喉及喉咽部非上皮源性恶性肿瘤

Nonepithelial malignant neoplasms of the larynx and hypopharynx

目的讨论临床罕见喉腔及喉咽部非上皮源性恶性肿瘤的临床特征、诊断及治疗。方法自１９８５～１９９６年１２年间，共诊治喉及喉咽部非上皮源性恶性肿瘤２６例，其中喉２３例，喉咽部３例；男２１例，女５例；年龄１６～６５岁。喉肉瘤１１例，髓外浆细胞瘤１例，恶性淋巴瘤９例，恶性黑色素瘤２例，喉咽部平滑肌肉瘤１例，恶性黑色素瘤２例。对２１例患者首选手术切除，并根据其不同的组织病理学特性选择放射治疗或／和化学治疗。结果经６个月～１０年随访，１２例存活４～１０年，其中喉肉瘤６例，声门上区恶性淋巴瘤２例，喉恶性黑色素瘤２例，喉咽部平滑肌肉瘤、恶性黑色素瘤各１例。结论此类肿瘤的共有特征为：①肿瘤表面粘膜多光滑；②喉腔肿瘤较少发生颈淋巴结转移；③临床及病理学诊断、组织学分级较困难，免疫组化检查有助于确诊。

Objectives Nonepithelial Malignant Neoplasms of the larynx and hypopharynx are rare. Their clinical features、diagnosis and treatment were discussed. Methods From 1985 to 1996, 23 cases of nonepithelial malignant neoplasms of the larynx and 3 cases of hypopharynx were diagnosed . There were 21 males and 5 females. Age of the patients ranged from 16 to 65 years. Laryngeal tumours included 11 cases of sarcomas, 1 extramedullary plasmocytoma, 9 lymphomas and 2 malignant melanomas. Hypopharyngeal tumours included 1 leiomyosarcoma and 2 malignant melanomas. Extensive resection was the first treatment for 21 patients. Then, according to their histopathologic features,irradiation or/and chemotherapy were chosen. Results Follow up period was from 6 months to 10 years. There were 12 patients survived for 4 to 10 years , including 6 cases of laryngeal sarcomas, 2 supraglottic lymphomas, 2 malignant melanomas of the larynx, 1 malignant melanoma and 1 leiomyosarcoma of the hypopharynx. Conclusions Characteristics for these tumours were: ①usually covered by intact mucosa; ②laryngeal tumours rarely metastasize to the cervical lymph nodes; ③difficulties in histopathological diagnosis, and immunohistochemistry is helpful to differentiation and determination.