摘要
鼻竇鼻腔的小型細胞癌(small cell carcinoma)，好發的年齡在40至50歲，好發的部位是上鼻甲及篩竇。它通常是單側的，在影像學檢查下呈現侵犯性的軟組織腫瘤，它會侵蝕骨頭甚至擴展到臨近的組織。治療是用手術合併放射治療，再以化學治療作為輔助。鼻竇鼻腔之小細胞癌與其他頭頸部之小型細胞癌相比，有較高之局部復發率，較低之遠處轉移率，及較佳之預後。本院於2002年8月經歷一個個案，初診時主訴是單側鼻出血有一週，眼球運動正常，檢查發現右側中鼻甲有息肉樣變化，稍微觸碰就會流血，故予以切片，病理檢查結果為小型細胞癌，電腦斷層掃描顯示右側篩竇和上頜竇內皆有腫瘤，往外侵犯眼窩並有壓迫內直肌，往上已侵蝕顱底骨，但未侵犯腦部。安排由外側鼻腔切開術進入，施行上頜竇切除術及篩竇切除術將腫瘤移除。術後再加上放射治療。因為此病例罕見，故提出報告，望各位先進不吝指教。
並列摘要
Small cell carcinoma, neuroendocrine carcinoma, usually growing unilaterally, was stated by Silva et al in 1982, is predisposed in the upper nasal cavities, superior turbinate and ethmoid sinuses for 40-50 years old male patients. It appears to be an aggressive soft tissue mass in the image studies which invades the bones and extends to its neighboring tissues. The treatment usually used is a combination of surgery and radiotherapy, with chemotherapy as an adjuvant. Compared with other area of the head and neck, the carcinoma in the sinonasal area has higher rates of local recurrence, lower rates of distant metastases, and better prognosis. The patient whose chief complaint was unilateral nasal bleeding for one week and whose eyeballs moved normally when he first came to our hospital in Aug. 2002. The examination perceived polypoid changes of the right middle turbinate. The biopsy was executed for the changes where bled easily when touched even lightly. They were a neuroendocrine carcinoma pathologically. The CT of sinus certified a tumor in the right side of the maxillary and ethmoid sinuses, and the tumor invaded the orbit, compressed the medial rectus muscle, and went upward to erode the cribriform plate, but with no invasion into the brain. For removal of the tumor, lateral rhinotomy with maxillectomy and ethmoidectomy was performed, with postoperative radiotherapy. The reported case is rare, so please give your advice kindly.
延伸閱讀
- Kuan, C. C., Shen, F. C., & Hsieh, T. (2004). 鼻腔鼻竇未分化細胞癌. Mid-Taiwan Journal of Medicine, 9(3), 191-195. https://doi.org/10.6558/MTJM.2004.9(3).9
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- 陳鴻鑫、李佳茹、黎瓊柱、蔡青劭（2009）。鼻－鼻竇之漿細胞瘤。台灣耳鼻喉頭頸外科雜誌，44(5)，155-159。https://doi.org/10.6286/2009.44.5.155
- 謝國斌、方深毅、靳應台（2007）。Sinonasal Small Cell Neuroendocrine Carcinoma-Report of Five Cases。台灣耳鼻喉頭頸外科雜誌，42(3)，101-106。https://doi.org/10.6286/2007.42.3.101