复发性鼻咽血管纤维瘤

目的探讨复发性鼻咽血管纤维瘤的临床特征,减少复发率,进一步提高诊治水平。方法回顾分析了16例复发性鼻咽血管纤维瘤的症状、体征、CT及MRI表现、手术方法和径路,手术效果及复发因素。结果手术后平均复发时间为8个月,其中1次复发9例,2次复发5例,3次复发2例,肿瘤的复发与肿瘤的分期有关;术中出血量与患者的年龄、病程、肿瘤的分期及手术径路的选择有关。结论术前充分了解肿瘤的范围是降低复发率的关键,选择合适的手术径路是降低复发率的必要措施,完全彻底的切除肿瘤是降低复发率的根本保证。     

经鼻内镜鞍内肿瘤切除术

目的总结52例经鼻内镜鞍内肿瘤切除的一些经验以供参考.方法 1996年9月～2001年2月根据术前病理学分类和影像学分期,选择经鼻内镜外科治疗垂体腺瘤患者49例、鞍内颅咽管瘤患者2例、鞍内脑膜瘤1例.结果除1例非分泌性腺瘤(Ⅴ期)和1例脑膜瘤仅行大部分切除外,其余病例瘤组织均得到了完全切除,手术时间为40～180 min(平均90 min).术野清晰、广阔. 术后头痛、视力障碍和闭经泌乳等症状改善.血清泌乳素(prolactin,PRL)和(growth hormone,GH)水平恢复正常.术后随访 3～72个月,2例垂体瘤和1例颅咽管瘤复发,行相同进路的二次手术,复发率为5.8%.本组病例术后有6例患者出现尿崩,仅1例患者需应用口服抗利尿激素治疗.1例颅咽管瘤患者术后第3天出现一次癫痫发作,意识不清,经治疗后痊愈出院.全部病例均未见颅内出血、视神经损伤、脑脊液鼻漏、脑膜炎及其他垂体功能低下等并发症发生.结论经鼻内镜鞍内肿瘤切除术安全、简便、微创,是鞍内肿瘤切除的良好途径.     

鼻内镜下低温等离子射频切除术治疗鼻咽血管纤维瘤的初步观察

目的 探讨鼻内镜下低温等离子射频切除术治疗鼻咽血管纤维瘤(nasopharyngeal angiofibroma,NA)的可行性.方法 回顾性分析2005年12月至2009年8月诊治的4例NA患者的临床资料,其中1例为Ⅰ期患者,3例为Ⅱ期患者,4例患者术前均行选择性动脉栓塞,采用控制性低血压全身麻醉,在鼻内镜下采用低温等离子射频刀完成肿瘤切除手术,双极电凝辅助止血.结果 4例患者肿瘤均彻底切除,手术时间分别为60、80、110、90 min,术中出血量分别为250、250、320、280 ml,所有患者术中、术后均未输血.术后随访6个月至4年,无并发症发生,肿瘤无复发.结论 鼻内镜下低温等离子射频切除手术治疗Ⅰ期及Ⅱ期NA患者,具有出血量少、肿瘤切除彻底等优点,是一种微创的手术治疗方法.     

经鼻内镜鞍内肿瘤切除术

目的 总结52例经鼻内镜鞍内肿瘤切除的一些经验以供参考。方法 1996年9月－2001年2月根据术前病理学分类和影像学分期，选择经鼻内镜外科治疗垂体腺瘤患者49例，鞍内颅咽管瘤患者2例，鞍内脑膜瘤1例。结果 除1例非分泌性腺瘤（V期）和1例脑膜瘤仅行大部分切除外，其余病例瘤组织均得到了完全切除，手术时间为40－180min(平均90min)，术野清晰，广阔，术后头痛，视力障碍和闭经泌乳等症状改善。血清泌乳素（prolactin,PRL)和（rowth hormone,GH）水平恢复正常。术后随访3－72个月，2例垂体瘤和1例颅咽管瘤复发，行相同进路的二次手术，复发率为5．8％。本组病例术后有6例患者出现尿崩，仅1例患者需应用口服抗利尿激素治疗。1例颅咽管瘤患者术后第3天出现一次癫痫发作，意识不清，经治疗后痊愈出院。全部病例均未见颅内出血，视神经损伤，脑脊液鼻漏，脑膜炎及其他功能低下等并发症发生。结论 经鼻内镜鞍内肿瘤切除术安全，简便，微创，是鞍内肿瘤切除的良好途径。     

The mucosal invasion model: a novel in vitro model for evaluating the invasive behavior of mucocutaneous malignancies.

BACKGROUND: Prevention of regional and metastatic spread of cutaneous malignancies requires understanding the physiologic mechanism of tumor cell invasion. In vitro models are convenient for studying the in vitro invasive phenotype of normal cells, tumor cell lines, or genetically altered cells in a 3-dimensional matrix, but they should attempt to recapitulate the complex in vivo submucosal environment. A new acellular extracellular matrix, porcine submucosal matrix (PSM), is thought to accurately recapitulate the submucosal matrix. A novel in vitro model using PSM to assess mucocutaneous tumor cell invasion was studied. METHODS: The morphologic characteristics, growth, and invasive behavior of human head and neck squamous cell carcinoma (UM-SCC-1, UM-SCC-5, UM-SCC-17B, and OSC-19) cell lines were assessed on the PSM gel and compared with commonly used in vitro invasion models (type I collagen and Matrigel matrices). The invasive phenotype of canine kidney cells was also assessed on each matrix, because this cell line is known to demonstrate a characteristic in vitro invasive phenotype. RESULTS: The PSM-supported head and neck squamous cell carcinoma tumor cell line growth and single cell invasion were seen under stimulated conditions, similar to type I collagen gels. The invasive phenotype of canine kidney cells behaved similarly on PSM and collagen. Matrigel did not support growth well, and invasion occurred only superficially in isolated areas. CONCLUSION: The PSM is a good in vitro model for assessment of pharmacologic and genetic manipulations of head and neck squamous cell carcinoma tumor cell lines and has several advantages over other commonly used matrices.     

Comparison of techniques for transsphenoidal pituitary surgery

BACKGROUND: The aim of this study was to compare three different techniques for transsphenoidal pituitary surgery: (1) sublabial transseptal approach with microscopic resection, (2) transnasal transseptal approach with endoscopic resection, and (3) endoscopic approach with endoscopic resection. METHODS: We performed a retrospective review of 50 pituitary surgeries performed by the same neurosurgeon. Demographic, radiographic, and clinical data were collected. RESULTS: Fifteen patients underwent sublabial approach with microscopic tumor resection, 21 patients underwent the transnasal approach with endoscopic resection, and 14 patients underwent the completely endoscopic technique. There were a total of 20 complications in the sublabial group, 13 transnasal complications, and 6 endoscopic complications. Cerebrospinal fluid leak incidence was 53% in the sublabial approaches, 47% transnasal, and 28% in the endoscopic patients. Diabetes insipidus was encountered in 33% of sublabial approaches, 5% of transnasal approaches, and 7% of endoscopic approaches. Lumbar drains were required in 40% of sublabial approaches, 38% of transnasal approaches, and 7% of endoscopic approaches. Nasal packing was used in 100% of sublabial and transnasal approaches and 0% of endoscopic approaches. Mean recurrence rate and follow-up was sublabial in 6.6% (50 months), transnasal in 9.5% (11 months), and endoscopic in 0% (7 months). Average hospital stay for sublabial approaches, transnasal approaches, and endoscopic approaches was 8.3, 6.2, and 3.4 days, respectively (p < 0.05). CONCLUSION: Transsphenoidal pituitary surgery has evolved over the past several decades, because advances in technology have been the catalyst for minimally invasive surgeries. Less invasive approaches, such as the transnasal approach with endoscopic resection of tumor and the completely endoscopic .technique have less morbidity and a shorter hospital stay than traditional sublabial approaches. Continued follow-up is needed to confirm long-term benefits and similar recurrence rates.     

Protein expression of the tumor suppressors p16INK4A and p53 and disease progression in recurrent respiratory papillomatosis

BACKGROUND: Recurrent respiratory papillomatosis (RRP) is a benign condition that rarely metastasizes as invasive squamous cell carcinoma. Although this disease is associated with human papillomavirus, the role of this virus in tumorigenesis is unclear. OBJECTIVES: The aim of this study is to assess the involvement of the tumor suppressors P16INK4A and p53 in RRP tumor progression. DESIGN: Immunohistochemistry of p16INK4A and p53 was performed on biopsies of recurrent squamous papillomas and invasive lesions in nine patients. RESULTS: Twenty biopsies were graded as papillomas (RP), three as papillomas with high-grade dysplasia/carcinoma in situ (HGD/CIS), and two as invasive squamous cell carcinoma (SCCA). Forty-five percent of RP and 60% of HGD/CIS/SCCA expressed p16INK4A. Fifty percent of RP and 100% of HGD/CIS/SCCA expressed p53. The difference in the frequency of p53-positive staining between HGD/CIS and SCCA (100% of tissues examined) and RP (50% of tissues examined) approached statistical significance. Neither p16INK4A nor p53 was predictive of invasive transformation. CONCLUSIONS: Expression of p16INK4A, which is a surrogate for the tumor suppressor retinoblastoma (Rb), did not immediately lead to invasive disease. There is no correlation between disease severity of RRP and level of p16INK4A.     

Endoscopic resection of large sinonasal ossifying fibroma

Fibroosseous lesions of the maxilla and paranasal sinuses differ from one another in their prognosis and treatment, with the most important distinction being that of an ossifying fibroma (OF) and fibrous dysplasia. A clinically significant OF with its potentially more aggressive behavior must be completely resected. A look at historical and current approaches along with a case report of a 19-year-old woman with a recurrent sinonasal OF removed using endoscopic techniques are discussed. The case adds to the growing amount of literature showing a successful alternative to open surgery for large benign sinonasal tumors, when the character of the tumor, desire of the patient, and expertise of the physician permit endoscopic resection. With the improving techniques of sinonasal endoscopy, better care can be provided with less invasive surgery resulting in less recovery time, more aesthetically pleasing results, and decreased potential for infection.     

内镜经口入路腮腺深叶多形性腺瘤切除术

目的探讨内镜经口入路切除腮腺深叶多形性腺瘤的可行性及疗效。方法采用单纯内镜经口入路切除腮腺深叶多形性腺瘤6例,男4例,女2例,年龄18~56岁,平均年龄36岁。其中2例为无意中体检发现咽侧壁膨隆,1例为头痛,3例为咽喉异物感半年。结果6例均完整切除,且无面瘫、声嘶、吞咽困难、伸舌偏斜等颅神经受损症状,仅有1例术后出现腮区肿痛,加压抗感染后改善。术后随访12~40个月,平均24个月,其中1例术后2年复发,病理为腮腺混合瘤恶变。结论内镜经口入路可以彻底切除腮腺深叶多形性腺瘤,是安全、微创的能保留面神经功能的手术入路,但对腮腺恶性肿瘤仍建议开放式入路。     

Aggressive Papillary Tumors of the Temporal Bone

Aggressive papillary tumors of the temporal bone are neoplasms that are locally invasive and destructive. Previously classified on histologic study as middle ear adenomas or adenocarcinomas, observational evidence suggested that they arose from endolymphatic sac. To evaluate this hypothesis, we established a tissue culture from cells derived from such a papillary tumor and compared immunohistochemical stains of the original tumor with stains on endolymphatic epithelium. Similarities in expression of neuroectodermal antigens were observed. Similar staining antigens in cells derived from tumor and the endolymphatic sac provide evidence that epithelium from endolymphatic sac is the site of origin for these aggressive neoplasms. In tissue culture the cells remain contact inhibited and dependent on serum or growth factors with survival beyond the expected senescence at 30 to 50 generations. Therefore the cell culture technique provides a model for study of the disruption of growth control and invasive properties of this tumor.     

甲状腺未分化癌的分子机制研究

甲状腺未分化癌(ATC)是一种罕见的侵袭型甲状腺恶性肿瘤,进展迅速、预后差,目前缺乏疗效显著的治疗方法和早期诊断方案。有学者研究显示,ATC预后不良是由于肿瘤早期突变以及肿瘤侵袭性生长,因此针对ATC发病机制的驱动突变及靶向药物的研究成为新方向。在ATC中涉及与肿瘤进展相关的不同分子途径,并且有学者探讨实施作用于这些分子途径的新疗法,以改善患者生活质量。对ATC分子结构特征的研究成果,为新的靶向治疗带来希望,新的分子机制将有助于发现更多潜在的治疗靶点,综述近年来ATC的分子机制研究概况。     

顺铂和氟脲嘧啶白蛋白微球颈外动脉栓塞化疗治疗头颈部晚期癌

选择性动脉注射抗癌药微球的方法称栓塞化疗，因其具有阻断肿瘤供血和提高局部药物浓度及延长药物活性的双重作用，故对治疗恶性肿瘤有明显疗效。本文采用预外动脉分支注射顺铂白蛋白微球和5－Fu微球的栓塞化疗方法治疗晚期头颈部肿瘤共10例，取得显著效果：10例中有1例肿块完全消退，9例肿块部分消退（肿块缩小在30～70％）；有4例随后施行了根治性手术。随访时间最短26个月，最长44个月，到最后随访时间为止，有5例死亡，5例健在。本文认为，颈外动脉分支注射顺铂微球和5－Fu微球的栓塞化疗方法对治疗晚期头颈肿瘤不失为一种有效的术前辅助手段或一种姑息治疗方法。     

Buccal fat pad flap for transoral repair of radiation-induced necrosis in the lateral oropharyngeal wall

Soft tissue necrosis (STN) is a late toxicity after radiotherapy. Extensive tissue defects due to STN near the carotid artery, such as in the lateral oropharyngeal wall, may lead to infectious pseudoaneurysms associated with fatal bleeding. Such defects are usually treated with transcervical reconstructive surgeries, which are highly invasive and technically difficult.We report a case in which a buccal fat pad (BFP) flap was used for minimally invasive transoral repair of tissue defects due to radiation-induced STN in the lateral oropharyngeal wall. The BFP flap covered the tissue defect, and the wound epithelialized completely. The patient had no dysfunctional mouth opening, speech, or swallowing.The BFP flap can be easily harvested via a minimally invasive transoral approach and is expected to be further utilized for radiation-induced STN in the lateral oropharyngeal wall.     

Endoscopy-assisted transoral resection of a parapharyngeal space schwannoma without mandibular dissection

Of the schwannomas that arise from the parapharyngeal space, those in the high cervical region are particularly invasive, requiring mandibular dissection. Because these tumors are benign, however, excessive surgical invasion and postoperative neurological complications should be avoided. Postoperative dropout symptoms may be avoided by intracapsular extraction, including nerve integrity monitoring (NIM) and narrow-band imaging (NBI). Video laryngoscopy surgery is reported to be useful for transoral resection of pharyngeal and laryngeal tumors. This report describes the transoral removal of a giant schwannoma located in the high cervical region from a 74-years-old man using a surgical support device without mandibular dissection.The tumor was located on the right lateral pharyngeal wall and extended from the upper oropharynx to the hypopharynx while compressing the epiglottis to the skull base. No separation was observed between the internal jugular vein and the internal carotid artery. The tumor was diagnosed as a schwannoma with no malignancy on the basis of the histology of a core needle biopsy (CNB), and was completely and safely removed endoscopically using NIM and NBI, with no need for an external incision or mandibular dissection. This case illustrates that even a huge sympathetic schwannoma located in the parapharyngeal space at a high cervical position can be excised transorally using video-laryngoscopic surgery (TOVS) without mandibular dissection.     

Sialoblastoma of salivary glands in children: Chemotherapy should be discussed as an alternative to mutilating surgery

Sialoblastoma is a very rare congenital salivary gland tumor. No consensus has been reached concerning the treatment of this tumor due to its rarity. The treatment of reference is surgery, which can be mutilating, in the case of a locally invasive tumor. The treatment of metastatic disease is also controversial. The authors report a new case of a 6-year-old girl with a progressively growing left parotid mass since birth. The first cytological diagnosis was that of pleomorphic adenoma. Due to local progression, superficial parotidectomy was performed at the age of 3.5 years and revealed a diagnosis of sialoblastoma. Six months later, local recurrence and lung metastasis were treated by neoadjuvant chemotherapy with a very good partial response on the local recurrence and the lung metastasis, allowing complete parotidectomy with sacrifice of the facial nerve. Bilateral lung biopsies after adjuvant chemotherapy showed total necrosis. No recurrence was observed with a follow-up of 1 year.This case and a review of the literature confirm the very good chemosensitivity of this tumor and argue in favor of neoadjuvant chemotherapy for locally invasive tumors rather than extensive mutilating surgery.     

Mucus-producing adenopapillary carcinoma of minor salivary gland origin with signet ring cells and intracytoplasmic lumina

Summary A histological and subcellular study of a mucus-producing adenopapillary carcinoma of a minor salivary gland is presented. The tumor was located on the buccal mucosa of a 36-year-old white man. Microscopic examination showed that the tumor was an invasive papillary growth with numerous signet-ring cells and mucous production. When viewed under the electron microscope, the tumor exhibited clusters of cells showing intracellular lumina and finely dispersed chromatin.     

Mucus-producing adenopapillary carcinoma of minor salivary gland origin with signet ring cells and intracytoplasmic lumina. A light and electron microscopic study

A histological and subcellular study of a mucus-producing adenopapillary carcinoma of a minor salivary gland is presented. The tumor was located on the buccal mucosa of a 36-year-old white man. Microscopic examination showed that the tumor was an invasive papillary growth with numerous signet-ring cells and mucous production. When viewed under the electron microscope, the tumor exhibited clusters of cells showing intracellular lumina and finely dispersed chromatin.     

Expression of MMP-1 in invasive well-differentiated thyroid carcinoma

The objective of this study is to examine the expression of matrix metalloproteinase 1 (MMP-1) in invasive well-differentiated thyroid carcinoma (WDTC) and its relation to clinicopathological features. This retrospective case study group included 26 patients with invasive WDTC who were treated at our center between January 1985 and May 2007. Clinical data were collected from the medical files. MMP-1 expression was tested in samples from paraffin-embedded tumor by immunohistochemical staining. MMP-1 expression correlated with laryngotracheal invasion (p = 0.032), multifocality of the tumor (p = 0.044), and presence of regional (p = 0.034) and distant metastases (p = 0.048). In conclusion, the expression of MMP-1 in invasive WDTC is consistent with tumor aggressiveness, manifested by laryngotracheal invasion, multifocality, and regional and distant metastases. MMP-1 expression may serve as a prognostic marker and an indicator for the need for more aggressive surgical treatment.     

Sublabial approach to sinonasal juvenile ossifying fibroma

Juvenile ossifying fibroma is a rare, unusual fibro-osseous benign tumor of the craniofacial region. It is a progressively growing tumor and has to be removed completely to prevent recurrence. A radical surgery is not advisable in a pediatric patient. Here we describe the sublabial approach for excision of this tumor that allows the complete removal of the tumor without compromising with the aesthetic looks of the patient.     

Riedel’s thyroiditis associated with follicular carcinoma

Riedel’s thyroiditis is an uncommon disorder of unknown etiology that is characterized by an invasive fibrotic process that partially destroys the gland and extends into adjacent neck structures. Its clinical manifestation as a stony-hard, poorly defined enlargement over the thyroid gland and local compression of the trachea, esophagus and recurrent laryngeal nerve can mimic invasive thyroid carcinoma. Because Riedel’s thyroiditis is a self-limiting disease, its management should be conservative. However, invasive cancer such as follicular carcinoma can occur in association with Riedel’s thyroiditis. Such a concurrence completely changes the focus of management. We report a case of Riedel’s thyroiditis that was found in a patient with a follicular carcinoma. The strategy of management is discussed together with a review of the relevant literature. Received: 27 October 1998 / Accepted: 16 February 1999