喉梭形细胞癌1例并文献复习

Spindle cell carcinoma of larynx: a case report and literature review

目的探讨喉梭形细胞癌(spindle cell carcinoma,SPCC)临床病理学特点、诊断、鉴别诊断及预后。方法对1例喉梭形细胞临床特征、组织学及免疫表型进行观察,并复习相关文献。结果患者,男,79岁,主因"声嘶半年,加重1月"入院。患者自诉半年前无明显诱因出现声嘶,专科检查:双声带全长及左室带前联合处可见菜花样新生物。术中见:双侧声带及前联合处不光滑新生物,肿瘤主体位于声带前联合及上方,双侧声带全长表面不光滑,声门下无明显受累。行"支撑喉镜下喉肿物活检+喉全部切除术+左颈部Ⅱ、Ⅲ区淋巴结清扫术"。镜检:肿瘤实质由鳞状细胞癌巢与梭形细胞肿瘤所构成,梭形细胞占肿瘤的主体,约占70-75%,而无明确的骨、软骨、横纹肌肉瘤等异源性成分。免疫表型:梭形细胞Vinmentin、Syn弥漫阳性; P63、P53区域阳性;上皮性标记物CKpan、CK5/6、CK8/18散在阳性; P40散在弱阳性; EMA、CD56、S100均阴性; Ki67指数,呈区域性表达差异,5～55%。结论喉梭形细胞癌是一种罕见的肿瘤,发病率低,文献报道相对较少,对其生物学行为及预后以及治疗方案的研究尚未取得一定的共识,有待于更多病例资料的积累和大宗量的病例研究。

Objective This study aims to investigate the clinicopathological features,diagnosis,differential diagnosis and prognosis of laryngeal spindle cell carcinoma(Spindle Cell Carcinoma of the Larynx). Methods The clinical features,histology and immunophenotype of a case of laryngeal spindle cell combined with the related literatures were observed. Results The patient,a 79-year-old man,was hospitalized with the main cause of "hoarseness half a year,aggravated for one month".There was no obvious inducement to hoarseness half a year ago according to the patient.However,special examination showed that a vegetable pattern could be seen at the site of the full length of double vocal cord and left ventricular anterior band.Intraoperative findings showed a rough structure was located in the bilateral vocal cords and anterior junctions.The tumor was located at the anterior and superior of the vocal cords.The surface of full-length of bilateral vocal cords was not smooth,and the subglottic involvement was not obvious.All laryngectomy with laryngoscope was performed for the lymph node dissection of area Ⅱ and Ⅲ of the left neck.Microscopic examination showed that the tumor substance is composed of squamous cell carcinoma nest and spindle cell tumor,within which spindle cells account for 70-75%.There are no specific allogenic components such as bone,cartilage,rhabdomyosarcoma and so on.Immunophenotype showed that spindle cells were diffusely positive for Vinmentin,Syn,region positive for P53 and P63,scattered positive for epithelial marker CKpan,CK5/6,CK8/18,weak positive for P40 and negative for EMA,CD56,S100.Ki67 index of spindle cells showed regional differences between 5% and 55%. Conclusion Spindle cell carcinoma of larynx is a rare tumor with low incidence and few reports in literature.There is no consensus on its biological behavior,prognosis and treatment.Consequently,more case data accumulation and a large number of case studies are needed.