腮腺肿瘤治疗及并发症防治体会

目的 探讨腮腺肿瘤的手术方式与并发症防治联系.方法 对我科1992年-2008年收治的112例腮腺肿瘤进行回顾性分析,按病理分类,其中良性99例,恶性3例.所有肿瘤均行手术治疗,其中复发6例,对恶性肿瘤术后酌情放疗.结果 112例腮腺肿瘤经手术治疗.4例良性肿瘤(5.35%),2例恶性肿瘤术后复发.暂时性面瘫28例(25%),涎瘘3例(2.68%),耳颞综合征16例(14.28%), 角膜干燥1例(0.89%).结论 腮腺肿瘤的首次手术治疗方式至关重要,可以有效预防和减少术后并发症.     

Unexpected Tumor: Primary Asymptomatic Schwannoma in Thyroid Gland

The discovery of a tumor as a primary schwannoma in the thyroid gland is rare (Andrion et al. in Virchows Arch 413:367–372, 1988). It represents less than 1 % of mesenchymal neoplasms of this gland. Therefore, few cases of this type are described in medical literature (Aron et al. in Cytopathology 16:206–209, 2005; Cashman et al. in Medscape J Med 10(8):201, 2008; Coleman et al. in AJR Am J Roentgenol 140:383–7, 1983). In this article, we introduce the clinical case of a 27-year-old female patient, who presented a nodular mass located in the neck region. This mass was not associated with other symptoms and during the imagistic investigation it appeared to be a thyroglossal duct cyst. A fine needle aspiration biopsy was performed which revealed benign mesenchymal cells. After a pathology study of the piece resected through a thyroidectomy, it was confirmed that the tumor had neural characteristics, the final diagnosis being a primary schwannoma. The importance of a cytology study is emphasized, since in this case, it made it possible to accurately diagnose a mesenchymal tumor, despite their low frequency. It constitutes a highly useful tool for diagnosing non-epithelial neoplasia of the thyroid gland.     

Paraganglioma of the Thyroid Gland: A Rare Entity

Paragangliomas are neuroendocrine tumors. The thyroid gland is one of the anatomic sites in which paraganglia are not normally located and are exceptionally rare. We report a case of a 36-year-old Hispanic woman with a soft mass measuring about 30 mm in the right thyroid lobe. Patient was operated on and the neoplasm showed microscopically a typical nesting organoid pattern (zellballen). The inmunohistochemical analysis revealed that the tumor showed strongly and diffuse stain for NSE, Synaptophysin, Chromogranin A, and S-100 protein in the sustentacular cells, whereas no inmunoreactivity was detected with antibodies against thyroglobulin, calcitonin, TTF-1, CEA, and AE1-AE3. The MIB-1 labeling showed 7% of neoplastic cells. Head and neck paragangliomas usually develop slowly, and this tumor exhibited a low proliferative activity. In view of the uncertain malignant potential of paragangliomas, we recommended a careful long-term follow-up.     

Oncocytic Neoplasms of the Thyroid Gland

Among well differentiated thyroid tumors, oncocytic neo plasms feature a distinctive set of clinical, morphologic and biologic characteristics, some of which have been a matter of controversy. The world literature on this subject has been reviewed to show that: 1) Morphology accurately predicts the behavior of Hurthie cell tumors assuming that the specimen has been adequately sampled; 2) Capsular and/or vascular invasion is the sine qua non condition for a diagnosis of malignancy; 3) "Indeterminate" or "pos sibly malignant" categories are useless because in the absence of invasion these neoplasms almost invariably behave in a benign fashion; 4) Among cases histologically classified as malignant, a clinically aggressive behavior is to be expected in a high percentage of cases; 5) Size alone cannot be used as a criterion of malignancy; 6) Less than total thyroidectomy provides an adequate treatment for histologically benign tumors; aggressive surgical proce dures (i.e. total thyroidectomy) do not diminish the inci dence of metastasis; 7) Analysis of DNA content may be helpful in defining subsets of patients with Hurthle cell carcinomas having a particulaly poor prognosis; 8) Mito-chondrial and/or nuclear DNA abnormalities probably play an important role in the cellular alterations which charac terize the phenotype of oncocytes. Acta Pathol Jpn 42 : 305–315, 1992.     

Renal Cell Carcinoma Metastatic to the Thyroid Gland: A Comparative Molecular Study Between the Primary and the Metastatic Tumor

A case of renal cell carcinoma metastatic to the thyroid gland is presented. The thyroid tumor showed typical features: clear cells arranged in nets with a prominent sinusoidal vascular pattern. The histologic appearance was identical to the renal tumor removed 6 yr before. A comparative molecular study between the primary and the metastatic tumor showed a common profile with a loss of heterozygosity at identical loci on chromosome 3, which provided further support to the metastatic nature of the thyroid tumor. However, the frequent existence of allele losses on chromosome 3p in both renal cell carcinomas and primary thyroid follicular carcinomas rest some force from such a molecular approach to the differential diagnosis of thyroid tumors that contain a predominant population of clear cells.     

Intraductal Pancreatic Neuroendocrine Tumor

Intraductal lesions of the pancreas are usually due to intraductal papillary mucinous neoplasms and the less common intraductal tubular adenoma. Cases of acinar cell carcinoma within intraductal location have also been encountered recently. Pancreatic neuroendocrine tumors are rarely encountered within the main pancreatic duct. A 74-year-old male presented with non-specific abdominal symptoms and was found to have an obstructive lesion in the main pancreatic duct with associated chronic pancreatitis. A distal pancreatectomy was performed which revealed a solid and cystic tumor measuring 6 × 3 × 2 cm situated wholly within the main pancreatic duct. It formed an obstructing intraluminal polypoid lesion that resulted in surrounding chronic pancreatitis. Microscopic evaluation of the mass showed it to be a well-differentiated pancreatic neuroendocrine tumor with entrapped, non-malignant tubules. Intraductal pancreatic neuroendocrine tumors may occur in two settings. Firstly, and more commonly, there is a parenchymal-based tumor that then encroaches on and pushes into the main pancreatic duct. The less common scenario is of a primary intraductal location without a pancreatic parenchymal lesion. While an intraductal location of a pancreatic neuroendocrine tumor is rare, it should be borne in mind when confronted by an intraductal lesion in the pancreas.