Extraskeletal myxoid chondrosarcoma of the nasal cavity

Extraskeletal myxoid chondrosarcoma presenting in the head and neck is extremely rare. Histologic diagnosis is difficult and close co-operation among clinician, radiologist and pathologist is recommended. The tumour has a better prognosis than myxoid chondrosarcoma of the bone but surgical resection may be difficult due to its geletinous nature. We present a case of extraskeletal myxoid chondrosarcoma originating in the left nasal cavity of a 35-year-old woman.Presented as a poster in Rhinology 2005 24th ISIAN International Symposium on Infection and Allergy of the Nose. April 20–23, 2005, Sao Paolo, Brazil     

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。     

头颈部恶性肿瘤患者β-葡萄糖苷酸酶活性的检测

研究头颈部恶性肿瘤患者上呼吸道分泌物和血清中β－葡萄糖着酸酶（beta－glu－curonidase，β－GD）活性变化。采用微量比色法检测头颈部恶性肿瘤患者、健康人和头颈部良性疾患者各40例上呼吸道分泌物和血清中β－GD活性，并进行对比研究。结果表明：三级血清中β－GD活性差异无显著性；上呼吸道分泌物中β－GD活性在健康人群组与良性疾患组间差异亦无显著性，而恶性肿瘤组则明显升高，与前两级相比，差异有极显著性（P＜0．001），若以正常对照组的均数加两个标准差为阳性判断标准，则敏感性、可靠性和特异性分别为85．0％、92．5％和100％。晚期、有淋巴结或远处转移者β－GD活性较早期、未发生转移者升高更明显。对6例恶性肿瘤患者治疗前后上呼吸道分泌物中β－GD活性进行一年的动态监测，其变化气临床症状相一致。实验结果提示上呼吸道分泌物中β－GD活性的检测可作为头颈部恶性肿瘤早期诊断、临床分期分级、疗效评估及判断肿瘤有无复发或转移的有价值的辅助指标。     

Multifocal adult rhabdomyoma of the head and neck: a case report and literature review

Adult extracardiac rhabdomyomas are rare benign skeletal muscle tumors that most commonly present in the head and neck region. Only a few multifocal cases have been described to date in the world literature. We hereby present an additional multifocal case, the 14th worldwide, and review the literature.     

儿童头颈部侵袭性纤维瘤病(附3例报告)

目的：探讨儿童头颈部侵袭性纤维瘤病的治疗方法。方法：回顾性分析3例头颈部侵袭性纤维瘤病患儿的临床资料。结果：3例患儿均经手术切除肿瘤,病理明确,随访过程中无复发。结论：儿童侵袭性纤维瘤病局部呈浸润性生长,手术彻底切除是主要的治疗方法,但由于儿童生长发育问题很难做到彻底切除,由于位于头颈部,易造成面容破坏和畸形。     

正电子发射断层摄影术在头颈部恶性肿瘤诊断中的应用

目的 :探讨18F FDG正电子发射断层摄影术 (PET)在头颈部恶性肿瘤诊断中的价值。方法 :回顾性分析应用18F FDGPET检查的 75例头颈部肿瘤患者 (鼻咽癌 36例 ,食管癌 18例 ,甲状腺癌 13例 ,喉癌 6例 ,下咽癌 2例 )的临床资料 ,其18F FDGPET显像结果与病理结果进行比较 ,部分与CT、MRI比较。结果 :18F FDGPET显像结果与病理结果相符率极高 ,鼻咽癌的灵敏度为 91.30 % ,特异度为 76 .92 % ,准确率为 86 .11% ;食管癌的灵敏度为 10 0 .0 0 % ,特异度为 83.33% ,准确率为 94 .4 4 % ;甲状腺癌、喉癌和下咽癌的灵敏度、特异度及准确率均为 10 0 %。结论 :18F FDGPET在头颈部恶性肿瘤的诊断中具有明显的优势。     

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。     

头颈部神经鞘瘤23例临床分析

目的：探讨头颈部神经鞘瘤的临床特征,以提高对头颈部神经鞘瘤的诊治水平。方法：23例均行手术切除,其中颈侧切开切除颈部肿瘤15例,鼻侧切开切除鼻腔肿瘤1例,经口径路切除肿瘤3例,2例面神经鞘瘤分别经中耳乳突中后颅窝联合径路和乳突根治径路切除,1例位于梨状窝的神经鞘瘤在食管镜下钳取完整取出,1例气管内神经鞘瘤行气管切开切除。结果：20例术后随访3个月－7年,19例无复发;1例鼻腔、鼻窦肿瘤术后3年复发。1例术后出再霍纳征,2个月后消失,1例术后出现声嘶。结论：神经鞘瘤术前诊断困难,确诊有赖于病理检查;一旦确诊应尽早手术完整摘除,尽可能保护神经功能,避免并发症的发生。     

Head and neck ultrasound in the pediatric population

Ultrasound, as a diagnostic modality, has been developing rapidly. High-resolution ultrasound machines have been reduced to the size of a laptop computer. Ultrasound can be adopted by otolaryngologists for use within the clinic and the operating room. Ultrasound offers several advantages to the pediatric patient population. It is well tolerated and adds a degree of precision to the physical examination. It can be done repeatedly as lesions evolve and treatment is performed. It is valuable for guidance and therapeutic treatment of lesions in the operating room. It is likely that ultrasound use will continue to rapidly grow and evolve as a tool within the field of otolaryngology.     

Aneurysmal bone cysts of the head and neck in pediatric patients: a case series

OBJECTIVES: To characterize aneurysmal bone cysts (ABCs) of the head and neck as seen at a tertiary care center. DESIGN: A case series. METHODS: A retrospective chart review of pediatric patients with aneurysmal bone cyst of the head and neck treated at the Hospital for Sick Children during the years 1994-2006 was carried out. RESULTS: Nine patients with ABC were treated. The average age at diagnosis was 9.3 years (range: 5 months-15 years), six males and three females. Four cysts originated in the paranasal sinuses, two in the mandible, one in the zygoma, one in the mastoid and one in the parietal bone. Two cases were associated with a previous localized trauma (mandible, zygoma). 5/9 presented with pain, 4/9 presented as an asymptomatic mass, 2/9 were associated with proptosis and nasal obstruction, 2/9 with nasal obstruction and 1/9 presented with an aural polyp. Seven cysts were successfully excised while one (in the pterygomaxillary fossa) is being followed conservatively. In one case the ABC was found to be secondary to an extensive osteoblastoma and this child continuous to be problematic. Follow-up time ranged from 2 years and 6 months to 10 years. CONCLUSIONS: ABC of the head and neck may vary in presentation and severity. Surgical removal is the treatment of choice at our institution and may provide a satisfying outcome. ABC may be secondary to an underlying bone pathology (e.g., osteoblastoma) which may make it refractory to treatment.     

Aggressive cementifying fibroma of the maxilla

Summary The cementifying fibroma is a benign fibro-osseous lesion. Its usual location is in the mandible while rare sites of involvement have been the maxilla and ectopic locations. These tumors are generally believed to originate from the connective tissue of the periodontal ligament. Clinically, lesions are usually asymptomatic, slow-growing, and well-circumscribed. However, in very few cases, particularly in younger patients, these tumors have demonstrated and apparent aggressive course of development. We describe a case of an aggressive cementifying fibroma of the maxilla in a middle-aged male. The pathogenesis of the tumor is discussed, and the need for appropriate surgical management is emphasized.     

原发性颈胸结合部肿瘤的诊治

目的 总结原发性颈胸结合部肿瘤的诊治经验.方法 统计2005年3月至2009年12月在解放军总医院住院手术并经病理确诊的17例患者的临床资料,对患者的临床表现、手术方法选择及并发症预防进行分析.17例患者的肿瘤主体位于左侧9例,右侧8例.行颈侧切开(阶梯切口)1例,颈胸联合手术3例,颈根部及锁骨上切开6例,颈根部及上纵隔肿瘤切除7例,3例神经纤维瘤患者因肿瘤与局部重要组织结构粘连严重未能全部切除.结果 5例(29.4％)患者发生手术并发症,其中1例术中左锁骨下动脉破裂出血及喉返神经损伤,术后伤口感染、皮肤缺损;1例术中椎动脉和颈总动脉破裂,术后出现霍纳综合征伴上肢运动受限和不能耸肩;1例手运动障碍;2例上肢运动受限.术后病理结果:囊肿、静脉血管瘤、节细胞神经瘤、纤维源性肿瘤、纤维肉瘤、脂肪肉瘤、肌纤维母细胞瘤、异位错构瘤性胸腺瘤(腮原基混合瘤)各1例,神经纤维瘤3例,神经鞘瘤6例.随访1.0～4.5年,中位时间2.5年.2例恶性肿瘤患者随访3年8个月和2年,均无瘤存活;3例神经纤维瘤未完全切除患者带瘤生存,其余12例良性病变暂无瘤生存.结论 原发性颈根部肿瘤类型多,其中神经鞘瘤较多;当肿瘤范围广泛、与局部神经血管等重要结构粘连紧密时,手术难以彻底切除,其手术并发症发生率高.     

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。     

应用菱形皮瓣修复头颈部皮肤肿瘤切除术后缺损

目的:总结菱形皮瓣修复头颈部皮肤肿瘤切除术后缺损的临床经验.方法:2002年7月～2006年9月收治的24例头颈部皮肤肿瘤患者.所有患者均采用术中冷冻切片监测标本及切缘,皮肤缺损范围为1.0 cm×1.5 cm～3.0 cm×3.5 cm,全部缺损均采用菱形皮瓣修复.结果:所有患者Ⅰ期修复,随访6个月～3年,术区皮肤色质正常、瘢痕不明显,无继发明显畸形.术后无复发.结论:菱形皮瓣设计合理,取材方便、操作简便,是临床即时修复头颈部皮肤肿瘤根治件切除术后缺损的较好方法.     

Role of the physician versus the patient in the detection of recurrent disease following treatment for head and neck cancer

OBJECTIVES/HYPOTHESIS: Objective evidence supporting current National Comprehensive Cancer Network guidelines regarding surveillance of patients treated for head and neck cancer is presently lacking. The study examines the relative role of current surveillance methods on disease detection in this patient population. STUDY DESIGN: Prospective nonrandomized study. METHODS: Clinical information was prospectively collected in a standardized format during 3645 encounters with patients with head and neck cancer over an 18-month period. Data pertaining to visit history, symptom history, patient findings, physician findings, and disease status for each encounter were reviewed. RESULTS: Of 3645 visits, disease recurrence or new primary tumor was documented in 180 encounters (5%). Salvage therapy was thought to be feasible in at least 65% of cases. Of these 180 recurrences or new primaries, there were 142 patients (79%) who had identified new symptoms or physical findings, or both, before the physician's examination. Most commonly reported was the presence of a neck mass (38%), progressive pain (27%), or other visible lesion or ulcer (14%). Patients with recurrence represented nearly 40% of all patients reporting new symptoms or findings (142 of 367). Conversely, recurrence was rare in the absence of reported symptoms or findings (1.2%). Surprisingly, despite patients reporting new symptoms or findings, physician evaluation most commonly occurred at the patient's routine surveillance visit rather than an earlier time point (104 of 142 [73%]). CONCLUSION: Self-diagnosis of recurrent or new primary disease is extremely common by virtue of symptoms or findings noted by patients before interaction with the clinician. However, presence of symptoms or findings did not motivate the patients to seek earlier medical attention. In the absence of such symptoms, physician diagnosis of recurrence is uncommon. Given the significant social and economic impact involved in surveillance of patients with head and neck cancer, further prospective study to optimize the method and frequency of this type of clinical activity is warranted and planned.     

头颈部肿瘤组织中纤溶酶原激活物的测定

采用纤维蛋白板测定头颈肿瘤组织中纤溶酶原激活物（ＰＡ），结果表明：①头颈恶性肿瘤原发灶、颈淋巴结转移癌ＰＡ活性增高，比活性均值高于相应癌灶邻近正常组织和头颈良性肿瘤组织（Ｐ＜０．０１）；②在原发灶中ＰＡ比活性均值随肿瘤分期的进展而递增。提示ＰＡ可能是参与头颈恶性肿瘤生长、浸润及转移的机制之一，ＰＡ使头颈癌细胞激活纤溶系统降解癌周组织而浸润、转移。     

Twenty-five years experience with laser surgery for head and neck tumors

During the last 25 years, the treatment of tumors arising in the upper aerodigestive tract has changed fundamentally. Whereas surgery in the 1970s aimed at radical block resection and defect repair from outside, the establishment of transoral laser microsurgery marked a new era of organ- and function-preserving therapy. An international symposium, held on 10 and 11 June 2005 in Göttingen, was dedicated to a critical review and assessment of the current role of laser surgery for the treatment of head and neck cancer. Experts from five continents presented their experiences and scientific results and had an intensive exchange with participants from different countries. The topics of the symposium were focused on the surgical principles of laser resection, the oncological and functional results in comparison with traditional therapy, the difficulties and limits of laser surgery in distinct anatomical regions and on the role of radiotherapy. This report summarizes the most important results and statements and gives an overview of actual developments. The names and addresses of the participants mentioned in this report are appended below.     

Lymphomas of the head and neck in the pediatric population

OBJECTIVE: Little is known about the incidence and survival outcomes of pediatric patients with head and neck (HN) lymphomas in Asian populations. This study sought to identify the incidence of HN involvement of pediatric lymphomas and to identify factors prognostic of patient survival. METHODS: We reviewed the medical records of all children aged 0-14 years with previously untreated lymphomas of HN region and compared patient clinicopathologic characteristics and final outcomes in patients with Hodgkin's disease (HD) and non-Hodgkin's lymphoma (NHL). Potential prognostic factors for patient survival were investigated. RESULTS: Of 106 eligible lymphoma patients, 45 (42.5%; 31 boys and 14 girls) showed HN involvement. Overall, NHL (n=37) showed more unusual and aggressive presentations than did HD (n=8) in the head and neck region. Cervical lymphadenopathy was frequently observed (30/45, 66.7%) in these patients. Involvement of extralymphatic head and neck sites was found in 15 of 37 NHL patients (40.5%) but not in any HD patients (p=0.027). Five-year disease-free survival (DFS) of all HN lymphoma patients was 76.0%. On multivariate analysis, advanced stage and absence of complete remission following 3 cycles of chemotherapy were poor prognostic indicators of patient survival (p<0.05). CONCLUSIONS: The incidence of HN involvement in pediatric lymphomas was 42.5% in the studied population. Stage of the lesion and early response to chemotherapy were independent factors prognostic of patient survival.