鼻腔鼻窦非肠型腺癌6例临床分析

Sinonasal non-intestinal type adenocarcinoma of the nasal cavity and paranasal sinuses: clinical analysis of 6 cases

摘要:

目的 以临床病例结合文献分析原发性鼻腔鼻窦非肠型腺癌（non-ITAC）的临床特性和病理免疫学特征，以期给临床医生在今后的诊疗中提供参考。方法 回顾性分析2014—2020年于北京协和医院经手术病理确诊的6例鼻腔鼻窦non-ITAC患者的临床资料和影像学、病理免疫学特点。结果 6例患者中男4例，女2例，年龄29~72岁，平均年龄54.8岁，其中4例为高级别non-ITAC，2例为低级别non-ITAC。临床表现以涕中或痰中带血、鼻塞等为主。4例男性均有吸烟史，其中1例工作中接触木屑较多。治疗方案为手术或术后加放疗或放/化疗。免疫组化结果：6例患者CK7均为阳性，其中4例患者P63为阴性；4例高级别non-ITAC患者Ki-67增殖指数为60%~90%，低级别non-ITAC患者Ki-67增殖指数1%~2%。随访至今，1例患者因肺转移死亡，其余患者均未有复发或转移。结论 鼻腔鼻窦non-ITAC患者临床表现及影像学对诊断有重要意义，病理免疫学对分级、治疗方案和预后有指导作用。

Abstract:

Objective To analyze the clinical, pathological and immunological characteristics of primary non-intestinal adenocarcinoma (non-ITAC) of the nasal cavity and paranasal sinuses with clinical analysis and literature review, so as to provide reference for its diagnosis and treatment. Methods The clinical, imaging and pathological data of 6 cases with non-ITAC of the nasal cavity and paranasal sinuses confirmed by surgery and pathology in our hospital from 2014 to 2020 were analyzed retrospectively. Results Of the 6 cases, 4 were male and 2 were female, with age ranged from 29 to 72 years old (average 54.8 years). Pathology confirmed high grade non-ITAC in 4 patients and low grade in 2. The main clinical manifestations were blood in nasal mucus or sputum and nasal obstruction. All of the 4 males had a history of smoking, and one of them was exposed to sawdust at work. The treatments were surgery and postoperative radiotherapy or chemoradiotherapy. Immunohistochemical results showed that CK7 was positive in 6 cases and P63 was negative in 4, the Ki-67 index was 60% to 90% in the 4 cases with high grade non-ITAC and 1%~2% in the 2 with low grade non-ITAC. One patient died of pulmonary metastasis during follow-up, and none of the other patients had recurrence or metastasis. Conclusion The clinical and imaging features of non-ITAC of the nasal cavity and paranasal sinuses are important for diagnosis, and the pathological immunology is helpful for grading, treatment and prognosis.