咽旁间隙Castleman病1例

Castleman病是一种少见的淋巴组织增殖性疾病,又名血管滤泡性淋巴组织增生或者巨大淋巴结病。临床根据肿大淋巴结的分布和器官受累情况分为单中心型和多中心型;病理可分为透明血管型、浆细胞型和混合型。我科收治1例咽旁间隙单中心型Castleman病患者,现报道如下。     

先天性腮裂囊肿误诊为颈淋巴结结核的原因分析

先天性腮裂囊肿发病率很低 ,临床上易误诊为其它疾病。笔者收集 6例被误诊为颈淋巴结结核患者的临床资料进行分析 ,以便为该病的临床鉴别诊断提供帮助。1 　 临床资料1 992年 8月～ 1 999年 1 0月被误诊为颈淋巴结结核的先天性腮裂囊肿患者 6例 ,其中男 2例 ,女 4例 ;年龄 1 9～ 5 0岁 ,平均 3 8.9岁。6例患者均表现为一侧颈部孤立性包块 ,逐渐长大 ,无痛痒及其他不适。包块位于胸锁乳突肌前缘上、中位 ,质软 ,皮温不高 ,无触痛。 6例均行抗结核治疗 ,疗程 4～1 5个月 ,均无效。 5例初诊时行颈部包块穿刺 ,抽出“脓性分泌物”,其中 2例行分…     

声门上型喉癌临床颈淋巴结阴性患者颈清扫区域的选择

目的　探讨声门上型喉癌临床诊断N0 (clinicalN0 ,cN0 )患者颈淋巴结转移的特点 ,选择合理的清扫区域。方法　 5 7例声门上型喉癌患者行喉切除术的同时行改良性颈清扫术 ,将颈清扫的淋巴结标本分区域逐一行病理学检查 ,确定转移区域或复发的区域。结果　 5 7例 (6 3侧 )颈清扫标本共获淋巴结 1877枚 ,平均每侧获 2 9 8枚 ,有转移的 4 3枚 ,其中 4 1枚位于Ⅱ、Ⅲ区 ,占 95 4 % (41/ 4 3)。15例 (17侧 )患者有淋巴结转移 ,转移率为 2 6 3% (15 / 5 7)。其中 14例位于Ⅱ、Ⅲ区 ,占转移例数的93 3% (14 / 15 )。颈部复发 3例 ,复发率为 5 3% (3/ 5 7) ,复发部位分别位于Ⅱ、Ⅲ、Ⅳ区。 5年生存率为 80 7% (46 / 5 7)。结论　对声门上型喉癌cN0重点行Ⅱ和Ⅲ区颈淋巴结清扫术 ,Ⅲ区受累时应包括Ⅳ区 ,Ⅰ、Ⅴ区在无明显转移证据时可避免行颈清扫术     

颈部肿块和瘢痕病变致颈动脉窦过敏综合征(附2例报告)

报告1例鼻咽癌颈淋巴结转移致颈动脉窦过敏综合征和1例全喉切除加颈淋巴结清扫术术后瘢痕形成出现颈动脉窦过敏综合征.对耳鼻咽喉科相关疾病引起的颈部肿块和瘢痕病变压迫颈动脉窦所致颈动脉窦过敏综合征的致病原因、临床表现及诊断、治疗原则进行了讨论.此类患者在临床上少见,易误诊,应引起重视.     

颈淋巴结结核临床分析

目的 分析颈淋巴结结核的临床表现及诊治。方法　回顾性分析我院2007～2015年收治100例颈淋巴结结核患者临床资料。结果　纳入患者多以颈部肿块就诊,仅8例伴有低热、盗汗、乏力等全身中毒症状。95例患者经术后病理检查确诊,15例患者术前经细针穿刺确诊。共95例患者接受手术治疗,术后行全身标准抗结核治疗6个月;余 5例患者予以全身标准抗结核治疗,取得满意疗效。手术方式主要有单纯颈淋巴结切除术31例、颈淋巴结清扫术53例和脓肿切开清创术11例,所有患者随访均无复发。结论 颈淋巴结结核的临床表现复杂,细针穿刺活检阳性率不高,术后病理检查有助于进一步明确诊断,外科手术联合术后全身规范抗结核治疗可作为颈淋巴结结核的治疗方法。     

颈淋巴结结核43例分析

颈淋巴结结核主要以颈部淋巴结肿大为表现,多数不伴有结核病的典型全身中毒症状,且颈部肿块发病多样、性质复杂.这给颈淋巴结结核的临床诊断带来一定困难,易发生误诊漏诊.为提高对颈淋巴结结核的认识,使患者能够得到合理、正规的诊治.现将我科1997年1月～2002年9月诊治的43例颈淋巴结结核患者的临床资料分析报道如下.     

声门上型喉癌临床颈淋巴结阴性患者颈清扫区域的选择

目的 探讨声门上型喉癌临床诊断NO(clinical NO,cNO）患者颈淋巴结转移的特点，选择合理的清扫区域。方法 5例声门上型喉癌患者行喉切除术的同时行改良性颈清扫术，将颈清扫的淋巴结标本分区域逐一行病理学检查，确定转移区域或复发的区域。结果 57例（63侧）颈清扫标本共获淋巴结1877枚，平均每侧获29．8枚，有转移的43枚，其中41枚位于Ⅱ、Ⅲ区，占转移例数的95．4％（41／43）。15例（17侧）患者有淋巴结转移，转移率为26．3％（15／57）。其中14例位于Ⅱ、Ⅲ区，占转移例数的93．3％（14／15）。颈部复发3例，复发率为5．3％（3／57），复发部位分别为Ⅱ、Ⅲ、Ⅳ区。5年生存率为80．7％（46／57）。结论 对声门上型喉癌cNO重点行Ⅲ和Ⅲ区颈淋巴结清扫术，Ⅲ区受累时应包括Ⅳ区，Ⅰ、Ⅴ区在无明显转移证据时可避免行颈清扫术。     

彩超在诊断分化型甲状腺癌颈淋巴结转移中的应用

目的评价彩超在诊断甲状腺癌患者颈淋巴结转移中的作用.方法回顾性分析1998年2月～2002年2月收治51例颈淋巴转移的甲状腺癌患者的临床资料：30例（34侧）颈部可触及有肿大淋巴结并经彩超检查诊断有颈淋巴结转移;21例（24侧）颈部未触及有肿大淋巴结但彩超检查诊断有颈淋巴结转移.对上述58侧颈部实行改良性颈清扫,将术前彩超检查结果与术后病理结果进行比较.结果彩超诊断有颈淋巴结转移的58侧行改良性颈清扫术后53侧病理报告有转移淋巴结,彩超检查的灵敏度为91.4%（53/58）.4例患者在随访过程中发现颈侧区淋巴结转移,复发率为7.5%.彩超可以发现39.6%有临床漏诊颈淋巴结转移的患者.术前彩超检查：中颈淋巴转移率最高71.7%（38/53）;术后病理检查：Ⅲ区淋巴转移率最高67.9%（36/53）,其结果基本相同.结论彩超在术前可以判断是否发生颈淋巴结转移并能够准确定位,在甲状腺癌的术前颈淋巴结的评价中十分重要,甲状腺癌患者应常规进行术前彩超检查.     

淋巴转移阳性舌体鳞癌的颈部治疗策略探讨

目的 分析影响淋巴转移阳性(pathologically node positive,pN+)舌体鳞癌患者颈部复发的相关因素和淋巴转移规律,探讨pN+舌体鳞癌的颈部治疗策略.方法 回顾性分析1991年1月至2006年12月期间138例pN+舌体鳞癌患者的临床和随访资料,分析pN+舌体鳞癌颈部转移淋巴结和复发淋巴结的分布规律和pN+舌体鳞癌临床病理因素和治疗方法对颈部复发的影响.结果 全部病例随访2年以上或至患者死亡.Kaplan-Meier法计算3年生存率为46.4%,5年生存率为36.2%.138例共203个分区发生转移,其中同侧Ⅰ、Ⅱ、Ⅲ区累及频率达94.6%,47例共66个分区出现颈部淋巴结复发,其中同侧Ⅰ、Ⅱ、Ⅲ区复发频率达77.3%.颈部复发率与pT分期、pN分期、pTNM分期、淋巴结包膜外侵犯有关(P值均＜0.05);当淋巴结有包膜外侵犯时,术后放疗组的颈部复发率低于未放疗组,但差异无统计学意义(P=0.076);不同颈清扫方式间的颈部复发率差异无统计学意义(P值均＞0.05).Cox多因素生存分析显示,pTNM分期和淋巴结包膜外侵犯是影响pN+舌体鳞癌预后的独立危险因素.结论 pT分期、pN分期、pTNM分期、淋巴结包膜外侵犯是影响pN+舌体鳞癌颈部复发的因素;当淋巴结有包膜外侵犯时,术后放疗有可能降低颈部复发率;改良性颈清扫的颈部复发率与经典性颈清扫没有差异,对非淋巴结构无肿瘤侵犯的pN+舌体鳞癌尽量行改良性颈清扫;pN+舌体鳞癌转移和复发淋巴结主要分布在同侧Ⅰ、Ⅱ、Ⅲ区,择区性颈清扫可应用于pN+舌体鳞癌.     

颈清扫术治疗晚期颈转移癌的远期效果及复发相关因素分析

目的 探讨颈清扫术治疗晚期颈转移癌的远期效果及术后颈部复发的相关影响因素。方法 对112例接受全颈清扫手术的头颈部鳞状细胞癌N2、N3患者，利用手术标本病理检查及随访资料进行回顾性分析。结果 晚期颈转移癌全颈清扫术后5年颈部复发率为27．7％(31／112)，其中N2、N3患者的术后5年颈部复发率分别为16．5％(13／79)、54．5％(18／33)。31例全颈清扫术颈部复发患者，Kaplan-Meier法统计术后3年生存率、5年生存率分别为16．1％(5／31)、9．7％(3／31)。单因素χ^2分析显示，临床N分期、病理颈淋巴结大小、转移淋巴结包膜外扩散、颈部非淋巴组织结构受侵情况与术后颈部复发有关。多因素Logistic回归分析结果表明，仅病理检查颈淋巴结大小与术后颈部复发明显相关。结论 颈部复发是晚期颈转移癌患者最常见的术后肿瘤复发原因。转移颈淋巴结大小是全颈清扫术后颈部复发根本和决定性影响因素。而临床N分期、转移淋巴结包膜外扩散、颈部非淋巴组织结构受侵情况对全颈清扫术后颈部复发具有重要影响。     

Castleman's disease in ear, nose, and throat practice

Castleman's disease, also called angiofollicular lymph node hyperplasia or benign giant lymphoma, is a rare lymphoproliferative disorder of unknown etiology. Three histologic subtypes are described--hyaline vascular (80-90%), plasma cell (10-20%), and mixed (rare). In the clinical setting, localized and multicentric entities are distinguished. Due to the lack of tumor-specific clinical, biochemical, and radiological features, final diagnosis of Castleman's disease depends on histopathology. Surgical tumor resection is the treatment of choice for localized disease. Prognosis is good, and adjuvant therapy is not required. Therefore, early invasive removal and histopathological differentiation from neoplasia is mandatory. In contrast, the prognosis for multicentric Castleman's disease remains poor even if multimodal treatment regimens are employed. Major clinical symptoms, histology, and therapy are summarized, and the disease characteristics are highlighted presenting the case of an 11-year-old girl. On admission, the patient complained of a painless pharyngeal tumor mass and ipsilateral lymph node swelling. Magnetic resonance imaging revealed a parapharyngeal contrast-enhancing lesion extending from the hypopharynx to the skull base without signs of infiltration and accompanied by ipsilateral lymph node hyperplasia of the neck. Laboratory test results were within normal limits. After tumor resection, histopathological examination, and clinical staging, localized Castleman's disease was diagnosed (hyaline vascular subtype).     

Alleinige Kondylusresektion versus alloplastische Rekonstruktion

Castleman’s disease, also called angiofollicular lymph node hyperplasia or benign giant lymphoma, is a rare lymphoproliferative disorder of unknown etiology. Three histologic subtypes are described – hyaline vascular (80–90%), plasma cell (10–20%), and mixed (rare). In the clinical setting, localized and multicentric entities are distinguished. Due to the lack of tumor-specific clinical, biochemical, and radiological features, final diagnosis of Castleman’s disease depends on histopathology. Surgical tumor resection is the treatment of choice for localized disease. Prognosis is good, and adjuvant therapy is not required. Therefore, early invasive removal and histopathological differentiation from neoplasia is mandatory. In contrast, the prognosis for multicentric Castleman’s disease remains poor even if multimodal treatment regimens are employed. Major clinical symptoms, histology, and therapy are summarized, and the disease characteristics are highlighted presenting the case of an 11-year-old girl. On admission, the patient complained of a painless pharyngeal tumor mass and ipsilateral lymph node swelling. Magnetic resonance imaging revealed a parapharyngeal contrast-enhancing lesion extending from the hypopharynx to the skull base without signs of infiltration and accompanied by ipsilateral lymph node hyperplasia of the neck. Laboratory test results were within normal limits. After tumor resection, histopathological examination, and clinical staging, localized Castleman’s disease was diagnosed (hyaline vascular subtype).     

Castleman's disease as an unusual neck mass: case report

Castleman's disease is a rare, benign disease of unknown cause that induces reactive lymph node hyperplasia, most commonly in the mediastinum. It has 2 histologic subtypes: hyaline vascular and plasma cellular. A definitive diagnosis necessitates tissue biopsy. A specimen may be even misdiagnosed as lymphoma in frozen section. Surgery is the treatment of choice for the solitary form, whereas chemotherapy, radiotherapy, and steroids are proposed for the multicentric type. A neck mass diagnosed as Castleman's disease in a 48-year-old woman is reported.     

Giant lymph node hyperplasia a diagnostic dilemma in the neck

Giant lymph node hyperplasia (GLNH) or Castleman's disease is a rare pathological entity commonly presenting as a solitary mediastinal tumour (unifocal variant), although other anatomical sites have been reported including the head and neck, abdomen and axilla. Though the head and neck is the second commonest site for this lesion, only 60 cases [1,2] have been reported in the literature. Pre-operative diagnosis of the unifocal variant can be difficult as routine investigations carried out in the clinic setting are often inconclusive. A multicentric form of this disease with a poorer prognosis in comparison to the unifocal lesion has been described by Gaba et al. in 1978 [3]. We present a case of an unusually large, slow growing, asymptomatic, unifocal variant of this tumour restricted to the neck which underwent successful surgical excision. A review of the literature, histopathological characteristics and differential diagnosis is also presented.     

Castleman’s disease (giant lymph node hyperplasia) of the neck: a case report

Castleman’s disease (giant lymph node hyperplasia) is an uncommon cause of neck mass. Its cause and pathogenesis are still unknown. Giant lymph node hyperplasia (GLH) usually presents as an asymptomatic solitary mass and can occur anywhere in the head and neck. Diagnostic test results are always inconclusive. Excision and histopathological evaluation are the only ways to make a definitive diagnosis. The disease is curable by surgical excision. A case of GLH presenting as a solitary neck mass in a 68-year-old man is reported. There has been no recurrence during about 7 months. Received: 25 May 1999 / Accepted: 7 September 2000     

甲状腺乳头状癌颈淋巴结转移形成巨大囊性变的诊断总结

颈部囊性肿物来源较为丰富,多为良性病变,但也有少数病例为恶性来源,如甲状腺癌。临床上,针对表现为颈部囊性肿物的病例,应加以详细的鉴别,以防漏诊及误诊。报道甲状腺乳头状癌颈淋巴结转移形成巨大囊性变1例,简述其诊治过程及总结经验教训。     

Elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck: analysis of 1444 patients from 1970 to 1998

OBJECTIVE: The purpose of this article is to evaluate the effects on survival, disease-free interval, and recurrence patterns for patients undergoing elective, therapeutic, and delayed lymph node dissection for malignant melanoma of the head and neck. STUDY DESIGN AND METHODS: A retrospective computer-aided analysis was performed comparing 1444 patients treated from 1970 to 1998 at Duke University Medical Center. A total of 446 of the 1444 (32%) of patients with head and neck melanoma underwent some form of lymph node dissection. Survival, disease-free interval, and recurrence rates for patients having 1) no initial lymph node dissection (no LND), 2) elective lymph node dissection (ELND) within 2 months of date of diagnosis, 3) therapeutic lymph node dissection (TLND) for metastatic regional disease at diagnosis, or 4) delayed lymph node dissection (DLND) for patients developing regional lymph node metastasis later than 3 months from the date of diagnosis were compared. RESULTS: A total of 246 patients undergoing ELND demonstrated 11% with occult disease. DLND for regional lymph node recurrence was reported at a median time interval of 1.2 years from diagnosis. Multivariate analysis indicated a significant improvement in survival for DLND when compared with patients undergoing ELND plus sign in circle or TLND (P =.01). Distant metastasis was the site of first recurrence in 12% of patients undergoing no initial LND. Five-year survival after DLND and TLND was 56% and 36%, respectively. CONCLUSION: Patients undergoing DLND had an overall better survival than patients undergoing TLND or ELND with positive nodes. The progression of metastatic disease following regional node disease occurred in 35% to 45% of cases, underscoring the need for effective adjunctive therapy.     

Necrotizing lymphadenitis (Kikuchi-Fujimoto disease) as a rare cause of cervical lymphadenopathies. Diagnosis and differential diagnosis

BACKGROUND: The ENT specialist is often confronted with the inquiry as to the cause of lymph node enlargements. Common causes include inflammations, neoplastic, or autoimmune diseases. We report on three cases of Kikuchi-Fujimoto disease as a benign self-limiting lymphadenopathy of unknown etiology, which is usually found in young women between 20 and 30 years of age. Main symptoms are indolent or light tender, enlarged lymph nodes in the neck area. The correct diagnosis requires the histologic examination of the lymph node. Even for the experienced pathologist the differential diagnosis of malignant systemic disorders can be difficult. PATIENTS: Three female patients suffering from Kikuchi-Fujimoto disease were treated in our department between September 1997 and March 1998. RESULTS: All patients showed indolent and enlarged lymph nodes in the neck. In one case we were able to diagnose an acute cytomegalovirus infection; in another case an acute Epstein-Barr virus infection. After 3-5 months the symptoms disappeared spontaneously in all patients. In two of the three cases, histologic lymph node examination revealed T-cell lymphoma and Hodgkin's disease and in one case led to initial chemotherapeutic treatment. As a result of a second histologic examination, both diagnoses were reviewed and Kikuchi-Fujimoto disease was diagnosed. Chemotherapy was discontinued. CONCLUSIONS: Kikuchi-Fujimoto disease is a benign, self-limiting lymphadenopathy which is usually diagnosed in young women. Distinguishing Kikuchi-Fujimoto disease from malignant systemic disorders may even be difficult for pathologists using histological examination techniques and requires close cooperation between the ENT specialist and the pathologist. In order to minimize the risk of misdiagnosis and incorrect treatment, the ENT specialist should inform the pathologist about the differential diagnosis of Kikuchi-Fujimoto disease in such cases.     

前哨淋巴结检测在头颈部鳞状细胞癌中的应用

目的　评价前哨淋巴结 (sentinellymphnode ,SLN)检测在N0头颈鳞状细胞癌 (简称鳞癌 )中的可行性以及SLN对微小转移灶的诊断价值。方法　分析研究中国医学科学院肿瘤医院头颈外科 2 0 0 1年 8月～ 2 0 0 2年 2月收治的 10例头颈鳞癌患者 ,为未经治疗临床诊断为N0的患者。所有患者术前均在肿瘤周围的黏膜下注射锝标记的右旋糖酐胶体 (technetium 99m preparedwithdextrancolloid ,99mTc DX) ,约 30min后行单光子发射计算机断层显像术扫描 ,在相应的颈部皮肤上标记显像“热点” ;术中翻开皮瓣后用手提探测仪探测术野 ,以高于背景计数 4倍以上确定为SLN。将确定的SLN送病理学检查 ,并借助淋巴结连续切片和免疫组化法检测微小转移灶。结果　术前淋巴结显像及术中探测仪探测所识别的SLN行病理学检查 ,10例N0患者有 3例发现隐性转移 ,其隐性转移率为 30 % (3/ 10 ) ,SLN的阳性率为 2 2 .7% (5 / 2 2 ) ,非SLN的阳性率为 0 .4 % (1/ 2 4 7)。经病理证实为SLN阴性的患者的非SLN无阳性发现。结论　头颈鳞癌颈部N0的SLN检测对发现临床隐性转移灶是可行的。SLN检测技术可缩小手术范围 ,减少手术的创伤及并发症 ,该技术的进一步推广还需更多的研究。     

Strategy of neck dissection in parotid cancer

We conducted definitive surgery on 45 patients with untreated primary parotid cancer from 1975 to 1995, and evaluated methods of neck dissection and results of treatment. All 14 with clinical neck lymph node metastasis underwent ipsilateral radical neck dissection and only 1 developed neck lymph node recurrence at the peripheral dissected site. Of 31 patients without clinical neck lymph node metastasis, 27 of 19 of 36 with high-grade malignancy and 12 of 24 with T3 or T4 did not undergo prophylactic neck dissection and developed latent neck lymph node metastasis in 2 cases (7.4%). Whereas in most cases we achieved good control of the primary site but neck lymph node recurrences occurred, recurrent sites were observed all around the ipsilateral neck and prognosis were very poor if neck dissection was conducted as secondary treatment. Although histopathological diagnosis was considered feasible for predicting occult neck lymph node metastasis, correct diagnostic with fine needle aspiration cytology revealed only 21.8%. Pathological positive lymph nodes in 15 patients who underwent neck dissection were detected all over (level I to V) the ipsilateral neck and the recurrent positive rate at level II was 100%. Based on the above results, we conclude that (1) in cases with neck lymph node metastasis in preoperative evaluation, ipsilateral radical neck dissection is mandated, and (2) in cases without neck lymph node metastasis, prophylactic neck dissection is not usually needed. When pathological results of frozen section from intraoperative jugulodigastric nodal sampling are positive, ipsilateral radical neck dissection is mandated.