喉中分化鳞状细胞癌与低分化神经内分泌癌的碰撞癌1例诊疗分析

Analysis of Collision Carcinoma of Larynx Between Moderately Differentiated Squamous Cell Carcinoma and Poorly Differentiated Neuroendocrine Carcinoma from One Case

男性患者,75岁,因声音嘶哑2月入院。喉镜检查提示:右侧喉室见肿物突起、遮挡右侧声带前中份;病检报告提示:查见低分化癌,倾向鳞状细胞癌。全喉切除送病检,诊断为复合性癌,含中分化鳞状细胞癌(约5%)成份及低分化神经内分泌癌(约95%)成份,生长状况考虑为碰撞癌。最终诊断为喉鳞状细胞癌及神经内分泌癌碰撞癌(声门型T4N0M0Ⅳ期)。术后规律放疗,随访6月无复发,但长期是否会发生复发或转移,仍有待观察。头颈部碰撞癌的发病率很低,且多见于甲状腺,而喉部少见。明确诊断大多依靠手术完整切除病变组织后的病理检查及免疫组化检查。碰撞癌治疗方式的选择与病理成分、发病部位、以及是否有远处转移均密切相关,应根据不同组成成分的肿瘤特性制定个性化的治疗方案。由于碰撞癌的偶然性和个体差异性,应引起重视和报道。

A 75-year-old male patient was hospitalized in hoarseness for 2 months. Laryngoscopy showed a mass protruding in right laryngeal chamber and covering the middle part of right vocal cord. Since tumor biopsy showed low differentiation cancer, he received total laryngectomy, and post-operative pathological result found composite carcinoma,which containing medium differentiated squamous cell carcinoma(about 5%) and low differentiated neuroendocrine carcinoma(about 95%). The growth status of tumor indicated it was collision carcinoma. After postoperative regular radiotherapy, no recurrence was found at 6 months of follow-up. The incidence of head and neck collision carcinoma is quite low, and the majority of them occurs in thyroid, which is rare in larynx. The confirmed diagnosis of larynx collision carcinoma is based on postoperative pathological study. The choice of treatment for collision cancer is closely related to the pathological components, the location of the disease and whether there is distant metastasis.