喉類癌的臨床及病理特征
發(fā)布時(shí)間：2018-12-08 06:55
【摘要】：目的： 探討喉類癌的臨床及病理特征,并對其診斷、鑒別診斷、治療和預(yù)后進(jìn)行討論。 方法： 回顧性分析4例喉類癌患者的臨床及隨訪資料,觀察臨床及病理特點(diǎn)并進(jìn)行免疫組織化學(xué)檢查,抗體選用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。 結(jié)果： 4例中TC 1例,AC 3例。①臨床特征：TC以咽喉疼痛為首發(fā)癥狀；AC中2例以咽喉疼痛為首發(fā)癥狀,1例以聲嘶為首發(fā)癥狀。4例均為聲門上型,TC發(fā)生于右側(cè)室?guī)?表現(xiàn)為黏膜下新生物,無頸淋巴結(jié)轉(zhuǎn)移；1例AC發(fā)生于右室?guī)�、披裂及杓會厭皺�?1例AC發(fā)生于右側(cè)室?guī)?1例AC發(fā)生于會厭,AC患者腫瘤呈表面光滑腫物或表面不平腫物,均伴有頸淋巴結(jié)轉(zhuǎn)移,發(fā)生于右披裂、杓會厭皺襞者及右側(cè)室?guī)д哂覀?cè)頸淋巴結(jié)分別有1/8、1/9發(fā)生轉(zhuǎn)移,1例發(fā)生于會厭者頸淋巴結(jié)分別有左側(cè)3/18,右側(cè)9/22發(fā)生轉(zhuǎn)移。②病理特征：光鏡檢查TC器官樣結(jié)構(gòu)較為典型,癌組織主要由圓形和梭形的細(xì)胞所組成,細(xì)胞排列呈小巢狀、小梁狀,并被數(shù)量不等的纖維血管及透明變形的結(jié)締組織所分隔,菊形團(tuán)樣結(jié)構(gòu)可被觀察到。癌細(xì)胞大小及形態(tài)較均一,異型性小,核仁和有絲分裂未見,不見壞死,間質(zhì)血管較豐富。AC癌細(xì)胞排列呈小巢狀、小梁狀、腺樣、片狀、管狀、篩狀和器官樣,與喉TC相比,癌細(xì)胞體積大,且大小不一,形態(tài)多樣,呈多邊形或圓形,異型性明顯,核有絲分裂象多見,細(xì)胞質(zhì)量中等,伊紅色,胞核為中心或偏心,有明顯核仁,可見有腫瘤壞死,間質(zhì)相對較少。免疫組化標(biāo)記顯示癌細(xì)胞CgA、Syn、CK均為陽性。TC：癌細(xì)胞CgA、Syn、TTF、Ki67、Vim、CK(AE1/AE3)、CD56陽性；AC：癌細(xì)胞CgA、Syn、TTF、CEA、P53、Ki67、CK7、Vim、CK(AE1/AE3)、CD56、CK8/18、CT陽性。③治療方法及隨訪：4例都以外科手術(shù)為主：TC單純行喉垂直部分切除術(shù)者于術(shù)后隨訪6個(gè)月未見復(fù)發(fā)；2例AC均行喉垂直部分切除術(shù)+患側(cè)頸淋巴結(jié)清掃術(shù),術(shù)后隨訪分別為3年1個(gè)月、8個(gè)月,未見復(fù)發(fā)；1例AC行喉聲門上水平部分切除術(shù)+雙側(cè)頸淋巴結(jié)清掃術(shù)+細(xì)胞免疫治療的聯(lián)合性治療方案,術(shù)后隨訪6個(gè)月未發(fā)現(xiàn)有復(fù)發(fā)。4例均已拔氣管套管。 結(jié)論： 臨床上喉類癌非常罕見,該病主要為黏膜下病變,早期可有喉痛癥狀,診斷主要依賴病理,光學(xué)顯微鏡、電子顯微鏡、尤其免疫組織化學(xué)為其檢出率的提高提供了大大的幫助,其2個(gè)亞型即TC和AC在腫瘤生物學(xué)行為、臨床特征及病理學(xué)上差別迥異,應(yīng)根據(jù)其不同的病理類型來選擇有效的手術(shù)治療方法和判斷預(yù)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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R739.65
[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.
【學(xué)位授予單位】：吉林大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2011
【分類號】：R739.65
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