原发性额窦癌三例临床分析

目的 总结诊断和治疗原发性额窦癌的经验与教训.方法 回顾性分析2006-2010年在解放军总医院诊治的3例原发性额窦恶性肿瘤的临床资料.3例均为鳞状细胞癌,其中基底细胞样鳞癌1例,内翻性乳头状瘤癌变(中分化鳞癌)1例,乳头状鳞癌1例.所有病例均通过内镜+额部颅骨切开进路切除肿瘤,手术后给予放疗+化疗.结果 例1放疗结束后半年复查,发现沿发际内冠状切口多发转移癌,遂给予化疗,术后16个月死亡.例2手术后40d(放疗期间)复查,左侧眶内和左侧额窦内上部肿瘤复发,遂行第二次手术(眶内容切除术+肿瘤切除术),第二次术后继续放疗+化疗,3个月后复查,发现骨转移.第一次术后10个月患者死亡.例3手术后出现右侧眶尖综合征,视力丧失.手术+放疗后14个月复查,肿瘤复发,侵犯颅内,患者拒绝再次手术,自动出院,手术后21个月电话随访,患者带瘤生存.结论 原发性额窦恶性肿瘤少见,早期诊断困难.确诊后应积极施行扩大切除术,彻底切除肿瘤,手术后辅助放疗和化疗.原发性额窦恶性肿瘤的预后不佳.

Three cases of primary squamous cell carcinoma in the frontal sinus

Objective Three cases of primary squamous cell carcinoma in the frontal sinus were reported, and the experience obtained from diagnosis, treatment of this rarely seen tumor was presented.Methods Between August 2006 and January 2010, 3 cases of primary squamous cell carcinoma in the frontal sinus were diagnosed and treated including one case of basaloid squamous carcinoma, one moderately differentiated squamous cell carcinoma and one papillary squamous cell carcinoma. All 3 cases were treated with a combined approach using the endoscope and a frontal craniotomy, followed by radiotherapy and chemotherapy. Results Case one developed multiple metastatic carcinoma lesions along the coronal incision inside the hairline. She received radiotherapy and chemotherapy, but died 16 months after surgery. Case 2 was found to have tumor recurrence in the left frontal sinus and orbit 40 days after surgery during his course of radiotherapy. Salvage surgery ( orbital exoneration and tumor resection) was performed and radiotherapy and chemotherapy continued. Three months later, he was found to have bone metastasis and died 10 months after the first surgery. The third case developed orbital apex syndrome and loss of vision on the right side immediately after surgery. Fourteen months after surgery and radiotherapy, she was found to have tumor recurrence in the frontal sinus with intracranial invasion. She refused a second surgical procedure and is still alive with tumor 21 months after her operation. Conclusions The prognosis for patients with frontal sinus carcinoma remains extremely poor. Early detection and extended surgical resection combined with radiotherapy and chemotherapy are needed to improve the survival rates of patients with frontal sinus carcinoma.