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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

39

期数:

2022年12

页码:

1158-1162

栏目:

临床研究

出版日期:

2022-12-05

文章信息/Info

Title:

Clinical analysis of 13 cases of head and neck carcinosarcoma

作者:

郭晓; 郭相岑; 曹华; 张亚民; 王刘中

（郑州大学第一附属医院咽喉头颈外科，河南　郑州　450052）

Author(s):

GUO Xiao; GUO Xiangcen; CAO Hua; ZHANG Yamin; WANG Liuzhong

（Department of Otorhinolaryngology Head and Neck Surgery,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,Henan Province,China）

关键词:

头颈部肿瘤; 癌肉瘤; 病理学特征; 治疗; 预后

Keywords:

head and neck tumor; carcinosarcoma; pathology feature; treatment; prognosis

分类号:

R739.91

DOI:

10.7683/xxyxyxb.2022.12.011

文献标志码:

A

摘要:

目的　探讨头颈部癌肉瘤的病理学特征、治疗及预后。方法　回顾性分析2010年4月至2020年7月郑州大学第一附属医院收治的13例头颈部癌肉瘤患者的临床资料，总结其病理学特性、治疗方式及随访情况，应用Kaplan-Meier法计算其累积生存率。结果　超声检查结果显示，1例患者仅左侧颈部Ⅱ、Ⅲ区淋巴结直径>1 cm，形态不规则，血流丰富，与周围血管粘连；3例患者双侧颈部Ⅱ~Ⅳ区均存在直径>1 cm淋巴结，形态不规则，血流信号增强，诊断为异常肿大淋巴结，考虑颈部淋巴结转移。头颈部CT检查显示，13例患者均可见病变部位软组织低密度影，形态不规则，与周围组织边界欠清，增强为不均匀轻中度强化，考虑恶性肿瘤可能。核磁共振成像检查结果显示，平扫表现为软组织团片状稍长T1加权信号、稍长T2加权信号，弥散加权成像呈不均匀稍高或低信号，增强扫描观察到病变明显不均匀强化，考虑恶性肿瘤可能。13例患者术后常规组织病理形态学检查结果均证实为癌肉瘤，肉眼观呈菜花样或结节状，表面呈灰红色及棕红色，质地软或稍韧，部分肿瘤内部可见出血或坏死组织；在光镜下其形态学表现为上皮样癌成分与间质样肉瘤成分共存，相互之间存在移行或过渡现象。癌成分主要为鳞状细胞癌（8例）、腺癌（3例）、未分化癌（2例）；肉瘤成分复杂多样，包括恶性纤维肉瘤、梭形细胞肉瘤、平滑肌肉瘤、横纹肌肉瘤及未分化肉瘤等。13例患者均完成随访，中位随访时间16个月，其中4例无瘤生存，2例复发后死亡（1例于术后6个月复发伴颈部淋巴结转移，经放化疗后病灶未见明显改变，10个月后死亡；另1例为鼻侧切右侧上颌窦根治术后9个月复发，再次行鼻侧切鼻窦肿物切除术，二次手术后1个月死亡），余7例发生远处转移（肺转移5例，骨转移1例，肠道转移1例）；发生远处转移时间最短的1例为术后4个月发生骨转移，转移后2个月死亡；发生远处转移时间最长的1例为术后51个月发生肺转移，转移后11个月死亡。Kaplan-Meier法计算结果显示，13例头颈部癌肉瘤患者1、3、5 a累积生存率分别为61.5％、46.2％、30.8％。结论　头颈部癌肉瘤临床特征缺乏特异性，确诊主要依据术后病理，其恶性程度高，预后差，手术是目前治疗的首选方法。

Abstract:

Objective　To investigate the pathological features,treatment and prognosis of head and neck carcinosarcoma.Methods　The clinical data of 13 patients with head and neck carcinosarcoma admitted to the First Affiliated Hospital of Zhengzhou University from April 2010 to July 2020 were retrospectively analyzed,the pathological characteristics,treatment methods and follow-up were summarized.The cumulative survival rate was calculated by Kaplan-Meier method.Results　The ultrasonic examination showed that one patient′s,diameter of lymph nodes in the left neck region Ⅱ and Ⅲ was more than 1 cm,the shape was irregular,the blood flow was abundant,and the lymph nodes adhered to the surrounding vessels;in 3 patients,the diameter of lymph nodes in bilateral cervical regions Ⅱ-Ⅳ was more than 1 cm with irregular shape and enhanced blood flow signal,they were diagnosed as abnormal enlarged lymph nodes and considered cervical lymph node metastasis.CT examination of head and neck showed that 13 patients could be found low-density shadow of soft tissue at the lesion site,with irregular shape,unclear boundary with surrounding tissues,and uneven light to moderate enhancement,considered the possibility of malignant tumor.The results of magnetic resonance imaging showed that the plain scan showed a slightly long T1 weighted signal and a slightly long T2 weighted signal of soft tissue mass,while the diffusion weighted imaging showed a slightly uneven high or low signal,and the enhanced scan showed significant uneven enhancement of the lesion,they were possibility considered as malignant tumor.Thirteen cases were confirmed as carcinosarcoma by routine histopathological examination after operation,which was cauliflower like or nodular shape by naked eye,with gray red and brownish red surface,soft or slightly tough texture,and bleeding or necrotic tissue could be seen in some tumors;Under the light microscope,the morphology showed that epithelioid carcinoma components coexisted with stromal sarcoma components,and there was migration or transition between them.The main cancer components were squamous cell carcinoma (8 cases),adenocarcinoma (3 cases) and undifferentiated carcinoma (2 cases);sarcomas were complex and diverse,including malignant fibrosarcoma,spindle cell sarcoma,leiomyosarcoma,rhabdomyosarcoma and undifferentiated sarcoma.All of the 13 cases were followed up,with a median follow-up time of 16 months.Among them,4 cases survived without tumor and 2 cases died after recurrence (1 case recurred with cervical lymph node metastasis at 6 months after surgery,the focus did not change significantly after radiotherapy and chemotherapy,and died after 10 months;the other one recurred at 9 months after the right maxillary sinus root surgery,and then underwent the nasal sinus tumor resection again,and died at 1 month after the second operation),and the other 7 cases had distant metastasis (5 cases of lung metastasis,1 case of bone metastasis,1 case of intestinal metastasis);the shortest time of distant metastasis was 4 months after operation in one case,they occurred bone metastasis and died at 2 months after metastasis;one patient occurred lung metastasis with the longest time of distant metastasis at 51 months after operation and died at 11 months after metastasis.Kaplan-Meier method showed that the 1,3 and 5-years cumulative survival rates of the 13 patients with head and neck carcinosarcoma were 61.5%,46.2% and 30.8%,respectively.Conclusion　The clinical features of head and neck carcinosarcoma are lack of specificity,and the diagnosis is mainly based on postoperative pathology;the malignancy is high and the prognosis is poor;surgery is the first choice for treatment at present.

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更新日期/Last Update: 2022-12-05