下颌骨分泌性癌1例

分泌性癌属于低度恶性肿瘤,主要发生于腮腺、下颌下腺或口腔内小唾液腺,发生于颌骨者目前尚未见报道.本文报道1例发生于右侧下颌角的分泌性癌,并结合文献对其诊断、治疗及预后进行讨论.     

Primary synovial sarcoma involving the submandibular gland

Synovial sarcoma represents 5.6%-10% of all soft-tissue sarcomas. Adolescents and young adults are most frequently affected, mainly in the deep soft tissue of the extremities. Only 10% of synovial sarcomas affect the head and neck region; most of these are biphasic. We describe a case of an 18-year-old man who complained of a mass in the right submandibular region that had been present for approximately 12 months. On surgical removal, microscopic analysis showed a tumor formed by sheets of malignant spindle cells involving the submandibular gland. Immunohistochemistry displayed positivity for AE1/AE3, CK18/8, epithelial membrane antigen, CD99, CD56, and TLE-1. Based on these immunohistochemical and histopathologic features, a diagnosis of monophasic synovial sarcoma was rendered. The patient was treated with adjuvant radiotherapy and after 1 year was free of disease. To the best of our knowledge, this is the first reported case of synovial sarcoma involving the submandibular gland.     

Giant pleomorphic adenoma of the submandibular gland. Case report

Salivary glands are sites for a great variety of tumors. The parotid gland is the most common site followed by the submandibular gland. The pleomorphic adenoma represents the 60-70% of all tumors involving the major salivary glands, while the submandibular gland is involved in 8% of cases. The pleomorphic adenoma of the submandibular gland is rare and can present difficulty in diagnosis. The heterogeneous histology, a possible malignant transformation, an incomplete capsule that can determine a recurrence, are the most important characteristics of pleomorphic adenoma. A complete surgical removal of the tumor is the treatment of choice. In the case presented, the mass showed an unusual vascularization and remarkable dimensions.     

Epithelial–myoepithelial carcinoma of a minor salivary gland in the buccal mucosa

Epithelial–myoepithelial carcinoma (EMC) is a rare tumor constituting less than 1 % of all salivary gland tumors. This neoplasm most often involves the parotid glands, with less frequent involvement of the submandibular or minor salivary glands. This case report describes EMC arising from a minor salivary gland in the buccal mucosa. A 71-year-old Japanese man with a painless submucosal mass in the left buccal region was referred to our hospital. The patient stated that the tumor had been present for more than 4 years and was painless but increasing in size. Oral examination showed a mobile, well-defined mass of approximately 19 × 15 mm; its surface was covered mostly by normal mucosa. Magnetic resonance imaging showed a mass with well-defined borders and relative homogeneity internally. Incisional biopsy led to a histological diagnosis of a suspected pleomorphic adenoma or low-grade malignant tumor originating from the salivary gland. The patient underwent surgical excision under general anesthesia to obtain a definitive diagnosis, and EMC was diagnosed based on histopathological and immunohistochemical examination of the whole specimen. Because the surgical margins were positive in some areas, the patient underwent external postoperative radiotherapy (total of 60 Gy at 2 Gy/day). Recovery was uneventful, and good function returned after postoperative treatment. Four years after tumor resection and radiotherapy, no recurrence had been detected and no other lesions had developed.     

先后罹患2种不同类型头颈部恶性肿瘤病例报告

临床上同一患者身患2种不同恶性肿瘤的病例并不罕见,但2种恶性肿瘤均发生于头颈部的情况实属少见,本文报告1例鼻NK／T细胞淋巴瘤,经放化疗治愈,18年后再发左侧下颌下腺腺样囊性癌病例。该病例提示,患恶性肿瘤病史的患者需谨慎对待,恶性肿瘤虽有复发及转移的可能,但结合病史及体征,仍需多方面考虑其他疾病的可能。     

Metastasis to the submandibular gland as the initial presentation of small cell ("oat cell") lung carcinoma

A 45-year-old man had a submandibular mass, which was resected. Histopathologic evaluation and the subsequent course revealed it to be a metastasis from a small cell carcinoma of the lung. This is the first case in which a metastatic lesion in the submandibular gland was the presenting manifestation of an extrasalivary neoplasm, predating discovery of the primary tumor. Metastases to the salivary glands in general and to the submandibular gland in particular are discussed, as is the differential diagnosis with primary salivary gland carcinoma.     

Basal Cell Adenoma of the Submandibular Gland

Basel cell adenoma is a benign epithelial salivary gland tumor that appears to have unique histologic characteristics. The diagnosis of this entity must be established by histological study. It commonly occurs in parotid gland and very rarely in submandibular gland. Here we report a case of basel cell adenoma of submandibular gland.     

颌下腺转移性多形性腺瘤1例

本文报道1例罕见的转移性多形性腺瘤,患者女性,30岁,左颌下腺及右锁骨上包块术后病检结果与患者8年前左颌下腺肿块切除后病检结果一致,病理形态均表现为良性多形性腺瘤。并结合文献报道,对转移性多形性腺瘤的临床病理特征、发病机制及防治方法等进行讨论。     

Chronic sclerosing sialadenitis of the parotid gland

Chronic sclerosing sialadenitis (Küttner's tumor) is a benign and chronic inflammatory condition of the submandibular gland that clinically cannot be easily distinguished from salivary malignant neoplasia. This is a report of a case of chronic sclerosing sialadenitis located as a solitary mass in an accessory parotid gland.     

睑板腺癌腮腺及下颌下区颈淋巴结转移1例报告

睑板腺癌常发生于上眼睑,转移至腮腺及下颌下淋巴结者较为少见,临床上需与腮腺原发肿瘤相鉴别。本文报告1例上眼睑睑板腺癌转移至腮腺及下颌下区淋巴结病例,为此类疾病的诊断及治疗提供指导。     

A case of carcinosarcoma arising in the submandibular gland

A 54-year-old man presented with an 8-year history of a hard asymptomatic mass of the left submandibular area. Total excision of the left submandibular gland with radical neck dissection was performed under a diagnosis of a submandibular tumor, probably a malignant mixed tumor. The pathologic diagnosis was carcinosarcoma consisting of carcinomatous and sarcomatous elements. The epithelial component was composed of squamous cell carcinoma, undifferentiated carcinoma, and adenocarcinoma. The nonepithelial component was composed of chondrosarcoma, osteosarcoma, spindle cell sarcoma, rhabdomyosarcoma, and liposarcoma. In the central area of the tumor, a few remnants of benign pleomorphic adenoma were identifiable. The finding suggested that in our patient, the carcinosarcoma arose from a preexisting pleomorphic adenoma. In view of the expected aggressive nature of the tumor, the patient was treated with postoperative radiotherapy of 60 Gy total, in 30 daily fractions of 2 Gy, and chemotherapy. He currently remains well and free of disease 24 months after treatment.     

Tumors of the submandibular gland: clinicopathologic analysis of 23 patients.

PURPOSE: Tumors of the submandibular gland are rare, comprising less than 2% of head and neck neoplasia. Both benign and malignant lesions show a mild symptomatology, resulting in late presentation and in advanced stage of disease. The purpose of this article was to report our experience in treating submandibular gland neoplasia during the last 10 years. PATIENTS AND METHODS: The medical records of all patients with histologically confirmed epithelial tumors of the submandibular gland were retrospectively reviewed. This review found 23 patients with 9 benign and 14 malignant tumors. The collection of data included demographic data, diagnostic procedures, operative and pathology reports, complications, additional treatment, and follow-up. RESULTS: There were 10 men and 13 women with a mean age of 60 years. Pleomorphic adenoma was the most frequently encountered benign tumor; adenocarcinoma and adenoid cystic carcinoma had an equal presentation in the malignant group of patients. Eleven of the 14 patients with malignant tumors presented in advanced stages of disease (stage III and IV). Surgery was the sole treatment for the benign tumors. There were no recurrences. In the majority of cases, patients with malignant tumors were treated with surgery and postoperative radiotherapy. Eight patients died during the follow-up period, giving a mortality rate of 61.5%. CONCLUSION: Benign submandibular gland tumors manifest a mild course of disease, and local excision along with the gland is a safe and effective method of treatment. Malignant tumors have a poor symptomatology that results in late diagnosis. Radical surgery and postoperative radiotherapy is the treatment of choice. Prognosis depends on the histopathology and biologic behavior of the specific type of malignant tumor.     

Synchronous mucoepidermoid carcinoma of tongue and pleomorphic adenoma of submandibular gland

Presentation with synchronous salivary gland tumors is rare, with the most typical combination being Warthin's tumor and pleomorphic adenoma of the parotid gland. Involvement of minor salivary glands in such occurrences is extremely uncommon. We report a case of simultaneous mucoepidermoid carcinoma of the tongue and pleomorphic adenoma of the submandibular gland in a 40-year-old woman. The submandibular mass was initially considered to represent regional lymph node tumor metastasis but later was shown to be an intraglandular primary neoplasm.     

64排螺旋CT灌注诊断涎腺肿瘤的临床应用研究

目的:评价64排螺旋CT灌注成像对涎腺肿瘤的临床诊断价值。方法:29例涎腺部肿瘤(腮腺22例,颌下腺6例,舌下腺1例;其中良性肿瘤17例,恶性肿瘤12例)行CT灌注检查,取得相应的灌注参数:血流量(blood flow,BF),血容量(blood volume,BV),平均通过时间(mean transit time,MTT)和表面渗透性(permeability surface,PS),并均经术后病理证实。结果:所有肿瘤的BF、BV、MTT和PS值明显高于正常涎腺组织(P<0.05),恶性肿瘤组BF、BV、PS值高于良性肿瘤组(P<0.05),MTT参数则在良、恶性肿瘤之间无统计学差异。结论:涎腺肿瘤的CT灌注成像是一种较为准确的定量分析肿瘤血流灌注状态的方法,具有较高的临床应用价值。     

False diagnosis caused by Warthin tumor of the parotid gland combined with actinomycosis

A case is reported in which a unilateral parotid gland cystadenolymphoma was combined with actinomycosis. A 48-year-old woman presented with a mass in the left parotid region and paresis of the lower left palpebra. The computed tomography, echography, and parotid radiographic findings did not exclude a neoplasm of the left parotid gland. The ramus of the mandible was involved in the process. Intraoperative freezing histology, total parotidectomy, and partial mandibulectomy were performed, with sacrifice of the facial nerve followed by nerve reconstruction. The final histological evaluation was Warthin tumor with actinomycosis. Four years after treatment, the patient is free of disease. No similar cases seem to have been reported thus far.     

Submandibular gland excision: 15 years of experience.

PURPOSE: The surgical management of submandibular gland diseases has always been a challenge because it carries a considerable risk of nerve injury. The aim of this study was to review a single institution's experience of a nonselected case series of submandibular gland excision over 15 years. MATERIALS AND METHODS: We retrospectively analyzed 258 unselected submandibular excisions of a tertiary university center for the histopathologic diagnosis and postoperative morbidity; 119 patients (46%) with sialolithiasis, 88 patients (34%) with sialadenitis, and 51 patients (20%) with submandibular tumors were operated. RESULTS: We found a high rate of malignant tumors (42%) in the group of submandibular gland tumors. A low rate of transient palsies of the mandibular branch of the facial nerve (9%) and lingual nerve (2%) was observed. One patient developed a permanent paresis of the mandibular branch (<1%). CONCLUSION: Our large series has shown that standardized submandibular sialadenectomy is a safe operation with a low rate of complications. Malignant disease is frequent in tumors of the submandibular gland.     

下颌下腺涎石病伴发黏液表皮样癌1例报告

黏液表皮样癌是最常见的唾液腺恶性肿瘤之一,最常发生于腮腺（约占2/3）,其次为腭部、小唾液腺（特别是磨牙后腺）及下颌下腺,而发生于由涎石病导致的慢性炎性下颌下腺者极为罕见。本文报告1例发生于慢性炎性下颌下腺中的黏液表皮样癌病例,并对其诊断和治疗方法进行讨论。     

下颌骨成釉细胞癌-原发型伴颌下淋巴结转移1例

成釉细胞癌-原发型是一种少见的原发型牙源性恶性肿瘤,临床报道较少。本文报道1例下颌骨成釉细胞癌-原发型伴颌下淋巴结转移患者,并结合文献资料,对其临床组织病理学特征、诊断和治疗等进行讨论。     

Ectopic submandibular thyroid tissue with a coexisting active and normally located thyroid gland: case report and review of literature

Ectopic thyroid tissue in the submandibular space with the thyroid gland in its normal location is an extremely rare phenomenon. We present a case of a 75-year-old woman who had painless swelling in the left submandibular space and was referred to our hospital with the suspicion of having a malignant tumor originating from the submandibular gland. Histologic examination showed normal follicular thyroid tissue without any sign of malignancy.In general there are 3 explanations for the presence of ectopic thyroid tissue found in the submandibular region: (1) displacement during the course of embryonal development, (2) spread of tissue during surgery on a normally located thyroid gland, and (3) metastasis of a highly differentiated papillary thyroid carcinoma.We reviewed the literature with respect to the embryological background and the clinical management of such cases.     

A case report of coexistence of a sialolith and an adenoid cystic carcinoma in the submandibular gland

The occurrence of sialoliths in the submandibular gland is 80% due to the specific anatomy of both the gland and its duct. The diagnosis is rather easy because of the obvious clinical signs of the entity. Imaging studies are always necessary in order to treat the patient as effectively as possible. The stones do not tend to occur within the gland as frequently as in the respective duct. The coexistence of sialoliths and malignant tumors is extremely rare. A 70-year-old woman with intraparenchymal stone was operated in our ENT department. In addition to the sialolith the pathological examination revealed the existence of an adenoid cystic carcinoma (ACC), that extended to the neighboring skeletal muscle. This is the reason why we believe it would be useful to report this case of a large stone (14 mm in diameter) located in the submandibular gland coexisting with ACC. This case report is a very good example illustrating that all available means should be used prior to reaching a conclusion and making a health professional decision.