头颈部恶性纤维组织细胞瘤21例临床分析

Malignant Fibrous Histiocytoma of Head and Neck:Clinical Analysis of 21 Cases

背景与目的:恶性纤维组织细胞瘤是一类组织结构较复杂的多形性肿瘤,其组织来源和是否应定为独立的疾病尚存在争议,既往文献常将其混同于其他类型恶性肿瘤。本文旨在研究恶性纤维组织细胞瘤的临床及病理特点,以探讨其最佳诊疗方法。方法:回顾性分析我科1984年6月至1999年6月收治的经病理检查证实的头颈部恶性纤维组织细胞瘤患者21例的病例资料。结果:本研究的病例中除有1例失访(按死亡计算)外,其余均已随访3年以上,3年生存率为42.9%(9/21)。采用非手术治疗的2例,因就诊时即已相对晚期,疗效不佳,分别在就诊后2个月、5个月死亡;采用手术治疗的19例,6例术后3年内无复发,13例术后2年内局部复发,9例发生转移,其中7例经再次手术,3例已生存3年以上。21例中,12例术后证实有颈淋巴结转移,颈部淋巴转移率为57.1%。结论:头颈部恶性纤维组织细胞瘤是一类复发率较高的恶性肿瘤,治疗以扩大根治术为首选方法,单独放疗或化疗效果不佳。对术后复发的病例,不应放弃再次手术的机会。

BACKGROUND &OBJECTIVE: Malignant fibrous histiocytoma (MFH) is a type of pleomorphic neoplastic diseases with complex pathological structure. Its histological origin is uncertain. It was often classified as other carcinoma. This study was designed to investigate the clinical and pathological features and improve the diagnosis and treatment. METHODS: To summarize and analyze the clinical experiences of 21 cases of MFH at head and neck proved histologically from June 1984 to June 1999 treated in Department of Head and Neck Surgery, Henan Tumor Hospital. RESULTS: Twenty cases were followed up more than 3 years; one case was lost. The 3 year survival rate was 42.9%(9/21). Nineteen cases were treated with surgery. Two cases in advanced stage were treated by non surgery who died in 2 and 5 months. Among the patients treated with surgery, 6 cases survived without evidence of recurrence more than 3 years, 13 cases recurred within 2 years and 9 cases with metastasis. Seven cases received second surgery after recurrence. Among them,3 cases survived more than 3 years after second surgery. Of all 21 patients, 12 were proved with cervical lymph node metastasis. CONCLUSION: MFH at head and neck region is a kind of malignant disease with high recurrent rate and the cervical lymph node metastasis rate was 57.1%. Amplified radical surgery is the first choice of treatment. The second surgery has special value to the recurrent patients. Radiotherapy alone or chemotherapy alone is not effective to MFH of head and neck region.