鼻尤文肉瘤3例

Ewing’s Sarcoma of the Nose: A Report of Three Cases

摘要: 目的：总结鼻部尤文肉瘤的临床特征，加深对该病的认识，制定更加完善临床诊疗方案。方法：对发生在鼻部的尤文肉瘤3例的临床表现、体格检查、影像学检查、实验室检查及治疗过程等进行回顾性分析并讨论。结果：本文报道3例发生于鼻部的尤文肉瘤(Ewing’s sarcoma)，简称ES。2例发生在鼻腔及鼻窦区，均有鼻塞及头痛，其中例1合并反复左侧鼻腔出血及嗅觉减退，术前出现感染症状，例2伴流涕，2例查体鼻腔可见新生物，鼻部CT可示新生物，均在全身麻醉下行鼻内镜下鼻腔鼻窦肿物切除术 + 鼻窦开放术。另1例发生于鼻翼的尤文肉瘤，院外局麻下行鼻部肿物切除术。术后病理均示小圆细胞肿瘤，结合免疫组化考虑为骨外尤文肉瘤。例1患者术后接受化疗和放疗联合治疗，例2患者出院后未再于我院就诊，已电话随访，例3术后2年于我院就诊。至今均无复发及转移迹象。结论：肉眼观鼻部尤文肉瘤较难与恶性肿瘤鉴别，故加大了我们诊断的难度。需结合多学科联合诊疗，以采取更加完善的治疗方案，提高患者生存率，改善预后。

Abstract: Objective: To summarize the clinical features of nasal Ewing’s sarcoma in order to enhance understanding of this disease and develop more comprehensive clinical diagnosis and treatment strategies. Methods: A retrospective analysis was conducted on three cases of Ewing’s sarcoma located in the nasal region, including clinical manifestations, physical examination, imaging studies, laboratory findings, and treatment courses. Results: This article reports three cases of Ewing’s sarcoma (ES) occurring in the nose. Two cases involved the nasal cavity and paranasal sinuses, both presenting with nasal obstruction and headache. Case 1 also exhibited recurrent epistaxis from the left nasal cavity and hyposmia, with preoperative signs of infection, while Case 2 was accompanied by rhinorrhea. Physical examination revealed neoplastic masses in the nasal cavity in both cases, and nasal CT scans showed the presence of neoplasms. Both patients underwent endoscopic excision of the nasal and sinus mass + sinusotomy under general anesthesia. The third case involved Ewing’s sarcoma of the nasal ala, which had been excised under local anesthesia at another hospital. Postoperative pathological examination indicated small round cell tumors in all cases, and extraosseous Ewing’s sarcoma was confirmed based on immunohistochemical findings. The patient in Case 1 received combined chemotherapy and radiotherapy postoperatively, Case 2 was lost to follow-up at our hospital but was contacted via telephone, and Case 3 returned to our hospital two years after surgery. To date, there have been no signs of recurrence or metastasis in any of the cases. Conclusions: Macroscopically, nasal Ewing’s sarcoma is difficult to distinguish from other malignant tumors, which complicates diagnosis. Multidisciplinary collaboration is essential to formulate more effective treatment plans, improve patient survival rates, and enhance prognosis.