鼻咽粘液表皮样癌(附1 2例临床分析)

背景与目的:鼻咽粘液表皮样癌是鼻咽原发腺癌的一种类型,非常少见,鲜有单独报道。本研究拟对在我院治疗过的鼻咽粘液表皮样癌病例的发病、临床情况、治疗效果进行总结分析。方法:回顾性分析1975年1月至2003年12月在我院经过病理确诊和治疗的鼻咽粘液表皮样癌患者共12例的临床资料,分析其发病特点、临床治疗效果。结果:本组病例仅占同时期我院鼻咽癌患者总数的0.26‰,发病年龄为20～60岁,男女比例为2∶1。EBV血清学检查(VCA-IgA,EA-IgA,DNA酶中和率)阳性率均较低。有随访资料的11例患者中,单纯放疗4例,手术 放疗4例,放疗 化疗3例。本组患者的5,10年生存率分别为27.3%及9.0%,疗效较差。结论:鼻咽粘液表皮样癌是鼻咽癌的一种特殊类型,有其特有的发病规律,放化疗疗效较差,治疗上可能应采取以局部彻底切除为主的综合治疗为宜。     

Muco-Epidermoid carcinoma of the nasopharynx

A rare case of mucoepidermoid carcinoma of the nasopharynx is reported. The salient features of the disease are discussed in the light of available literature.     

Spindle cell carcinoma of the nasopharynx

Two cases of spindle cell carcinoma of the nasophrynx are reported. The pathological features are bfiefly discussed, and the common clinical presentations, along with the current management, are reviewed.     

Adenoid cystic carcinoma of nasopharynx

Adenoid Cystic Carcinoma is quite distinct from other epithelial tumours in selective tissue of origin clinical behaviour and histologic patterns. We report a case wherein the Primary lesion had been successfully treated with radiotherapy and the recurrence with Surgery, After five years patient is living a comfortable life and being followed up. The salient features of the disease are described.     

Merkel cell carcinoma: report of two cases and clinical considerations.

We present the clinical and pathological features of two cases of facial Merkel cell carcinoma (MCC) and a critical reappraisal of the literature on this subject. Among patients with this presentation of a rare neoplasm, the disease is very often localized (local or locoregional growth, without distant metastases). Radiotherapy seems to be highly effective in obtaining local control and possibly cure, even when used as the sole treatment method; prompt regression of the neoplastic masses has been observed in both the cases we treated. One of them, and many of those reported in the literature and treated with radiotherapy alone or combined with surgery, achieved long-term survival.     

Three-dimensional photon treatment planning for carcinoma of the nasopharynx

The role of 3-D treatment planning for carcinoma of the nasopharynx was assessed in a four institution study. Two patients were worked up and had an extensive number of CT scans on which target volumes and normal tissues were defined. Treatment planning was then performed using state of the art dose planning systems for these patients to assess the value of the new technology. In general, it was demonstrated that multi-field conformal plans could achieve good tumor dose coverage, while at the same time reducing normal tissue doses, compared to standard treatment planning techniques. The role of inhomogeneity corrections, beam energy, and the use of CT vs. simulation films for defining target volumes were also discussed. In addition, techniques to evaluate 3-D plans for the nasopharynx were considered, and some analysis of this problem is presented in this paper.     

Transnasal permanent interstitial implantation for carcinoma of the nasopharynx

A technique for transnasal permanent interstitial implantation of the nasopharynx with ¹²⁵I seeds is described. This technique allows the precise placement of radioactive sources into mucosal and submucosal tumors, without the need for palatal fenestration. Preliminary results in 10 patients treated by this technique for recurrent nasopharyngeal carcinoma are presented. In the future we also hope to employ this technique for delivering “boost” irradiation to the primary site, in the initial definitive management of carcinoma of the nasopharynx.     

鼻咽部神经内分泌癌的病理特征和临床分析

目的 探讨鼻咽部神经内分泌癌（neuroendocrine carcinoma,NEC）的临床病理特征、免疫组化特点、治疗方法及预后。方法 回顾性分析12例NEC患者的临床和病理资料,并复习相关文献。 结果 12例患者中,男性10例,女性2例,平均年龄49.4岁,病理类型均为小细胞型NEC。光镜下可见较小瘤细胞,呈圆形、卵圆形和梭形,核深染,胞浆少,核浆比例高,伴有较明显的病理性核分裂象,染色质细腻。免疫表型：CgA、Syn、CD56和EBERs阳性或部分阳性者分别有6例、10例、9例和3例。临床分期Ⅰ期1例,Ⅱ期1例,Ⅲ期4例,Ⅳ期5例,分期不详1例。所有患者均接受放疗和（或）化疗,至随访结束存活者9例,死亡3例。结论 鼻咽部神经内分泌癌临床上较少见,好发于中老年男性,病理类型以小细胞型为主,易出现颈部淋巴转移,就诊时大部分已处中晚期,治疗以放化疗为主。     

Carcinomas of the nasopharynx in children. Analysis of 50 cases

From 1980 to 1990, 50 children were treated for nasopharyngeal carcinoma in the Department of Oncology at the hospital Center Ibn Rochd in Casablanca. There were 34 boys and 16 girls with a median age of 12.3. UCNT were observed in 70% of cases. Fourty six percent were stage T3-T4 and 70% were N2-N3 disease. All children received irradiation therapy and 16 of them have had a neo-adjuvant chemotherapy. Thirty seven children were evaluable, the immediate response was complete in 26/37 cases. Recurrence of disease was noted for four children and metastatic for four others children. Two children have both recurrence and metastatic disease. The overall survival was 40.5% at 3 years. Disease free survival was 37.8% at 3 years.     

Malignant melanoma of nasal fossae: clinical and therapeutic considerations about three cases]

We report in this publication three cases of mucous malignant melanoma of the nasal fossae. The nasal mucous malignant melanoma creates a unilateral obstructive and hemorrhagic tumour, readily septal or situated on the external wall of the nasal fossae (inferior and middle turbinates). The diagnosis established by the clinical examination (pigmented forms) is confirmed by the anatomopathological examination--thanks in particular to its tinctorial affinity for Fontana-Masson colouring. The immunohistochemistry reinforces the diagnosis in the presence of any achromic varieties or those simulating an undifferentiated tumour or neurinoma. Modern imagery (CT Scan, IRM) is impossible to circumvent for a precise loco-regional assessment, an essential preliminary to the therapeutic protocol--mainly of radiosurgical type. Chemotherapy (deticene) remains in force in the metastatic forms. Specific therapies are being evaluated (immunological-hormonal therapy). The forecast of the mucous malignant melanoma remains pejorative with a 10 to 40% survival rate of five years. The improvement of the forecast depends on an early diagnosis, an evolutionary locoregional assessment as complete as possible with an adapted and multidisciplinary choice of therapies (surgery, radiotherapy, immunotherapy, hormonal therapy).     

Chemotherapy-related hemolytic-uremic syndrome following treatment of a carcinoma of the nasopharynx

OBJECTIVE: A cisplatin-containing regimen followed by radiation therapy is the recommended treatment for patients with advanced nasopharyngeal carcinoma. We report a case of a 58-year-old woman with hemolytic-uremic syndrome (HUS) who received induction chemotherapy for undifferentiated squamous cell carcinoma of the nasopharynx. PATIENTS AND METHODS: During the 2nd course of chemotherapy (consisting of bleomycin, cisplatin and epirubicin), the patient developed hemolytic anemia, thrombocytopenia, and acute renal failure. After HUS had been diagnosed, the patient was transferred to the intensive care unit. RESULTS: Twice daily therapeutic plasma exchange (TPE) with fresh-frozen plasma, hemodialysis and high-dose cortisone was performed. Two weeks after the start of plasma exchange, thrombocytes and renal function began to normalize. Low-dose cortisone was continued until the patient recovered from hemolytic anemia. Six weeks after the administration of the second course of chemotherapy, the patient had fully recovered from HUS, and radiation therapy was carried out as planned. The patient responded well to treatment, but died 9 months after the diagnosis due to liver metastases. CONCLUSION: We demonstrated that early TPE with fresh-frozen plasma and high-dose cortisone is a potentially successful treatment modality for the usually fatal, fulminant form of chemotherapy-induced HUS.     

Adenoid cystic carcinoma of the nasopharynx: a case report]

Nasopharyngeal adenoid cystic carcinoma is a rare tumor, few cases have been reported in the literature. The aim of this report is to present a new case of an adenoid cystic carcinoma of the nasopharynx. We report the case of a 50 years-old woman presenting with an adenoid cystic carcinoma of the nasopharynx with diffuse pulmonary metastasis. The treatment combined chemotherapy, based on cisplatin and adriamycin drugs, and palliative radiation therapy at the dose of 30 Gy. The patient died 6 months after diagnosis establishment. The best treatment of adenoid cystic carcinoma is complete surgical resection but extended resection can be difficult in some locations as nasopharynx. The adjuvant radiation therapy seems to improve local control.     

Hodgkin disease of the nasopharynx: report of three cases]

We report three cases of Hodgkin's disease (HD) involving the nasopharynx. Their clinical presentations, morphological and immunohistochimical features and their therapy modalities are discussed. The patients were aged 36, 41 and 77, presenting with increasing bilateral nasal obstruction in one case and a cervical mass in the two others. Histological study showed mixed cellularity type of HD in all cases. The Reed Sternberg cells expressed both of CD15 and CD30 in one case, and only one of them in the other cases. In one case, LMP1 was detected, CD20 and CD3 were not. HD of nasopharynx should be differentiated from EBV-associated lymphoproliferations. The treatment is based on radiotherapy that can be associated to neoadjuvant chemotherapy if nodes are involved.