Current status of the diagnosis and treatment of temporal bone squamous cell carcinoma
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摘要: 颞骨鳞状细胞癌是颞骨恶性肿瘤中最常见的类型，临床罕见。该病的罕见性导致其分期、颞骨的切除方法、腮腺和颈部淋巴结的处理以及放化疗的应用等仍然存在诸多争议，国内外至今未提出针对性指南共识。本文对颞骨鳞状细胞癌诊断与治疗的最新进展进行综述，希望能够对该病的诊疗提供一定的帮助和参考。Abstract: Temporal bone squamous cell carcinoma, which is rare in the clinical setting, is the most common type of temporal bone malignancy. Its rarity makes the staging, the way of temporal bone resection, the management of parotid gland and cervical lymph node, and the application of radiotherapy and chemotherapy still controversial.There is no unanimous consensus and guideline about it to date at home and abroad.This paper reviewed the recent advance in the diagnosis and treatment of temporal bone squamous cell carcinoma in the hope of providing some help and reference for the management of the disease.
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Key words:
- temporal bone /
- squamous cell carcinoma /
- diagnosis /
- treatment
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图 1 T1~4期肿瘤骨质破坏的影像学表现 1a：肿瘤(T1期)没有破坏外耳道骨质; 1b：肿瘤(T2期)破坏骨性外耳道前壁部分骨质; 1c：肿瘤(T3期)破坏骨性外耳道全层; 1d：肿瘤(T4期)破坏中耳内侧壁骨质; 图 2 1例72岁男性患者发现左外耳道新生物2年 2a：颞骨CT检查显示肿瘤破坏鼓室盖，但无法判断是否有硬脑膜受累; 2b：颞骨MRI检查显示肿瘤累及硬脑膜和乙状窦。
表 1 改良匹兹堡分期标准
分期 具体描述 T分期 T1 肿瘤局限于外耳道，不伴骨质破坏或软组织累及 T2 肿瘤局限于外耳道，伴有骨质破坏(未及全层)或者有局限性(< 0.5 cm)软组织累及 T3 肿瘤侵及骨性外耳道(累及全层)且软组织受累有限(< 0.5 cm)或者肿瘤侵及中耳和/或乳突 T4 肿瘤侵及耳蜗、岩尖、中耳内壁、颈动脉管、颈静脉孔或硬脑膜，或广泛性(>0.5 cm)软组织累及，如侵及颞下颌关节或茎突，或伴有面神经麻痹的证据 N分期 N0 无区域淋巴结转移 N1 同侧单个淋巴结转移，直径≤3 cm，且ENE(-) N2a 同侧单个淋巴结转移，直径>3~6 cm，且ENE(-) N2b 同侧多个淋巴结转移，直径≤6 cm，且ENE(-) N2c 双侧或对侧淋巴结转移，最大直径≤6 cm，且ENE(-) N3a 最大直径>6 cm且ENE(-)的淋巴结转移 N3b 任何表现为临床ENE(+)的淋巴结转移 总体分期 Ⅰ期 T1N0M0 Ⅱ期 T2N0M0 Ⅲ期 T3N0M0 Ⅳ期 T4N0M0，任何T1~4N+M0，任何T1~4N0M1，任何T1~4N+M1 ENE：淋巴结包膜外播散。 
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