Hörmann K, Donath K
Laryngol Rhinol Otol (Stuttg). 1986 May;65(5):297-302.
Mechanisms of invasion of squamous cell carcinoma into the framework of the larynx were studied in nondecalcified acrylic embedded tissue. Destruction was always an indirect process mediated by giant cells or proteases. Two different stages of tissue specific response were seen. Bone was reacting with osteoneogenesis in the interface and with apposition of bone at the tumour non-attached side. Hyaline cartilage was responding with new formation of bone distant to the tumour and with production of protease inhibiting cartilage substance, whenever the tumour was attached to cartilage directly. Macrophages resorbed the product of these local tumour-host-interactions. There were plasma cells indicating a local immunological activity. In cases of irradiated carcinomatous larynxes this local immunological process seemed to be not in action. Here tumour invaded the skeleton of the larynx directly and microphages were seen removing the waste of destruction showing sequesters of cartilage and bone. These findings confirm the therapeutic principle that in carcinomas infiltrating the framework of the larynx irradiation is insufficient. Irradiation disarranges the specific local mechanism of defence and advances destruction and metastases by the tumour. Therefore, if operative treatment is not possible, it must be discussed, whether an alternative palliative proceeding--for example endolaryngeal reduction of tumour masses by laser surgery conservating the laryngeal framework--is a more adequate solution.
在非脱钙丙烯酸包埋组织中研究了鳞状细胞癌侵犯喉支架的机制。破坏总是由巨细胞或蛋白酶介导的间接过程。观察到两个不同阶段的组织特异性反应。骨在界面处通过骨生成反应，并在肿瘤未附着侧有骨的附着。每当肿瘤直接附着于软骨时，透明软骨会在远离肿瘤处形成新骨，并产生抑制蛋白酶的软骨物质。巨噬细胞吸收这些局部肿瘤-宿主相互作用的产物。有浆细胞表明存在局部免疫活性。在接受过放疗的喉癌病例中，这种局部免疫过程似乎不起作用。在此情况下，肿瘤直接侵犯喉的骨骼，可见巨噬细胞清除破坏产物，呈现软骨和骨的碎片。这些发现证实了这样的治疗原则：对于浸润喉支架的癌，放疗是不够的。放疗扰乱了局部特异性防御机制，促进肿瘤的破坏和转移。因此，如果无法进行手术治疗，就必须讨论是否一种替代的姑息性治疗方法——例如通过保留喉支架的激光手术进行喉内肿瘤块缩小——是一种更合适的解决方案。
