-
摘要: 目的:分析成人单侧鼻-鼻窦病变(USD)的临床特征及病理学特点,探讨诊疗中值得注意的问题。方法:对江苏省人民医院耳鼻咽喉科2015-01-2016-12期间收治的376例成人USD患者的临床表现、辅助检查及病理学结果进行回顾性分析。结果:炎症组267例(71.01%),有4种病理类型;良性肿瘤60例(15.96%),有8种病理类型;恶性肿瘤共49例(13.03%),共15种病理类型,包括鳞状细胞癌、恶性黑色素瘤、淋巴瘤等,以及较为罕见的肌上皮癌、恶性外胚层间叶瘤。炎症组患者的发病年龄低于良性肿瘤组(Z=-2.471,P＜0.05)和恶性肿瘤组(Z=-2.787,P＜0.01),差异有统计学意义。3组间性别差异无统计学意义(χ2=3.645,P=0.162)。良性肿瘤组有骨质破坏的例数显著少于恶性肿瘤组(χ2=13.029,P＜0.01)。良性肿瘤中5例术前误诊,误诊率为8.33%;恶性肿瘤中也有5例术前误诊,误诊率为10.20%,最常见的误诊是将良恶性肿瘤误诊为息肉(5例)。结论:成人USD病变类型复杂多样,肿瘤性病变比例较高,且无特异性临床征象,临床上应审慎鉴别诊断此类病例,减少误诊。Abstract: Objective:To investigate the clinical and pathological features of patients with unilateral sinonasal disease (USD).Method:A retrospective analysis was completed on 376 adult patients with USD from January 2015 to December 2016. Their presenting symptoms, nasal endoscope, CT scanning, and pathology were analyzed respectively.Result:Among the 267 (71.01%) patients with inflammatory disease, there were 4 pathological types. And there were 8 pathological types in 60 (15.96%) patients with benign tumor. Of the 49 patients with malignant tumor, there were 15 pathological types which included squamous carcinoma, malignant melanoma, and lymphoma, as well as myoepithelial carcinoma and Mesodermal mesoderm. The onset age of inflammation group was younger than that of benign (P＜0.05) or malignant tumor groups (P＜0.05). The misdiagnosis rate was 8.33% in benign tumor (5/60), and 10.20% in malignant tumor (5/49). Nasal polyps was the most common misdiagnosis in the groups of benign and malignant tumor.Conclusion:The pathology of adult patients with USD is complicated, and no specific clinical feature was found for distinguishing between benign and malignant lesions. The tumor took a quite proportion in adult patients with USD. Therefore, careful consideration should be taken before diagnosing patients with USD in order to reduce misdiagnosis rate.
-
Key words:
- sinonasal disease /
- pathology /
- benign tumor /
- malignant tumor /
- misdiagnosis
-
-
[1] PAZ SILVA M, PINTO J M, COREY J P, et al.Diagnostic algorithm for unilateral sinus disease:a 15-year retrospective review[J].Int Forum Allergy Rhinol, 2015, 5:590-596.
[2] 郑春泉.单侧鼻腔鼻窦病变诊断的有关问题[J].临床耳鼻咽喉头颈外科杂志, 2014, 28 (2):71-74.
[3] TRITT S, MCMAINS K C, KOUNTAKIS S E.Unilateral nasal polyposis:clinical presentation and pathology[J].Am J Otolaryngol, 2008, 29:230-232.
[4] HABESOGLU T E, HABESOGLU M, SURMELI M, et al.Unilateral sinonasal symptoms[J].J Craniofac Surg, 2010, 21:2019-2022.
[5] 房高丽, 王成硕, 张罗.鼻腔鼻窦内翻性乳头状瘤起源部位的影像学研究进展[J].临床耳鼻咽喉头颈外科杂志, 2014, 28 (23):1902-1906.
[6] FUC H, TSENG H J, HUANG C C, et al.Nasal nitric oxide in unilateral sinus disease[J].PLoS One, 2017, 12:e0171965.
[7] WOOD J W, CASIANO R R.Inverted papillomas and benign nonneoplastic lesions of the nasal cavity[J].Am J Rhinol Allergy, 2012, 26:157-163.
[8] PATRA S K, PANDA N K, SAIKIA U N.Epithelial-myoepithelial carcinoma of the maxillary sinus:a rare case[J].Laryngoscope, 2012, 122:1579-1581.
[9] ASCIERTO P A, ACCORONA R, BOTTI G, et al.Mucosal melanoma of the head and neck[J].Crit Rev Oncol Hematol, 2017, 112:136-152.
[10] HARVEY R J, DALGORF D M.Chapter 10:Sinonasal malignancies[J].Am J Rhinol Allergy, 2013, 27Suppl 1:S35-38.
[11] CHOPRA S, KAMDAR D P, COHEN D S, et al.Outcomes of nonsurgical management of locally advanced carcinomas of the sinonasal cavity[J].Laryngoscope, 2017, 127:855-861.
[12] National Comprehensive Cancer Network, FORASTIERE A A, ANG K K, et al.Head and neck cancers[J].J Natl Compr Canc Netw, 2008, 6:646-695.
[13] MAJHI U, MURHEKAR K, SUNDERSINGH S, et al.Malignant ectomesenchymoma of paranasal sinuses with proptosis and nodal involvement[J].J Cancer Res Ther, 2012, 8:465-467.
[14] DRENO M, GEORGES M, ESPITALIER F, et al.Sinonasal mucosal melanoma:A 44-case study and literature analysis[J].Eur Ann Otorhinolaryngol Head Neck Dis, 2017, 134:237-242.
-
计量
- 文章访问数: 421
- PDF下载数: 121
- 施引文献: 0
下载: