口腔颌面-头颈部癌肉瘤10例临床分析

Clinicopathological features of carcinosarcoma in oromaxillofacial head and neck region

目的:探讨口腔颌面-头颈部癌肉瘤(carcinosarcoma)的临床特征、病理特征、治疗方法及预后。方法:对上海交通大学医学院附属第九人民医院收集的10例口腔颌面-头颈部癌肉瘤患者的临床及病理资料进行分析,包括临床表现、影像学表现、病理表现、治疗及愈后等方面。结果:10例患者中,男8例,女2例;年龄20~81岁,平均44岁(中位年龄45.5岁)。肿瘤大小不一,直径在1.5 cm以上,与发生部位有关。临床表现多为异物感或迅速增大的肿物,甚至疼痛不适。病理证实含癌及肉瘤样间质,为癌肉瘤。临床上主要与鳞癌相鉴别,确诊取决于术后病理检查尤其是免疫组织化学分析。鳞状细胞癌为上皮样组织的恶性肿瘤,而癌肉瘤则兼有上皮样组织及间叶样组织。预后较差,5年生存率50%。结论:癌肉瘤确诊依赖于术后病理学检查,手术完整切除+血管化皮瓣修复+术后放疗为常规治疗方法,根据实际情况予以化疗。

PURPOSE： To analyze the clinical features, histopathological features, treatment and prognosis of carcinosarcoma in oromaxillofacial head and neck region. METHODS： The clinical and histopathologieal data of 10 cases with carcinosarama were collected from database of Shanghai Ninth People＇s Hospital and further analyzed. RESULTS： A total of 10 cases （8 males and 2 females） of earcinosareoma were collected and analyzed. The age of patients ranged from 20 to gl years （mean： 44, median：45.5）. The tumor size was related to the primary site. The main clinical manifestations indicated rapid increase of foreign body sensation or mass, even feeling of pain. Pathologic examination confirmed the presence of carcinoma and sarcomatoid stroma. Carcinosareoma had low incidence and was easily misdiagnosed. Diagnosis depended on pathologic examination especially immunohistochemistry. The prognosis was poor, and 5 year survival rate was 50%. CONCLUSIONS： Diagnosis to careinosarcoma depends on pathological examination after operation. Complete resection ＋ free flap transplantation ＋ postoperative radiotherapy and chemotherapy are conventional treatment.