喉部癌肉瘤及肉瘤样癌6例临床分析

Clinical analysis of 6 cases of laryngeal carcinosarcoma and sarcomatoid carcinoma

摘要:

目的 分析喉部癌肉瘤及肉瘤样癌的临床特征及病理学特点，避免漏诊误诊，以提高该病的诊断、治疗及预后判断的水平。方法 通过回顾性研究方法,总结2012年7月—2016年1月收治的6例喉部癌肉瘤及肉瘤样癌患者的临床病理资料、诊疗过程和随访结果，并复习相关文献。结果 6例患者首次治疗全部为手术治疗，术后常规病理检查结合免疫组化均确诊为喉部癌肉瘤或肉瘤样癌，其中1例行术后放疗。随诊期间，6例患者中有4例复发，均再次手术。共随访67~87个月，其中目前存活4例、失访1例、死亡1例。结论 喉部癌肉瘤或肉瘤样癌多以声嘶为首发症状，形态不一，早期表面光滑，易误诊为声带息肉；完全确诊需常规病理检查结合免疫组化；治疗以手术切除为主，建议扩大切除，可辅以术后放疗；术后相对容易复发，预后总体良好。

关键词:喉部癌肉瘤;喉部肉瘤样癌;诊断;病理;免疫组织化学

Abstract:

Objective To analyze the clinicopathological features of laryngeal carcinosarcoma and sarcomatoid carcinoma, and avoid missed diagnosis and misdiagnosis, so as to improve the level of diagnosis, treatment and prognosis of this disease.Methods Clinicopathological data, diagnosis and treatment process, as well as follow-up results of 6 cases of laryngeal carcinosarcoma and sarcomatoid carcinoma admitted to our hospital from July 2012 to Jan 2016 were analyzed retrospectively with literature review.Results All the 6 patients were surgically treated for the first time, and diagnosed as laryngeal carcinosarcoma or sarcomatoid carcinoma by routine postoperative pathological examination combined with immunohistochemistry. One of them underwent postoperative radiotherapy. During the follow-up period of 67 to 87 months, 4 of them relapsed and underwent reoperation. Four patients survived, one was lost to follow-up and one died.Conclusions Hoarseness is usually the first symptom of laryngeal carcinosarcoma or sarcomatoid carcinoma. With various morphological features and early smooth surface, they’re easy to be misdiagnosed as vocal cord polyp. Definite diagnosis depends upon routine pathological examination combined with immunohistochemistry. The main treatment is surgical resection, and extended resection is recommended, supplemented by postoperative radiotherapy. They are relatively easy to relapse after operation and the prognosis is generally good.

Key words:Laryngeal carcinosarcoma;Laryngeal sarcomatoid carcinoma;Diagnosis;Pathology;Immunohistochemistry