咽喉部肉瘤样癌5例报告及文献复习

doi:10.13481/j.1671-587x.20190339

摘要/Abstract

摘要： 目的：探讨5例咽喉部肉瘤样癌患者的临床特征、病理学表现、治疗方法和预后。方法：回顾性分析5例经病理检查证实的咽喉部肉瘤样癌患者的临床资料，并进行相关文献复习。结果：5例咽喉部肉瘤样癌患者中，4例患者为男性，1例患者为女性；发病年龄为55~77岁；3例患者有长期吸烟史，2例患者有长期饮酒史。患者均表现为咽痛、咽部异物感、声音嘶哑及呼吸困难等，5例患者均行电子喉镜检查，1例患者表现为菜花样肿物，其余患者表现为较光滑肿物。2例患者行CT检查，肿物表现为软组织密度影，无骨质破坏。5例患者均行手术治疗，2例患者行术后辅助性放疗，1例患者行术后化疗；术后组织病理学检查及免疫组织化学染色结果显示5例患者均诊断为肉瘤样癌；术后随访1~36个月，随访率为100%，其中1例患者存活，4例患者死亡。结论：咽喉部肉瘤样癌无特异的临床特点，多呈息肉状生长，易误诊，其恶性程度高于鳞状细胞癌，易复发，晚期易转移，预后差，确诊依靠组织病理学检查，治疗首选手术切除。

关键词: 肉瘤样癌, 咽喉部, 梭形细胞癌, 组织病理学, 免疫组织化学

Abstract: Objective:To investigate the clinical features,pathological features,treatment methods and prognosis of 5 patients with sarcomatoid carcinoma of throat. Methods:The clinical data of 5 patients with sarcomatoid carcinoma of throat confirmed by pathology were retrospectively analyzed,and the relevant literatures were reviewed. Results:Among 5 patients with sarcomatoid carciroma of throat,4 patients were male and 1 patient was female,with the onset age from 55 to 77 years old. Among them, 3 patients had a long-term smoking history and 2 patients had a long-term drinking history.The chief complaints of the patients were pharyngeal pain,foreign body sensation in the pharynx,hoarseness and dyspnea,etc.All 5 patients underwent electronic laryngoscope examination,and 1 case presented cauliflower mass,while the other patients presented smooth mass.CT examination was performed in 2 patients,and the mass showed soft tissue density shadow without bone destruction. All 5 patients received surgical treatment,including 2 cases of adjuvant radiotherapy after operation and 1 case of chemotherapy after operation.The postoperative histopathological examination and immunohistochemical staining results showed that the diagnosis of 5 patients was sarcomatoid carcinoma.The postoperative follow-up time was 1-36 months,and the follow-up rate was 100%;among 5 patients,1 case survived and 4 cases died. Conclusion:Sarcomatoid carcinoma of throat has no specifically clinical characteristics,and mainly present polypoid growth and is easy to be misdiagnosed.Its malignant degree is higher than that of squamous cell carcinoma,and it is easy to relapse and metastasis in the late stage. Its prognosis is poor,the diagnosis depends on the pathological examination,and surgical resection is preferred.

Key words: sarcomatoid carcinoma, throat, spindle cell carcinomas, histopathology, immunohistochemistry

中图分类号:

R739.65

田艳华, 苏凯, 王三春, 童卫芳, 张旭, 魏明雪, 冯青杰. 咽喉部肉瘤样癌5例报告及文献复习[J]. 吉林大学学报(医学版), 2019, 45(03): 697-700.

TIAN Yanhua, SU Kai, WANG Sanchun, TONG Weifang, ZHANG Xu, WEI Mingxue, FENG Qingjie. Sarcomatoid carcinoma of throat: A report of 5 cases and literature review[J]. Journal of Jilin University(Medicine Edition), 2019, 45(03): 697-700.

参考文献

[1] BOAMAHH, BALLARD B. A case report of spindle cell (sarcomatoid) carcinoma of the larynx[J]. Case Rep Med,2012,2012:370204.
[2] LEWIS JE, OLSENl KD, SEBO TJ. Spindle cell carcinoma of the larynx:review of 26 cases including DNA content and immunohistochemistry[J]. Hum Pathol,1997, 28:664-673.
[3] MARIONI G, BOTTIN R, SSTFFIER A, et al. Spindle-cell tumours of the larynx:diagnostic pitfalls. A case report and review of the literature[J]. Acta Otolaryngol,2003,123:86-90.
[4] SAMDHANI S, CHOUDHARY A, MAHANTA VR, et al. Spindle cell sarcoma of larynx[J]. Indian J Otolaryngol Head Neck Surg,2006, 58:305-306.
[5] SINGH P, KANOTRA JP, LUTHRA D, et al. Sarcomatoid carcinoma of larynx[J].Indian J Otolaryngol Head Neck Surg,2000,52:189-190.
[6] TULUNAY O, KUCUK B, YORULMAZ I, et al. Sarcomatoid carcinoma of the larynx:immunohistochemical analysis in two cases[J]. Otolaryngol Head Neck Surg,2006, 134:1057-1059.
[7] LYU D, YANG H, XIONG S, et al. Clinicopathologic study with sarcomatoid carcinoma of the larynx:report of eight cases[J]. Chin J Otorhinolaryngol Head Neck Surg, 2015, 50(6):512-514.
[8] OLSEN K D, LEWIS J E, SUMAN V J. Spindle cell carcinoma of the larynx and hypopharynx[J]. Otolaryngol Head Neck Surg, 1997, 116(1):47-52.
[9] CHANG N J, KAO D S, LEE L Y, et al. Sarcomatoid carcinoma in head and neck:a review of 30 years of experience-clinical outcomes and reconstructive results[J]. Ann Plastic Surg, 2013, 71:S1-S7.
[10] THOMPSON L D R, WIENEKE J A, MLIETTINENI M, et al. Spindle cell (sarcomatoid) carcinomas of the larynx:a clinicopathologic study of 187 cases[J]. Am J Surg Pathol, 2002, 26(2):153-170.
[11] ZIDAR N, GALE N. Carcinosarcoma and spindle cell carcinoma-monoclonal neoplasms undergoing epithelial-mesenchymal transition[J]. Virchows Archiv, 2015, 466(3):357-358.
[12] 赵玮,周岩,顾朝辉.喉肉瘤样癌一例[J].中国医师进修杂志,2013,36(18):76.
[13] VWANATHANIS S, RAHMAN K, PALLAV S, et al. Sarcomatoid (spindle cell) carcinoma of the head and neck mucosal region:a clinicopathologic review of 103 cases from a tertiary referral cancer centre[J]. Head Neck Pathol,2010,4:265-275.
[14] 廖芝玲.恶性纤维组织细胞瘤40例临床病理分析[J].广西医学,2000,22(2):329.
[15] LEVENTON G S, EVANS H L. Sarcomatoid squamous cell carcinoma of the mucous membranes of the head and neck:a clinicopathologic study of 20 cases[J]. Cancer, 1981, 48(4):994-1003.
[16] MENDENHALL W M, PARSONS J T, STRINGER S P, et al. Management of Tis, T1, and T2 squamous cell carcinoma of the glottic larynx[J]. Am J Otolaryngol, 1994, 15(4):250-257.
[17] SU H H, CHU S T, HOU Y Y, et al. Spindle cell carcinoma of the oral cavity and oropharynx:factors affecting outcome[J]. J Chin Med Associat, 2006, 69(10):478-483.
[18] BALLO MT, GARDEN AS, El-NAGGAR AK, et al. Radiation therapy for early stage (T1-T2) sarcomatoid carcinoma of true vocal cords:outcomes and patterns of failure[J]. Laryngoscope, 1998, 108:760-763.
[19] KELLY M, HAHN S, SPAULDING C, et al. Definitive radiotherapy in the management of stage Ⅰ and Ⅱ carcinomas of the glottis[J]. Ann Otol Rhinol Laryngol,1989, 98:235-239.
[20] OSORIO-VELASQUEZ A, CHIESA-ESTOMBA C M, BETANCES-REINOSO F A, et al. Sarcomatoid carcinoma of larynx. A histological challenge?[J]. Revista Espanola De Patologia,2018, 51(1):30-33.
[21] ZHANG M, ZHAO L M, LI X M, et al. True carcinosarcoma of the larynx[J]. J Laryngol Otol, 2013, 127(1):100-103.
[22] LUNA-ORTIZ A. Mosqueda-taylor supracricoid partial laryngectomy as a primary treatment for carcinosarcoma of the larynx[J]. Ear Nose Throat J, 2006,85(5):337-341.
[23] AMPIL F L. The controversial role of radiotherapy in spindle cell carcinoma (pseudosarcoma) of the head and neck[J]. Radiat Med,1985,3:225-229.