ocular lesions of nasopharyngeal carcinoma
Introduction
Introduction to ocular lesions in nasopharyngeal carcinoma Nasopharyngeal carcinoma (nasopharyngealcarcinoma) is a malignant tumor that occurs in the mucosa of the nasopharyngeal cavity. Most of the patients are squamous cell carcinomas originating from the epithelium. In a few cases, adenoid cystic carcinomas of the submucosal parotid gland, malignant mixture Tumor, mucoepidermoid cancer, etc. Nasopharyngeal carcinoma is an invasive tumor that invades deep structures early. Advanced nasopharyngeal carcinoma often invades the optic nerve near the optic chiasm, causing decreased vision, hemianopia on the nose or temporal side, which can cause blindness in one or both eyes, and optic atrophy in fundus examination. The age of good hair is 30 to 50 years old, which is more common in men. The ratio of male to female is 2:1. basic knowledge The proportion of illness: 0.001% Susceptible people: no specific people Mode of infection: non-infectious Complications: hearing impairment
Cause
Causes of ocular lesions in nasopharyngeal carcinoma
(1) Causes of the disease
The etiology of nasopharyngeal carcinoma is unknown, and it is speculated that genetic factors and traditional habits of life may play an important role in the development of nasopharyngeal carcinoma.
Genetic factors: According to the study of cell chromosomes and human histocompatibility antigen (HLA), the obvious ethnic aggregation of nasopharyngeal carcinoma suggests that nasopharyngeal carcinoma may be a multi-gene genetic factor.
Environmental factors: salty fish with excessive diet, bacon and pickled foods containing nitrosamines. These foods have the effect of inducing nasopharyngeal cancer. Nickel in drinking water and lead content are high, while zinc, copper and cadmium are relatively low. The high content of nickel in rice and the low content of molybdenum, chromium, lead and cadmium may also be related to the occurrence of nasopharyngeal carcinoma.
Epstein-Barr virus: A lymphoblastoid cell line with Epstein-Barr virus was isolated from the tissues of nasopharyngeal carcinoma, and Epstein-Barr virus granules were found. The EBV high titer antibody was present in the nasopharyngeal carcinoma, and the severity of the disease was high. The condition recovered and the antibody titer decreased, indicating that Epstein-Barr virus is closely related to nasopharyngeal carcinoma.
(two) pathogenesis
Tumor-causing factors cause infinite proliferation, malignant transformation and distant metastasis of mucosal cells in the nasopharyngeal cavity.
Prevention
Prevention of ocular lesions in nasopharyngeal carcinoma
prevention
First, try to avoid long-term exposure to polluted environments.
Second, eat less salted fish, cured meat and other foods, because it contains carcinogenic nitrosamines.
Third, actively treat nasal and nasopharynx inflammation, ulcers and other diseases.
Fourth, for repeated symptoms of nasal congestion, nasal discharge, salivation, etc., should not be underestimated, should go to the regular hospital as soon as possible.
5. Patients with high incidence of nasopharyngeal carcinoma and family history of nasopharyngeal carcinoma should be investigated for nasopharyngeal carcinoma. Epstein-Barr virus test can be used as an indicator of census. About 80% of patients with nasopharyngeal carcinoma have positive EB virus test.
Complication
Complications of ocular lesions in nasopharyngeal carcinoma Complications, hearing impairment
Bone destruction of the skull base and hearing loss.
Symptom
Symptoms of ocular lesions in nasopharyngeal carcinoma Common symptoms Tinnitus, bone destruction, epistaxis, sag, sag, complex view, reflex blunt
The nasopharyngeal cavity is deep and concealed. The local symptoms of this part of the malignant tumor are not significant. It is caused by the spread of adjacent structures or lymphatic metastasis. Because of the pain in the ankle area, extraocular muscle paralysis and eyeball protrusion are first seen in the ophthalmology. Rare.
Advanced nasopharyngeal carcinoma often invades the optic nerve near the optic chiasm, causing vision loss, nasal or temporal hemianopia, which can cause blindness in one or both eyes. Fundus examination reveals optic atrophy, long nerve length, and is easily invaded by nasopharyngeal carcinoma. Therefore, it is often and earlyly violated, causing double vision, the eyeball can not be turned outwards, showing strabismus, the trochlear nerve is affected, the rotation of the outer and lower eyeball is restricted, causing difficulty in lower vision, the oculomotor nerve is compressed, causing eye movement disorder, upper jaw Drooping, trigeminal nerve branch involvement, numbness of the upper and lower palate skin and corneal reflex or disappear, eyelid tissue is affected by invasion and eyeball protrusion (Figure 2), nasopharyngeal carcinoma enters the eyelid by:
1. Transcranial sputum In most patients, cancerous tissue invades the cavernous sinus through the ruptured hole, and then reaches the eyelid through the supracondylar sac.
2. Transcranial spread to eye cancer tissue and enter the eyelid in three different ways:
(1) The cancer tissue enters the pterygopalatine fossa via the wing tube and invades the apex and the iliac crest.
(2) Nasopharyngeal carcinoma on the posterior wall of the nasopharynx invades the nasal cavity forward.
(3) When the nasopharyngeal carcinoma invades the back of the nose, it may penetrate the outer side wall of the sinus sinus into the sac.
Other clinical manifestations include bloody nasal discharge or nosebleed, which is caused by surface ulceration of irregular cancer tissue. Tumor infiltrating pharyngeal crypt and eustachian tube round pillow area cause tinnitus or hearing loss, and tumor tissue obstructs nasal posterior hole to produce nasal obstruction. Skull base bone destruction or nerve involvement leads to headache, manifested as unilateral persistent paralysis, top pain, is the most common initial symptoms, the age of good hair 30 to 50 years old, more common in men, male to female ratio of 2:1.
Examine
Examination of ocular lesions in nasopharyngeal carcinoma
Check the EB virus-related antibodies to understand the occurrence and development of the disease.
1. Nasopharyngeal examination for early diagnosis of nasopharyngeal carcinoma lacks clinical symptoms and is not easy to find. When cervical lymphadenopathy occurs, accompanied by ear, nose and eye symptoms, the nasopharyngeal part should be examined promptly, and the mucosa hypertrophy can be found in the nasopharynx. , cauliflower, nodular or spherical mass, should be taken for biopsy, if no cancer cells are found, multiple biopsy is required.
2. X-ray examination of the nasopharyngeal lateral radiograph, see the posterior wall soft tissue diffuse thickening or local prominent, skull base tablets, if the skull base bone is violated, see the edge of the irregular osteolytic defect or enlarged tunnel.
3. CT scan with high resolution, can clearly show the soft tissue density of the mass and bone destruction area, the range of lesions around the nasopharyngeal (Figure 3), eyelid, sinus, pterygopalatine and cavernous sinus involvement (Fig. 4), CT examination is of great significance for the design of radiotherapy, surgical mode selection and follow-up observation, and should be used as a routine examination.
4. Histopathological examination In the presence of a mass or suspected tumor area, the affected lymph nodes should also be removed for pathological diagnosis. The squamous cell carcinoma is large and the intercellular bridge is visible, so the cell boundaries are clear and the cytoplasm is more. Eosinophilic, partial keratinization; obvious nuclear, deep staining, large nuclear heteromorphism, visible nuclear division, keratinization of some cells in the center of the cancer nest, formation of keratinized beads, according to the degree of keratinization or the number of keratinized beads and the number of intercellular bridges Squamous cell carcinoma can be divided into three types: high, moderate and poorly differentiated. The special type of nasopharyngeal and oropharyngeal squamous cell carcinoma is lymphopyremia (lymphoepithelioma), which is poorly differentiated and may have been invaded even before the primary tumor. Eyelids, lymphatic metastasis, sometimes small primary lesions, difficulty in local biopsy, most blind biopsies may reveal primary lesions, 1/3 of patients have a certain degree of skull base destruction, most of the brain nerves are damaged, the first is nerve Damage, after other nerve spasms, lymphoid epithelioma is divided into two subtypes:
(1) Regaud type: the cells are large, poorly differentiated, and the nucleus is round or elliptical. The vacuoles are like, and the mitotic cells are distributed in a rich lymphoid matrix.
(2) Schmincke type: a cancer cell similar to the degeneration of reticulocytes, which is dispersed in a lymphoid matrix in a small nest or a mass.
These two types lack keratinization, so the diagnosis is difficult, but electron microscopy showed tension between the cytoplasm and intercellular desmosome, and positive Keratin staining confirmed from the epithelium.
Diagnosis
Diagnosis and diagnosis of ocular lesions in nasopharyngeal carcinoma
Sore throat, discomfort, foreign body sensation as early symptoms, subsequent bloody nose or nasal obstruction, limited abduction of the eyeball, diplopia, or oculomotor involvement, vision loss or blindness, should consider the diagnosis of nasopharyngeal carcinoma, Perform some auxiliary checks to help with the diagnosis.
The identification of mucosal inflammation with nasopharynx mainly depends on biopsy.
