颈淋巴结转移瘤的临床病理学分析

THE CLINICAL PATHOLOGICAL ANALYSIS IN PATIENTS WITH METASTATIC TUMORS IN CERVICAL LYMPH NODES

目的:分析颈淋巴结转移瘤的病理学特点,为判断颈淋巴结起源未明转移瘤(metastasis of unknown origin,MUO)的可能原发部位提供参考性诊断思路.方法:对275例颈淋巴结转移瘤病人的临床资料进行一般性分析,对其中235例已知原发瘤部位病人的颈淋巴结侧位、转移瘤的组织学类型与原发瘤部位进行相关性分析.结果:(1)男性MUO率(19.01%)显著高于女性(9.77%)(P＜0.05).(2)男、女性病人年龄分布均较广泛.(3)Ⅰ～Ⅴ组颈淋巴结转移瘤所在区域与其原发器官淋巴引流区基本相符,而Ⅵ组转移瘤的原发部位除一些常见部位(如肺、乳腺、甲状腺、肾、上消化道)外,还可来自腹、盆腔等远处引流区域且转移至左侧显著多于右侧(P＜0.01).(4)男性有4个组织学类型,依次为鳞癌、腺癌、未分化癌、髓样癌,相对应的原发瘤部位有16个,女性除上述类型外,还有黑色素瘤共5个组织学类型,相对应的原发瘤部位有15个.结论:颈淋巴结转移瘤的原发部位十分复杂,在寻找其原发部位时除要想到每一区域淋巴结回流的常见部位,任何其他可能的原发灶位置也必须系统地回顾,尤其对左锁骨上淋巴结转移瘤.

Objective： Some pathologic characteristics of metastatic tumors in cervical lymph nodes are analysed to provide referenced diagnostic idea of speculating primary site of metastatic tumors in cervical lymph nodes in metastasis of unknown origin （MUO）. Methods. The clinical information of 275 patients with the metastatic tumors in cervical lymph nodes were generally analysed and the relationship between some pathologic parameters and the primary sites of 235 patients in metastasis of known origin （MKO） were especially analysed. Results： （1）The ratio of MUO in male（19.01%） was much higher than that in female （9.77%） remarkably （ P 〈0. 05）. （2）The age ranges of male and female were all extensive. （3）Metastatic tumors in group Ⅰ～Ⅴ cervical lymph nodes were in accord with the draining lymph nodes of primary tumor organs, those in group Ⅵ can be occasionally origined for distant intraabdominal and pelvic organs, besides the common sites, ones in left group Ⅵ were significantly higher than those in right group Ⅵ （P 〈 0. 01）. （4） Adenocarcinoma, squamous cell carcinoma, undifferentiated carcinoma, medullary carcinoma were basical histopathological types in male for 16 and in female for 15 primary sites. Conclusion： Identifying the primary sites in the presence of cervical lymph node metastasis is very complex, the most common sites of origin for each regional group of lymph nodes are considered first, any other possible locations of primary tumors must be systematically reviewed, especially when metastatic tumors in left group Ⅵ cervical lymph nodes.