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目的:分析上呼吸道髓外浆细胞瘤(EMP)的临床特点、治疗情况及转归,提高对上呼吸道EMP的诊治水平。方法:回顾性分析26例上呼吸道EMP患者的临床资料,并与同期因相似症状首诊于耳鼻咽喉科的多发性骨髓瘤(MM)患者对比分析。结果:26例EMP患者中,发生于鼻腔9例,鼻窦7例,咽部6例,喉部4例;临床表现主要为局部肿物及其引起的相应症状,患者局部活检标本均经病理学诊断为浆细胞瘤;其临床表现、内镜下所见及病理组织学改变与MM上呼吸道受累患者无区别,但MM患者常伴贫血、骨质破坏等表现,其侵犯颈部淋巴结者较上呼吸道EMP患者多见。EMP患者中单纯手术治疗10例,综合治疗(手术加放疗)16例;局部复发5例,转化为MM 4例。有颈部淋巴结受累的7例患者均接受了综合治疗,其中4例患者在综合治疗的基础上接受了化疗。该4例患者均未发生局部复发,亦未转化为MM;而未接受化疗的3例患者中1例局部复发,1例转化为MM。结论:上呼吸道EMP的诊断有赖于病理学检查,病理医生对EMP认识的提高及先进分子生物学技术手段的应用,是提高诊断水平的关键。在EMP的诊治过程中必须行相关检查排除MM。EMP的治疗以手术治疗及局部放疗为主,预后较好,但应长期随访。对于淋巴结受累者应加用化疗,以提高疗效,减少局部复发及转化为MM的风险。
Objective: To analyze the clinical features, treatment and prognosis of upper respiratory tract extramedullary plasmacytoma (EMP) and to improve the diagnosis and treatment of EMP in upper respiratory tract. Methods: The clinical data of 26 patients with upper respiratory tract EMP were retrospectively analyzed and compared with patients with multiple myeloma (MM) who were diagnosed with otolaryngology at the same period due to similar symptoms. Results: Twenty-six patients with EMP occurred in 9 cases of nasal cavity, 7 cases of sinus, 6 cases of pharynx and 4 cases of larynx. The clinical manifestations were mainly local tumor and their corresponding symptoms. Local biopsy specimens of patients were pathologically Diagnosis of plasma cell tumor; its clinical manifestations, endoscopic and pathological changes seen in patients with upper respiratory tract involvement MM no difference, but patients with MM often accompanied by anemia, bone destruction and other performance, its invasion of cervical lymph nodes were Respiratory EMP patients more common. EMP patients were treated by simple surgery in 10 cases, comprehensive treatment (surgery plus radiotherapy) in 16 cases; 5 cases of local recurrence, converted to MM in 4 cases. Seven patients with cervical lymph node involvement received combined treatment, and four of them received chemotherapy on a combined basis. None of the 4 patients had local recurrence and did not convert to MM; 1 of 3 patients who had not received chemotherapy had a local recurrence and 1 had converted to MM. Conclusion: The diagnosis of upper respiratory tract EMP depends on the pathological examination. The pathologists’ understanding of EMP and the application of advanced molecular biology techniques are the keys to improve the diagnosis. In the process of diagnosis and treatment of EMP must check related to exclude MM. EMP treatment with surgical treatment and local radiotherapy, the prognosis is good, but should be long-term follow-up. For patients with lymph node involvement should be added chemotherapy to improve efficacy and reduce the risk of local recurrence and conversion to MM.