Kayakabe Mikiko, Takahashi Katsumasa, Okamiya Tomofumi, Segawa Atsuki, Oyama Tetsunari, Chikamatsu Kazuaki
Department of Otolaryngology-Head and Neck Surgery, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
Department of Diagnostic Pathology, Gunma University Graduate School of Medicine, Maebashi, Gunma 371-8511, Japan.
Oncol Lett. 2014 Apr;7(4):1253-1256. doi: 10.3892/ol.2014.1882. Epub 2014 Feb 13.
Combined small cell carcinoma (SmCC) and squamous cell carcinoma (SqCC) is a rare malignant neoplasm in the head and neck. This study presents the first reported case of combined SmCC and SqCC originating from the sinonasal tract accompanied by syndrome of inappropriate secretion of antidiuretic hormone (SIADH). An 80-year-old female presented with a four-week history of right nasal discharge, nasal obstruction and left neck swelling. Imaging studies revealed a tumorous lesion in the maxillary sinus encroaching upon the right nasal cavity and left cervical lymph node (LN) swelling. An incisional biopsy carried out from the right maxillary sinus and LNs resulted in a diagnosis of combined SmCC with SqCC, staged as T4aN2cM0. Clinical examination revealed a sustained increase of antidiuretic hormone, hyponatremia with urinary sodium increase, and serum hypo-osmosis, resulting in SIADH. Water restriction to <1,000 ml/day was effective in improving sodium and osmotic imbalance. Curative treatment for the tumor was not prescribed due to the poor condition of the patient. Palliative treatment was administered and the patient succumbed to cachexia five months after histological diagnosis. The presence of SIADH may have marked implications for the treatment and prognosis of this disease.
小细胞癌（SmCC）与鳞状细胞癌（SqCC）合并存在是头颈部一种罕见的恶性肿瘤。本研究报告了首例起源于鼻窦的小细胞癌与鳞状细胞癌合并存在并伴有抗利尿激素分泌不当综合征（SIADH）的病例。一名80岁女性，有为期四周的右侧鼻分泌物、鼻塞及左侧颈部肿胀病史。影像学检查显示上颌窦有一肿瘤性病变，侵犯右侧鼻腔并伴有左侧颈部淋巴结（LN）肿大。对右侧上颌窦及淋巴结进行切开活检，诊断为小细胞癌与鳞状细胞癌合并存在，分期为T4aN2cM0。临床检查发现抗利尿激素持续升高、低钠血症伴尿钠增加以及血清低渗，导致抗利尿激素分泌不当综合征。限制每日饮水量至<1000 ml可有效改善钠及渗透压失衡。由于患者病情较差，未进行肿瘤的根治性治疗。给予了姑息治疗，患者在组织学诊断后五个月死于恶病质。抗利尿激素分泌不当综合征的存在可能对该疾病的治疗及预后有显著影响。
