Scheurleer W F Julius, Braunius W Weibel, de Ridder M, Voormolen Eduard H J, de Bree Remco, Bleys Ronald L A W, Kalmann Rachel, Breimer Gerben E, Rijken Johannes A
Department of Head and Neck Surgical Oncology, University Medical Center Utrecht, Utrecht, Netherlands.
Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, Netherlands.
Case Rep Otolaryngol. 2024 Nov 29;2024:6637565. doi: 10.1155/crot/6637565. eCollection 2024.
The following case potentially provides insight into the mechanisms of lymphogenic metastasis in sinonasal cancer. A 63-year-old patient who presented with progressive diplopia and left-sided periocular pain was diagnosed with a cT4bN0M0 mucosal melanoma of the ethmoid sinus. She underwent a combined endonasal and transcranial tumor resection, and an orbital exenteration. Upon histopathological examination, besides the primary tumor, two separate localizations of melanoma surrounded by lymphoid tissues and lymph follicles were identified. The tumor was upstaged to pT4bN1, and the patient received a combination of adjuvant immunotherapy and radiotherapy. At present, the patient displays no evidence of disease. The presence of orbital lymph nodes has previously never been confirmed. These findings indicate the potential involvement of lymphatic drainage through the retrobulbar fat in the regional spread of sinonasal tumors closely associated with the orbit.
以下病例可能有助于深入了解鼻窦癌的淋巴转移机制。一名63岁患者因进行性复视和左侧眼周疼痛就诊，被诊断为筛窦cT4bN0M0黏膜黑色素瘤。她接受了鼻内和经颅联合肿瘤切除术及眼眶内容物剜除术。经组织病理学检查，除原发性肿瘤外，还发现了两个被淋巴组织和淋巴滤泡包围的独立黑色素瘤病灶。肿瘤分期上调为pT4bN1，患者接受了辅助免疫治疗和放疗联合治疗。目前，患者无疾病证据。眼眶淋巴结的存在此前从未得到证实。这些发现表明，在与眼眶密切相关的鼻窦肿瘤区域扩散中，通过球后脂肪的淋巴引流可能参与其中。
