喉部未分化软组织肉瘤1例并文献复习

Laryngeal undifferentiated soft-tissue sarcoma:a case report and review of literature

1病例报告患者,男,74岁,因“声嘶1月余”首次入院,伴有咳嗽、咳白色黏痰,偶有气促,无痰中带血、发热、乏力,无反酸、烧心,无咽部异物感,无吞咽困难等。既往吸烟、饮酒史60年。电子喉镜示前连合肿物,大小约1.0cm×0.5cm×0.5cm,呈哑铃状,部分脱入声门下（图1a）。于全身麻醉显微支撑喉镜下行喉肿物切除术,术后病理及免疫组织化学倾向于炎性肌纤维母细胞瘤（图1b）。

Patient presented as a 74-year-old male complaining of hoarseness. Electronic laryngoscope showed a neoplasm whose size was about 1.0 cm×0.5 cm×0.5 cm at anterior commissure. A surgery was con- ducted to excise the neoplasm en bloc. The histopathologieal and immunohistochemistry examination suggested in- flammatory myofibroblastic tumor. A month later, the patient presented with dyspnea and blood-stained sputum. CT scan of neck showed an occupation lesions under glottis. A tracheotomy and a CO2 laser surgery was conducted due to patients will. The histopathological and immunohistochemistry examination suggested undifferentiated sar- coma. We advised him keeping a tracheal cannula to receive further treatment such as radiotherapy or chemothera- py in ontology department, but the patient was not compliant with care instructions for personal reason. He was readmitted 2 months later for dyspnea after plugging the tube. Electronic laryngoscope showed a large neoplasm occupied the laryngeal vestibule, covering the glottis. CT and MRI scan showed the lesion involved spaces of supra- glottic, glottic, subglottic and soft tissue around larynx. Hence, a total laryngotomy and bilateral functional neck dissection was conducted. The histopathological examination agreed with the former one. Three weeks later, the skin around his tracheal cannula swelled, ulcerated and pyorrheal. After 10 days of dressing change, patient died of uncontrolled infection.