颈静脉球体瘤误诊分析

目的提高颈静脉球体瘤的诊断水平,研究其误诊因素,降低误诊率。方法回顾性分析47例颈静脉球体瘤患者的临床、术前影像学及病理学诊断资料。结果47例中34例首诊时误诊（72.3%）,误诊疾病分别为慢性中耳炎、分泌性中耳炎、外耳道肿物、神经性耳鸣、Bell麻痹、慢性咽喉炎、神经性耳聋、眩晕、突聋、声带麻痹。术前,影像误诊8例（17.0%）,分别为慢性中耳炎及血管瘤;病理检查10例,误诊8例（80.0%）,分别为外耳道炎性肉芽组织、血管瘤、炎性息肉、鳞状上皮及角化物。结论颈静脉球体瘤少见,临床症状无特征性表现,CT及MRI为重要的诊断依据,免疫组织化学检查有助于颈静脉球体瘤的诊断及鉴别诊断,医师对该病认识不足是导致误诊的主要原因。

Misdiagnosis of glomus jugulare tumor

Objective To improve the successful diagnosis rate of glomus jugulare tumor（GJT）.Methods Clinical diagnosis,imaging diagnosis,and pre-operative pathological diagnosis were retrospectively analyzed in 47 GJT patients（18 males and 29 females） treated at our department from July 1987 to October 2006.Results In this group,34 patients failed to be diagnosed at the first time of medical consultation.The misdiagnosis ratio of the clinic,imaging and pathology was 34/47（72.3%）,8/47（17.0%） and 8/10（80.0%）.The disease was clinically misdiagnosed as chronic otitis media in 14/47（29.8%）,secretory otitis media 6/47（12.8%）,external acoustic meatus mass 3/47（6.4%）,nervous tinnitus 2/47（4.3%）,Bell′s palsy 2/47（4.3%）,chronic pharyngo-laryngitis 2/47（4.3%）,sensorineural deafness 2/47（4.3%）,vertigo 1/47（2.1%）,sudden hearing loss 1/47（2.1%）,and vocal cord paralysis 1/47（2.1%）.Pre-operative imaging studies were misdiagnosed as chronic otitis media in 7/47（14.9%） and hemangioma in 1/47（2.1%）.The disease was pathologically misdiagnosed as inflammatory granulation tissue in 4 cases（40.0%）,hemangioma in 2（20.0%）,inflammatory polyp in 1（10.0%） and keratinized squamous epithelium in 1（10.0%）.Conclusions GJT is likely to be misdiagnosed.The main causes of misdiagnosis are： low incidence of the disease,nonspecific clinical symptoms and unawareness of the doctor.CT and MRI play important roles in diagnosis and also immunohistochemical analysis is beneficial in diagnosis and differential diagnosis of GJT.