喉类癌的临床及病理特征

发布时间：2018-12-08 06:55

【摘要】：目的：探讨喉类癌的临床及病理特征,并对其诊断、鉴别诊断、治疗和预后进行讨论。方法：回顾性分析4例喉类癌患者的临床及随访资料,观察临床及病理特点并进行免疫组织化学检查,抗体选用CgA、Syn、TTF、CEA、P53、Ki67、CK7、Vim、CK(AE1/AE3)、CD56、CK8/18、CT、HMB-45、CD34、SMA及CD10, S-P二步法染色。结果： 4例中TC 1例,AC 3例。①临床特征：TC以咽喉疼痛为首发症状；AC中2例以咽喉疼痛为首发症状,1例以声嘶为首发症状。4例均为声门上型,TC发生于右侧室带,表现为黏膜下新生物,无颈淋巴结转移；1例AC发生于右室带、披裂及杓会厌皱襞,1例AC发生于右侧室带,1例AC发生于会厌,AC患者肿瘤呈表面光滑肿物或表面不平肿物,均伴有颈淋巴结转移,发生于右披裂、杓会厌皱襞者及右侧室带者右侧颈淋巴结分别有1/8、1/9发生转移,1例发生于会厌者颈淋巴结分别有左侧3/18,右侧9/22发生转移。②病理特征：光镜检查TC器官样结构较为典型,癌组织主要由圆形和梭形的细胞所组成,细胞排列呈小巢状、小梁状,并被数量不等的纤维血管及透明变形的结缔组织所分隔,菊形团样结构可被观察到。癌细胞大小及形态较均一,异型性小,核仁和有丝分裂未见,不见坏死,间质血管较丰富。AC癌细胞排列呈小巢状、小梁状、腺样、片状、管状、筛状和器官样,与喉TC相比,癌细胞体积大,且大小不一,形态多样,呈多边形或圆形,异型性明显,核有丝分裂象多见,细胞质量中等,伊红色,胞核为中心或偏心,有明显核仁,可见有肿瘤坏死,间质相对较少。免疫组化标记显示癌细胞CgA、Syn、CK均为阳性。TC：癌细胞CgA、Syn、TTF、Ki67、Vim、CK(AE1/AE3)、CD56阳性；AC：癌细胞CgA、Syn、TTF、CEA、P53、Ki67、CK7、Vim、CK(AE1/AE3)、CD56、CK8/18、CT阳性。③治疗方法及随访：4例都以外科手术为主：TC单纯行喉垂直部分切除术者于术后随访6个月未见复发；2例AC均行喉垂直部分切除术+患侧颈淋巴结清扫术,术后随访分别为3年1个月、8个月,未见复发；1例AC行喉声门上水平部分切除术+双侧颈淋巴结清扫术+细胞免疫治疗的联合性治疗方案,术后随访6个月未发现有复发。4例均已拔气管套管。结论：临床上喉类癌非常罕见,该病主要为黏膜下病变,早期可有喉痛症状,诊断主要依赖病理,光学显微镜、电子显微镜、尤其免疫组织化学为其检出率的提高提供了大大的帮助,其2个亚型即TC和AC在肿瘤生物学行为、临床特征及病理学上差别迥异,应根据其不同的病理类型来选择有效的手术治疗方法和判断预后。
[Abstract]:Objective: to investigate the clinical and pathological features of laryngeal carcinoid, and discuss its diagnosis, differential diagnosis, treatment and prognosis. Methods: the clinical and follow-up data of 4 patients with laryngeal carcinoid were retrospectively analyzed. The clinical and pathological features were observed and immunohistochemical examination was performed. CgA,Syn,TTF,CEA,P53,Ki67,CK7,Vim,CK (AE1/AE3) and CD56, were used as antibodies. CK8/18,CT,HMB-45,CD34,SMA and CD10, S-P two-step staining. Results: of the 4 cases, 1 was TC and 3 were AC. (1) the first symptom of TC was pharynx and larynx pain. In AC, the first symptom was pharynx and larynx pain in 2 cases, and the first symptom was hoarseness in 1 case. All the 4 cases were supraglottic type. TC occurred in the right ventricular zone with submucosal neoplasm and no cervical lymph node metastasis. One case of AC occurred in the right ventricular zone, drape fissure and dipper epiglottis fold, one case of AC occurred in the right ventricular zone, and one case of AC occurred in epiglottis. The tumor of AC patients showed smooth surface or uneven surface, all with cervical lymph node metastasis, and occurred in right drape fissure. 1 / 8 / 1 / 9 of the right cervical lymph nodes of the arytenoid epiglottis fold and the right ventricular band had 1 / 8 / 9 metastasis, and 1 case of the epiglottic lymph node had 3 / 18 of the left cervical lymph nodes, respectively. The histologic features of 9 / 22 on the right were as follows: the TC organoid structure was typical by light microscopy. The cancer tissue was mainly composed of round and fusiform cells, and the cells arranged in the shape of nests, trabeculae, and trabeculae. The chrysanthemum-like structure can be observed by a number of fibrous vessels and transparent deformed connective tissue. The size and shape of the cancer cells were uniform, the heterogeneity was small, nucleolus and mitosis were not seen, no necrosis was found, and the interstitial vessels were abundant. AC cancer cells were arranged in the shape of nests, trabeculae, glandular, flaky, tubular, sieve and organoid, compared with laryngeal TC. The cancer cells are large in size, various in size, diverse in shape, polygonal or circular, obvious in heteromorphism, often seen in nuclear mitosis, moderate in cell mass, eosin, with nuclei as the center or eccentricity, with obvious nucleolus and tumor necrosis. The stroma is relatively small. Immunohistochemical staining showed that CgA,Syn,CK was positive in all cancer cells. CgA,Syn,TTF,Ki67,Vim,CK (AE1/AE3) and CD56 were positive in TC: cells. AC: cancer CgA,Syn,TTF,CEA,P53,Ki67,CK7,Vim,CK (AE1/AE3), CD56,CK8/18, CT positive. 3 treatment method and follow-up: 4 cases were mainly operated by surgery: there was no recurrence after 6 months follow up in patients with TC simple vertical laryngectomy; Two cases of AC underwent partial laryngectomy and neck lymph node dissection. The follow-up was 3 years and 8 months, respectively. No recurrence was found. One case of AC underwent supraglottic horizontal laryngectomy combined with cellular immunotherapy for bilateral neck lymph node dissection. No recurrence was found after 6 months follow-up. Tracheal cannula was removed in 4 cases. Conclusion: laryngeal carcinoid is very rare in clinic. The disease is mainly submucous lesion and larynx pain can occur in the early stage. The diagnosis mainly depends on pathology, optical microscope, electron microscope, etc. In particular, immunohistochemistry has greatly contributed to the improvement of the detection rate. The two subtypes, TC and AC, are very different in the biological behavior, clinical characteristics and pathology of tumor, and the two subtypes of the two subtypes, TC and AC, are different in biological behavior, clinical characteristics and pathology. The effective surgical treatment and prognosis should be selected according to its different pathological types.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2011
【分类号】：R739.65

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