後鼻孔之腺樣囊狀癌

Adenoid Cystic Carcinoma of the Choanal

袁聖博(Sheng-Po Yuan) ； 賴銘堂(Ming-Tang Lai) ； 許博涵(Po-Han Hsu) ； 陳志榮(Chih-Jung Chen) ； 邱康瑄(Kang-Hsuan Chiu)

《台灣耳鼻喉頭頸外科雜誌》 45卷2期 (2010/04) Pp. 59-63

https://doi.org/10.6286/2010.45.2.59

摘要

腺樣囊狀癌在大小唾液腺皆可發生，尤其以小唾液腺之發生率最高；凡有小唾液腺分佈之頭頸部，如鼻腔、鼻竇、口腔硬腭及上呼吸道均可能發生。其中起源於鼻腔及鼻竇小唾液腺之腺樣囊狀癌相當罕見，只佔頭頸部腺樣囊狀癌的10-25%。早期之臨床症狀有單側鼻塞、鼻衄、鼻漏及腫脹等狀似鼻腔鼻竇炎之急性發炎。其臨床特徵主要爲：(1)腫瘤生長緩慢但早期即易發生神經周圍(perineural space)侵犯，(2)手術治療後之高復發率，(3)罕見局部淋巴轉移但常見遠隔轉移至肺及骨骼，(4)5年存活率極高，但10年、20年存活率卻極低。本科經歷1名37歲男性病患，因右臉部漸進性麻木感4個月來求診。理學檢查發現一個約1.5×1cm，軟而微痛性的腫瘤位於右側後鼻孔，切片檢查結果爲右後鼻孔腺樣囊狀癌，但無頸部腫塊之表現，亦未發現任何遠隔轉移。核磁共振影像檢查發現腫瘤沿三叉神經之上頜分支通過圓孔侵入顱內。經查閱文獻報告得知，腺樣囊狀癌之治療方式以手術切除爲主，但若已侵犯至顱內則需手術治療併放射治療。此病例爲位置罕見之後鼻孔腺樣囊狀癌，因其特殊之顱內侵犯而接受強度調控放射治療(intensity-modulated radiation therapy)，特提出討論。

關鍵字

腺樣囊狀癌 ； 後鼻孔 ； 強度調控放射治療

並列摘要

Originating from major and minor salivary glands, adenoid cystic carcinoma (ACC) is the most common malignant neoplasm of minor salivary glands. Although sinonasal ACC represents 10% to 25% of the head and neck ACC, sinonasal tract remains an uncommon primary site for this malignant neoplasm. Early manifestations such as unilateral nasal obstruction, epistaxis, discharge, facial pain and swelling can mimic inflammatory diseases such as rhinosinusitis. The clinical behavior of ACC is characterized by: (1) tumor growth is slow, but perineural space invasion is early, (2) high local recurrence rate after surgical intervention, (3) metastasis to regional lymph nodes is uncommon, but distant metastasis to lungs and bones is frequent, (4) 5-year survival rates are high, but 10 to 20-year survival rates are low. We present a 37 years old male patient with right progressive facial numbness for 4 months. Physical examination did not show any neck mass. Nasal endoscopy revealed a soft, tender tumor about 1.5×1cm at right choana. An endoscopic biopsy of the tumor revealed adenoid cystic carcinoma. Magnetic resonance imaging showed intracranial invasion along maxillary branch of CNV. Intensity-modulated radiation therapy was advocated for the control of this intracranial invasion of ACC.

並列關鍵字

adenoid cystic carcinoma ； choana ； intensity-modulated radiation therapy