孤立型蝶竇倒生性乳突瘤

Isolated Inverted Papilloma of the Sphenoid Sinus

洪莉婷(Li-Ting Hung) ； 許志宏(Chih-Hung Shu) ； 何青吟(Ching-Yin Ho)

《台灣耳鼻喉頭頸外科雜誌》 50卷3期 (2015/09) Pp. 159-165

https://doi.org/10.6286/2015.50.3.159

摘要

背景：蝶竇之倒生性乳突瘤相當罕見，因其早期症狀大都不具特異性，易延誤診斷，造成治療困難且預後差。而電腦斷層特徵與慢性鼻竇炎並無明顯差異，若無病理切片可能造成診斷困難。本研究目的針對蝶竇之倒生性乳突瘤的症狀、特徵、診斷及治療結果加以分析。方法：回溯性收集2009至2014年間，共68例在本院經病理切片診斷並接受治療的倒生性乳突瘤患者，其中7例為源自蝶竇之倒生性乳突瘤，分析病患特徵、症狀、病理診斷、治療及預後。結果：7名病患，4名男性，3名女性，年齡分佈47至65歲，平均年齡57.9歲，症狀以單側鼻塞為主，餘為頭痛及咳血痰。所有病患均於術前安排鼻竇內視鏡及電腦斷層檢查，並皆接受鼻竇內視鏡手術摘除腫瘤，其中1例為惡性腫瘤。有2例復發，再次用鼻竇內視鏡手術清除乾淨後，追蹤至今7名病患皆無復發跡象。結論：蝶竇的倒生性乳突瘤症狀不具特異性，故見到單側鼻息肉時需列入鑑別診斷。鼻內視鏡、影像學檢查、切片檢查可幫助確診及治療。大部分的腫瘤可用鼻竇內視鏡手術摘除乾淨。因為倒生性乳突瘤有容易復發的特性，故提醒病人術後定期追蹤是很重要的。

關鍵字

鼻竇內視鏡手術 ； 頭痛 ； 倒生性乳突瘤 ； 蝶竇

並列摘要

BACKGROUND: Isolated inverted papilloma of the sphenoid sinus, a rarely seen disease, is often diagnosed late due to non-specific symptoms. Invading to the surrounding tissue, such as orbit, skull base, or cranial nerve, makes treatment more difficult and has poorer prognosis. Because it's hard to differentiate the computed tomography of inverted papilloma from chronic sinusitis, pathologic diagnosis remains the gold standard. The aim of this study is to analyze symptoms, characteristics, diagnosis, and the results of therapy. METHODS: In this retrospective study, we evaluated 68 inverted papilloma patients from 2009 to 2014. Seven patients were diagnosed with isolated inverted papilloma of the sphenoid sinus. Patients' age, sex, symptoms, underlying medical disease, diagnosis, pathologic report, treatment and outcome were analyzed. RESULTS: A total of 7 cases of isolated inverted papilloma of the sphenoid sinus were included. There were 4 men and 3 women, with a mean age of 57.9 years (range, 47- 65years). The most common symptom is unilateral nasal obstruction, followed by headache and blood-tinged sputum. All patients received sinoscopy and computed tomography preoperatively, and underwent endoscopic sinus surgery for tumor removal. Pathology confirmed inverted papilloma, with one transformed into squamous cell carcinoma. There were two recurrence cases, and received repeated endoscopic sinus surgery. All patients were free of disease during follow-up period. CONCLUSIONS: Initial presentation of isolated inverted papilloma of the sphenoid sinus is nonspecific, making the diagnosis more difficult. Clinicians should keep the diagnosis in mind when encountering unilateral nasal polyps. Sinoscopy, image study, and even the pathologic diagnosis are the key to diagnosis and treatment. Most of the tumors can be removed completely by endoscopic sinus surgery. However, a long-term follow-up is required to identify recurrence of the disease.

並列關鍵字

endoscopic sinus surgery ； headache ； inverted papilloma ； sphenoid sinus