奇譽【 廖倩茹、林沁梅、林彩勤 】與【光田劉耿僚主任】的 醫療中心

惡性纖維性組織細胞瘤(malignant fibrous histiocytoma)是起源於結締組織的肉瘤(sarcoma)，好發於四肢軀幹之軟組織及偶見於經放射線治療後的黏膜組織，而頭頸部的原發性侵犯則較為罕見。其治療目前以手術切除加上術後放射線治療為主，但療效仍待研究。本例為一52歲男性，因口腔硬腭腫塊於2001年7月接受腫瘤切除，病理報告為惡性纖維性組織細胞瘤。同年發現雙側頸部腫塊，細胞穿刺報告為惡性轉移並接受雙側頸部廓清及術後放射線治療。門診追蹤時，陸續於頸肩部及下牙齦處發現腫瘤（2003年5月及7月），予以切除並送化驗，報告結果仍為惡性纖維性組織細胞瘤，經多次放射線治療及大範圍腫瘤切除術仍無法根除，終因患者體力衰弱及敗血症而病逝於加護病房。惡性纖維性組織細胞瘤為頭頸部較罕見之腫瘤且目前療效不明，故特提出此多發轉移性之病例報告。
Malignant fibrous histiocytoma (MFH) is a malignancy originating from the connective tissues. It mostly occurs in the soft tissues of the extremities, and occasionally in the mucosa after radiotherapy. However, the head and neck region is rare as a primary site. The treatment of MFH includes wide surgical excision and radiotherapy, but the results are still controversial. A 52-year-old man complained of having detected a hard palate mass over two weeks in July 2001. The excisional biopsy showed MFH. However, at our hospital and soon afterwards in the same year, bilateral neck masses were noted and cytology showed metastatic MFH. He received bilateral radical neck dissections and radiotherapy. Multiple tumors were found over the left shoulder and lower gingival areas in May and July 2003 respectively. Pathology of the excisions still showed MFH. After several courses of radiotherapy and wide excisions, the tumor continued to recur around the head and neck area. Eventually, he died in the SICU from septic shock and multiple organ failure in 2004. This is a rare case of multiple head-and-neck metastatic MFH, which had a poor treatment outcome.