头颈部血管平滑肌瘤临床特点分析

Analysis of clinical features of head and neck angioleiomyomas

摘要:

摘 要： 目的 分析总结头颈部血管平滑肌瘤（Angioleiomyoma，ALM）的临床特点，为其临床诊疗提供参考。方法 回顾性分析我院2009年11月至2021年7月收治的17例头颈部ALM患者的临床病历及随访资料。结果10例女性，7例男性，平均年龄49.5岁。发病部位位于耳廓、面颊部各6例，鼻前庭1例，鼻腔2例，鼻咽部1例，左上唇侧前庭沟1例。位于鼻前庭者诉鼻塞，位于鼻咽部者诉鼻塞伴涕中带血，其余病例均表现为无痛性肿块。17例患者，总共6例行CT检查，其中4例行增强CT扫描后可见肿物血管丰富，呈明显强化或不均匀强化；5例行细针穿刺细胞学检查均查见血细胞。15例由HE染色确诊，2例由HE染色和免疫组化确诊。根据Morimoto分类方法，实体型8例，静脉型4例，海绵型4例，实体型-海绵型1例。所有病例均采用手术治疗，其中1例位于鼻咽部的肿物术中大量出血，约2000ml，予以电凝、压迫止血，其余病例术中均无明显出血。术后平均随访5年，所有病例均无复发、恶变。结论 头颈部ALM临床表现各异，组织学和免疫组化检测可明确诊断。对位于头颈部腔隙内、瘤体较大、完整切除困难且术前影像学检查提示瘤体血供丰富的病例，术前可考虑行瘤体血管栓塞以减少术中出血。手术切除预后良好。

Abstract:

Abstract: Objective To study the clinical characteristics of angioleiomyomas in the head and neck, and to provide reference for its clinical diagnosis and treatment. Methods From November 2009 to July 2021, the clinical records and follow-up data of 17 patients with angioleiomyoma of head and neck were analyzed retrospectively. Results 10 females and 7 males were included, with an average age of 49.5 years. The locations and numbers of cases of the tumors were as follows: auricle, six; cheek, six; nasal vestibule, one; nasal cavity, two; nasopharynx, one; vestibular groove on the left upper lip side, one. Fifteen patients showed painless masses, one located in the nasal vestibule complained of nasal obstruction and one located in the nasopharynx showed nasal obstruction with blood in the snot. Of the 17 patients, computed tomography were performed in 6 cases in total, and 4 of which showed vascularity of the mass with significant enhancement or heterogeneous enhancement after enhanced CT scan. The results of Fine needle aspiration in 5 cases were blood cells. Fifteen cases were confirmed by HE staining, and 2 cases were confirmed by HE staining and immunohistochemistry. According to the Morimoto’s classification, the histological subtypes were reported as solid in eight cases, venous in four, cavernous in four and solid-cavernous in one. All cases were treated by operation, and one case of a mass located in the nasopharynx with massive intraoperative bleeding, about 2000 ml, was stopped by electrocoagulation and compression. The rest of cases had no significant bleeding during surgery. All patients followed for 5 years averagely. All tumors were excised surgically without recurrence and malignant changes. Conclusion The clinical manifestations of angioleiomyomas in the head and neck are different. Histological and immunohistochemical tests can make a definite diagnosis of the disease. For large cases which were located in the space of the head and neck and difficult to remove completely, with the preoperative imaging test suggesting abundant blood supply to the tumor, vascular embolization of the tumor may be considered before surgery to reduce intraoperative bleeding. The prognosis of surgical excision is excellent.