头颈部皮脂腺癌的诊断与治疗探讨医学论文.doc

头颈部皮脂腺癌的诊断与治疗探讨_医学论文 作者：黄健男，占顺堂，邹苑斌，张学辉，赵晓明，彭树文，郑明奋【关键词】 皮脂腺癌；头颈部；病 理学 　　［摘要］ 目的 探讨头部皮脂腺癌的诊断与 治疗 ，进一步提高诊治率方法 收集28例经病理证实的头颈部皮脂腺癌患者的临床资料，其中眼睑皮脂腺癌10例；腮腺皮脂腺癌2例；外耳道皮脂腺癌5例；颌面部皮脂腺癌7例；颈部皮脂腺癌4例，颈部淋巴结转3例，采用手术、放疗、化疗等综合治疗结果 皮脂腺癌确诊需要免疫组化检测，而罕见的腮腺皮脂腺癌还需和透明细胞癌、黏液表皮样癌和腺泡细胞癌鉴别，全组病例5年以上随访，5年生存率可达71.4%（20/28），5年内原发灶复发10例，其中，3例伴有区域淋巴结转移而再次手术，4例失访（按死亡计）；2例死于远处转移；2例死于其他疾病结论 皮脂腺癌多发于头面部尤其是眼睑，罕见的腮腺皮脂腺癌易被临床忽视，主要复发在局部病灶，较少发生淋巴结转移，死亡原因主要为远处转移，早期诊断、早期根治性综合治疗是提高5年生存率的关键　　 ［关键词］ 皮脂腺癌；头颈部；病理学　　Diagnosis and treatment of sebaceous carcinoma in the Head and Neck (Report of 28 Cases)　　［Abstract］ Objective To study the diagnosis and treatment of sebaceous carcinoma in Head and Neck. Methods Collecting 28 cases with sebaceous carcinoma in Head and Neck which was diagnosed with pathology. Of all these patients, the eyelid in 10 cases, parotid in 2cases, external auditory meatus in 5 cases, maxillofacial in 7 cases, neck portion in 4 cases, neck lymph node metastasis in 3 cases. They were treated with surgical operation, radical therapy and chemistry therapy.Results Diagnosis of sebaceous carcinoma demanded immunohistochemistry (IHC), and rare parotid sebaceous carcinoma was still distinguished with clear cell carcinoma, grume epidermis carcinoma and acinic cell carcinoma in pathology. By Follow-up of the all patients over 5 years, survival rate for 5 years was 71.4% (20/28), primary focus recurrence in 10 cases, in which, neck lymph node metastasis was discovered in 3 cases, and one was performed operation once again. Four cases lost communication (count for death); 2cases died of distant metastasis; 2cases died of other diseases.Conclusion The sebaceous carcinoma mostly occurred in Head and neck, especially in eyelid, rare in parotid, which were easily ignored in diagnosis. Recurrence mostly presented in primary focus,and neck lymph node metastasis is much less. The cause of death mainly is distant metastasis. It is key point that forepart diagnosis and treatment can promote survival rate for 5 years.　　［Key words］ sebaceous carcinoma;head and neck;pathology　　INTRODUCTION 　　Sebaceous carcinoma is a rare malignant tumor, whose incidence is more in eyelid than other portion, and more in old age man. From 1985 to 2001, 28 of patients with sebaceous carcinoma were collected and treated in our hospital. It is reported as following.　　 1 MATERIALS AND METHODS 　　1.1 Common Materials Twenty-eight patients were selected to receive treatment including 20 males and 8 females; age ranged: ＞50 years old in 22 cases,＜50 years old in 6cases;ill-period:at ＞4 years in 16 cases, 2 years in 6 cases,1～3 months in 6 cases. one of all was the longest ill-period for 10 years.Twenty-eight patients with sebaceous carcinoma in Head and Neck, which was approved with pathology. Of all these patients, the eyelid in 10 cases, parotid in 2 cases, external auditory meatus in 5 cases, maxillofacial in 7 cases, neck portion in 4 cases, neck lymph node metastasis in 3 cases. 　　1.2 Diagnosis and treatment methods All of these 30 cases were diagnosed as to sebaceous carcinoma through paraffin section and EMA, S-100, CK/H, ACTIN of IHC staining examination. All of these patients, primary focus of tumors were totally resected, treating neck lymph node dissection in 3 cases, preventing neck lymph node dissection in 7 cases. Twenty-eight patients receipted radical therapy 40GY and 5-FU 600mg, cisplatin 20 mg of chemistry therapyper day, in number 10 days, postoperatively.　　 2 RESULTS　　The diameter of tumor was 0.5～7 cm and color in hoar, dark blueness and rosiness, small saccule cavities in tumor were formed over 60%; the tumor bourn clear but non-full envelope; the edge became swelling property or local soakage. In cell modality, the tumor made up of many and large cells of nest, piece shape, nucleolus deep staining, abundant clear and acidophilia cells. Degree was not identical in pleomorphism and non-typicality of cells and squamaous and basilar shape differentiation became more in tumor. Of 28 cases, differentiation type in 21 cases, basilar cell type in 4 cases; squamaous cell type in 3 cases and EMA（＋），CK/H（＋），Actin（－）S-100（－） in total. Followed up the all patients over 5 years, Survival rate for 5 years in 71.4% (20/28), primary focus recurrence in 10 cases, in which, neck lymph node metastasis was discovered in 3 cases, and was performed operation once again. Four cases lost communication (count for death); 2cases died of distant metastasis; 2cases died of other diseases.　　 3 DISCUSSIONS　　The real sebaceous carcinoma is rare and mainly occurred in head- maxillofacial and was lower degree malignant tumor. It always arises in eyelid, lacrimal caruncle and orbit, rare in parotid, and more appearance in middle-old age people; but aggression of the sebaceous carcinoma at above portion was stronger than other ones. Yang Xiao-xiang(2004) searches interior data reportorial 22 cases of sebaceous carcinoma, only one case located thigh skin. S。