A case of oropharyngeal squamous cell carcinoma with nasopharyngeal extension via the levator veli palatini muscle.
A case of oropharyngeal squamous cell carcinoma with nasopharyngeal extension via the levator veli palatini muscle.
复制标题
口咽鳞状细胞癌经提腭帆肌向鼻咽部扩展一例。
DOI：
10.1093/jjco/hyt174
复制
发表时间：
2014
影响因子：
2.4
通讯作者：
H. Onaya
中科院分区：
文献类型：
--
作者：
H. Kuno;H. Onaya
一位83岁的妇女提出了一个主要投诉喉咙痛。发现左侧扁桃体肿瘤，活检显示鳞状细胞癌。临床检查显示肿瘤主要在粘膜下区域形成肿块（图1），最初诊断为T2期。磁振造影显示一侵犯性肿块主要位于左口咽壁，延伸至软腭。冠状位T2加权像显示左腭帆提肌增厚并呈高信号（图2A，箭头），与正常的右腭帆提肌（图2A，箭头）形成对比。鼻咽水平的脂肪饱和对比增强T1加权图像显示左侧腭帆提肌（图2 B，箭头）和周围组织增强，提示扩展到鼻咽水平。MRI后行鼻咽纤维镜检查证实左侧输卵管圆隆凸发红。诊断为IV期口咽癌T4bN2bM0，并开始放化疗。治疗结束后4周的MRI显示肿瘤几乎完全消失。术后随访4年，患者均未出现复发或转移。对于口咽癌累及鼻咽部的患者，一般考虑放化疗而非手术治疗。这种类型的肿瘤主要在粘膜下层扩散，鼻咽粘膜表面有时看起来是完整的。在这种情况下，没有MRI很难诊断。腭帆提肌是软腭的组成部分之一，起自颅底的下表面和咽鼓管软骨的内侧板。当软腭中的肿瘤在深部到达该肌肉时，该肌肉可以成为直接侵入颅底或鼻咽的途径。注意事项：本病例部分由国家癌症中心图像参考数据库（NCC-CIR），2013：CASE 0204（http：//cir. ncc。走了jp/zh/index. html）。
An 83-year-old woman presented with a chief complaint of throat pain. A left tonsillar tumor was detected, and biopsy revealed squamous cell carcinoma. Clinical examination showed that the tumor had formed a mass mainly in the submucosal area (Fig. 1), and it was diagnosed initially as stage T2. Magnetic resonance imaging (MRI) demonstrated an invasive mass located mainly in the left oropharyngeal wall extending to the soft palate. The coronal T2-weighted image demonstrated thickening of the left levator veli palatini muscle with hyperintensity (Fig. 2 A, arrowheads), in contrast to the normal right levator veli palatini muscle (Fig. 2 A, arrows). A fat-saturated contrast-enhanced T1-weighted image at the nasopharyngeal level showed enhancement of the left levator veli palatini muscle (Fig. 2 B, arrowheads) and surrounding tissue, suggesting extension to the nasopharyngeal level. Nasopharyngeal fiberscopy performed after MRI confirmed redness of the left torus tubarius. A diagnosis of stage IV oropharyngeal cancer, T4bN2bM0, was made, and chemoradiotherapy was initiated. MRI 4 weeks after the end of treatment showed almost total disappearance of the tumor. Subsequently, the patient was followed without further treatment, and no recurrence or metastasis was evident after 4 years.For oropharyngeal cancer with nasopharyngeal extension, chemoradiotherapy rather than surgery is generally considered. This type of tumor spreads mainly in the submucosa, and the nasopharyngeal mucosal surface sometimes appears to be intact. In such cases, diagnosis is difficult without MRI. The levator veli palatini muscle, one of the components of the soft palate, arises from the undersurface of the skull base and from the medial lamina of the cartilage of the auditory tube. When a tumor in the soft palate reaches this muscle in deep areas, the muscle can become a route of direct invasion to the skull base or nasopharynx. Note: The present case, in part, was provided with permission from National Cancer Center Image Reference Database (NCC-CIR), 2013: CASE 0204 (http://cir. ncc. go. jp/en/index. html).