- 期刊
下咽部鱗狀上皮細胞癌經由血循途徑併發顱內轉移以及其治療方式
Hypopharyngeal Squamous Cell Carcinoma with Hematogenous Intracranial Metastases
摘要
背景：臨床上鮮少於患有下咽部鱗狀上皮細胞癌(SCC)之病患中診斷出顱內轉移。這些顱內轉移的病例中，絕大部份轉移的位置都位於顱內海綿竇，且此等病例皆被認為是沿著神經周圍的路徑往上侵犯。 病例報告：我們提出一件經診斷為下咽部SCC的病患其遠端顱內轉移乃經由血循擴散的病例報告。一名49歲男性藉由組織學特徵來診斷出在腦部實質有兩個來自於下咽部SCC的遠端轉移（右側顳葉與枕葉），且術前MRI檢查並未發現有任何腫瘤細胞經由顱底或神經周邊往上侵犯的證據。右顳葉之病灶採取開顱手術切除之方法來診斷，術中也未發現有腦膜增厚或是腦膜被癌細胞浸潤的跡象。於術後對於此兩個顱內病灶再輔以全腦放射線治療(WBRT)，而右枕葉部之病灶則搭配立體定位放射手術(SRS)治療。 結論：就知識所及，尚未有下咽部SCC經由血循路徑轉移至腦部的病例報告被發表。外科手術再加上WBRT，提供了較良好的治療結果，而SRS目前的發展對於單一腦部轉移的病人不但可改善治療效果，降低罹病率且可以提升生活品質。最後，臨床上任何不明顯的神經學症狀都不應被忽視，因為這可能是顱內轉移的第一個徵兆，及早發現此症候可以及早診斷並改變治療方針。
並列摘要
Background: Intracranial metastases are rarely clinically diagnosed in patients with hypopharyngeal squamous cell carcinoma (SCC). In almost all cases, metastases occur in the cavernous sinus and have been considered to develop as perineural invasions. Case Report: We present a case of hypopharyngeal SCC with distant intracranial metastases through hematogenous spread. Two cerebral parenchymal metastases from hypopharyngeal SCC were histologically analyzed in a 49-year-old male patient. The preoperative MRI study did not show any evidences of perineural spread or skull base invasion. The right temporal metastasis was confirmed by surgery, however no signs of dural layer thickening or invasion were detected during the operation. The patient underwent radiotherapy after surgery, and the right occipital lesion was treated with stereotactic radiosurgery (SRS). Conclusions: To the best of our knowledge, this is the first report of hypopharyngeal SCC with cerebral metastases that developed via hematogenous spread. Radiotherapy along with surgery provides good outcomes, and SRS may improve the effect of treatments. Finally, any subclinical neurological deficit should not be neglected, because awareness of such signs and symptoms may lead to earlier diagnosis and alteration in treatment.
延伸閱讀
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