同时性头颈部多原发癌1例并文献复习

Synchronous Multiple Primary Cancers of the Head and Neck: A Case Report

摘要:

目的 通过报道1例同时性鼻咽癌合并喉癌及食管鳞癌，探讨头颈部多原发癌的可能机制、诊断及治疗方案。方法 回顾性分析患者的临床资料、诊疗经过及随访情况，并结合相关文献进行复习。结果 患者胃镜、电子鼻咽喉镜等检查提示鼻咽部、喉部、食管多部位病变，行显微镜下喉部病变激光切除术及鼻咽部活检术，病理提示鼻咽部淋巴上皮癌、右侧室带鳞状细胞癌、食管鳞状细胞癌、左侧声带息肉。经多学科讨论后，优先行鼻咽部放化疗，随后给予全身化疗。术后随访近11个月，鼻咽部病灶较前明显缩小，喉部及食管原病变区复查未见明显异常。结论 头颈部肿瘤患者可存在多原发癌，临床医师应提高对多原发癌的认识，重视多部位系统评估，减少漏诊，优化诊疗决策。

Abstract:

Objective This article reports a case of synchronous nasopharyngeal carcinoma, laryngeal carcinoma, and esophageal squamous cell carcinoma in situ. The possible mechanisms, diagnosis, and treatment strategies of multiple primary cancers of the head and neck were discussed based on the relevant literature. Methods The clinical data, diagnosis and treatment, and follow-up of the patient were retrospectively analyzed, and a literature review was conducted. Results The patient was a 65-year-old male.Gastroscopy and electronic nasopharyngolaryngoscopy revealed lesions in the nasopharynx, larynx, and esophagus. The patient underwent microscopic laser excision of the laryngeal lesions and biopsy of the nasopharyngeal lesion. Histopathological examination showed lymphoepithelial carcinoma of the nasopharynx, squamous cell carcinoma of the right ventricular fold, esophageal squamous cell carcinoma in situ, and a polyp of the left vocal fold. Following multidisciplinary discussion, chemoradiotherapy for the nasopharyngeal carcinoma was performed first, followed by systemic chemotherapy. During nearly 11 months of postoperative follow-up, the nasopharyngeal lesion was markedly reduced, and no obvious abnormalities were found at the original lesion sites in the larynx or esophagus. Conclusion Multiple primary cancers may occur in patients with head and neck tumors. Clinicians should improve their understanding of multiple primary cancers, attach importance to systematic evaluation of multiple sites, reduce missed diagnoses, and optimize diagnosis and treatment strategies.