头颈部肌上皮癌临床分析

Clinical analysis of myoepithelial carcinoma of head and neck

目的探讨头颈部肌上皮癌的临床特点、诊断、治疗方式及预后。方法回顾性分析中山大学肿瘤防治中心1992年1月至2006年12月收治的11例头颈部肌上皮癌患者的临床资料。111例患者的原发部位为腮腺5例，硬腭1例，上颌窦1例，咽隐窝1例，口颊1例，头皮1例，牙龈1例。男女比例为4：7；年龄14～60岁，中位年龄37岁。所有病例均经病理组织学或免疫组化诊断。结果11例患者均行手术治疗，其中单纯手术4例，手术＋术后放疗2例，手术＋术后化疗2例，手术＋术后放疗＋术后化疗3例。8例术后局部复发，淋巴转移4例，远处转移4例。病理学类型：梭形细胞型5例，透明细胞型、浆样细胞型各2例，上皮样细胞型、混合型各1例。中位随访时间40个月，至末次随访时8例患者因肿瘤复发死亡，3例存活。结论头颈部肌上皮癌侵袭性强，颈部淋巴转移和远处转移发生概率高，首次治疗不彻底易复发，预后差，是一种高度恶性的肿瘤。治疗以手术为主，术后辅以化、放疗可能有一定效果。

Objective To evaluate clinical feature, diagnosis, treatment and prognosis of myoepithelial carcinoma （MC） in the head and neck. Methods Clinical data of 11 patients which were confirmed by pathology and immunohistochemistry in Cancer Center, Sun Yat-sen University from Jan. 1992 to Dec. 2006 ,were reviewed. There were 5 cases in parotid gland, 1 in hard palate, 1 in maxillary sinus , 1 in pharyngeal recess, 1 in bucea cavioris, 1 in scalp, and 1 in gingiva. Male to female ratio was 4 to 7. The median age at diagnosis was 37 years （range：14-60 years）. Results A11 cases were operated,4 underwent surgery alone ,2 underwent surgery plus adjuvant radiotherapy,2 received surgery plus adjuvant chemotherap, 3 underwent surgery plus adjuvant chemoradiation. After operation, 8 cases occurred local recurrence and 4 cases occurred distance and lymph nodes metastasis. There was spindle cell type in 5 cases, clear cell type, plasmaeytoid cell type in 2 cases, epithelioid cell type, mixed type in 1 case. The median follow-up time was 40 months. Eight patients died of tumar until the last follow-up, while 3 patients lived. Conclusions The characteristic of the tumor was very aggressive, invading the surrounding regions, high rates of lymph node metastasis and high rates of distance metastasis. It was easily recurrence if the surgical excision was not radically for MC, and the prognosis was poorly. MC was a sort of high malignant tumor. Radical operation must be advocated initially. Chemotherapy and radiotherapy may be effective after ooeration.