中耳神经内分泌腺瘤的临床诊治  

Clinical diagnosis and treatment of middle ear adenomatous neuroendocrine tumors

作　　者：焦彦超[1] 洪拥军[1] 刘鹏[1] 曾培基 陈宏 丁鑫[2] JIAO Yanchao;HONG Yongjun;LIU Peng;ZENG Peiji;CHEN Hong;DING Xin(Department of Otolaryngology Head and Neck Surgery,Zhongshan Hospital Affiliated to Xiamen University,Xiamen 361004,China;Department of Pathology,Zhongshan Hospital Affiliated to Xiamen University,Xiamen 361004,China)

机构地区：[1]厦门大学附属中山医院耳鼻咽喉头颈外科,福建厦门361004 [2]厦门大学附属中山医院病理科,福建厦门361004

出　　处：《中国耳鼻咽喉颅底外科杂志》2024年第6期47-51,共5页Chinese Journal of Otorhinolaryngology-skull Base Surgery

基　　金：2021年厦门市医疗卫生指导性项目(3502Z20214ZD1060)。

摘　　要：目的探讨中耳神经内分泌腺瘤(MEANTs)的临床表现及诊疗方法,提高对该疾病的认识。方法回顾性分析2020—2022年厦门大学附属中山医院耳鼻咽喉科收治的2例MEANTs的临床资料,包括术前耳内镜、听力检查和影像学检查,术后病理诊断资料以及术后随访情况。结果2例均为男性,1例为右耳,1例为左耳。耳内镜下表现1例见外耳道淡红色新生物,鼓膜窥不清;另1例表现为鼓膜完整膨隆。颞骨CT显示鼓室软组织影,可延伸至乳突和外耳道,包绕听小骨,听骨链无明显骨质破坏;MRI表现为鼓室等T1等T2信号影,增强后明显强化。2例均行改良乳突根治术+听骨链重建术+鼓膜修补术。病理形态呈现腺样或巢状实性结构,免疫组化呈现CK-P和神经内分泌标记物不同程度的阳性表达。2例患者在随访期间内均未发现肿瘤复发。结论MEANTs是一种罕见疾病,具有良性形态特征和缓慢生长的特点,临床表现不典型,确诊依靠病理检查,手术完整切除是治疗MEANTs的主要手段。由于肿瘤具有潜在局部复发或转移的特性,术后需要定期随访。Objective To investigate the clinical manifestations,diagnosis and treatment of middle ear adenomatous neuroendocrine tumors(MEANTs)and improve the understanding of MEANTs.Methods The clinical data of 2 cases of MEANTs admitted to the Department of Otolaryngology,Zhongshan Hospital Affiliated to Xiamen University from 2020 to 2022 were retrospectively analyzed,including preoperative endoscopy,hearing examination and imaging examination,postoperative pathological diagnosis data and postoperative follow-up.Results All two cases were male.One MEANTs occurred on the right side,another occurred on the left side.Endoscope examination of one case revealed that the right external ear canal was filled with reddish polypoid tissues,tympanic membrane was not possible to visualize.Another case presented with complete bulging of the tympanic membrane.In temporal bone CT,the soft-tissue mass located the middle ear was found to extend to the antrum and the external auditory canal.MEANTs tend to surround the ossicles without erosion.MRI images showed equalT1and T2 signals with intensifying in tympanum.Two patients underwent canal wall down mastoidectomy and ossicular reconstruction.Both cases showed adenoid or solid nest-like structures in the pathological morphology.Immunohistochemistry showed different levels of CK-P and neuroendocrine markers.Two patients showed no evidence of recurrence during followed up.Conclusions MEANTs are rare middle ear masses with benign morphological features and its clinical manifestations are not typical.MEANTs surgical resection of the tumor is the main method of treatment.Regular follow-up of the patients is required after surgery.

关 键 词：中耳 神经内分泌腺瘤 乳突根治术 免疫组织化学 

分 类 号：R764.2[医药卫生—耳鼻咽喉科]