鼻腔鼻窦肌上皮癌临床分析

Clinical analysis of sinonasal myoepithelial carcinoma

目的探讨鼻腔鼻窦肌上皮癌的临床病理特点、治疗方法及疗效。方法回顾性分析四川省人民医院和浙江大学医学院附属第一医院1990年1月～2008年12月经病理确诊的鼻腔鼻窦肌上皮癌7例患者的临床资料。结果 7例患者均行手术治疗,随访6个月～7年,6例术后复发。3例术后出现颈淋巴结转移,其中2例行颈淋巴结清扫术,1例无手术指征而行放、化疗。3例出现远处转移,至末次随访,6例死亡,1例无瘤生存。结论肌上皮癌是预后极差的恶性上皮性肿瘤,好发于涎腺,而发生于鼻腔鼻窦极为罕见。颈部淋巴结转移和远处转移率较高,治疗以手术为主,术后复发率较高,对放疗和化疗有一定敏感性,宜采用以手术为主的综合治疗。对于cN0的患者,应行分区性颈淋巴结清扫术。

OBJECTIVE To investigate the clinopathological features,therapeutic methods and therapeutic efficacy of myoepithelial carcinoma in head and neck region.METHODS Clinical data of 7 cases which were diagnosed by pathology and immmunohistochemistry from January 1990 to December 2008 were retrospectively analyzed.All cases were proved by pathology and immmunohistochemistry.RESULTS All the cases were received operations.All the patients were followed up for a period of 6 months to 7 years after operation.Three cases occurred cervical lymph node metastasis,of which 2 cases received neck dissection and 1 case received chemotherapy and radiotherapy due to no surgical indications.Three cases occurred distant metastasis.Six patients died of tumor until the last follow-up,while one patient lived with no evidence of disease.CONCLUSION The sinonasal myoepithelial carcinoma is a rare malignant tumor and had a poor prognosis,which often occurs in salivary gland.The incidence of cervical lymph node and distant metastasis is high.Extended local excision with tumor-free margin is the treatment of choice.Chemotherapy and radiotherapy may be helpful to prevent recurrence after operation.The elective neck dissection is generally necessary.