經口切除－巨大軟顎部之孤立性纖維瘤

Tansoral Excision of Huge Solitary Fibrous Tumor of the Soft Palate

林東佑(Tung-Yu Lin) ； 方端仁(Tuan-Jen Fang) ； 張良慈(Liang-Che Chang) ； 楊士維(Shih-Wei Yang)

《台灣耳鼻喉頭頸外科雜誌》 46卷3期 (2011/07) Pp. 162-166

https://doi.org/10.6286/2011.46.3.162

摘要

孤立性纖維瘤(solitary fibrous tumor, SFT)是一種罕見的紡錘狀細胞腫瘤，常好發於肋膜、臟膜或腹膜。此病例報告描述一個奇特罕見巨大的軟顎孤立性纖維瘤，造成吞嚥困難、嚴重阻塞性睡眠呼吸中止症以及端坐呼吸。此報告討論孤立性纖維瘤的臨床病理特徵、手術時需考慮的因素、以及鑑別診斷。孤立性纖維瘤的鑑別診斷需要電腦斷層或核磁共振檢查。手術切除巨大的口咽腫瘤經常是困難的，尤其是血管豐富的腫瘤。血管攝影提供了有用的術前評估，降低術中出血的風險。針對一個巨大的軟顎部腫瘤，建議在軟顎上以Y型切口，經口切除此腫瘤。術後需要長期的追蹤，避免局部復發或可能的惡性變化。

關鍵字

孤立性纖維瘤 ； 軟顎 ； 經口切除 ； 血管攝影

並列摘要

Solitary fibrous tumors (SFTs) are rare spindle cell neoplasms that mostly occur in the parietal/visceral pleura or peritoneum. Here we report a case with a huge SFT of the soft palate that caused dysphagia, severe obstructive sleep apnea and orthopnea. Diagnosis of SFT usually cannot be made clinically. A huge oropharyngeal mass often makes surgery difficult, especially when the tumor is vessel-rich, including paraganglioma, hemangioma and others. Angiography is able to provide useful information when making surgical plans before surgery. The clinicopathologic characters, various opinions related to surgical treatment, and approaches to the differential diagnosis of SFTs are discussed.Computed tomography or magnetic resonance image is usually helpful when differentially diagnosing SFT. A Y-shape incision is suggested for transoral extirpation of a huge soft palate tumor mass such as the one encountered here. Preoperative angiography should reduce the risk of unexpected massive intraoperative bleeding. Long-term postoperative follow-up is recommended in order to avoid local recurrence or potential malignant transformation.

並列關鍵字

solitary fibrous tumor ； soft palate ； transoral excision ； angiography