31例复发性腮腺腺样囊性癌临床分析

目的探讨腮腺腺样囊性癌诊断及复发癌治疗方法。方法对31例复发性腮腺腺样囊性癌作临床分析。结果局部切除或浅叶切除复发时间比全腮腺切除复发时间短。复发后采用手术 放疗比单纯手术的疗效好。颈淋巴结转移率低,本组为10.3%(3/29)。结论B超、CT及肿瘤穿刺细胞学检查有助术前诊断。全腮腺切除应视为常规,术后复发可采用扩大切除术,但应补充放疗。预防性颈淋巴结清除术不应视为常规。     

涎腺腺样囊性癌的复发转移因素分析

通过６０例涎腺腺样囊性癌的随诊，结果发现：局部复发率为２１．７％。复发主要与原发部位，病理类型，局部扩散及切除范围有关。腺样囊性癌局部侵袭性强，切除范围不易确定，对术后切缘有癌残留者，应追加术后放疗。本组淋巴结转移少见，转移部位多在原发灶周围。在广泛切除原发灶后，一般无需行预防性颈清扫术。     

涎腺腺样囊性癌的复发转移因素分析

通过６０例涎腺腺样囊性癌的随诊，结果发现：局部复发率为２１．７％。复发主要与原发部位、病理类型、局部扩散及切除范围有关。腺样囊性癌局部侵袭性强，切除范围不易确定，对术后切缘有癌残留者，应追加术后放疗。本组淋巴结转移少见（３％），转移部位多在原发灶周围。在广泛切除原发灶后，一般无需行预防性颈清扫术。血行转移较多见（２１．７％），常发生于肺部。但出现血行转移的病人经治疗后仍可长期带瘤生存，故血行转移并非切除原发灶的手术禁忌证。     

巴氏腺腺样囊性癌临床病理分析

目的 探讨巴氏腺腺样囊性癌的临床病理特征和治疗方法.方法 回顾性分析6例巴氏腺腺样囊性癌患者的临床及病理资料.6例患者的中位年龄为40.5岁(30～54岁).主要治疗方式为手术切除,其中单纯外阴肿物剥除术1例,外阴根治性切除术加双侧腹股沟淋巴结清扫或活检术4例,外阴局部扩大切除术加双侧腹股沟淋巴结活检术1例.有2例患者术后补充放疗.6例患者均随访至2009年4月1日,中位随访时间124.5个月(8～241个月).结果 6例巴氏腺腺样囊性癌均经病理确诊,肿瘤细胞呈筛状排列及侵犯神经是其典型的病理特点.术后病理显示,切缘阳性2例,阴性1例,邻近肿瘤1例,不详2例.腹股沟淋巴结阴性5例,不详1例.有4例患者复发,其中3例局部复发,后出现肺转移;1例仅出现肺转移.在复发患者中,死亡1例,生存时间为135个月;另3例患者分别带瘤生存120、30和36个月,总生存时间分别为241、128和103个月.2例无复发患者无瘤生存8个月和121个月.结论 巴氏腺腺样囊性癌生长缓慢,患者长期预后较好,但容易局部复发和肺转移.首选治疗方法为手术切除,对于术后切缘阳性、局部浸润较深或侵犯神经者以及复发无法手术者可行辅助放疗或姑息性放疗.     

对放疗敏感的腺样囊性癌1例

对放疗敏感的腺样囊性癌１例陈乐腺样囊性癌对放射线欠敏感，单纯放射治疗的疗效差，复发及转移的病例更难达根治，治疗多以手术为主，术后辅以放疗或化疗。但笔者治疗１例颌下腺腺样囊性癌术后１年多又复发并转移的患者，效果好，报道于此。患者张某，男，３８岁，以左颌...     

甲状腺癌再次手术39例临床分析

1985～1995年10年间，住院手术治疗的甲状腺癌患者共119例，其中30例行再次手术。其中5例行甲状腺肿瘤摘除术后，再行残叶切除，3例证实有癌残留（3／5）；行选择性颈淋巴结清除者11例有颈淋巴结转移（11／25）；6例甲状腺隐性癌并颈淋巴结转移者经手术活检证实诊断后行联合根治术；3例甲状腺乳头状癌行联合根治术后颈部复发，再次手术切除。作者认为：对于甲状腺癌首次手术应行患侧腺叶合并峡部切除术，尽量避免肿瘤摘除术；对于侵出包膜的甲状腺乳头状癌可行选择性颈淋巴结清除术；应重视甲状腺隐性癌的诊断；对于行联合根治术后颈部复发的甲状腺乳头状癌，可考虑手术切除配合放疗。     

外耳道耵聍腺恶性肿瘤的综合治疗与转归

目的 探讨外耳道耵聍腺恶性肿瘤的最佳治疗方式。方法 通过回顾性研究22例外耳道耵聍腺恶性肿瘤的临床表现、病理类型及治疗效果。结果 22例中以腺样囊性癌多见,共17例（占77.3%)。7例作局部切除后4例出现局部复发,14例行肿瘤切除加乳突根治术,2例出现局部复发。17例腺样囊性癌5年生存率为76%。结论 对有外侵的外耳道耵聍腺恶性肿瘤,提倡综合治疗,手术采用肿瘤切除加乳突根治术,或颞骨部分切除及肋腺切除。放疗可以采用术前放射或术后放射,剂量应在40Gy上。耵聍腺腺癌和恶性混合瘤愈后较差,其治疗及转归有待进一步探索。     

90例腮腺腺样囊性癌的临床分析

目的总结腮腺腺样囊性癌的疗效.方法本组90例手术治疗30例,综合治疗60例.其中术后化疗30例,术后放疗80例.手术、化疗、放疗综合治疗.结果随访1～10年,3年生存率为100%,5年生存率为90%,10年生存率为60%.结论综合治疗是治疗腮腺腺样囊性癌的根本方法.     

腮腺恶性肿瘤的术后放疗

１１３例腮腺恶性肿瘤行术后放疗。总的５年生存率６６．４％，肿瘤局部控制率８３．２％，远处转移率２３．９％，局部复发率１５．９％。术后放疗剂量以５１～６０Ｇｙ疗效较好，５年生存率７７．５％，肿瘤局部控制率９２．５％。病理类型中腺样囊性癌、腺泡细胞癌、粘液表皮样癌预后情况较好，５年生存率分别为８３．３％、７６．９％和７２．４％。建议对腮腺恶性肿瘤应采用手术加放疗的综合治疗。     

30例甲状腺髓样癌诊治分析

[目的]探讨甲状腺髓样癌(MTC)诊治情况。[方法]回顾性分析30例甲状腺髓样癌的临床资料。[结果]30例MTC以手术切除患侧腺叶及峡部为主,合并淋巴结转移者,行颈淋巴结清扫术,随访23例,生存5年以上16例,术后复发8例。[结论]甲状腺髓样癌术前诊断困难,手术方法应以患侧甲状腺叶加峡部切除为主,有淋巴结转移者加同侧颈淋巴结清扫术。     

Lymph node metastases in adenoid cystic carcinoma of the submaxillary gland

The incidence of neck metastases in adenoid cystic carcinoma of the head and neck is considered low and reported incidence range from 0 to 18%. If tumors of the submaxillary gland are considered separately, the incidence of neck metastases reported ranges from 0 to 100%, with a pooled incidence of 34%, significantly higher (P less than 0.001) than that reported for the parotid gland, which ranges from 0 to 21% with a pooled incidence of 10%. It may be suggested that the high incidence of neck metastases in adenoid cystic carcinoma of the submaxillary gland is due, in some cases, to direct extention of the tumor from the gland to the adjacent nodes or from infiltrated surrounding soft tissues rather than by a classic embolic metastasis. In our series of 10 cases, 4 cases showed lymph node metastases. In 3 of these, slides of the radical neck dissection were available for review and showed direct extension of the tumor from surrounding involved soft tissues, although the possibility of embolic metastasis could not be excluded. In the 3 patients with neck metastases at the time of initial diagnosis, distant metastases also developed early in the course of the disease.     

Recurrent malignant salivary gland neoplasms

Recurrent salivary gland malignancies present difficult therapeutic decisions and poor prognosis in many instances, and treatment becomes of a palliative nature only. As many of the salivary gland malignancies we see are of the recurrent type, the following study was done to determine the efficacy of a vigorous attempt at retreatment. During the period January 1, 1960, through December 31, 1984, 352 patients with major and minor salivary gland tumors were evaluated at our institution. There were 149 benign lesions and 203 patients with malignant tumors. Of these, 99 patients had recurrent and metastatic tumors that had been treated initially elsewhere. Thirty-three of these patients were able to be treated with curative intent: surgery, 21; surgery plus radiation, 9; radiation therapy alone, 2; and radiation plus chemotherapy, 1. The 5 year survival with no evidence of disease was achieved in three patients with surgery alone and two patients with surgery plus radiation therapy. The group of five patients was comprised of two patients with adenoid cystic carcinomas of the parotid, one with intermediate grade mucoepidermoid carcinoma of the parotid, one, sebaceous cell carcinoma of the parotid, and one, adenoid cystic carcinoma of an accessory salivary gland. The results of this study serve to re-emphasize the relative poor yield of attempts at retreatment of loco-regional recurrence of salivary gland tumors.     

Management of salivary gland tumors

Surgery after proper imaging (MRI or CT scan) is the main stay of treatment for salivary gland tumors. Although excision margins should be ≥5 mm for malignant tumors in cases of parotid gland carcinoma, the facial nerve should be preserved whenever it is not infiltrated. Adjuvant external radiation is indicated for malignant tumors with high-risk features such as close (or invaded) margins, perineural speed, lymphatic and/or vascular invasion, lymph-node involvement and high-grade histology. A Phase II trial testing adjuvant concomitant cisplatin plus radiation therapy versus adjuvant radiation therapy alone after surgery is currently under investigation for high-risk salivary gland cancer. For inoperable cancers, photons combined with proton boost seem to be a valuable option. Even if protons or carbon ions are promising, access to the latter is limited for usual treatment. For recurrent and/or metastatic cancer, polychemotherapy (cisplatin based) gives a 25% response rate in adenoid cystic carcinoma and should be used when the disease is overtly in progression. Targeted therapies with anti-EGF receptor molecules, antiangiogenic agents and tyrosine kinase inhibitors are ongoing, but more trials are needed to establish their efficacy, as is the use of bortezomib followed by doxorubicin. The products of fusion oncogenes, which have a pathogenic role in some adenoid cystic carcinoma and mucoepidermoid carcinomas, are of interest as potential therapeutic targets.     

Multiple cutaneous metastases from a parotid adenoid cystic carcinoma

Cutaneous metastasis from salivary gland adenoid cystic carcinoma is extremely rare. We report a case of a 39-year-old man that presented multiple cutaneous metastases from a parotid salivary gland adenoid cystic carcinoma. The clinical, histopathological and immunohistochemical features are described and discussed. This case shows the importance of a detailed and periodical skin examination in patients treated for salivary gland adenoid cystic carcinoma.     

腮腺腺样囊性癌的治疗进展

腺样囊性癌是最常见的腮腺恶性肿瘤之一.腮腺腺样囊性癌(parotid gland adenoid cystic carcinoma)具有嗜神经侵袭和远处转移的特点,局部控制率和长期生存率不佳.现结合文献,对目前腮腺腺样囊性癌的治疗现状及进展做一综述.     

Salivary gland carcinoma in Denmark 1990-2005: a national study of incidence, site and histology. Results of the Danish Head and Neck Cancer Group (DAHANCA)

To describe the incidence, site and histology (WHO 2005) of salivary gland carcinomas in Denmark. Nine hundred and eighty-three patients diagnosed from 1990 to 2005 were identified from three nation-wide registries. The associated clinical data were retrospectively retrieved from patient medical records. Histological revision was performed in 886 cases (90%). Based on histological revision, 31 patients (3%) were excluded from the study leaving 952 for epidemiological analysis. The mean crude incidence in Denmark was 1.1/100,000/year. The male vs. female ratio was 0.97 and the median age was 62 years. The parotid gland was the most common site (52.5%) followed by the minor salivary glands of the oral cavity (26.3%). The most frequent histological subtypes were adenoid cystic carcinoma (25.2%), mucoepidermoid carcinoma (16.9%), adenocarcinoma NOS (12.2%) and acinic cell carcinoma (10.2%). The revision process changed the histological diagnosis in 121 out of 886 cases (14%). The incidence of salivary gland carcinoma in Denmark is higher than previously reported. More than half of salivary gland carcinomas are located in the parotid gland with adenoid cystic carcinoma being the most frequent subtype. Histological classification of salivary gland carcinomas is difficult and evaluation by dedicated pathology specialists might be essential for optimal diagnosis and treatment.     

Late intracranial metastasis from adenoid-cystic carcinoma of the parotid gland: Imaging,histologic and molecular features

We describe the neuroradiologic, histologic, and genetic features of a very unusual intracranial dural metastasis from adenoid cystic carcinoma of the parotid gland detected 27 years after the initial diagnosis.     

Metastasis of oral cancer to the parotid node

Background

The parotid node is an uncommon site of metastasis in head and neck cancer. This study was intended to clarify the incidence and indicators of oral cancer metastases to the parotid node.

Patients and methods

We reviewed the records of 253 patients with oral carcinomas who had undergone a total of 289 neck dissections between April 2001 and December 2006. The histologic diagnoses of the primary tumors were squamous cell carcinoma in 239 patients, mucoepidermoid carcinoma in 5, adenoid cystic carcinoma in 4, and miscellaneous others in 5. In all neck dissections, the tail of the parotid gland below the marginal mandibular branch of the facial nerve was resected. The cervical and parotid lymph nodes were isolated from the surgical specimens. One section through the maximum cross-sectional area of each node was examined histologically.

Results

From 183 of the 289 neck specimens, we collected 539 parotid nodes: 222 extraglandular and 317 intraglandular. Of the 253 patients, 10 (4.0%) had 19 parotid node metastases, of which 4 were extraglandular and 15 intraglandular. Parotid node involvement occurred in 2.5% of oral squamous cell carcinoma cases. For the other cancers, there were too few cases to determine a meaningful frequency. In terms of indicators, the likelihood of metastasis to the parotid nodes increased with the number of cancer-positive cervical nodes.

Conclusions

Metastasis to the parotid nodes should be considered in patients with oral cancer. Resection of the tail of the parotid gland is warranted during the neck dissection.