[头颈部髓外浆细胞瘤：一项临床病理及免疫组织化学研究]

Zhou G Y, Gao B Q, Liu Y F, Zhang X L, Wang J Q

Department of Otolaryngology, First Affiliated Hospital of West China University of Medical Sciences, Chengdu, 610041.

Lin Chuang Er Bi Yan Hou Ke Za Zhi. 2000 Apr;14(4):168-70.

OBJECTIVE

To investigate the relation between histopathological feature, clinical behavior characters, immunoglobulin (Ig) secretory function and prognosis of the extramedullary plasmacytoma (EMP) of the head and neck.

METHOD

12 cases of EMP in the head and neck region were studied retrospectively. The clinicopathological records from January, 1977 to December, 1996 were reviewed. Immunohistochemical (IHC) stains for detecting intracytoplasmic immunoglobulin kappa (IgG kappa) and lambda (IgG lambda) were carried out.

RESULT

10 cases of the patients were male and 2 female; Their ages ranged from 32 to 67 years with an average of 57 years. The tumors were located in the nasosinus (6), nasopharynx (2), Larynx (3) and ear (1). Low-(I), intermediate (II) and high-grade (III) tumors were 3, 3 and 6 cases respectively. Two patients with EMP of nasopharynx were treated with radiotherapy, in others radiotherapy was administered after complete surgical resection. Follow-up time ranged from 10 to 76 months. IHC showed monoclonality of the plasma cell and was positive for IgG lambda (6 cases) and IgG kappa (6 cases, conferming the identical clonal origin of the plasma cells. The 5-year survival for grade I, II and III were 75.0%, 62.0% and 37.6%, 37.5% and 68.50% for IgG lambda positive and IgG kappa positive cases, respectively. There are statistically significance between them (P < 0.01).

CONCLUSION

EMP in head and neck region are rare plasma cell tumors. IHC play an important role in differential diagnosis. The combination of surgery and radiotherapy proved to be an adequate and effective treatment. The grading and IgG secretory function may be valuable for predicting the prognosis of EMP.

目的

探讨头颈部髓外浆细胞瘤（EMP）的组织病理学特征、临床行为特点、免疫球蛋白（Ig）分泌功能与预后的关系。

方法

回顾性研究12例头颈部EMP患者。查阅1977年1月至1996年12月的临床病理记录。进行免疫组织化学（IHC）染色以检测胞浆内免疫球蛋白κ（IgGκ）和λ（IgGλ）。

结果

患者中男性10例，女性2例；年龄32至67岁，平均57岁。肿瘤位于鼻窦（6例）、鼻咽（2例）、喉（3例）和耳（1例）。低级别（I级）、中级（II级）和高级别（III级）肿瘤分别为3例、3例和6例。2例鼻咽EMP患者接受了放疗，其他患者在完整手术切除后进行放疗。随访时间为10至76个月。IHC显示浆细胞呈单克隆性，IgGλ阳性6例，IgGκ阳性6例，证实浆细胞起源相同。I级、II级和III级的5年生存率分别为75.0%、62.0%和37.6%，IgGλ阳性和IgGκ阳性病例分别为37.5%和68.50%。两者之间有统计学意义（P<0.01）。