喉神经内分泌癌临床分析

Neuroendocrine neoplasms of the larynx

目的探讨喉神经内分泌癌的临床表现、诊断及治疗。方法回顾分析我科收治的3例喉神经内分泌癌,其中非典型类癌1例,行手术切除及颈淋巴结清扫术;神经内分泌型小细胞癌2例,1例行手术切除及颈淋巴结清扫术加术后放化疗,另外1例行放化疗。结果非典型类癌1例,术后19个月发现全身多发骨转移,行化疗后现情况稳定。行手术及术后放化疗的神经内分泌型小细胞癌患者治疗后6个月后死于肿瘤。行放化疗的神经内分泌型小细胞癌患者在两年内死于肿瘤。结论喉神经内分泌肿瘤是一组形态预后各异的病变,正确诊断有赖于临床特点、光镜、免疫组化检查,部分患者需行超微结构检查。放射性核素标记的生长抑素类似物是神经内分泌肿瘤诊断的新方法。不同病理亚型的喉神经内分泌肿瘤的治疗方法及预后是不同的。

Objective To discuss the clinical manifestation, diagnosis and treatment of laryngeal neuroendocrine neoplasms. Methods Three cases of laryngeal neuroendocrine neoplasm were analyzed. One case was diagnosed as atypical carcinoid treated by radical surgery and neck dissection. Another two cases were diagnosed as small cell neuroendocrine carcinoma of the larynx, of which one case was treated by radical surgery and neck dissection combined with radiotherapy and chemotherapy after operation. The other small cell carcinoma case was treated by radiotherapy and chemotherapy. Results Bone metastasis was found 19 months later in the patient of atypical carcinoid after operation. He is in a good condition after chemotherapy. The patient of small cell carcinoma treated by radiotherapy and chemotherapy after operation died of the cancer five months later.The patient of small cell carcinoma treated by radiotherapy and chemotherapy died of distant metastases within two years. Conclusion Laryngeal neuroendocrine neoplasm is composed of a morphologically heterogeneous group of lesions. Accurate diagnosis is primarily based on clinical characteristic, light microscopic and immunohistochemical examination. In some instances, it may be supported by ultrastructural studies. The labeled somatostatin analogues are new methods in the diagnosis of neuroendocrine neoplasms. The therapy and prognosis of different hypotype of the laryngeal neuroendocrine neoplasms are different.