鼓室球体瘤误诊3例分析并文献复习

目的：探讨鼓室球体瘤的误诊原因及诊断方法。方法：对2003-2006年住院并经手术和病理证实的3例鼓室球体瘤患者的临床资料进行分析。结果：3例均以听力下降,耳闷胀感为临床特征,类似分泌性中耳炎。增强CT、MR、DSA检查均见异常。取耳后乳突径路完整切除肿瘤。结论：单纯依靠症状及特征,鼓室球体瘤容易误诊为分泌性中耳炎或胆固醇肉芽肿,CT、MR、DSA有助于确诊。

Malignant Proliferating Trichilemmal Tumor in the Right Post Auricular Region

OBJECTIVE To report a case of a malignant proliferating trichilemmal tumor (PTT) in the right postauricular region, and to describe the clinical and histopathologic findings. METHODS Interventional case report and literature review. RESULTS A 46-year-old woman presented with a 15-year history of a nodule of 30×30×10 mm in diameter in the right postauricular region. It was diagnosed as a sebaceous cyst. A local mass excision was performed. Histopathologic examination revealed proliferation of the outer hair sheath epithelium with multiple central areas of trichilemmal kera-tinization. The presence of marked cellular atypia and frequent mitoses indicated a malignant transformation. A second operation employing an enlarged excision was conducted followed by a histopathologic examination showing that there was no malignant tumor remaining. Two weeks after the second operation, 50 cGy of regional prophylactic radiotherapy was applied. The patient was well after 26 months of follow-up and neither recurrences nor metastases were observed. CONCLUSION Malignant PTT is a rare skin neoplasm, with its diagnosis depending on a histopathologic examination. An extend excision is the main treatment after diagnosis.

原发性外耳道神经鞘瘤误诊为囊肿1例分析

对外耳道神经鞘瘤误诊1例分析如下。 1病历摘要 女，23岁。因发现左外耳道肿物1a于2009-08—27收入院。1a前患者无意中触摸到左外耳道下壁有一米粒大肿物，无触痛，无瘙痒，无破溃，无听力改变，一直未诊治，此后该肿物渐增大，现已增大至黄豆粒大小。并觉胀痛，遂于此日来我院门诊，门诊拟“外耳道囊肿”收住本科。入院症见：患者左耳外耳道内可见一黄豆粒大小肿物，位于皮下，质硬，稍触痛，边界清，活动差，鼓膜不能完全视及，无红肿，无出血，无破溃，无耳鸣及听力下降，余无异常。

儿童外耳道胆脂瘤21例分析

目的探讨儿童外耳道胆脂瘤临床特点和治疗方法。方法分析21例4~12岁患者的临床资料。结果 21例均以患耳疼痛、渗液就诊,有血性液17例,CT报告为外耳道软组织样影。12例外耳道内段扩大;8例鼓膜内移;4例侵入中耳。术中见胆脂瘤为黄白发亮或干酪样,13例外耳道骨部皮肤不同程度缺损;10例鼓膜后上象限上皮受损;5例鼓膜穿孔;2例锤骨柄破坏。结论外耳道胆脂瘤侵袭破坏性强,早期症状隐匿,多在耳痛、感染时发现,应早期发现并及时正确治疗。