认识。方法回顾性分析2005年8月～2011年4月经手术治疗的11例头颈部肉瘤样癌患者的临床资料及诊疗过程。结果 11例患者,其中发生于喉部2例、下咽部5例、鼻窦2例、舌根部1例、颞部1例。所有患者均经相应的术式及对症支持治疗后随访7～55个月,平均随访15.5个月。其中5例存活、3例死亡、3例失访。5例存活患者中2例患者出现可疑肺、颈椎转移。结论肉瘤样癌有其特殊的生物学行为及病理学特点,确诊依赖于免疫组化;对无远处转移的肉瘤样癌首选手术切除治疗,放疗是术后重要的辅助手段。     

两种扁桃体切除方法的临床观察

目的比较两种不同扁桃体切除及止血方法的优缺点。方法将诊治的90例扁桃体切除术患者随机分为等离子手术组（A组）和传统手术组（B组）,每组各45例,所有手术均由同一术者完成。等离子手术组用低温等离子法切除扁桃体并止血;传统手术组则采用常规扁桃体剥离并用双极电凝止血。记录切除双侧扁桃体所需时间和出血量;术后第1天起每日记录患者咽部疼痛评分情况,连续10 d;术后第10天观察并记录扁桃体窝内的白膜状况。结果A、B两组手术总时间分别为（18.0±1.6）min、（43.5±3.4）min,术中总出血量分别为（9.3±1.3）ml、（53.8±5.5）ml,两组间差异均具有统计学意义（P〈0.05）;两组患者术后1周内疼痛指数差异比较具有统计学意义（P〈0.05）,1周后疼痛指数比较差异无统计学意义（P〉0.05）;A、B两组术后出血发生病例数分别为3例、4例,出血发生率比较差异具有统计学意义（P〈0.05）,术后比较,A、B两组白膜与扁桃体窝面积比分别为（43.8±6.6）%、（40.5±5.1）%,两组之间差异无统计学意义,但等离子组白膜较为清洁。结论与传统扁桃体剥离法比较,低温等离子法切除扁桃体具有手术损伤小、术中出血少、术后疼痛轻、恢复好等优点,可作为扁桃体切除手术的首选。     

Familial head and neck cancer: molecular analysis of a new clinical entity

OBJECTIVE: The tumor suppressor gene p16 encodes a cyclin-dependent kinase inhibitor that normally inhibits cell proliferation by causing a G1 cell cycle arrest. The p16 gene is frequently mutated in a variety of somatic tumors, as well as in familial melanoma and familial pancreatic carcinoma. We identified a family with a high incidence of head and neck squamous cell carcinoma (HNSCC) and melanoma. Molecular analyses of the p16 gene locus in blood and tumor DNA from this family was performed to determine whether an association between germline p16 gene mutation and HNSCC exists. STUDY DESIGN: Molecular pedigree analyses. METHODS: Exon 2 of p16 was polymerase chain reaction amplified from blood, tumor, or nontumor DNA isolated from affected and unaffected members, then directly sequenced and compared with consensus p16 sequence. Cell cycle position of cells expressing wild-type or mutant p16 was determined by flow cytometry. RESULTS: Molecular analyses revealed a nonfunctional germline point mutation within exon 2 of the p16 gene that encodes a mutant p16 protein substituting proline at amino acid position 87 for the wild-type arginine (p16R87P). Relative to wild-type p16, p16R87P lost ability to cause a growth arrest following ectopic expression. The mutant (p16R87P) allele segregated with cancer predisposition in tested family members, and analyses of HNSCC tumor tissues demonstrated universal loss of wild-type allele. CONCLUSIONS: Significance of the mutant p16 (p16R87P) in HNSCC tumorigenesis is strongly suggested by its loss of cell cycle arrest activity and its retention in tumor tissue with simultaneous loss of the wild-type allele. Further, the germline p16 mutation segregated with cancer predisposition within the family. In aggregate, these data suggest that there is a direct causal relationship between the germline p16 mutation in this family and HNSCC tumorigenesis. Based on our observations, the spectrum of familial cancers associated with p16 mutations should include a new clinical entity, familial HNSCC.     

The clinical value of image cytometry DNA analysis in distinguishing branchial cleft cysts from cystic metastases of head and neck cancer

OBJECTIVES/HYPOTHESIS: A branchial cleft cyst presents as a lump in the neck that, generally, is easily cured by surgical excision. The preoperative diagnosis is based on clinical examination and, especially in the Scandinavian countries, fine-needle aspiration cytology. However, at times, the histopathological analysis of the excised cyst reveals a cystic metastasis of squamous cell carcinoma of the head and neck. If adequate diagnosis could be obtained preoperatively, patients would most likely fare better. The study was performed to investigate whether the diagnostic accuracy for these lesions could be improved preoperatively by image cytometry DNA analysis of the fine-needle aspiration cytology specimen. STUDY DESIGN: Image cytometry DNA analysis was performed on the preoperative fine-needle aspiration cytology specimen and the surgical specimens from 51 patients with solitary cysts in the lateral region of the neck. Thirty-six patients were selected because there was a discrepancy between findings on fine-needle aspiration cytology and the final histopathological diagnosis or an uncertain cytological diagnosis. There were 25 metastatic squamous cell carcinomas and 3 thyroid cancers, there was 1 lymphoma and 1 sialoadenitis, and there were 21 branchial cleft cysts. METHODS: The cytodiagnostic Giemsa-stained slides were destained in Methanol and then stained with Schiff's reagent. The paraffin-embedded material from excised cysts were cut and deparaffinized and then stained with Schiff's reagent. Ahrens image analysis was used for DNA analysis and lymphocytes were used as control cells. DNA valves exceeding 5c was regarded as aneuploid. RESULTS: Image cytometry DNA analysis of the preoperative cytological specimen was possible in 41 of 51 patients. We found that in 53% of the cases with cystic metastasis, image cytometry DNA analysis, when possible, revealed aneuploidy, thus indicating malignancy. DNA analysis showed diploidy in all benign cases. CONCLUSIONS: Aneuploidy is highly specific for malignancy. Image cytometry DNA analysis increases the diagnostic sensitivity for malignant cystic metastasis and therefore is a valuable supplement to conventional cytological study for these lesions.