鼻咽部胚胎型横纹肌肉瘤一例报告-耳鼻咽喉科学专业论文.docxVIP

郑重声明 本人的学位论文是在导师的指导下独立撰写并完成的，学校 论文没有黯窃、抄袭、造假等违反学术道德、学术规范和侵权行 为，本人愿承担由此而产生的法律后果和法律责任安特此郑重声 明。 学位论文作者〈签名):或是严 。忆年u 月 6 日 一、病情简介 患者，女， 12 岁，于 2003 年 1 月 10 日因感冒后鼻塞，在当地医院以鼻窦炎 治疗无效。 2003 年二月初患者自觉仰卧时呼吸困难，进食较大团块状食物时感吞咽困 难，家人观察到其睡眠时打斜，遂至南京某大医院就诊。行头颈部 MRl检查发现左鼻 咽部巨大肿物，初诊为鼻咽部纤维血管瘤。 2 月 4 日行活检镜下见异型小细胞及坏死 组织，再行活检经免疫组化诊断为鼻咽部胚胎型横纹肌肉瘤，遂转至我院治疗 。入 院时 II度呼吸困难，急诊行预防性气管切开术。请肿瘤内科会诊，决定先行化、放疗， 酌情再行手术治疗。在中南医院行 6 周期化疗，并加鼻咽部放疗，剂量共 54Gy 。治疗 结束时，患者鼻咽部肿物基本消失，颈部未扪及明显淋巴结，复查鼻咽部 M阳示肿块 基本消失达临床治愈。出院观察至今，患者一般情况良好?仍在随访中。 -、 Brief introduction of patients condition 丁be patient was a 12-year-old girl. She felt nasal obstruction after catching a cold in Jan， 2003 and was treated as sinusitis in the local hospital but it has no effects. In Feb 2003，she felt dyspnea when backlying and dysphagia when chewing a little big bolus of food. Her p缸ents a1so observed her snoring during her s1eeping. So they went to the local hospital and MRI in nasopharynx showed a tumour in levonasopharynx. The primary diagnose wa fibroangioma of nasopharynx. But the d?agnosis of Embryonal rhabdomyosarcoma was confirmed by biopsy. Therefore ，the patient was transferred to our hospital. She was received tracheotomy in emergency because of IIdegree dysphagia. Due to the tumor is too big to be exairesised. So the patient was transferred to 也e dep缸tment of oncology of Zhongnan hospital and received 6 cyc1es chemotherapy and radiotherapy of nasopharyn. When 也e treatment was finished ，the twnour of nasoph缸归 was disappeared and MRI showed the tumour was shrinked. The fowllow-up told us that the patient was fairly well. The followup wil1 be continued. 2 三、诊断及诊断依据 诊断:鼻日囡部胚胎型横纹肌肉瘤 III期 诊断依据: 1 主诉:鼻塞一月，伴进行性呼吸困难一周 2 病史:患JL 自2003 年元月感雪后出现鼻塞，在当地医院按鼻窦炎治疗无 效。 2 月上旬患者自觉仰卧时有轻度呼吸困难，进食较大团块状食物时感吞咽困难， 家人发现其黯践时打鼻子，遂至南京某大医院就诊。头颈部 MRI 发现 u鼻喃偏左侧巨大 肿块影，填充大部鼻咽腔，ti..侧咽隐窝消失，周围骨质未见明显破坏吸收，病灶部分 侵入左侧蝶窦及后组筛窦，报告为左侧巨大纤维血管瘤。 2 月 14 日行活检，镜下见 异型小细胞和坏死组织。 2 月 19 日再行活检，兔疫组化检查示 Des (+)、 MG (土〉、 Vim (川、 LCA (一)、 Kt (一)，报告为胚胎性横纹肌肉瘤。患者渐感呼吸困难加室， 无头痛、面部