4例喉炎性肌纤维母细胞瘤临床表现与组织病理学特点分析

Clinical manifestations and histopathologic features of laryngeal inflammatory myofibroblastic tumour in 4 cases

目的分析4例喉炎性肌纤维母细胞瘤(IMT)患者的临床表现及组织病理学特点、并对患者进行术后随访,为IMT临床诊治提供经验。方法回顾性总结2007年10月—2019年6月复旦大学附属眼耳鼻咽喉科医院诊治的4例喉IMT患者的临床资料,对其临床表现、组织病理学特点及其治疗方法和预后进行统计学分析。结果4例喉IMT患者病变位于声门上及声门区,根据患者的病变范围及病情严重程度,选择显微喉镜手术或开放性手术,术后随访25~140个月,除1例患者死于其他疾病外,其余患者均恢复良好且未见复发和转移。术后切除标本均行组织病理学检查,免疫组织化学结果显示:Vimentin(+),SMA(部分+),Desmin(-),CK(-),Ki67(+)≤45%,ALK(-),CD34(血管+),CD68(±)。结论喉IMT是一种具有复发潜能的低度恶性头颈部肿瘤,其诊断依赖于组织病理学免疫组织化学检查。目前的治疗手段仍首选手术切除为主,必要时行术后放(化)疗,术后需密切随访。

Objective To provide clinical experience for the diagnosis and treatment of laryngeal inflammatory myofibroblastic tumour(IMT)by analyzing and discussing the clinical manifestations and histopathological characteristics as well as follow-up outcomes of this tumour.Methods Clinical data of 4 patients with laryngeal IMT treated in our hospital from Oct 2007 to June 2019 were analyzed retrospectively.The analyzed data included clinical manifestations,histopathological features,treatment methods and prognosis.Results The lesions were located in the glottic and supraglottic compartments in all the 4 patients.Microlaryngoscopic or open surgery was selected according to the extent of lesion and severity of illness.All the postoperative specimens were examined histopathologically with immunohistochemical results as follows:Vimentin(+),smooth muscle actin(SMA)(partial+),Desmin(-),CK(-),Ki67(+)≤45%,anaplastic lymphoma kinase(ALK)(-),CD34(vascular+)and CD68(±).Postoperative follow-up ranged from 25 to 140 months revealed that all patients were in good health without recurrence or metastasis except one died of other disease.Conclusion Laryngeal inflammatory myofibroblastoma is a low-grade malignant head and neck tumour with relapse potential,and its diagnosis depends on histopathological and immunohistochemical examinations.Surgical resection is the preferred treatment method for the disease with postoperative radiotherapy and chemotherapy if necessary.Postoperative close follow-up is required.