額竇鱗狀細胞癌－病例報告

源自額竇的鱗狀細胞癌非常少見，僅佔鼻腔與鼻竇的惡性腫瘤的0.3%。又因其臨床表徵及檢查結果並無特異性，易與額竇最好發的黏液囊腫（mucocele）或囊性腫瘤（pyocele）混淆，造成診斷的困難。本科於1999年4月經歷1例75歲男性病患，主訴左眼球凸出、複視、併前額凸出一無痛性腫塊20餘天，最近有左側鼻塞及流鼻涕的情況。追溯其過去病史，該病患曾於10年前接受左側Caldwell-Luc氏手術。電腦斷層攝影（CT）顯示不均質的軟組織密度陰影充斥左側額竇、篩竇，腫塊甚至侵犯至前顱窩之顱底骨及左眼窩內。磁振造影（MRI）結果亦同，顱內腫塊與腦組織間並無明顯界線，推斷該腫塊應與硬腦膜沾黏但未侵及腦組織。在額竇黏液囊腫的臆斷之下安排內視鏡鼻竇手術，並送冷凍切片檢查證實為鱗狀細胞癌。在考慮無法獲得安全邊緣、根治性手術罹病率太高及家屬意願後，合併外部切開（external approach）盡量摘除腫瘤組織，並安排術後放射治療合併化學治療。追蹤至今迄12個月，尚未有復發或明顯後遺症。

關鍵字

額竇；鱗狀細胞癌；黏液囊腫

並列摘要

Carcinoma of frontal sinus is very rare. The incidence is only 0.3% of all paranasal sinus carcinomas. It is easily confused with mucocele and pyocele because of the nonspe-cific clinical symptoms and examination results. A 75 year-old man came to our hospital with complaints of left proptosis, blurred vision, and a painless frontal mass for 20 days. He had a Caldwell-Luc operation on the left paranasal sinus 10 years ago. Computed tomography revealed that a heterogeneous soft tissue density filled the left frontal sinus and anterior ethmoid sinus. The mass invaded the skull base of the anterior cranial fossa and medial wall of the left orbital cavity. Magnetic resonance imaging showed the intracranial portion of this mass had compressed brain tissue with dura invasion. Under the impression of frontal mucocele, endoscopic sinus surgery was performed. A frozen section and pathology report revealed frontal sinus squamous cell carcinomas. After extir-pation of the tumor, the patient had chemo-radiotherapy(cisplatin 55mg IVP once a week for 8 weeks; 7080 cGy). There has been no recurrence or significant sequelae after 12months of follow-up. We conclude that excision of the tumor combined with post-oper-ative concomitant chemo-radiotherapy on an isolated frontal sinus malignancy results in an acceptable outcome. Combined therapy offers another choice of treatment in addition to radical craniofacial surgery, especially in older patients.

並列關鍵字

frontal sinus ； squamous cell carcinoma ； mucocele

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額竇鱗狀細胞癌－病例報告

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