摘要目的 探讨恶性肿瘤合并头颈部真菌感染的临床与病理特点.方法回顾分析21例恶性肿瘤合并头颈部真菌感染患者的临床和病理资料;用HE染色、过碘酸-雪夫(PAS)染色和环六亚甲基四胺银(GMS)染色显示组织病变特点及真菌的形态特征,用黏蛋白5B(MUC5B)抗体免疫组织化学EnVision法染色标记真菌;13例组织标本进行了真菌培养.结果患者发病年龄12～72岁(中位年龄48岁),男性17例,女性4例.病理学检查证实合并侵袭性真菌性鼻窦炎(IFS)有8例(38.1%),其中波及眶内者6例(28.6%),侵入颅内1例;原发疾病为白血病(7例)及鼻咽癌(1例);病原真菌为接合菌(5例)和曲霉菌(3例),均有化疗或放疗及使用抗生素的病史.其余13例真菌感染发生于鼻腔鼻窦、咽喉及腭部原发肿瘤的坏死组织内,病原真菌主要为曲霉菌(6例)和念珠菌(4例),7例有放疗等治疗史.真菌培养结果9例阳性(9/13).随访病例14例,死亡6例.结论 恶性肿瘤可合并头颈部真菌感染,以IFS最为多见,好发于白血病化疗后,易累及眼眶,预后较差;病原真菌的类别在IFS以接合菌和曲霉菌多见;病理学检查仍然是尽快确定诊断及初步鉴别常见接合菌和曲霉菌类别的一个重要手段.

abstractsObjective To study the clinicopathologic features of malignant tumors in head and neck region complicated by fungal infection. Methods Twenty-one cases of malignant tumors occurring in head and neck region complicated by fungal infection were retrieved from the archival file. The light microscopic findings were reviewed. Histochemical (for PAS and GMS) and immunohistochemical (for MUC5B) studies were carried out. Fungal culture results were available in 13 of the 21 cases. Results The age of the (38.1% ) were complicated by invasive fungal sinusitis, with orbital involvement in 6 cases and brain involvement in 1 case. The primary tumors in such cases included leukemia (n = 7) and nasopharyngeal carcinoma ( n = 1 ). The fungi belonged to Zygomycete in 5 cases and Aspergillus in 3 cases. These patients had history of chemotherapy / radiotherapy or antibiotics usage. The remaining 13 cases of fungal infection often affected necrotic tumor tissue in nasal cavity, paranasal sinuses, pharynx, larynx and palate. The fungi involved were Aspergillus (n =6) and Candida (n=4). Seven of such patients had received radiotherapy.Fungal culture was positive in 9 cases. Fourteen patients had follow-up information available and six of them died of the disease. Conclusions Malignant tumors occurring in head and neck region can be complicated by fungal infection. Invasive fungal sinusitis ( due to Zygomycetes and Aspergillus) often occurs in patients with leukemia, tends to involve orbit and is associated with poor prognosis. On the other hand, Aspergillus and Candida are the commonest fungi found in the necrotic tumor tissue. Pathologic examination remains the hallmark in confirming the diagnosis and fungal typing.