鼻颅底小圆细胞恶性肿瘤的诊断(附123例回顾性分析)

目的:探讨鼻颅底小圆细胞恶性肿瘤的特征和诊断方法。方法:回顾性分析123例病理学特点为小圆细胞的鼻颅底恶性肿瘤患者的资料,比较其临床特点、组织学特征、免疫组织化学和电镜检查结果。结果:123例患者临床上多表现为鼻塞,头痛,涕中带血,复视,视力下降伴体重减轻等。体检发现多数患者单侧鼻腔鼻窦有粗糙易出血的肿物。影像学检查发现鼻颅底软组织肿块,膨胀性或浸润性生长,骨壁破坏。组织学上是分化差的小圆细胞;免疫组织化学检测多数患者在进行5～6个标记物的检测后作出诊断,个别甚至检测20多个标记物才确诊。透射电镜检查5例,可找到桥粒、肌丝等特征性表现。结论:本组患者的临床症状、体征及影像学改变对肿物的恶性生物学特性有重要的提示作用;病理组织学特征可进一步确定病变为小圆细胞恶性肿瘤,但往往难以单凭此作出具体诊断;各种标记物的免疫组织化学检测有助于确定病变的组织来源,是确诊关键之一;透射电镜检查是诊断的有力辅助。

Diagnosis of small round cell tumor of nasal sinus and bases of skull (A report of 123 cases)

Objective:To investigate the features and diagnosis way of small round cell tumor of nasal sinus and bases of skull.Method: A retrospective analysis of 123 case with small round cell tumor of nasal sinus and bases of skull were carried out in our hospital in past ten year. Clinical, histological, radiological and immunohistochemical characters of these cases were studied.Result:All cases usually complained of nasal obstruction, headache, diplopia, nasal mucus with bleeding, vision or weight loss. Expansible or infiltrative lumps were found in nasal sinus or bases of skull in radiological examination. A lot of small round cells were found in these tumors in histological pathology. At least 5-6 cell, tissue or tumor markers were examined immunohistochemically in most of cases before the final diagnosis were made. In some cases over 20 markers were examined. Five cases were carried out transmission electron microscope examination, special features such as desmosome and myofilament were found.Conclusion:Clinical symptom, physical signs and radiological finding can supply malignant evidences of these tumors. Histological examination can make certain that they are small round cell tumors, but final diagnosis is still hard to make only by these. Immunohistochemical examination of various markers can tell the original cha-racters of the specimen tissues, it is the key for final diagnosis. Transmission electron microscope examination is another helpful way for diagnosis.