头颈部皮脂腺癌的诊断与治疗探讨

头颈部皮脂腺癌的诊断与治疗探讨 头颈部皮脂腺癌的诊断与治疗探讨 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7 1.4%(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 cases with sebaceous carcinoma in Head and Neck which was diagnosed Collecting 28 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 7 1.4% (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 munication (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 2017, 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.。