攝護腺腺癌病人發生鼻及鼻竇未分化癌併頸部轉移

Sinonasal Undifferentiated Carcinoma with Neck Metastasis in a Patient with Prostate Adenocarcinoma

趙品植(Pin-Zhir Chao) ； 黃鈞鼎(Chun-Ding Huang) ； 楊宗翰(Tsung-Han Yang) ； 李飛鵬(Fei-Peng Lee) ； 鄭建睿(Chien-Jui Cheng)

《台灣耳鼻喉頭頸外科雜誌》 39卷s-2期 (2004/12) Pp. 96-101

https://doi.org/10.6286/2004.39.s-2.96

摘要

鼻及鼻竇未分化癌(sinonasal undifferentiated carcinoma)為一罕見且極具侵襲性的惡性腫瘤，由於其與其他惡性較低的分化不良腫瘤，如淋巴上皮瘤、嗅神經母細胞瘤及神經內分泌癌等的鑑別不易，診斷須綜合臨床症狀、組織病理及免疫組織化學染患的特徵。治療方面以多模式為主，病人的預後極差。本科會診1名75歲男性病患，於2001年2月被診斷罹患攝護腺腺癌併有頸部無痛性腫塊，頸部淋巴結切片為轉移癌，但並非源自攝護腺腺癌。兩個月後病患主訴左眼複視、眼瞼下垂及左邊顏面麻木感。理學檢查可見一灰色息肉樣組織由中鼻道突出於鼻腔中，病理切片及免疫組織化學染色法判斷為未分化癌。病患接受化學治療的效果不佳，並於2001年7月死亡。謹提出此一罕見病例以供討論，對於有頸部轉移病灶的非頭頸部癌症病患，仍須積極尋找其位於頭頸部的原發位置，以尋求最適當的治療方式。

關鍵字

未分化癌 ； 鼻及鼻竇區域 ； 攝護腺腺癌 ； 頸部轉移 ； 多模式治療

並列摘要

Sinonasal undifferentiated carcinoma, a rare and clinically aggressive neoplasm, is often advanced at the time of diagnosis and bears a poor prognosis. It should be differentiated from other small to medium-sized malignant tumors, such as melanoma, lymphoepithe-lioma, esthesioneuroblastoma and neuroendocrine carcinoma, on the basis of their light microscopic, immunohistochemical, and ultrastructural features. Multimodal therapy, comprising chemotherapy, radiotherapy and surgery, is the current treatment of choice and is advocated for selected cases, nevertheless the survival rate remains unsatisfactory. A 75-year-old male patient was diagnosed as prostate adenocarcinoma and noted to have bilateral neck mass in February, 2001. Pathological report of the neck mass revealed metastatic undifferentiated carcinoma with unknown origin. Two months later, he complained of nasal obstruction and facial numbness of left side, accompanied by ptosis of left eye. A grayish, polyp-like mass protruding from middle meatus occupied the left nasal cavity. Sinus CT scan showed an irregular soft tissue mass within the left ethmoid and sphenoid sinus. Specimen obtained under endoscopy proved to be sinonasal undifferentiated carcinoma. The patient's general condition deteriorated with multiple complications while receiving chemotherapy and died in July, 2001. For patients of non-head-and-neck malignancy with metastatic lesions of the neck, it is advisable and important to evaluate the primary site in the head and neck in order to devise the optimal treatment for the patients.

並列關鍵字

undifferentiated carcinoma ； sinonasal region ； prostate adenocarcinoma ； neck metastasis ； multimodal treatment