喉平滑肌肉瘤1例并文献复习

Laryngeal Leiomyosarcoma:A Case Report and Review of Literatures

目的探讨喉平滑肌肉瘤(leiomyosarcoma,LMS)的临床特征、诊断与治疗方法。方法报道1例喉LMS并复习相关的国内外文献。结果首次就诊纤维喉镜下见声门上有菜花样肿物生长,无溃烂,声门呈裂隙状;再次就诊时肿物已长满声门,有灰白色伪膜附着,声门下无法窥见。电子计算机断层扫描(computed tomography,CT)示会厌、双侧声带及前连合见一结节状等密度影,密度均匀,增强扫描动脉期呈均匀对比强化,边界欠清晰。病理示瘤组织由交织束状排列的嗜伊红梭形细胞组成,胞质宽而丰富,多形性,异型性明显,核分裂像易见。免疫组织化学检测中波形蛋白、钙结合蛋白、特异性平滑肌蛋白、结蛋白呈阳性,肌红蛋白、酪氨激酶受体、抗黑色素特异性抗体、细胞角蛋白、S-100阴性。结论喉LMS是一种罕见的、侵袭性实体肿瘤,其预后通常较差。诊断主要依靠病理及免疫组织化学检测。

Objective To investigate the el＇inical features,diagnostic and therapeutic methods of laryngeal leiomyo- sarcoma （LMS）. Methods The one laryngeal LMS cases and relevant literatures were reviewed. Results The fiber la ryngoscopy showed a cauliflower-like tumor wilhoul fester in the glottis which showed a fissured shape. The re-examina lion of fiber laryngoscopy showed a gray-white pseudomembrane on the surface of the tumor which proliferated and ex- tended all of the glottie area, and the subglottie area could not be detected. Computed tomography （CT） showed a nodular middle-density mass in the epiglottis, two-sided vocal cord abducting paralysis and anterior commissure. Enhanced scan showed homogeneous contrast enhancement in the arterial phase, with unclear boundary. Hematoxylin-eosin stains demon strated that tumor tissues were composed of spindle cells. The cells had wide and abundant cytoplasm with eosinophilic red dye. And many cells were obviously atypia and mitotic. Immunohistochemistry detection showed positive were vimentin, caldesmon, smooth muscle actin, and desmin, at the same time, negative were myoglobin, tyrosine phosphokinase receptor, melanin specific antibody, cytokeratin, and S-100. Conclusion Laryngeal leiomyosarcoma is an extremely rare solid tumor,a poor prognosis,and its diagnose depends on histopathology and immunohistochemistry detections.