Clinical characteristics and literature review of 12 cases of granulosa cell tumor of head and neck
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摘要: 目的 探讨头颈部颗粒细胞瘤(GCT)的临床特征、病理表现、治疗手段、预后及其影响因素。方法 回顾并收集在首都医科大学附属北京同仁医院诊治，经病理证实的12例头颈部GCT患者的临床病历资料。结果 随访4~57个月，中位随访23个月。12例患者中，肿瘤原发于声带3例、环后区2例、室带1例、杓间区1例、声门旁间隙1例、会厌1例、软腭1例、喉室1例、斜方肌内1例。12例患者均接受手术治疗，其中1例二次手术并在术后辅助放射治疗。结论 GCT好发于头颈部，通常为良性肿瘤，形态多样，其确诊主要依据肿瘤组织病理学检查。大多采用手术局部切除，尤其推荐微创手术，术后复发率较低，预后较好。Abstract: Objective To investigate the clinical and pathological features, treatment, prognostic and its influence factors of granulosa cell tumor of head and neck.Methods The clinical medical records of 12 patients with head and neck granulosa cell tumor confirmed by pathology for diagnosis and treatment in Beijing Tongren Hospital affiliated to Capital Medical University were reviewed and collected.Results The follow-up durations were 4-57 months, with a median of 23 months. The origination of twelve cases were reviewed: 3 cases of the vocal cords, 2 cases of the retroannular region, 1 cases of the ventricular bands, 1 cases of the interarytenoid region, 1 cases of the paraglottic space, 1 cases of the epiglottis, 1 cases of the soft palate, 1 cases of the ventricle of larynx, 1 cases of the trapezius muscle. All 12 patients were undergoing surgical treatment in our hospital, including one who had postoperative adjuvant radiotherapy after second operation.Conclusion Granulosa cell tumor occurs in the head and neck, usually a benign tumor with diverse morphology, and its diagnosis is mainly based on tumor histopathological examination. Surgical local excision is used in most cases, especially minimally invasive surgery is recommended, with lower postoperative recurrence rate and better prognosis.
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表 1 患者基本情况
序号 性别 年龄/岁 肿瘤位置 主诉 病理诊断 1 男 24 环后区 咽部不适、异物感 GCT 2 男 30 声带 声音嘶哑 GCT 3 男 58 会厌 声音嘶哑伴咽异物感 GCT 4 女 12 声带 声音嘶哑 GCT 5 男 31 声带 发现声带肿物 GCT 6 男 59 室带 声音嘶哑 GCT 7 女 61 声门旁间隙 声音嘶哑渐进性加重 GCT 8 女 36 喉室 呼吸困难 GCT 9 女 63 软腭 咽痛 GCT 10 女 58 斜方肌 发现右颈部肿物 GCT 11 女 47 杓间区 声音嘶哑渐进性加重 GCT 12 女 34 环后区 发现喉部肿物伴咽异物感 GCT 
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表 3 患者治疗方式及预后
序号 治疗方式 手术方式 结局 1 手术 支撑喉镜下CO2激光下咽肿物切除术 失随访 2 手术 支撑喉镜下CO2激光声带肿物切除术 无瘤存活 3 手术 支撑喉镜下CO2激光喉肿物+会厌肿物+舌根肿物切除术 无瘤存活 4 手术 支撑喉镜下CO2激光声带肿物切除术 无瘤存活 5 手术 支撑喉镜下CO2激光声带肿物切除术 无瘤存活 6 手术 支撑喉镜下CO2激光室带肿物切除术 无瘤存活 7 手术 支撑喉镜下CO2激光声门旁间隙肿物切除术 无瘤存活 8 手术+放疗 支撑喉镜下喉肿物取病理术+CO2激光并等离子喉肿物切除术
支撑喉镜下喉肿物取病理术+扩大全喉切除术+颈部淋巴结清扫(双侧Ⅱ区、右侧Ⅵ区)+甲状腺腺叶切除术+气管造瘘口术无瘤存活 9 手术 咽部肿物切除术 无瘤存活 10 手术 颈部肿物切除术 无瘤存活 11 手术 支撑喉镜下CO2激光喉肿物活检术+左侧扁桃体肿物切除术+左侧扁桃体部分切除术 无瘤存活 12 手术 支撑喉镜下CO2激光环后肿物切除术 无瘤存活
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