喉恶性纤维组织细胞瘤

目的 探讨喉恶性纤维组织细胞瘤的诊断和治疗。方法 对9例喉恶性纤维组织细胞瘤的临床、病理、诊断、治疗和预后进行回顾性分析。结果 9例喉恶性纤维组织细胞瘤患者，男8例，女1例；年龄43—87岁，平均56岁。喉恶性纤维组织细胞瘤诊断较困难，3例标本经多次活检，5例标本进行免疫组化检查协助诊断。喉恶性纤维组织细胞瘤以手术治疗为主，7例喉恶性纤维组织细胞瘤患者行喉全切除术，2例行喉部分切除术。随访3年以上，在访的6例喉恶性纤维组织细胞瘤无1例死亡。结论 喉恶性纤维组织细胞瘤容易误诊，有时需免疫组化鉴别诊断。喉恶性纤维组织细胞瘤手术切除力求彻底，可根据肿瘤范围大小决定不同的手术方式。     

28例头颈部恶性纤维组织细胞瘤的临床分析

目的：分析头颈部恶性纤维组织细胞瘤（MFH）的临床特征和治疗方法。方法：回顾性分析28例头颈部MFH患者的临床资料,其中上颌骨9例,鼻腔3例,喉部5例,腮腺3例,颞骨3例,甲状腺1例,头颈软组织4例,均经免疫组织化学检测确诊。单纯手术切除4例,手术加放疗23例,单纯放疗1例。结果：5例1年后失访,按死亡计算,余均随访3年以上,1、3年生存率分别为96．4％（27／28）和57．1％（16／28）;随访满5年23例,5年生存率为26．1％（6／23）。3年内复发率为60．7％（17／28）,复发次数1～7次,平均复发时间为5．6个月,复发者1例采用放疗,12例采用非定型手术扩大切除。结论：头颈部MFH的确诊有赖于免疫组织化学技术,早期诊断、广泛手术切除、综合治疗能减少复发,提高生存率;复发者可采用非定型手术扩大切除以延长生命。     

上颌窦恶性纤维组织细胞瘤（病例报告及文献复习）

目的：探讨原发于上颌窦的恶性纤维组织细胞瘤（MFH）的病理，临床表现及治疗措施。方法：分析2例原发于上颌窦的恶性纤维组织细胞瘤的临床资料并复习相关文献。结果：（1）MFH在病理上主要表现为轮辐状排列的纤维母细胞的背景中多种细胞成分并存，瘤细胞异型性明显；（2）病情发展快，临床表现为面部肿痛，肿瘤体积大，术前无转移；（3）1例接受鼻侧切开术，术后4个月局部复发并发现肝脏转移；1例行上 骨次全切除术加放疗，术后1年发现颈部淋巴结转移，3年局部复发。结论：原发于上颌窦的MFH是一种罕见病，有特征性的病理表现，临床表现多样性，病情发展快，治疗上采取根治性手术切除并联合放疗及化疗的综合治疗措施。术后易于复发及转移，预后差。     

喉恶性纤维组织细胞瘤

目的　探讨喉恶性纤维组织细胞瘤的诊断和治疗。方法　对 9例喉恶性纤维组织细胞瘤的临床、病理、诊断、治疗和预后进行回顾性分析。结果　 9例喉恶性纤维组织细胞瘤患者 ,男 8例 ,女 1例 ;年龄 43～ 87岁 ,平均 56岁。喉恶性纤维组织细胞瘤诊断较困难 ,3例标本经多次活检 ,5例标本进行免疫组化检查协助诊断。喉恶性纤维组织细胞瘤以手术治疗为主 ,7例喉恶性纤维组织细胞瘤患者行喉全切除术 ,2例行喉部分切除术。随访 3年以上 ,在访的 6例喉恶性纤维组织细胞瘤无 1例死亡。结论　喉恶性纤维组织细胞瘤容易误诊 ,有时需免疫组化鉴别诊断。喉恶性纤维组织细胞瘤手术切除力求彻底 ,可根据肿瘤范围大小决定不同的手术方式     

侵犯翼腭窝肿瘤的诊断和手术治疗

目的分析肿瘤主体位于翼腭窝的临床表现,探讨其手术方法及其疗效。方法回顾分析7例以翼腭窝为主要病变区域的肿瘤性疾病的诊治经过,其中原发性肿瘤3例,分别为纤维组织细胞瘤、神经纤维瘤和胆脂瘤,继发性肿瘤4例,其中上皮肌上皮癌、腺样囊性癌各1例,鼻内翻性乳头状瘤和恶性组织细胞瘤外院术后复发各1例。神经纤维瘤和胆脂瘤患者分别行内镜辅助下鼻腔上颌窦或口腔上颌窦径路,纤维组织细胞瘤患者及4例继发性肿瘤者采用鼻侧切开径路。结果腺样囊性癌患者术后4个月局部复发,激光扩大切除后随访3年无复发或转移,其余6例患者术后1个月～3个月术腔上皮化,随访2～4年无复发或转移。主要并发症为鼻口腔瘘2例,愈合时间分别为术后9个月和11个月,鼻咽反流和下眼睑水肿各1例,分别于术后1个月和3个月消失。结论CT或MRI是诊断翼腭窝肿瘤的主要方法,经鼻腔上颌窦、口腔上颌窦或鼻侧切开径路可有效切除该处肿瘤。     

上颌窦恶性纤维组织细胞瘤的诊断和治疗

对１３例上颌窦恶性纤维组织细胞瘤的临床、病理、诊断和预后进行回顾性分析。结果显示上颌窦恶性纤维铰累浸润性生长为主，临床主要表现为鼻窦、鼻出血、面颊部麻木肿瘤、突破奶等；容易侵犯鼻腔、筛窦、蝶窦１、翼凳容和眼眶等重要结构，容易发生误诊，免疫组化检查有助于鉴别诊断。上颌窦恶性纤维组织细胞瘤对放疗不敏感，术后容易复发和远处转移，预后罗差，宜尽早行根治性上颌骨切除术。     

原发性甲状腺恶性纤维组织细胞瘤临床分析

目的 探讨原发性甲状腺恶性纤维组织细胞瘤(malignant fibrors histiocytoma,MFH)的临床特点及预后,寻求有效诊治方法.方法 回顾性分析我科1987～2007年收治的12例经病理检查证实的原发性甲状腺MFH患者的病例资料.其中单独手术5例,手术加放疗6例,5例患者行术后放疗,1例行术前超分割放疗,1例行活检加术后化疗.结果 10例有完整随访资料患者中,7例术后1年内死亡,3例患者分别在术后14、18、24个月死亡.4例死于肿瘤远处转移,1例死于肿瘤局部复发和远处转移,4例死于肿瘤局部复发,1例为术后1个月因脑出血死亡.结论 原发性甲状腺MFH恶性程度高,预后差.治疗以手术治疗为主,如能早期诊断,彻底切除并配合放、化疗综合治疗,有望提高生存率.     

喉纤维组织细胞瘤

目的 为提高对喉纤维组织细胞瘤的认识及诊治水平。方法 报道１例喉纤维组织细胞瘤的病理改变及其手术治疗过程，并综合文献复习。结果 随访１５个月无局部复发和转移。结论 发生于喉部的纤维组织细胞瘤为良性者，临床罕见，以外科治疗为主，预后好。     

上颌窦恶性纤维组织细胞瘤5例报告

目的：提高临床对上颌窦恶性纤维组织细胞瘤(MFH)的认识。方法：报告分析经病理确诊的5例MFH的临床资料。结果：5例均手术,术后均行放疗,1例复发后化疗。5例随访至今,3例复发。无一例死亡。结论：对病史不长,有一侧上列牙痛,面部麻木,伴面颊部结节样隆起患者,应考虑到MFH。结合CT、术中所见、病理检查等确诊;MFH恶性程度一般较低,少有转移者,但易复发。适当扩大手术切除范围,结合术后放疗,可减少复发。     

上颌窦恶性纤维组织细胞瘤的诊断和治疗

对 1 3例上颌窦恶性纤维组织细胞瘤的临床、病理、诊断和预后进行回顾性分析。结果显示上颌窦恶性纤维组织细胞瘤以浸润性生长为主 ,临床主要表现为鼻塞、鼻出血、面颊部麻木肿痛、突眼等 ;容易侵犯鼻腔、筛窦、蝶窦、翼颌窝和眼眶等重要结构 ;容易发生误诊 ;免疫组化检查有助于鉴别诊断。上颌窦恶性纤维组织细胞瘤对放疗不敏感 ,术后容易复发和远处转移 ,预后较差 ,宜尽早行根治性上颌骨切除术。     

Synovial cell sarcoma: diagnosis,treatment, and outcomes

OBJECTIVES/HYPOTHESIS: Synovial cell sarcoma is a mesenchymal tumor predominantly of the lower extremities. Three percent of cases arise in the head and neck region. It is thought that head and neck synovial sarcoma has a better prognosis than tumors of the extremities. Our experience has demonstrated aggressive behavior of this neoplasm in the head and neck. This compelled us to compare our experience with other studies. STUDY DESIGN: Retrospective chart review. METHODS: We obtained the records of patients diagnosed with head and neck synovial sarcoma from the Tumor Registry of the University of Louisville School of Medicine (Louisville, KY) and affiliated hospitals for data compiled between January 1990 and December 2000. Data on patient demographics, clinical findings and symptoms, histological findings, treatment, extent of disease, recurrence, and survival were recorded. The literature was reviewed identifying reports of synovial cell sarcoma. RESULTS: Five consecutive patients with synovial cell sarcoma were assessed at our facility. The median patient age was 28.2 years. All of the patients underwent an aggressive primary surgical excision followed by irradiation. All patients received chemotherapy after recurrence. Four of the five patients had local recurrence, and all five of the patients developed distant metastases. Three of the patients have died, and two are alive with evidence of disease. Novel sites are reported including the ethmoid sinus and the parotid gland. This group demonstrated a 40% 5-year overall survival, which was lower than the 60% 5-year survival reported in the literature for all sites. CONCLUSIONS: Synovial cell sarcoma of the head and neck is a disease of young people and carries a poor prognosis. The aggressive nature of the disease may require modification of accepted treatment modalities and sequence.     

头颈部肌上皮癌临床分析

目的 探讨头颈部肌上皮癌的临床特点、诊断、治疗方式及预后.方法 回顾性分析中山大学肿瘤防治中心1992年1月至2006年12月收治的11例头颈部肌上皮癌患者的临床资料.11例患者的原发部位为腮腺5例,硬腭1例,上颌窦1例,咽隐窝1例,口颊1例,头皮1例,牙龈1例.男女比例为4:7;年龄14～60岁,中位年龄37岁.所有病例均经病理组织学或免疫组化诊断.结果 11例患者均行手术治疗,其中单纯手术4例,手术+术后放疗2例,手术+术后化疗2例,手术+术后放疗+术后化疗3例.8例术后局部复发,淋巴转移4例,远处转移4例.病理学类型:梭形细胞型5例,透明细胞型、浆样细胞型各2例,上皮样细胞型、混合型各1例.中位随访时间40个月,至末次随访时8例患者因肿瘤复发死亡,3例存活.结论 头颈部肌上皮癌侵袭性强,颈部淋巴转移和远处转移发生概率高,首次治疗不彻底易复发,预后差,是一种高度恶性的肿瘤.治疗以手术为主,术后辅以化、放疗可能有一定效果.     

Retrospective study and review of polymorphous low-grade adenocarcinoma

OBJECTIVES/HYPOTHESIS: We review a single institution's experience with polymorphous low-grade adenocarcinoma. To our knowledge, this is the largest patient series of polymorphous low-grade adenocarcinoma with clinical follow-up in the otolaryngology literature. STUDY DESIGN: We retrospectively identified 19 patients with polymorphous low-grade adenocarcinoma who had adequate clinical follow-up and pathologic specimens available for examination. METHODS: All pathologic materials were reviewed by one head and neck pathologist. RESULTS: The median follow-up was 9.6 years. The most frequently affected sites were the hard palate (12 patients) and soft palate (9 patients). Fifteen patients had their initial treatment at our institution, and four patients presented with a recurrent tumor. Five patients had a local recurrence after surgery; of those patients, two had initially presented with recurrent tumors. Local tumors recurred as late as 15 years after the initial surgery. One patient had regional nodal disease 20 years after the initial procedure, and another had lung metastasis. No patients received chemotherapy. The most common initial diagnoses were polymorphous low-grade adenocarcinoma, adenoid cystic carcinoma, and pleomorphic adenoma. CONCLUSIONS: Polymorphous low-grade adenocarcinoma is an increasingly recognized malignancy that originates predominantly in the minor salivary gland. Our experience confirms good local control after a wide local excision is performed, but local recurrences can occur despite having negative margins after surgery. The delayed local recurrences and regional nodal metastases noted in our series show that prolonged follow-up is needed. This series also reports one of the first pathologically confirmed cases of distant metastasis.     

39例头颈部滑膜肉瘤患者的回顾研究

目的：本研究目的在于探索头颈部滑膜肉瘤（SS）的病理诊断、肿瘤部位和临床预后之间的关系。方法：对1966—2011年间华西医院收治的39例头颈部SS患者病历资料进行回顾性研究，复习术中标本的病理切片。术后随访1～192个月，平均43．2个月。临床预后指标主要观察术后首次复发时间和患者随访时间，对结果进行统计学处理。结果：患者中男27例，女12例；年龄8～66岁，中位年龄35岁；病理诊断18例为双相性SS，17例为单相性SS，3例为低分化SS。其中4例患者标本通过荧光原位杂交或逆转录聚合酶链反应等细胞遗传学方法确诊。采用单一手术治疗的23个病例术后出现复发，其中最多的进行了4次手术。所有患者中，仅有1例发生了可疑淋巴系统转移。16例在术后行辅助放疗或化疗。4例死亡，但仅有1例死亡与肿瘤复发直接相关。肿瘤的病理分型与复发无显著相关性（Fisher确切概率法，P〉0．05），肿瘤的原发部位与复发亦无显著相关（Fisher确切概率法，P〉0．05）。结论：头颈部sS是一类特殊的实体肿瘤，具有容易复发的特点，但是预后良好。手术仍应作为头颈部SS的首选治疗方式。细胞遗传学方法对本病的确诊以及制定治疗方案具有重要意义。     

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。     

西妥昔单抗联合术后同步放化疗治疗晚期复发性头颈癌的初步观察

目的 评价西妥昔单抗联合术后同步放化疗治疗晚期复发性喉癌及下咽癌患者的近期疗效和不良反应。方法 晚期复发性头颈癌患者6例,其中喉复发癌2例,下咽复发癌1例,下咽癌伴肺转移1例,气管造瘘口复发癌2例。分别予以手术治疗后3周,西妥昔单抗与同步放化疗,用法：西妥昔单抗第1周初始剂量为400mg/m2,以后每周维持剂量为250mg/m2,共3周。所有患者均采用直线加速器放疗,常规分割调强放疗,总剂量60Gy,6周完成。在放疗的同时给予化疗,方案是：DDP 80mg/m2/d1,5 Fu 800mg/m2,120h持续化疗泵静滴。化疗1次/3周,共3次。结果 所有患者均顺利完成治疗计划。西妥昔单抗主要不良反应为皮疹、口腔炎、疲乏等。中位随访10个月,病例均存活且肿瘤无进展,未发生远处转移。结论 西妥昔单抗联合术后同步放化疗治疗晚期复发性头颈癌安全有效,治疗计划顺利进行,尚需进行进一步临床试验研究。     

Head and neck liposarcomas: A 32 years experience

Objective

The aim of this review is to study natural history, presentation, treatment and prognosis of head and neck liposarcomas.

Methods

We carry a retrospective study about 15 patients diagnosed and treated in our department between 1969 and 2001. Therapeutic modalities included surgery, radiotherapy and chemotherapy.

Results

Tumors were mostly localized at the neck (4 cases) and the scalp (3 cases). Cervical lymphadenopathy was found in 1 case. Chest X-ray found showed metastases in 2 cases. Histological types of liposarcomas were the following: myxoid (5 cases), well differentiated (4 cases), pleomorphic (4 cases), round cell (1 case) and dedifferentiated (1 case). Twelve patients underwent surgery. Complete excision was performed in 7 cases. In the other 5 cases, exeresis was incomplete and 4 of them received postoperative radiotherapy.Three patients were not operated because of vascular involvement (1 case) or metastasis (2 cases), and they all received radiotherapy alone. After initial treatment, complete remission was achieved in 7 cases (46.7%). A recurrence occurred in 8 cases (53.3%). Two of these patients were reoperated and another one received chemotherapy. In the other 5 cases, the tumor was uncontrollable and no additional treatment has been proposed. Five-year survival rate was 87% for patients who underwent surgery alone, 75% for those who underwent surgery and postoperative radiotherapy, and 0% for those treated by radiotherapy alone.

Conclusion

The mainstay of treatment of head and neck liposarcomas is surgical excision and the prognosis is largely determined by the histological grade and the clinical stage.     

头颈鳞状细胞癌乏氧微环境与放疗抵抗相关性的研究进展

头颈鳞状细胞癌(HNSCC)的治疗方式有手术和放化疗.治疗后HSNCC的高复发率及其显著的转移能力是影响HNSCC患者预后的主要因素,且放化疗存在各种并发症,包括放射性口腔黏膜炎、局部软组织损伤等,严重影响患者生活质量.而肿瘤局部组织内乏氧造成的乏氧微环境与肿瘤治疗抵抗和复发的关系密切相关,如果能采取措施改善肿瘤微环境...     

Distant lymphatic metastasis from head and neck cancer.

A predictable pattern of metastasis based on tumor histology and site of origin has been well documented for most cancers that arise in the head and neck region. The current study demonstrates that this predictable pattern of metastasis can be significantly impacted by previous therapy, resulting in unusual patterns of metastasis in patients with recurrent tumors. A retrospective case series of 5 patients with head and neck carcinomas who developed metastases to distant lymph nodes is presented. All patients underwent surgery and radiotherapy to the primary tumor and regional lymphatics at the time of their initial treatment. All of the patients developed a local recurrence less than a year before the detection of distant lymphatic metastases. Cytology or excision confirmed metastases to the axillary, inguinal, or anterior intercostal lymph nodes. All of the patients underwent aggressive surgery for attempted cure of the local recurrence shortly before the presence of distant lymphatic metastases was clinically recognized. The metastatic workup of patients with carcinomas of the head and neck frequently includes examination of the regional lymph nodes as well as chest radiography, liver function tests, and serum calcium determination. This evaluation may fail to detect metastases to distant lymph nodes in patients who present with recurrent or second primary cancers. Such patients should undergo careful examination of all major lymph node-bearing regions of the body when being evaluated for the presence of distant metastases.