头颈部黏膜鳞状细胞癌颈部淋巴结转移直接累及皮肤。
Direct skin involvement of cervical lymph node metastasis from mucosal squamous cell carcinoma of the head and neck.
作者信息
Dragan A D, Nixon I J, Orabi A A, Manganaris A, Jeannon J-P, Guerrero-Urbano M T, Simo R
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
Department of Clinical and Radiation Oncology, Guy's and St Thomas' Hospital NHS Foundation Trust, London, UK.
出版信息
J Laryngol Otol. 2013 Feb;127(2):181-6. doi: 10.1017/S0022215112002733. Epub 2012 Dec 10.
INTRODUCTION
Direct skin involvement of nodal metastasis from mucosal head and neck squamous cell carcinoma has traditionally been considered a poor prognostic indicator.
METHODS
This retrospective review identified eight patients (five with mucosal upper aerodigestive and three with occult primary squamous cell carcinoma) who presented between 2000 and 2007 with direct skin involvement of nodal metastasis.
RESULTS
Five patients were treated with extended radical and three with extended modified radical neck dissection. Closure was achieved directly (four cases), with local (two) or pedicled (two) flaps. Surgery was always followed by radiotherapy (pan-mucosal or to the primary site). The five-year recurrence-free and disease-specific survival rates were 100 per cent.
CONCLUSION
It is exceptionally rare to encounter direct skin involvement of metastatic lymph nodes from mucosal head and neck squamous cell carcinoma without evidence of involvement of other anatomical structures. Surgical intervention is possible and combined modality treatment with curative intent is essential, as most patients can have a favourable outcome.
引言
传统上认为，黏膜型头颈部鳞状细胞癌发生淋巴结转移并直接累及皮肤是预后不良的指标。
方法
这项回顾性研究纳入了2000年至2007年间出现淋巴结转移直接累及皮肤的8例患者（5例为黏膜型上呼吸消化道癌，3例为隐匿性原发性鳞状细胞癌）。
结果
5例患者接受了扩大根治性颈清扫术，3例接受了扩大改良根治性颈清扫术。4例直接缝合，2例采用局部皮瓣，2例采用带蒂皮瓣实现创口闭合。术后均进行放疗（全黏膜或针对原发部位）。5年无复发生存率和疾病特异性生存率均为100%。
结论
黏膜型头颈部鳞状细胞癌发生转移的淋巴结直接累及皮肤且无其他解剖结构受累证据的情况极为罕见。手术干预可行，采取具有治愈意图的综合治疗至关重要，因为大多数患者可获得良好预后。
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