侵及鼻腔鼻窦的罕见巨大肌上皮癌病例分析

目的探讨鼻腔鼻窦肌上皮癌的诊治要点,防范误诊误治。方法对行手术切除的1例巨大鼻腔鼻窦肌上皮癌的临床资料进行回顾性分析,并复习国内外相关文献。结果本例为56岁男性,因左侧面部凸出巨大肿物3年余,肿物表面间断出血1个月入院。根据专科查体情况及鼻窦CT、MRI检查结果考虑来源于小涎腺的多形性腺瘤恶变或其他罕见肿瘤。经充分术前准备,包括多学科会诊、备足血源、术前肿瘤血管栓塞,术中完整切除一重3 kg、约24.5 cm×16.0 cm×12.0 cm大小的肿瘤。术后病理诊断:肌上皮癌(侵及鼻腔鼻窦)。结论鼻科医师应警惕单侧鼻腔鼻窦病变,加强对肌上皮癌病理特点及免疫组织化学的认识,以期对该病早诊断、早治疗。

Case Analysis of a Giant Myoepithelial Carcinoma in Nasal Cavity and Nasal Sinus

Objective To study the clinical characteristics, diagnosis and management of myoepithelial carcinoma in nasal cavity and nasal sinus;to prevent misdiagnosis or mistherapy. Methods Retrospectively analysis of the clinical data of a patient with giant myoepithelial carcinoma in nasal cavity undergoing surgical removal was made. Results The patient was a 56-year-old male with a giant massive protruding from his face for 3 years and intermittent hemorrhage for 1 month. After careful examination of the head and neck region and assaying the results of computer tomography （ CT） as well as magnetic resonance imaging （ MRI） , malignancy from pleomorphic adenoma in minor salivary glands or other rare tumors was suspec-ted. Sufficient preoperative preparations were performed, including multi-disciplinary consultation, sufficient volume of blood and transvascular embolization. The giant 3 kg mass of 24. 5 cm × 16. 0 cm × 12. 0 cm was successfully removed by surgery. The pathological diagnosis was myoepithelial carcinoma （ invading nasal cavity and sinus） . Conclusion Attention should be paid to unilateral nasal cavity and nasal sinus tumor;and immunohistochemistry is helpful for early diagnoses and therapy.