头颈部髓外浆细胞瘤10例临床分析

Clinical analysis of 10 cases with extramedullary plasmacytoma of the head and neck

目的探讨头颈部髓外浆细胞瘤(extramedullary plasmacytoma,EMP)的临床特点、治疗方法和疗效。方法回顾性分析2005年1月至2020年1月期间河南省肿瘤医院收治的10例头颈部EMP患者的病历资料,其中男性6例,女性4例,年龄34~74岁。病变部位位于鼻腔3例,鼻咽部2例,喉部2例,鼻窦1例,口咽部1例,颈部淋巴结1例。根据肿瘤病变范围,能彻底切除(切缘阴性)的首选彻底切除,不能彻底切除的行术后放疗或者单纯放疗。分析EMP临床特点、诊断、治疗及预后情况。结果本组病例无特异性临床表现,主要表现为局部阻塞症状及局限性包块。所有患者病理均证实为单克隆浆细胞病变,骨髓穿刺均未发现异常,影像学检查未发现其他病灶。10例患者中,5例接受手术治疗,3例单纯放疗,2例同时接受了手术和放疗。随访时间为16~125个月,中位随访时间为92个月。在随访期间,5例单纯手术治疗的患者无局部复发及进展,1例单纯放疗患者及1例术后放疗患者进展为多发性骨髓瘤(multiple myeloma,MM)。1例术后给予放疗的患者,7年后复发,再次给予手术治疗,术后随访1个月无复发。其余患者随访期间无复发迹象。结论头颈部EMP预后好,对于可彻底切除的病变手术治疗具有重要意义。

Objective To explore the clinical characteristics,treatment methods and outcomes of extramedullary plasmacytoma of the head and neck.Methods A retrospective analysis was conducted on 10 cases with extramedullary plasmacytoma of the head and neck who were admitted to Henan Tumor Hospital from January 2005 to January 2020.Among the 10 patients,6 were male and 4 were female.The average age at diagnosis was 56.3 years old(34-74 years old).Among them,3 cases were located in the nasal cavity,2 cases in the nasopharynx,1 case in the sinuses,2 cases in the larynx,1 case in the oropharynx,and 1 case in the cervical lymph nodes.Treatments were administered according to tumor size and resection extent.Complete surgical excision(negative margins)was preferred,followed by adjuvant radiotherapy or radiotherapy alone.The clinical characteristics,diagnosis,treatment and prognosis of EMP were analyzed.Results The patients′symptoms were not specific,frequently with local obstruction symptom and localized masses.All patients were confirmed pathologically as suffering from monoclonal plasmacytoma,with negative bone marrow biopsy and negative skeletal survey.Five patients received surgery,3 received radiotherapy,and 2 received surgery with additional radiation.The follow-up time was 16-125 months,with a median of 92 months.Two patients developed into multiple myeloma.One patient who received radiotherapy after surgery relapsed after 7 years of follow-up and again received surgical treatment,with no evidence of second recurrence.The remaining patients had no recurrence or progression.Conclusion Extramedullary plasmacytoma of the head and neck has a good prognosis.Surgical treatment can be considered for completely resectable lesions.