Croce A, Neri G, Lattanzio G, Angelucci D
Istituto di Clinica Otorinolaringoiatrica, Università G. D'Annunzio-Chieti.
Acta Otorhinolaryngol Ital. 1994 Mar-Apr;14(2):157-65.
The high incidence of second primary malignant neoplasms in patients under treatment for head and neck tumors has been well documented in literature. In these cases the second primary reappears still in the upper aero-digestive tract or in distant organs (lung, esophagus, stomach, skin,....). The Authors report a case of a male, 64 year old patient, a moderate drinker and smoker, with two distinct simultaneous laryngeal malignant neoplasms. One tumor, which arose on the laryngeal face of the epiglottis, was a verrucous carcinoma (Ackerman's tumor); the other neoplasm, on the right vocal cord, was a well differentiated squamous cell carcinoma. Microlaryngeal examinations and TC-scans revealed a normal, uninvolved right false vocal cord and the Morgagni's ventricle. After surgical therapy, serial laryngeal samples were removed and underwent immunohistochemical studies. Microscopic examination revealed that the anterior commissure, the pre-epiglottic and paraglottic spaces were intact, furthermore, monoclonal antibody studies proved that the two simultaneous laryngeal cancers were independent. In the discussion the Authors report some clinical considerations, a review of literature concerning multiple simultaneous laryngeal tumours and emphasize the concept of "field cancerization", first described with regard to the oral cavity by Slaughter.
头颈部肿瘤患者在治疗过程中第二原发性恶性肿瘤的高发病率在文献中已有充分记载。在这些病例中,第二原发性肿瘤仍出现在上呼吸道消化道或远处器官(肺、食管、胃、皮肤等)。作者报告了一例64岁男性患者,有适度饮酒和吸烟习惯,患有两种同时存在的不同喉部恶性肿瘤。一种肿瘤发生在会厌的喉面,为疣状癌(阿克曼肿瘤);另一种肿瘤位于右侧声带,为高分化鳞状细胞癌。显微喉镜检查和CT扫描显示右侧假声带和 Morgagni 室正常且未受累。手术治疗后,取出系列喉部样本并进行免疫组化研究。显微镜检查显示前联合、会厌前间隙和声门旁间隙完整,此外,单克隆抗体研究证明这两种同时存在的喉癌是独立的。在讨论中,作者报告了一些临床考虑因素,回顾了有关多个同时存在的喉部肿瘤的文献,并强调了“场癌化”的概念,这一概念最初是由斯劳特针对口腔描述的。