26例上呼吸道髓外浆细胞瘤临床分析

葛圣雷; 谭志强; 谢鼎华; 易彦

doi:10.13201/j.issn.1001-1781.2013.05.002

26例上呼吸道髓外浆细胞瘤临床分析

- 1 中南大学湘雅二医院耳鼻咽喉头颈外科(长沙, 410011);
- 2 湖南省人民医院耳鼻咽喉头颈外科;
- 3 中南大学湘雅二医院血液内科
基金项目:
国家自然科学基金项目资助(No:30700940

No:81100360)

详细信息

通讯作者: 易彦,E-mail:yiyan_yi@yahoo.com.cn

中图分类号: R739.6

收稿日期: 2012-11-08

Clinical analysis on extramedullary plasmacytoma in the upper airway

- 1 Department of Otolaryngology-Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, China;
- 2 Department of Otolaryngology-Head and Neck Surgery, the People's Hospital of Hunan Province;
- 3 Department of Hematology, the Second Xiangya Hospital, Central South University

More Information

Corresponding author: YI Yan, E-mail: yiyan_yi@yahoo.com.cn

Received Date: 08 November 2012

摘要

摘要: 目的: 分析上呼吸道髓外浆细胞瘤(EMP)的临床特点、治疗情况及转归,提高对上呼吸道EMP的诊治水平。方法: 回顾性分析26例上呼吸道EMP患者的临床资料,并与同期因相似症状首诊于耳鼻咽喉科的多发性骨髓瘤(MM)患者对比分析。结果: 26例EMP患者中,发生于鼻腔9例,鼻窦7例,咽部6 例,喉部4例;临床表现主要为局部肿物及其引起的相应症状,患者局部活检标本均经病理学诊断为浆细胞瘤;其临床表现、内镜下所见及病理组织学改变与MM上呼吸道受累患者无区别,但MM患者常伴贫血、骨质破坏等表现,其侵犯颈部淋巴结者较上呼吸道EMP患者多见。EMP患者中单纯手术治疗10例,综合治疗(手术加放疗)16例;局部复发5例,转化为MM 4例。有颈部淋巴结受累的7例患者均接受了综合治疗,其中4例患者在综合治疗的基础上接受了化疗。该4例患者均未发生局部复发,亦未转化为MM;而未接受化疗的3例患者中1例局部复发,1例转化为MM。结论: 上呼吸道EMP的诊断有赖于病理学检查,病理医生对EMP认识的提高及先进分子生物学技术手段的应用,是提高诊断水平的关键。在EMP的诊治过程中必须行相关检查排除MM。EMP的治疗以手术治疗及局部放疗为主,预后较好,但应长期随访。对于淋巴结受累者应加用化疗,以提高疗效,减少局部复发及转化为MM的风险。
- 上呼吸道肿瘤 /
- 髓外浆细胞瘤 /
- 诊断 /
- 治疗 /
- 预后
Abstract: Objective: To investigate the clinical manifestation, treatment and prognosis of extramedullary plasmacytoma(EMP) in the upper airway, and to improve the diagnosis and outcome of EMP treatment.Method: Clinical data of 26 EMP cases were reviewed retrospectively, and then compared with multiple myeloma(MM) patients presenting with lesions in upper airway.Result: Of 26 cases, 9 cases with the tumors occurred in nasal cavities, 7 in nasal sinuses, 6 in pharyngeal, 4 in throat, mainly manifesting with local masses and relevant symptoms. The manifestations of clinical, endoscopy findings and pathologic results in EMP patients were not distinguishable from the lesions of MM patients, while MM patients often accompanied by other findings, such as anemia and bone damage. Involvement of neck lymph nodes was more common in MM patients than in EMP patients. Ten patients were treated with surgery, and 16 patients with surgery and radiotherapy. Of the seven EMP patients with involvement of neck lymph nodes, four patients received additional chemotherapy besides surgery and radiotherapy, and no local relapse and MM happened in them, while of the three patients only received surgery and radiotherapy, one local relapse were found and one progressed to MM.Conclusion: The diagnosis of EMPs mainly depends on pathological results. The judgment of pathologists and application of molecular biology technology are vital for the diagnosis of EMP in upper airway, and MM must be excluded very carefully in the diagnosis of EMP. Surgery combined with radiotherapy is the main treatment for EMP in the upper airway, and the prognosis is good but the follow-up should be taken. Besides surgery and radiotherapy, chemotherapy is beneficial for the EMP patients accompanied with lesions in neck lymph nodes.
- upper airway neoplasm /
- extramedullary plasmacytoma /
- diagnosis /
- treatment /
- prognosis

HTML全文

参考文献(8)

[1]	KILCIKSIZ S,KARAKOYUN-CELIK O,AGAOGLU F Y,et al.A review for solitary plasmacytoma of bone and extramedullary plasmacytoma[J].Scientific World J,2012,2012:8957-8965.
[2]	MORARIU I,BURNS P,ROCHE P,et al.Triple mani-festation of extramedullary plasmacytoma in the upper airway:an unusual clinical entity[J].J Laryngol Otol,2011,125:970-972.
[3]	刘天润,杨安奎,陈福进,等.10例头颈部髓外浆细胞瘤的临床分析及文献复习[J].癌症,2005,24(6):714-717.
[4]	杨曙,肖自安,王树辉,等.头颈部髓外浆细胞瘤临床分析[J].临床耳鼻咽喉头颈外科杂志,2007,21(18):817-819.
[5]	ZUO Z,TANG Y,BI C F,et al.Extraosseous(extr-amedullary)plasmacytomas:a clinicopathologic and im-munophenotypic study of 32 Chinese cases[J].Diagn Pathol,2011,19:123-133.
[6]	BACHAR G,GOLDSTEIN D,BROWN D,et al.Solitary extramedullary plasmacytoma of the head and neck-long-term outcome analysis of 68 cases[J].Head Neck,2008,30:1012-1019.
[7]	SASAKI R,YASUDA K,ABE E,et al.Multi-institution-痛,鼻中隔向左侧偏曲,右侧下鼻甲肥厚,鼻腔及鼻al analysis of solitary extramedullary plasmacytoma of the head and neck treated with curative radiotherapy[J].Int J Radiat Oncol Biol Phys,2012,82:626-634.
[8]	CREACH K M,FOOTE R L,NEBEN-WITTICH M A,et al.Radiotherapy for extramedullary plasmacytoma of the head and neck[J].Int J Radiat Oncol Biol Phys,2009,73:789-794.