原发性鼻腔透明细胞癌1例并文献复习

Primary nasal clear cell carcinoma:a case report and literature review

目的:探讨原发性鼻腔透明细胞癌的临床表现及病理特点,总结其诊断及治疗方法。方法:分析1例原发性鼻腔透明细胞癌患者的临床资料,复习1992年以来11例相关文献,做出总结报道。结果:12例原发性鼻腔-鼻窦透明细胞癌中8例(66.7%)主要表现为鼻出血,4例(33.3%)出现骨质破坏;CT显示鼻腔、鼻窦内条片状类似软组织密度影,行单纯手术切除治疗3例(25.0%),手术切除联合放、化疗7例(58.3%),单纯放化疗2例(16.7%)。治疗后随访6个月～10年,仅1例患者因出现肺部转移死亡,余均健在。结论:原发性鼻腔-鼻窦透明细胞癌较罕见,早期症状以鼻出血多见,病理学上需与转移性透明细胞癌及多种含透明细胞的涎腺肿瘤鉴别。治疗以手术切除联合放化疗为主,短期内预后较好。早期局限于鼻腔和鼻窦的有基底的肿瘤可考虑鼻内镜手术,术后建议每半年复查一次。

Objective： To explore the clinical and pathological characteristics of the primary nasal-sinonasal clear cell carcinoma, and then summarize the diagnosis and treatment. Method：The clinical, imaging and pathologi- cal data were analyzed in one patient with primary nasal-sinonasal clear cell carcinoma. The domestic and foreign related literatures from 1992 were reviewed and summarized. Result： In 12 cases of primary nasal-sinonasal clear cell carcinoma, 8 cases（66.7%）mainly presented with nasal bleeding,4 cases（33.3~） with destroyed bone. CT scan showed the sheet shadow similar to soft tissue density in the nasal cavity and paranasal sinuses. Three cases （25.0 %）were only treated by surgical resection, 7 cases（58.3 %） were treated by surgical resection combined with radiotherapy and chemotherapy, 2 cases（16.7 ~） were treated by radiotherapy alone. During the 6 months to 10 years follow up, only one patient died of lung metastasis. Conclusion： Primary nasal-sinonasal clear Cell carcinoma is rare. Nasal bleeding is commonly one of the early symptoms. It must be differentiated from metastatic clear cell carcinoma and a variety of salivary gland tumors with clear cell in pathology. Surgery combined with radiotherapy and chemotherapy is effective treatment. Short-term prognosis is good. Endoscopic surgery can be used to the tumor with a base limited in the nasal cavity and sinuses in early time. The regular check after surgery should be taken to the patients every half a year.