| Objective: Retrospective analysis of the clinical features,imaging manifestations,pathological features,diagnosis and treatment and prognosis of head and neck myoepithelial carcinomaMethods:1.From January 2000 to April 2020,the patients with head and neck myoepithelial carcinoma who were admitted to the Department of Otolaryngology and head and neck surgery,the First Affiliated Hospital of Guangxi Medical University were searched.To summarize and analyze the clinical data,imaging examination and pathological examination of patients with complete clinical data and follow-up results,and to follow-up the survival status of patients.2.The data of CNKI,Wanfang,VIP,Pub Med and MEDLINE were collected and analyzed.Result:(1)The case of the First Affiliated Hospital of Guangxi Medical University1.From January 2000 to January 2020,10 patients with myoepithelial carcinoma of the head and neck were admitted to the Department of Otolaryngology and head and neck surgery,the First Affiliated Hospital of Guangxi Medical University.Clinical analysis: 4 males and 6 females.The median age was 54.5 years.3 cases occurred in parotid gland,5 in nasal cavity and paranasal sinuses,1 in soft palate and 1 in submandibular gland.The first symptom was local tumor in 4 cases,nasal obstruction in 5 cases,and pharyngeal discomfort in 1 case.2.According to the location of the tumor,the corresponding symptoms can be divided into the nasal cavity and paranasal sinuses myoepithelial cancer and salivary gland myoepithelial cancer.The symptoms were as follows:(1)the symptoms of myoepithelial carcinoma of the nasal cavity and paranasal sinuses included: nasal obstruction(23%,5 cases),pain(4 cases),runny nose(4 cases),bleeding(18%,4 cases),hypoesthesia(2 cases),hoarseness(1 case),dysphagia(1 case),mouth opening restriction(1 case),hearing loss with tinnitus(1 case).(2)MEC symptoms in salivary gland included: local mass(4 cases),facial paralysis(2 cases),local swelling,ulceration and pus(1 case),eyeball fixation(1case),and pain(1 case).3.7 cases were examined by CT.The features were as follows:(1)the shape of tumor: regular(1 case);irregular or lobulated(6 cases,85.71%).(2)Boundary:clear(1 case),unclear(6 cases,85.71%).(3)The internal condition of the tumor:homogeneous density,no necrosis(1 case);uneven density,with liquefying necrosis(6 cases,85.71%).(4)The relationship with the surrounding tissue: no invasion of the surrounding tissue(1 case),infiltration of the surrounding tissue(6 cases,85.71%).MRI was performed in 5 cases.The features were as follows:(1)the shape of tumor: regular(1 case);irregular or lobulated(4 cases,80%).(2)Boundary: clear(1 case),unclear(4 cases,80%).(3)The internal condition of tumor: signal was uniform and non necrotic(1 case);signal was uneven and accompanied with liquefying necrosis(4 cases,80%).(4)The relationship with the surrounding tissue: no invasion of the surrounding tissue(1 case),infiltration of the surrounding tissue(4 cases,80%).4.MEC was diagnosed by operation or biopsy in 10 cases,and immunohistochemistry was performed in 6 cases.The positive rate of immunohistochemistry: CK(66.67%),CK5 / 6(50%),CK7(50%),p63(50%),p53(33.33%),S100(33.33%),Ki-67 > 10%(50%).5.The treatment included 4 cases of simple operation,3 cases of operation combined with postoperative radiotherapy,1 case of simple chemotherapy,1 case of traditional Chinese medicine treatment,and 1 case of other treatment.6.10 cases were followed up from 6 to 84 months,with a median follow-up of 16.5 months.There were 3 early patients and 7 late patients.4 cases survived,including 3 cases in early stage and 1 case in late stage;6 cases died in late stage.(2)Literature analysis of head and neck myoepithelial carcinoma1.A total of 67 available literatures were searched.44 in Chinese and 23 in foreign.There were 276 cases.Among 276 cases,144 were male and 142 were female.The age range was0.1 months to 89 years,and the median age was 48 years.The duration of symptoms was recorded in 81 patients,the median month was 10 months(0.1-276 months).259 cases,including parotid gland(90 cases,36.68%),palate(37cases,14.29%),nasal cavity and paranasal sinuses(31 cases,11.97%),submandibular gland(30 cases,11.58%),small salivary gland(27 cases,10.42%)were recorded at the time of first diagnosis.3.According to the location of the disease,the symptoms can be divided into four categories:(1)147 cases of MEC occurred in salivary gland in 29 literatures,including neck masses(73.14%,128 cases),pain(16.57%,29 cases),local redness,ulceration,skin temperature rise(5.14%,9 cases),facial paralysis(2.86%,5 cases).(2)In 11 literatures,33 cases of MEC occurred in the neck and face.The symptoms included painless mass(62.5%,20 cases),pain(15.63%,5 cases),hoarseness(9.38%,3 cases).(3)In 15 literatures,39 cases of MEC occurred in the nasal cavity and sinuses.The symptoms included nasal obstruction(38.67%,29 cases),runny nose(24%,18 cases),hyposmell(28%,21 cases).(4)In 12 articles,40 cases of MEC occurred in the oral cavity.The symptoms included painless masses(10%,4 cases),pharyngeal obstruction(29%,11 cases),dysphagia(24%,9 cases),mouth opening breathing and dyspnea(24%,9 cases)and pain(13%,5 cases).4.According to the four aspects of CT,45 cases of MEC in 32 literatures were examined.The characteristics of MEC were as follows:(1)tumor morphology:regular(16 cases,35.56%);irregular or lobulated(29 cases,64.44%).(2)The tumor boundary was clear(19 cases,42.22%)and unclear(26 cases,57.78%).(3)The internal condition of tumor: homogeneous density,no necrosis(10 cases,22.22%);uneven density or liquefying necrosis(35 cases,77.78%).(4)The relationship with the surrounding tissues: no invasion of the surrounding tissues(18 cases,40.00%),infiltration of the surrounding tissues(27 cases,60.00%).19 articles and 19 cases described the MRI results.MRI features were as follows:(1)the shape of tumor: regular(5 cases,26.32%);irregular or lobulated(14 cases,73.68%).(2)Boundary: clear(7 cases,36.84%),unclear(12 cases,63.16%).(3)The internal condition of the tumor was homogeneous and non necrotic(3 cases,15.79%);the signal was uneven or accompanied with liquefying necrosis(16 cases,84.21%).(4)The relationship with the surrounding tissue: no invasion of the surrounding tissue(4 cases,21.05%),infiltration of the surrounding tissue(15 cases,78.95%).5.131 cases of 60 articles mentioned immunohistochemical examination.There are 17 items of immunohistochemical indicators.Each article has 1-7 items.The main positive indicators include: cytokeratin(CK),cytokeratin 5 / 6(CK5 /6),cytokeratin 7(CK7)The positive rates of CKP,EMA,p63,vimentin,S100,NSE,SMA and calponin were high,and Ki-67 was more than 10%.CEA positive rate was low.6.238 cases in 64 articles mentioned the specific treatment,including 118 cases of simple operation(49.58%),4 cases of simple chemotherapy(1.68%),6cases of simple radiotherapy(2.52%),65 cases of operation + radiotherapy(27.31%),17 cases of operation + chemotherapy(7.14%),25 cases of operation+ radiotherapy + chemotherapy(10.50%),and 3 cases of other treatment(1.26%).7.In 67 articles,89 cases can collect follow-up data.In the early stage of tumor,death accounted for 25.93%(14 / 54),and survival accounted for 74.07%(40 /54);in the late stage of tumor,death accounted for 71.43%(25 / 35),and survival accounted for 28.57%(10 / 35).The 1-year,3-year and 5-year survival rates calculated by Kaplan Meier method were 81.4%,69.2% and 66.2%,respectively.The median survival time was 82 months(95% CI 51.818-112.182),and the mean survival time was 92 months(95% CI 69.579-115.198).Single factor analysis showed that the survival factors of patients were tumor stage(P = 0.006),tumor recurrence(P = 0.00),symptom duration(P = 0.018),and whether surgery was performed(P = 0.002).According to Cox regression analysis,among many factors,only tumor recurrence(P = 0.038)affected the prognosis.Conclusion:1.Myoepithelial carcinoma of head and neck is more common in 40-60 years old people.2.The head and neck myoepithelial carcinoma is characterized by local mass and local compression.3.CT and MR can show the capsule and internal structure of head and neck myoepithelial carcinoma,but there is no specificity.4.The pathological manifestations of myoepithelial carcinoma were S100,vimentin,SMA,EMA,calponin,CK,p63,CK7,and Ki-67 > 10%.5.The treatment of head and neck myoepithelial carcinoma is mainly surgery,which can be supplemented by radiotherapy and chemotherapy.6.The tumor stage of head and neck myoepithelial carcinoma is closely related to prognosis. |
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