上颌窦鳞状细胞癌眶侵犯患者眶内容物处理的探讨

目的:探讨晚期上颌窦鳞状细胞癌眶侵犯患者手术中眶内容物的处理。方法:将46例有眶侵犯的晚期上颌窦鳞状细胞癌手术患者分为眶骨壁侵犯组、眶骨膜侵犯组、眶内侵犯组,随访2、3、5年的生存率和2年复发率,并加以统计分析。结果:2、3、5年生存率和2年复发率眶骨壁侵犯组分别为65.2%、55.6%、46.7%和38.1%;眶骨膜侵犯组分别为57.1%、50.0%、45.5%和53.8%;眶内侵犯组分别为44.4%、37.5%、37.5%和62.5%。3组生存率依次降低,复发率依次升高,但均差异无统计学意义(均P>0.05)。结论:晚期眶侵犯上颌窦鳞状细胞癌患者的手术中对有眶骨壁或眶骨膜侵犯者保留眶内容物是可以考虑的。     

Acinic cell carcinoma originating in the nasal cavity

Summary The nasal cavity is a rare site for an acinic cell carcinoma. We have treated one such tumor in a 68-year-old man. He underwent a Denker's operation under general anesthesia and then received postoperative irradiation at 50Gy. He has been kept asymptomatic for the past 2 years. To the best of our knowledge, this case is the third report on the acinic cell tumor in the nasal cavity. A brief literature review is also presented.     

上颌窦内肾透明细胞癌转移1例报道

<正>鼻及鼻窦内转移性肿瘤较少见,多起源于肾癌,亦可见在肾切除术很长时间甚至几十年后转移[1],双侧鼻息肉伴上颌窦内肾透明细胞癌转移尤其罕见,我院近期收治1例双侧鼻息肉伴上颌窦内肾透明细胞癌转移病例,现报告如下。1临床资料患者,男,57岁,因"鼻塞流涕20余年伴上腭部不适2个月"于2013年8月22日收入我院耳鼻喉科。患者20余年前无明显诱因出现双鼻鼻塞,流     

Thymidylate synthase expression as a predictor of clinical response to 5-fluorouracil-based chemoradiotherapy in patients with maxillary sinus squamous cell carcinoma

Objective

The aim of this study was to evaluate the immunohistochemical TS expression in patients with maxillary sinus SCC.Methods The value of immunohistochemical TS expression as a predictive indicator for 5-FU efficacy was retrospectively examined in 47 patients with maxillary sinus SCC.Results Of the 47 patients, 29 (62%) showed complete response for 5-FU based chemoradiotherapy. Seventeen of 19 (89%) TS low cases showed a complete response, whereas 12 of 28 (43%) TS high cases showed complete response for 5-FU based chemoradiotherapy. Low TS patients had significantly better response rates compared with high TS patients.Conclusion These findings suggest that TS expression affects the chemotherapeutic effect of 5-FU in patients with maxillary sinus SCC and the assessment of TS expression level might be useful both in the management and in the treatment of maxillary sinus SCC.     

Prognostic significance of epidermal growth factor receptor in squamous cell carcinoma of the maxillary sinus

Summary The expression of epidermal growth factor receptor (EGFR) was determined immunohistochemically in two groups of maxillary sinus squamous cell carcinomas, one with recurrences at the primary site after combination therapy with radiotherapy, chemotherapy and/or surgery and one without local recurrences. Using a four-graded scale (-,+,++,+++), 9 of the 10 recurrent carcinomas had a staining intensity and proportion of stained cells of ++ or more. A comparable staining intensity was found in 9 of the 18 non-recurrent carcinomas. This difference is statistically significant (Fisher's exact probability test, P < 0.05). These results indicate that an increased expression of EGFR may influence the recurrence rate of squamous cell carcinoma of the maxillary sinus after combined therapy.     

The efficacy and safety of concurrent chemoradiotherapy for maxillary sinus squamous cell carcinoma patients

Objective

Combined treatment modality, e.g., definitive surgery followed by radiotherapy (RT) and definitive RT with concurrent chemotherapy, has been applied for advanced maxillary sinus squamous cell carcinoma (MSSCC) patients to obtain a better survival with organ preservation in Japan.

Methods

The outcome of 40 patients with MSSCC between 1991 and 2007 in our institute was analyzed retrospectively. There were 36 males and 4 females, the average age being 59.5 years (ranging from 34 to 81 years). The median follow-up time was 66.1 months. All the patients had received a combined treatment consisting of definitive surgery, RT, and intra-arterial or systemic chemotherapy. The chemotherapeutic regimen was different depending on the performance status and/or complications of the patients. Since 1998, concurrent chemoradiotherapy with cisplatin, 5-fluorouracil, methotrexate and leucovorin regimen (CCRT–PFML) instead of neo-adjuvant chemotherapy has been applied.

Results

The overall 5-year survival rate was 59.2%, the 5-year disease-specific survival rate was 71.7%, and the 5-year organ preservation survival rate was 42.4%. In the group receiving CCRT–PFML, the overall 5-year survival rate was 60.0%, the 5-year disease-specific survival rate was 76.0%, and the 5-year organ preservation survival rate was 60.3%.

Conclusion

CCRT–PFML for advanced MSSCC patients is feasible to preserve the organs without reducing the survival rate.     

Lymphoepithelial carcinoma of the maxillary sinus with orbital invasion

Lymphoepithelial carcinoma (LEC) of the maxillary sinus is a very rare neoplasm that shares some characteristics with nasopharyngeal carcinoma. Epstein-Barr virus (EBV) has been reported to be associated with LEC located outside of the nasopharynx in Asian populations.     

中晚期上颌窦癌综合疗法及远期疗效观察

自1984年起我院对25例中、晚期上颌窦癌（T26例，T315例，T44例）病人采用三联（术前放疗；保留上颌骨的窦腔病变刮除术，窦腔内贴敷化疗；术后放疗及免疫治疗）综合治疗方法，随访3年，存活16例（64．0％），随访5年存活10例（40．0％），随访10年存活4例（16．0％）。认为此疗法较以往单纯手术或单纯放疗有一定优越性。     

Oncocytic carcinoma of the maxillary sinus: a rare neoplasm

Oncocytic neoplasms are tumors composed of oncocytes (i.e., epithelial cells with a large cytoplasm that is rich in mitochondria). Most cases are benign and originate from the major salivary glands, while the minor salivary glands are rarely involved. Occurrence of oncocytic carcinoma (or malignant oncocytoma) within the sinonasal tract is an unusual event. We report a rare case of maxillary sinus oncocytic carcinoma occurring in a 45-year-old male. Biopsy was consistent with an unspecified salivary gland neoplasm. The patient underwent total maxillectomy through a lateral rhinotomic approach; hard palate reconstruction with temporal myofascial flap was performed. Definitive histology was consistent with oncocytic carcinoma. Due to the local extension of the lesion, postoperative radiotherapy (60 Gy) was delivered. Three years after surgery, the patient is free from disease. A brief analysis of the literature was also accomplished in order to discuss treatment options and prognosis of this unusual neoplasm.     

Schwannoma of maxillary sinus

Schwannoma, also known as neurilemmoma, is a solitary, encapsulated peripheral tumour of neuroectodermal derivation that originates from schwann cells of neural sheath of motor/ sensory peripheral nerves or sympathetic nerves. About one- third of all schwannomas occur in head and neck region but nose and paranasal sinuses, are rare sites. We report a case of schwannoma arising from the maxillary sinus and eroding the orbital floor. To the best of our knowledge, this is the sixth; case of schwannoma solely arising in the maxillary sinus, reported in the literature.     

晚期上颌窦鳞癌远期疗效分析

目的　回顾性分析采用不同方法（放射治疗、手术治疗及综合治疗） 治疗晚期上颌窦鳞癌的远期疗效。方法　资料完整的４３２ 例患者中,Ⅲ期１４１ 例,Ⅳ期２９１ 例;男２４４ 例,女１８８ 例;年龄１４ ～８７ 岁。选用单纯放射治疗、单纯手术及放射治疗＋ 手术的综合治疗。结果　５ 年生存率分别为：单纯放射治疗１５．６％ ,单纯手术２１．７ ％ ,综合治疗４０．１％ （ 其中术前放射治疗者为４０．０％ ,术后放射治疗者为４３．０ ％ ）。侵犯上方结构者５ 年生存率为３１．７％ ,侵犯下方结构者为４６．６％ ,上、下均受侵者２０．０ ％ 。治疗失败的２３８ 例中１９８ 例是局部复发。结论　晚期上颌窦癌的治疗以综合治疗较单纯放射治疗和单纯手术效果好,选择术前或术后放射治疗方式,对生存率无明显影响。术前放射治疗５０Ｇｙ 或术后放射治疗６０ ～７０ Ｇｙ 可能提高生存率。肿瘤侵犯下方结构者预后明显好于侵犯上方结构和上、下均侵及者。有效地控制局部复发是提高上颌窦癌５ 年生存率的关键。     

上颌窦鳞癌两种癌基因及增殖细胞核抗原的表达及意义

目的检测上颌窦鳞癌、上颌窦内翻性乳头状瘤及上颌窦炎性粘膜中ｒａｓ、ｐ５３及增殖细胞核抗原（ｐｒｏｌｉｆｅｒａｔｉｎｇｃｅｌｎｕｃｌｅａｒａｎｔｉｇｅｎ，ＰＣＮＡ）的表达情况，并分析其表达与上颌窦鳞癌临床病理特性和预后的关系。方法应用免疫组织化学方法检测４０例上颌窦鳞癌、２０例上颌窦内翻性乳头状瘤、１０例上颌窦炎性粘膜中ｒａｓ、ｐ５３、ＰＣＮＡ的表达情况。结果ｒａｓ基因表达与上颌窦鳞癌分化程度有关，其表达多见于高分化鳞癌中；ｐ５３基因表达只出现在上颌窦鳞癌中，在上颌窦内翻性乳头状瘤及炎性粘膜中无ｐ５３基因的表达；高ＰＣＮＡ指数上颌窦鳞癌较低ＰＣＮＡ指数者预后为差。结论ｐ５３基因表达可能作为上颌窦鳞癌诊断的标志物之一，ＰＣＮＡ指数可作为上颌窦鳞癌预后的参考指标，并可作为指导上颌窦鳞癌治疗的参考。     

上颌窦鳞状细胞癌细胞周期调控因子表达及意义

目的　检测上颌窦鳞癌、上颌窦内翻性乳头状瘤及上颌窦炎性黏膜中细胞周期蛋白D1(cyclinD1)、细胞周期蛋白E(cyclinE)、P2 1WAF1/CIP1和P2 7KIP1的表达情况 ,分析其表达与上颌窦鳞癌病理分化程度的关系。方法　应用免疫组织化学方法检测 5 0例上颌窦鳞癌、2 0例上颌窦内翻性乳头状瘤、10例上颌窦炎性黏膜中cyclinD1、cyclinE、P2 1WAF1/CIP1和P2 7KIP1的表达情况。结果　①在上颌窦鳞癌、上颌窦内翻性乳头状瘤及上颌窦炎性黏膜中 ,cyclinD1阳性表达率分别为 10 0 %、2 5 0 %、4 8 0 %(P <0 0 5 ) ;cyclinE阳性表达率分别为 2 0 0 %、35 0 %、5 8 0 % (P <0 0 5 ) ;P2 1WAF1/CIP1阳性表达率分别为 80 0 %、6 5 0 %、4 0 0 % (P <0 0 5 ) ;P2 7KIP1阳性表达率分别为 70 0 %、75 0 %、4 0 0 % (P <0 0 5 ) ;②cyclinD1、cyclinE、P2 1WAF1/CIP1和P2 7KIP1阳性表达率与上颌窦鳞癌的性别、T分型差异无显著性 (P >0 0 5 ) ;③P2 1WAF1/CIP1在高、中和低分化的上颌窦鳞癌中阳性表达分别为 11/15、11/19、4 /16 (P <0 0 5 ) ;cyclinD1、cyclinE和P2 7KIP1在高、中和低分化的上颌窦鳞癌中阳性表达率组间比较差异无显著性 (P值均 >0 0 5 )。结论　①在上颌窦炎性黏膜、上颌窦内翻性乳头状瘤及上     

上颌窦癌的治疗──254例临床分析

回顾1975～1991年间收治的254例上颌窦癌患者在不同治疗情况下，包括放疗、化疗、手术，单纯或综合治疗下的局部控制和生存情况。病例随访5年或至死亡，失访者按死亡计。统计学方法用U检验。结果：本组总的局部控制率为59．1％，Ⅱ、Ⅲ、Ⅳ期分别为71．4％、60．5％和54.6％，以R＋S，A＋R＋S的局部控制率为最高，分别为80．0％和92．0％。治疗失败原因多为局部复发。总的3、5年生存率分别为44．1％，35．0％，Ⅱ、Ⅲ、Ⅳ期的5年生存率分别为53．6％、35．3％、30．9％。R＋S和A＋R＋S的5年生存率为54．0％、56．0％，较其它治疗方法为高。上颌窦癌的治疗以计划性的综合术前放、化疗加手术的疗效为最好，早期发现和局部控制是治疗成功的关键。     

p53蛋白与上颌窦鳞癌复发及预后的关系

目的 :探讨上颌窦鳞癌组织中 p5 3蛋白表达的诊断意义及其与复发及预后的关系。方法 :采用鼠单克隆抗体 DO- 7,免疫组化法检测 45例上颌窦鳞状细胞癌患者 (T2 N0 M0 )手术切除的癌组织中 p5 3蛋白含量 ,其过量表达提示 p5 3基因突变体存在。结果 :复发组中 88.2 %的癌组织中有 p5 3蛋白表达 ,显著高于对照组(2 8.6 % ) ,其差异有极显著性意义 (P <0 .0 1)。复发组中 6 1%的癌组织有较强的染色强度 ,高于对照组 (38% ) ,但其差异无显著性意义 (P >0 .0 5 )。结论 :p5 3蛋白可作为预测上颌窦鳞癌复发的基因水平的标记物 ,对其复发及预后具有重要意义。     

经上颌窦前壁双管穿刺径路治疗上颌窦囊肿

目的 研究上颌窦囊肿的手术治疗方法,为临床治疗提供理论依据。方法 对40例上颌窦囊肿患者行经上颌窦前壁双管穿刺径路鼻内镜手术治疗。结果 术后均无牙列酸痛、面部麻木等不适,单纯上颌窦囊肿患者均术后3 d出院。随诊3个月至半年经鼻内镜及鼻窦CT检查,无脓性分泌物,未见囊肿复发。结论 经上颌窦前壁双管穿刺径路治疗上颌窦囊肿具有手术方法简单、治愈率高、创伤小的优点,可减轻患者痛苦,值得临床推广应用。     

Cholesterol granuloma of the maxillary sinus

Cholesterol granuloma (CG) of the maxillary sinus is very rare. In this study, the searching of the literature was performed with the keywords of cholesterol granuloma and maxillary sinus. All retrieved literature were reviewed throughout to identify and analyze all individual characteristics. Two additional cases in our hospital were also included. The result showed that, in the overall 37 cases, the ratio of male to female was about 3:1. Caucasian (14/37) and Turkish (10/37) were reported more frequently. CG of maxillary sinus had an opposite sex predilection compared with the fungus balls of the maxillary sinus. In addition, the comorbidity of these two diseases was found only in one patient in the literature. These results suggested that the different mechanisms other than poor aeration of the maxillary sinus played a role in the formation of CG of maxillary sinus. The diagnosis for CG of the maxillary sinus before operation is difficult, but the clear golden yellow rhinorrhea and hemorrhagic signs may provide a good diagnostic evidence. The symptoms were vague and about half of the patients presented with non-specific symptoms. Therefore, it seemed reasonable that CG of the maxillary sinus was under diagnosed in the clinical practice. Treatment consists of complete excision via Caldwell–Luc or endoscopic approach and provides a good prognosis. Bilateral involvements are rare but possible in this disease entity.     

鼻内窥镜术上颌窦自然开口的处理

目的探讨内窥镜鼻窦手术治疗慢性鼻窦炎、鼻息肉的上颌窦中鼻道开口的重要性及处理方法。方法配对研究５６例双侧鼻窦炎、鼻息肉患者，比较同一患者术中扩大或不扩大上颌窦自然开口的术后情况。结果窦口的开放率在不扩大和扩大上颌窦自然开口的术侧中分别为９２．９％和８０．４％（随访６个月时）。回顾性观察５１例施ＣａｌｄｗｅｌＬｕｃ术的患者，下鼻道造口的术后开放率仅为４０．６％。分析３８张单侧鼻窦炎或鼻息肉的鼻窦ＣＴ片，测量对照侧与病变侧的上颌窦口膜样部的上下径和前后径，差异无显著性。病变侧上颌窦口周围的中鼻甲气化、增生及钩突偏曲、筛泡骨性增生等解剖结构异常的发生率明显高于对照侧（Ｐ＜０．０５）。结论鼻内窥镜下处理上颌窦自然开口的关键是窦口周围的解剖异常因素。     

Bacteriology of acute rhinosinusitis in nasopharyngeal carcinoma survivors: a result of maxillary sinus punctures

Rhinosinusitis is a common complication in patients with nasopharyngeal carcinoma (NPC) who receive radiotherapy. An impaired mucociliary clearance due to this treatment may be the major cause of rhinosinusitis in these irradiated patients. The relative frequency with which various pathogens cause rhinosinusitis in these patients is unknown. This study investigates the bacteriology of acute rhinosinusitis in irradiated NPC patients by maxillary sinus puncture. From October 2001 through July 2006, 20 irradiated NPC patients with radiograph-proven acute maxillary sinusitis received maxillary sinus punctures. Aspirate contents of the sinuses were collected for aerobic and anaerobic cultivation. A total sampling of 26 sides was performed in the 20 patients. The culture rate was 85%. Frequently identified aerobes and facultative anaerobes included alpha-hemolytic streptococcus (n = 8), Staphylococcus aureus (n = 5) and Pseudomonas aeruginosa (n = 3). Streptococcus pneumoniae, Haemophilus influenzae and Moraxella catarrhalis, however, are far less common. This may provide important information about the antibiotic therapy in irradiated NPC patients with acute rhinosinusitis.     

Chromoblastomycosis of the maxillary sinus

Summary We describe a rare case of chromoblastomycosis of the maxillary sinus. Biopsy specimens from the sinus have characteristic features under light microscopy. The prognosis after appropriate treatment is good and involved surgical excision for primary-stage infection and chemotherapy with amphotericin B and 5-fluorocytosine for advanced-stage disease. The clinical possibility of severe fungal infection in the head and neck region is discussed.