第二原发性气管腺样囊性癌1例报告及文献复习
R734.1; 本文作者报道1例第二原发性气管腺样囊性癌(TACC)患者的诊疗经过.从疾病发生学角度看,该患者先后确诊气管基底细胞腺癌、气管腺样囊性癌,此情况在临床极为罕见,为研究不同类型气管癌的发病相关性及差异性提供参考.同时,在治疗过程中出现了放疗期间突发气管切开术后切口大量出血的情况,加深了对TACC放疗并发症的认识.患者,女性,61岁,5年前因行气管基底细胞腺癌手术治疗,1年前,患者自觉劳力性呼吸困难并逐渐加重,严重影响日常生活,遂入院寻求进一步诊疗.体格检查见右颈部有一 2cm×1cm包块,形态不规则,表面皮温和皮色正常,无触痛、无压痛,活动度良好.喉增强计算机断层扫描(CT)提示,...
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| Published in | 吉林大学学报（医学版） Vol. 51; no. 1; pp. 215 - 221 |
|---|---|
| Main Authors | , , , |
| Format | Journal Article |
| Language | Chinese |
| Published |
吉林大学中日联谊医院放疗科,吉林 长春 130033
28.01.2025
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| Subjects | |
| Online Access | Get full text |
| ISSN | 1671-587X |
| DOI | 10.13481/j.1671-587X.20250126 |
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| Abstract | R734.1; 本文作者报道1例第二原发性气管腺样囊性癌(TACC)患者的诊疗经过.从疾病发生学角度看,该患者先后确诊气管基底细胞腺癌、气管腺样囊性癌,此情况在临床极为罕见,为研究不同类型气管癌的发病相关性及差异性提供参考.同时,在治疗过程中出现了放疗期间突发气管切开术后切口大量出血的情况,加深了对TACC放疗并发症的认识.患者,女性,61岁,5年前因行气管基底细胞腺癌手术治疗,1年前,患者自觉劳力性呼吸困难并逐渐加重,严重影响日常生活,遂入院寻求进一步诊疗.体格检查见右颈部有一 2cm×1cm包块,形态不规则,表面皮温和皮色正常,无触痛、无压痛,活动度良好.喉增强计算机断层扫描(CT)提示,气管右侧壁及后壁可见菜花样软组织样肿块影,右侧锁骨上区胸锁乳突肌前缘结节,考虑为气管内肿瘤复发.需与气管鳞状细胞癌等相鉴别,鳞状细胞癌在病理形态上多有角化珠形成,细胞异型性更明显,免疫组织化学标志物也存在差异,通过病理和免疫组织化学检查结果可有效区分.后行肿物连同气管壁切除,并行右侧锁骨上肿物切除术.术后病理检查结果提示气管肿物腺样囊性癌,局部神经可见累及.鉴于患者已出现气管阻塞症状且有TACC颈部淋巴结转移可能,手术治疗是首要选择.术后放疗进一步控制局部残留肿瘤细胞,降低复发风险,提高局部控制率.放疗后随访12个月,未见肿瘤复发迹象.临床医生应强化诊断思维,高度警惕气管部位第二原发性肿瘤的可能,综合运用多种检查手段进行全面评估,提高早期诊断准确性,避免误诊漏诊,为患者赢得最佳治疗时机. |
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| AbstractList | R734.1; 本文作者报道1例第二原发性气管腺样囊性癌(TACC)患者的诊疗经过.从疾病发生学角度看,该患者先后确诊气管基底细胞腺癌、气管腺样囊性癌,此情况在临床极为罕见,为研究不同类型气管癌的发病相关性及差异性提供参考.同时,在治疗过程中出现了放疗期间突发气管切开术后切口大量出血的情况,加深了对TACC放疗并发症的认识.患者,女性,61岁,5年前因行气管基底细胞腺癌手术治疗,1年前,患者自觉劳力性呼吸困难并逐渐加重,严重影响日常生活,遂入院寻求进一步诊疗.体格检查见右颈部有一 2cm×1cm包块,形态不规则,表面皮温和皮色正常,无触痛、无压痛,活动度良好.喉增强计算机断层扫描(CT)提示,气管右侧壁及后壁可见菜花样软组织样肿块影,右侧锁骨上区胸锁乳突肌前缘结节,考虑为气管内肿瘤复发.需与气管鳞状细胞癌等相鉴别,鳞状细胞癌在病理形态上多有角化珠形成,细胞异型性更明显,免疫组织化学标志物也存在差异,通过病理和免疫组织化学检查结果可有效区分.后行肿物连同气管壁切除,并行右侧锁骨上肿物切除术.术后病理检查结果提示气管肿物腺样囊性癌,局部神经可见累及.鉴于患者已出现气管阻塞症状且有TACC颈部淋巴结转移可能,手术治疗是首要选择.术后放疗进一步控制局部残留肿瘤细胞,降低复发风险,提高局部控制率.放疗后随访12个月,未见肿瘤复发迹象.临床医生应强化诊断思维,高度警惕气管部位第二原发性肿瘤的可能,综合运用多种检查手段进行全面评估,提高早期诊断准确性,避免误诊漏诊,为患者赢得最佳治疗时机. |
| Abstract_FL | The author of this paper repored the diagnostic and treatment process of one patient with secondary primary tracheal adenoid cystic carcinoma(TACC).From the perspective of disease occurrence,the patient was successively diagnosed with tracheal basal cell adenocarcinoma and tracheal adenoid cystic carcinoma,which was extremely rare in clinical practice,providing a reference for studying the correlation and differences in the incidence of different types of tracheal cancer.At the same time,during the treatment process,massive bleeding from the tracheostomy site occurred during radiotherapy,deepening the understanding of radiotherapy complications in TACC.The patient,a 61-year-old female,underwent surgical treatment for tracheal basal cell adenocarcinoma five years ago.One year ago,the patient experienced exertional dyspnea,which gradually worsened,severely affecting her daily life,leading to her hospital admission for further diagnosis and treatment.The physical examination results showed a 2 cm ×1 cm irregular mass in the right neck,with normal skin temperature and color,no tenderness or pain on pressure,and good mobility.Enhanced computed tomography(CT)of the larynx indicated cauliflower-like soft tissue masses on the right and posterior walls of the trachea and a nodule on the anterior margin of the sternocleidomastoid muscle in the right supraclavicular region,suggesting recurrence of an intratracheal tumor.The differential diagnosis included tracheal squamous cell carcinoma,which often forms keratin pearls and exhibits more significant cellular atypia.The immunohistochemical markers are also different,and the results of pathology and immunohistochemistry examinations can effectively distinguish them.The patient underwent resection of the mass along with the tracheal wall and excision of the right supraclavicular mass.The postoperative pathology confirmed adenoid cystic carcinoma of the trachea with local neural involvement.Given the patient's symptoms of tracheal obstruction and the possibility of cervical lymph node metastasis of TACC,surgery was the primary treatment choice.Postoperative radiotherapy further controlled residual tumor cells,reduced the risk of recurrence,and improved the local control rates.After 12 months of follow-up post-radiotherapy,no signs of tumor recurrence were observed.The clinicians should reinforce diagnostic thinking and be highly vigilant for the possibility of secondary primary tumors in the trachea.They should comprehensively assess using various examination methods to improve the early diagnosis accuracy and avoid the misdiagnosis and missed diagnosis,thereby providing the best treatment opportunity for the patients. |
| Author | 王璐瑶 刘林林 张婉泽 赵晨曦 |
| AuthorAffiliation | 吉林大学中日联谊医院放疗科,吉林 长春 130033 |
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| Author_FL | LIU Linlin ZHAO Chenxi ZHANG Wanze WANG Luyao |
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| Author_xml | – sequence: 1 fullname: 王璐瑶 – sequence: 2 fullname: 赵晨曦 – sequence: 3 fullname: 张婉泽 – sequence: 4 fullname: 刘林林 |
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| Keywords | Tracheal adenoid cystic carcinoma Case report 病例报告 Second primary malignant tumor 气管腺样囊性癌 Radiotherapy 第二原发性恶性肿瘤 放射治疗 |
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