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目的 在梨状窝癌中确定浅表扩展癌的存在并研究其组织病理学及临床特点。方法 对43例梨状窝癌全喉下咽切除整体标本进行连续切片,行组织病理学研究。结果 发现4例梨状窝浅表扩展癌,其组织病理学特点为:由中或低分化鳞癌组成;完全或主要在粘膜内向四周扩散的生长方式;粘膜病变范围广泛,但对下咽粘膜下和喉结构无或只有局限性浸润;癌可有通过基底膜到达固有膜的早期浸润性生长;可有原位癌、非典型增生、粘膜坏死、典型深部浸润等多种病变;淋巴结转移常见。梨状窝浅表扩展癌临床症状较轻,甚至无咽部症状。结论 梨状窝浅表扩展癌是与典型深部浸润癌不同的另一种生长形态,不易确定其浸润范围,因此,以全喉及全或部分下咽切除为宜,并应行病侧颈廓清术。
Objective To determine the presence of superficially advanced carcinoma in pyriform squamous carcinoma and to study its histopathological and clinical characteristics. Methods 43 cases of pyriform sinus carcinoma underwent total laryngectomy and total histological specimens were cut and histopathologically studied. The results showed that there were 4 cases of superficial expanded carcinoma of the piriform gyrus, whose histopathological features consist of: moderately or poorly differentiated squamous cell carcinoma; growth patterns that are completely or mainly diffused in the mucosa in all directions; mucosal lesions are extensive, but the hypopharyngeal mucosa There is no or only limited infiltration of the inferior and laryngeal structures; carcinoma may have early invasive growth from the basement membrane to the lamina propria; there may be many lesions such as carcinoma in situ, atypical hyperplasia, mucosal necrosis, and typical deep infiltration; lymph node metastasis . Piriform fossa superficial extended cancer has mild clinical symptoms and even no pharyngeal symptoms. Conclusion The superficial expanded carcinoma of the piriform gyrus is another form of growth that is different from the typical deep invasive carcinoma. It is not easy to determine the extent of infiltration. Therefore, it is appropriate to use total larynx and total or partial hypopharyngectomy to remove the disease. Surgery.