30例原发性扁桃体恶性肿瘤的发病特征分析

Characteristics of 30 patients with primary tonsillar malignances

目的总结30例原发性扁桃体恶性肿瘤患者的发病特征。方法30例原发性扁桃体恶性肿瘤患者,回顾性分析患者的一般资料、首发症状、就诊经过、局部查体、病理类型等。结果30例患者中,男20例,女10例;年龄33~79岁,平均年龄(58.2±11.6)岁;有吸烟史20例,吸烟时间10~50年,平均吸烟时间(30.3±11.2)年,吸烟者中男19例,女1例。无症状2例,为体检发现;其余28例患者首发症状咽部疼痛(咽痛/吞咽痛)10例,咽异物感10例,颈部包块8例。病程0.5~120.0个月,平均病程(7.9±22.2)个月。其中15例在就诊过程中有抗生素应用史,4例用药后症状有不同程度的改善。局部检查可表现为非对称性扁桃体肿大17例、溃疡型5例、菜花样肿物8例。所有患者扁桃体触诊或扁桃体肿块触诊均明显质硬,溃疡型多有明显的触痛,占80%(4/5)。所有患者血常规白细胞总数均在正常范围。30例患者中鳞状细胞癌19例(63%),淋巴瘤11例(37%)。扁桃体鳞状细胞癌分化程度为高分化3例(16%,3/19),中/低分化16例(84%,16/19)。扁桃体淋巴瘤中弥漫大B细胞淋巴瘤8例(73%,8/11),外周T细胞淋巴瘤2例(18%,2/11),小淋巴细胞淋巴瘤1例(9%,1/11)。结论扁桃体触诊在诊断中占有重要地位,有以下情况建议常规行扁桃体触诊:①咽痛持续半个月以上,或咽异物感持续2个月以上,查体见非对称性扁桃体肿大,血常规正常;②颈部包块为首发症状,查体见非对称性扁桃体肿大。

Objective To summarize the characteristics of 30 patients with primary tonsillar malignances.Methods The general information,first symptoms,medical history,local physical examination,pathological type of 30 patients with primary tonsillar malignances was retrospectively analyzed.Results Among the 30 patients,there were 20 males and 10 females;aged 33-79 years,with an average age of(58.2±11.6)years;20 patients with a history of smoking,smoking for 10 to 50 years,and an average of(30.3±11.2)years.Among smokers,there were 19 males and 1 female.2 cases were asymptomatic and were found by physical examination;the remaining 28 patients had first symptoms of pharyngeal pain(salgia/swallowing)in 10 cases,pharyngeal foreign body sensation in 10 cases,and neck mass in 8 cases.The course of disease ranged from 0.5 to 120.0 months,with an average duration of(7.9±22.2)months.Among them,15 cases had a history of antibiotic application during treatment,and 4 cases had different degrees of improvement in symptoms.Local examination showed asymmetric tonsillar enlargement in 17 cases,ulcerative type in 5 cases and vegetable like tumor in 8 cases.The tonsils or tonsil masses of all patients were obviously hard on palpation,and the ulcer type was mostly tender,accounting for 80%(4/5).The total white blood cell count of all patients was in the normal range.Among the 30 patients,19 cases(63%)were squamous cell carcinoma and 11 cases(37%)were lymphoma.For the degree of differentiation of tonsil squamous cell carcinoma,there was 3 cases of high differentiation(16%,3/19),and 16 cases of medium/low differentiation(84%,16/19).Among tonsil lymphomas,8 cases were diffuse large B-cell lymphoma(73%,8/11),2 cases were peripheral T-cell lymphoma(18%,2/11),1 case was small lymphocytic lymphoma(9%,1/11).Conclusion Tonsillar palpation plays an important role in the diagnosis.Routine tonsil palpation is recommended in the following situations:①Sore throat lasts for more than half a month,or pharyngeal foreign body sensation lasts for more than 2 months,physical examination reveals asymmetric tonsillar enlargement,blood routine is normal;②Neck mass is the first symptom,physical examination revealed asymmetric tonsillar enlargement.