以岩尖综合征为首发症状的鼻咽癌的临床特点

Clinical characteristics of nasopharyngeal carcinoma with Gradenigo's syndrome as the first symptom

目的探讨以岩尖综合征为首发症状的鼻咽癌的临床特点。方法回顾性分析6例以岩尖综合征为首发症状的鼻咽癌患者的临床资料。结果本组6例患者均为男性,平均发病年龄69岁,平均病程136.8 d,从出现临床症状至诊断为鼻咽癌平均为149.5 d。主要临床表现为中耳乳突炎(6例)、三叉神经分布区疼痛(6例)、外展神经麻痹(2例)、视物模糊(2例)、复视(2例)、霍纳综合征(2例)、颈部及颌下淋巴结肿大(3例)。CT或MRI检查显示,鼻咽部顶后壁或侧壁增厚及颅底骨质破坏。6例患者均行鼻咽部活检,病理诊断为鼻咽癌(鳞状细胞癌),其中非角化性未分化型4例,非角化性分化型2例。4例行放化疗治疗,2例放弃治疗。结论以岩尖综合征为首发症状的鼻咽癌常表现为三叉神经分布区疼痛、中耳乳突炎、外展神经麻痹,可伴有霍纳综合征和颈部及颌下淋巴结肿大。

Objective To investigate the clinical characteristics of nasopharyngeal carcinoma patients with Gradenigo’s syndrome as the first symptom. Methods The clinical data of 6 patients with nasopharyngeal carcinoma having Gradenigo’s syndrome as the first symptom were retrospectively analyzed. Results All 6 patients were male,average age of onset was 69 years old,the average course of disease was 136. 8 d. From the onset of clinical symptoms to the diagnosis of nasopharyngeal carcinoma,the average was 149. 5 d. The main clinical characteristics were otitis media（ 6 cases）,pain in the distribution of the trigeminal nerve（ 6 cases）,palsy of the abducens nerve（ 2 cases）,blurred vision（ 2 cases）,diplopia（ 2 cases）,horner syndrome（ 2 case） and enlarged cervical and submandibular lymph nodes（ 3 cases）. CT or MRI revealed incrassation of soft tissue on posterior or sidewalls of nasopharynx,as well as bone destruction of the skull base. All the 6 patients underwent nasopharyngeal biopsy. The pathological diagnosis was nasopharyngeal carcinoma（ squamous cell carcinoma）, including non-keratinized undifferentiated in 4 cases and non-keratinized differentiated in 2 cases. Four patients underwent concurrent chemotherapy with radiotherapy for local lesion, and other two patients gave up treatment. Conclusion The symptoms of nasopharyngeal carcinoma with Gradenigo’s syndrome as the first symptom is often characterized by pain in the distribution of the trigeminal nerve,otitis media,palsy of the abducens nerve,which can be accompanied by horner syndrome,enlarged cervical and submandibular lymph nodes.