鼻腔鼻窦肾透明细胞癌5例报告并文献复习

Renal clear cell carcinoma in nasal cavity and paranasal sinuses:5 cases report and literature review

目的分析鼻腔鼻窦肾透明细胞癌的临床特征及治疗方案,并探讨其治疗策略及预后。方法回顾性分析2005-2020年解放军总医院耳鼻咽喉头颈外科医学部收治的5例鼻腔鼻窦肾透明细胞癌患者的年龄、性别、发病部位、病程时限等临床特征,探讨其治疗方案及预后,并对相关文献进行复习与总结。结果5例患者均为男性,鼻腔鼻窦肿瘤的发病年龄为49~81岁。5例均伴有反复多量鼻出血,其中1例伴视力下降。发病部位包括上颌窦2例,筛窦和蝶窦1例,筛窦和额窦2例。1例以鼻腔肿瘤为首发症状,全面查体时发现肾癌,后采用B超引导下腹腔灌注及微波消融进行治疗;4例鼻腔肿瘤迟发于肾癌,均在早年进行过肾脏根治性手术。5例患者均行鼻腔鼻窦肿瘤根治性切除,其中3例曾口服靶向药物治疗,1例鼻窦局部曾行放疗,但均无明显效果。截至2020年7月,1例失联,2例死亡,2例带瘤生存。结论鼻腔鼻窦肾透明细胞癌为少见病,以严重鼻出血和周围临近组织器官侵袭受累为主要临床症状,放疗、靶向药物治疗、免疫治疗均无明显效果,鼻腔根治性手术是治疗本病的有效措施,可以缓解临床症状,提高生存质量。

Objective To study the clinical features,treatment plan,treatment strategy and prognosis of renal clear cell carcinoma in nasal cavity and paranasal sinuses.Methods Five cases of renal clear cell carcinoma in nasal cavity and paranasal sinuses from 2005 to 2020 were retrospectively analyzed.The clinical features,such as age,gender,location of disease,duration of disease and so on,were analyzed.The clinical manifestations,treatment plan and prognosis were fully discussed,and the literature results analyzed comprehensively.Results All the 5 patients were male,and the onset age of nasal cavity and paranasal sinuses ranged from 49 to 81 years old.All the 5 patients had recurrent epistaxis,and one of them was accompanied with visual loss.The site of the disease was maxillary sinus in 2 cases,ethmoid sinus and sphenoid sinus in 1 case,ethmoid sinus and frontal sinus in 2 cases.One case with nasal tumor as the first symptom,renal cell carcinoma was found during comprehensive physical examination,and then the renal cell carcinoma was treated with B-ultrasound-guided intraperitoneal perfusion and microwave ablation;four cases with nasal tumor occurred later than renal cell carcinoma,and all had radical operation of kidney in early years.All the 5 patients underwent radical resection of nasal cavity and paranasal sinus tumor.Among them,3 cases were treated with oral targeted drugs,and 1 case was treated with local radiotherapy,but all of them had no obvious effect.As of July 2020,1 patient lost contact,2 patients died and 2 patients survived with tumor.Conclusions Renal clear cell carcinoma in nasal cavity and paranasal sinuses is a rare disease.The main clinical symptoms were severe epistaxis and invasion of adjacent tissues and organs.This disease had no obvious effect on radiotherapy,targeted drug therapy and immunotherapy.Radical resection of nasal cavity can relieve the clinical symptoms and improve the quality of life.