Ohta Nobuo, Noguchi Naoya, Shinohara Senri, Murakami Kazuhiro, Nakazumi Miho, Suzuki Takahiro, Sato Teruyuki, Ise Kazue, Kagaya Yuriko, Tamura Ryo, Murakami Keigo, Nakamura Yasuhiro
Division of Otolaryngology, Tohoku Medical and Pharmaceutical University, Sendai 981-8536, Japan.
Division of Pathology, Tohoku Medical and Pharmaceutical University, Sendai 981-8536, Japan.
Yonago Acta Med. 2021 Apr 15;64(2):217-221. doi: 10.33160/yam.2021.05.008. eCollection 2021 May.
A 49-year-old Japanese man presented with a rare case of sinonasal leiomyosarcoma with left nasal bleeding for 12 months. He had no history of irradiation or malignancies, including retinoblastoma. Preoperative histological examination suggested vascular leiomyoma. Complete resection with endoscopic surgery was performed. Histological examination during the operation suggested that the tumor was a leiomyoma. However, immunohistochemical staining for α smooth muscle actin and desmin were helpful in establishing a definitive diagnosis of sinonasal leiomyosarcoma. The resection margins were positive for tumor cells. Staging with CT of the neck and thorax, ultrasound of the abdomen, and MRI of the head ruled out metastases. Second endoscopic tumor resection surgery was performed for positive resection margins. The patient's condition was successfully managed with additional excision, and he remains well with no evidence of recurrence and metastasis 36 months after treatment. Endoscopic management should be considered in suitable cases.
一名49岁的日本男性患者，因罕见的鼻窦平滑肌肉瘤伴左侧鼻出血12个月前来就诊。他没有放疗史或包括视网膜母细胞瘤在内的恶性肿瘤病史。术前组织学检查提示血管平滑肌瘤。遂行内镜手术完整切除。术中组织学检查提示肿瘤为平滑肌瘤。然而，α平滑肌肌动蛋白和结蛋白的免疫组化染色有助于明确鼻窦平滑肌肉瘤的诊断。切除边缘肿瘤细胞呈阳性。颈部和胸部CT、腹部超声以及头部MRI分期检查排除了转移。因切除边缘阳性，再次进行了内镜肿瘤切除手术。通过额外切除，患者病情得到成功控制，治疗后36个月仍状况良好，无复发和转移迹象。对于合适的病例应考虑内镜治疗。
