前额恶性肿瘤——两个病例报告及文献综述

Malignant Tumor of the Forehead—Two Cases Reports and a Literature Review

摘要: 尽管大多数位于前额的肿瘤是良性的，但仍有恶性肿瘤发生，如果未能准确诊断并及时治疗可能导致不良预后。本报告详细描述了在一名51岁男性和一名72岁男性额头上发现的两例罕见恶性肿瘤。在第一例中，患者在右额部头皮上观察到肿块持续一年逐渐增大。磁共振成像(MRI)显示一个不均质性肿块，在T2-FLAIR加权和扩散加权成像(DWI)上表现为高信号，并在对比增强扫描中观察到明显增强。组织学分析显示细胞角蛋白(CK)阳性，CD56部分阳性，最终诊断为大细胞神经内分泌癌(LCNEC)。手术干预后，患者接受了放疗，在17个月的随访中，没有局部复发或远处转移的迹象。在第二例中，患者50年前在右额部发现一个肿块，肿块增大很少且未接受治疗。在心脏支架手术后，患者注意到三年前肿块迅速增大。计算机断层扫描(CT)显示信号均匀，未见颅骨侵犯。组织学检查显示CK7和上皮膜抗原(EMA)阳性，与汗腺癌一致，三个月的随访中没有局部复发或远处转移的迹象。我们对现有文献的回顾发现四例类似的罕见恶性肿瘤患者，这可能提供额外的诊断见解。此外，我们还研究了额头肿瘤切除后皮肤缺损的修补重建。

Abstract: Although most forehead tumors are benign, malignant tumors can also occur in this area. These tumors are highly aggressive and metastatic, and failure to diagnose and treat them appropriately can lead to a poor prognosis. Here, we describe two rare cases of malignant tumors occurring on the forehead in a 51-year-old man and a 72-year-old man. In the first case, the patient had a progressively enlarging mass on the right forehead for one year. Magnetic resonance imaging (MRI) revealed a heterogeneous mass with hyperintensity on T2-FLAIR and diffusion-weighted imaging (DWI). The mass showed distinct enhancement on contrast-enhanced scans. Histologically, the mass was positive for cytokeratin (CK) and partially positive for CD56. The patient was diagnosed with large cell neuroendocrine carcinoma (LCNEC). After surgical resection, the patient received radiotherapy. No local recurrence or distant metastasis was observed during the 17-month follow-up. In the second case, a mass was found on the right forehead 50 years ago. It had barely enlarged and was not treated. After undergoing heart stent surgery, the patient noticed rapid enlargement of the mass three years ago. Computed tomography (CT) showed a uniform signal without skull invasion. Histologically, the mass was positive for CK7 and epithelial membrane antigen (EMA), consistent with eccrine porocarcinoma. No local recurrence or distant metastasis was observed during the three-month follow-up. We reviewed the published literature and identified four previously reported cases of similar rare malignant tumors, which may provide additional diagnostic insights. We also explored the reconstruction of skin defects after forehead tumor resection.