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目的总结中耳鳞状上皮乳头状瘤的临床病理特征及诊治结果,以提高对本病的认识。方法回顾性分析我院2003年6月至2013年6月间经病理证实的4例中耳鳞状上皮乳头状瘤的临床资料,分析其临床表现、影像学发现、病理特征及治疗随访结果,同时对这些病例标本的病理切片进行重新阅片分析,并行广谱人乳头状瘤病毒(HPV)原位杂交检测。结果本组病例全部为男性,年龄29~70岁,临床表现为患耳流脓、听力下降、耳痛、耳鸣及耳胀满感等症状,其中患耳流脓是最常见的主诉。耳镜检查常发现鼓室内有红色或灰白色的肉芽样新生物。术前CT提示为中耳乳突炎改变或中耳腔内见软组织密度影延至外耳道深部,治疗以根治性手术为主,包括不同范围的颞骨切除术和乳突根治术。术后病理全部为鳞状上皮乳头状瘤,其中2例伴有癌前病变。所有病例标本HPV检测均为阴性,术后随访至今均无复发。结论本组资料表明中耳鳞状上皮乳头状瘤好发于老年男性,多数患者有较长时间的患耳流脓史。慢性炎症刺激可能为该肿瘤的诱因之一,而HPV感染可能与该病的发生无关。病理显示本肿瘤具有一定的恶变潜能,根治性手术切除预后良好。术前病理检查或术中快速切片检查有助于选择合适的术式,提高本病的根治率。术后长期的随访观察是必需的。
Objective To summarize the clinicopathological characteristics and diagnosis and treatment of middle ear squamous cell carcinoma in order to improve the understanding of this disease. Methods The clinical data of 4 cases of middle ear squamous cell carcinoma confirmed by pathology from June 2003 to June 2013 in our hospital were analyzed retrospectively. The clinical manifestations, imaging findings, pathological features and treatment follow-up results were analyzed. At the same time, the pathological sections of these specimens were re-read and analyzed in parallel with the detection of broad-spectrum human papillomavirus (HPV) in situ hybridization. Results All patients in this group were male, aged 29 to 70 years old. The clinical manifestations were pus, hearing loss, earache, tinnitus and fullness of the ear. The most common complaints were ear pus. Otoscope often found in the tympanic cavity with red or gray granulation-like new biology. Preoperative CT tips for the change of otitis media in the middle ear or soft tissue density in the middle ear cavity to the depth of the external auditory canal, the main treatment of radical surgery, including different ranges of temporal bone resection and radical mastectomy. All postoperative pathological squamous epithelial papilloma, of which 2 cases with precancerous lesions. All cases of HPV testing samples were negative, no follow-up postoperative recurrence. Conclusion This group of data show that the middle ear squamous epithelial papilloma occur in older men, most patients have a long history of ear pus history. Chronic inflammatory stimuli may be one of the causes of the tumor, and HPV infection may not be related to the occurrence of the disease. Pathology showed that the tumor has a certain malignant potential, radical surgical resection of a good prognosis. Preoperative pathological examination or intraoperative rapid biopsy helps to select the appropriate surgical procedures to improve the cure rate of the disease. Postoperative long-term follow-up observation is required.