摘要
鼻部恶性肉芽肿是一种进行性坏死性溃疡性肉芽肿,可同时或后发于面中部如内眦、腭部及鼻窦内侧,往往危及生命。病因未明。随着病理组织学与免疫组化技术的发展,许多学者认为恶性肉芽肿属于肿瘤,为恶性淋巴瘤(T/NK细胞淋巴瘤)的一种。据我院病理科统计,140例鼻部恶性肉芽肿约占同期2 014例鼻部恶性肿瘤的7%。本文报告4例,男、女各2例;年龄19～58岁;前驱期1例、活动期3例、无终末期病例(按Stemart分期法)。治疗以放疗为主。随访3例,时间分别为1年3个月、2年和2年半,皆存活。因本病少见,易误诊或延迟确诊,笔者提出如下一些建议,望有助于及时确诊与适当治疗。首先,需认识本病临床表现的特点,Wegener肉芽肿与本病有别,宜鉴别;其次,确诊依靠免疫组化检测的病理检查,有时需多次活检才能确定;最后,治疗以放疗为主,此外尚需重视全身支持治疗。本病经放化疗的5年生存率为20%～80%。
Nasal malignant granulomas( MG) is a life-threatening progressive necrotic granuloma with ulcer and it often occurs extending to the midface such as inner canthus,palate, and parasinuses simultaneously or secondarily. The etiology is still unknown. Because of the progress of histopathology and immunohistochemistry,a lot of scholars agreed that MG belonged to tumor,namely one kind of lymphoma( T/NK cell lymphoma). According to the statistics of our department of pathology,140 cases of nasal MG accounted for 7% of 2 014 cases of nasal malignant tumors. The paper reported four cases of MG,including two males and two females with the age between 19 and 58 years. According to Stewar's staging,one case was at prodromal stage,three cases were at active stage. Radiotherapy was the main treatment. Three patients were followed up for one year and three months,two years,two years and six months respectively and all were survival. Because MG is rare and is easily misdiagnosed,the author provides some suggestions for its timely diagnosis and therapy. Firstly,more attentions should be paid to the clinical characteristics of MG and Wegener should be distinguished. Secondly,the diagnosis of MG depends on the immunohistochemistry and multiple biopsies are needed. Lastly,radiotherapy is the main treatment and systematic therapy should be paid attention to. The 5-year survival rate is between 20% and 80% after the treatment.
引文
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