鼻咽部肿瘤及瘤样病变的临床病理分析

The clinicopathologic overview of nasopharyngeal tumors and tumour-like lesions

目的加深对鼻咽部肿瘤及瘤样病变发病情况和特点的全面了解,提高临床及病理诊断水平。方法收集鼻咽部肿瘤及瘤样病变活检标本1362例,统计其构成比、发病年龄及性别分布,观察其临床病理变化特点。结果(1)本组鼻咽部肿瘤及瘤样病变总的构成比按组织来源排序如下:淋巴造血组织>上皮组织>软组织>骨及软骨组织>异位颅内组织肿瘤及瘤样病变。恶性肿瘤中排在前五位的是鼻咽癌>淋巴瘤>涎腺型腺癌>脊索瘤>恶性软组织肿瘤;良性肿瘤及瘤样病变中排在前五位的是良性淋巴组织增生症>以血管纤维瘤为主的软组织肿瘤>被覆上皮的乳头状瘤>异位颅内组织肿瘤及瘤样病变>多形性腺瘤。(2)淋巴造血组织来源者868例,良性淋巴组织增生828例,恶性淋巴瘤等恶性病例40例(4.6%,40/868),其中以弥漫性大B细胞淋巴瘤及外周T/NK细胞淋巴瘤居多,男性多见;良性与恶性的比例为20.7:1。上皮组织来源者共373例,其中恶性多见为353例(94.6%,353/373),以鼻咽癌为最多[327例,分别占上皮性肿瘤及恶性上皮性肿瘤的87.7%(327/373)及92.6%(327/353)],其次为腺样囊性癌[11例,分别占2.9%(11/373)及3.1%(11/353)];良性肿瘤以乳头状瘤和错构瘤(16例)及多形性腺瘤(4例)居多;恶性与良性的比例为17.3:1。软组织肿瘤为101例(7.4%,101/1362),其中最常见的是血管纤维瘤77例(76.2%,77/101),均为男性患者;恶性者少见,仅10例;良性与恶性的比例为9.1:1。骨及软骨组织肿瘤中以脊索瘤最多见(11例),男2例,女9例。异位颅内肿瘤及瘤样病变也可见到,共观察到5例。除上述病变外,还收集到其他各种类型肿瘤及瘤样病变共32例,几乎涵盖了2005年版WHO鼻咽部肿瘤分类中列举的所有类型。结论鼻咽部可以发生多种组织类型的肿瘤及瘤样病变,其中以良性淋巴组织增生、鼻咽癌、鼻咽部血管纤维瘤、恶性淋巴瘤和涎腺型腺癌较常见,它们具有特征性的临床和病理改变,其他肿瘤及瘤样病变在临床和病理改变方面与全身其他部位者相同或相似,诊断及鉴别诊断主要依靠病理检查。

Objective To deepen overall understanding of nasopharyngeal tumors and tumor-like lesions and to elevate clinic and pathologic diagnostic level. Methods The samples of 1 362 cases of nasopharyngeal tumors and tumour-like lesions were collected and disease component ratio, age and sex distribution were counted and clinicopathologic features were observed. Results （ 1 ） Disease component ratio decreased in order of lymphohematopoietic tissue, epithelial tissue, soft tissue, bone and cartilaginous tissue, ectopic intracranial tumors and tumour-like lesions. Top five malignant tummours were nasopharyngeal carcinoma（NPC） ,lymphoma, salivary gland-type adenocarcinoma, chordoma and malignant soft tissue tumors. Top five benign lesions were benign lymphoid hyperplasia（BLH）, angiofibroma, papilloma, eetopie intraeranial tumors and tumour-like lesions and pleomorphic adenoma. （2）In lymphohematopoietie lesions, BLH （828 cases） were more than lymphohematopoietic tissue malignant tumors （40 cases）, in which diffuse large B cell lymphoma were more than periphery T/NK cell type with male predominance. Benign and malignant ratio was 20. 7： l. 373 cases arose from epithelium in which malignant ones（353 cases）were majority. The most one was NPC （327 cases, account for 87.7% in total epithelia tumors and 92.6% in epithelial carcinomas respectively）. The second most one was adenoid cystic carcinoma （ 11 cases, account for 2. 9% and 3. 1% respectively）. The most common benign lesions were papilloma and pleomorphic adenoma. The malignant and benign ratio was 17.3 ： 1. Soft tissue tumors were observed in which angiofibroma was most common （77 cases） and all were male. Malignant ones were less common （10 cases） and ratio to benign ones was 1： 9.1. Chordoma was the most common one in the tumors arising from bone and cartilaginous tissue. Ectopic intracrnial tumors and tumour-like lesions also could be seen. Besides above all,32 cases of other types were collected, almost occupying all classifications of WHO （2005）. Conclusions Lots of types of tumors can arise at nasopharygx, in which top five lesions are benign lymphoid hyperplasia, nasopharyngeal carcinoma, nasopharyngeal angiofibroma, malignant lymphoma and salivary gland-type adenocarcimona according to incidence,all of which possess characteristic clinic and pathologic changes. The other lesions are similar to those in other locations. The diagnosis and differential diagnosis depend mainly on pathologic examination.