腮腺原发良、恶性肿瘤CT表现的比较分析

背景与目的:腮腺富含脂肪组织,与周围骨骼肌肉形成天然对比,CT能够较好地评价腮腺病变及其对周围结构的侵犯情况。术前CT对腮腺良恶性肿瘤的准确判断与评估能够有效指导临床诊断与治疗。本研究探讨CT对腮腺原发良、恶性肿瘤的鉴别诊断价值,提高术前定性诊断精确性。方法:回顾性分析了经病理证实的17例腮腺原发良性肿瘤和15例恶性肿瘤的CT表现,并进行统计学处理。32例患者均行CT增强扫描。由两位资深放射科医生进行阅片分析。结果:本组良性肿瘤(14/17)多表现为圆形或类圆形肿块,而恶性肿瘤(9/15)以分叶状或不规则肿块影常见,P=0.027。良性肿瘤(6/17)常出现散在小片状低密度灶,恶性肿瘤组未见散在片状低密度灶,P=0.019。良性肿瘤(13/17)大部分边缘光滑清晰,恶性肿瘤(11/15)多表现为边缘毛糙模糊,P=0.012。个别良性肿瘤(2/17)与胸锁乳突肌分界欠清,恶性肿瘤部分(9/15)侵犯咬肌或胸锁乳突肌,P=0.008。良性肿瘤均未见肿大淋巴结及血管神经侵犯,恶性肿瘤6例(6/15)出现肿大淋巴结,4例(4/15)出现神经血管侵犯,P值分别为0.006和0.038。结论:肿块的形态、边缘、内部低密度灶分布以及与邻近咬肌及胸锁乳突肌分界情况是腮腺良恶性肿瘤的重要鉴别点,淋巴结转移及血管神经侵犯是恶性肿瘤的特异性征象。综合多指标观察分析,CT能对大多数腮腺良、恶性肿瘤做出正确诊断。     

功能性腮腺外科

涎腺肿瘤是常见口腔颌面部肿瘤之一,腮腺是涎腺肿瘤最常见的部位。腮腺肿瘤的功能性外科是指在根治肿瘤的基础上,尽量保存腮腺及其相关组织的功能。部分腮腺切除术可以缩短手术时间、减轻面神经损伤、减轻面部凹陷畸形、降低味觉出汗综合征发生率及保留腮腺功能。保留腮腺咬肌筋膜可以降低味觉出汗综合征的发生率,保留腮腺导管可保留面神经深部腮腺的功能,保留耳大神经可避免或减轻耳垂麻木症状。对于低度恶性肿瘤与面神经紧贴者,保留面神经后采用术中冷冻加术后放疗,或采用125I 放射性粒子植入,可有效预防肿瘤复发。利用天然隐蔽区,采用耳后或耳前发际内切口,可提高术后的美容效果。功能性腮腺外科的实施,可明显减少手术并发症,提高患者的生存质量。      

腮腺肿瘤病理与CT诊断分析

目的：探讨ＣＴ检查对腮腺疾病的诊断价值。方法：采用腮腺疾病术后病理检查材料,并结合术前ＣＴ检查结果对照方法进行回顾性分析。结果：病检恶性肿瘤６例,良性病变５例。ＣＴ检查为恶性肿瘤３例,３例可能为良性、４例良性肿瘤、１例炎性病变不除外早期癌。结论：腮腺ＣＴ扫描对肿瘤定位较明确,明显良性或恶性肿瘤者要结合组织密度和边缘情况确定。特殊病变ＣＴ诊断有困难者要考虑术中快速冰冻病理诊断。     

Clinical analysis of salivary gland tumor cases in West China in past 50 years

In our study, 3461 cases of salivary gland tumor treated between 1955 and 2002 at West China Stomatology Hospital of Sichuan University were retrospectively analyzed, and compared with the previous reports. Measures such as age, tumor location, tumor histological type, and the nature of the growth (benign or malignant) were recorded at the same time. The findings are as follows: the average ages of salivary gland tumor patients were 41.38 years for the benign cases and 45.20 for the malignant ones; the male:female ratio was 0. 99:1 in the benign cases and 1.34:1 in the malignant ones; primary tumors were mostly in the parotid gland, palate and submandibular gland in sequence. Pleomorphic adenoma was the most frequent benign tumor followed by Warthin's tumor and basal cell adenoma, whereas mucoepidermoid carcinoma, adenoid cystic carcinoma and adenocarcinoma not otherwise specified were the most frequent malignant tumors. The incidence of salivary gland tumors increased with age. The male:female ratio of malignant tumors was higher than that of benign ones. The parotid gland and palate were the most common locations of salivary gland tumors. Pleomorphic adenoma and mucoepidermoid carcinoma were the most frequent benign and malignant tumors, respectively.     

Imaging in head and neck cancer

Opinion statement The goals of imaging in head and neck cancer are to establish tumor extent and size, to assess nodal disease, to evaluate for perineural tumor spread, and to distinguish recurrent tumor from post-treatment changes. MRI is the preferred modality for assessment of nasopharyngeal, sinonasal, and parotid tumors, because of better contrast resolution, high frequency of perineural spread, and less prominent motion artifacts. MRI is the best modality to delineate the extent of intraorbital and intracranial extension of malignant tumors. Tumors of the oropharynx, larynx, and hypopharynx are frequently primarily imaged with CT, which is less affected by breathing and swallowing artifacts. MRI is also the initial study of choice for tumors confined to the oral tongue, and possibly also for other oral cavity locations because MRI is superior in detection of tumor spread into the bone marrow. There is no clear advantage of CT or MRI for evaluation of nodal disease. Positron emission tomography (PET) is very sensitive for metastatic lymph nodes that are at least 8 mm in size and is the technique of choice in dubious cases. Imaging-guided biopsies are performed whenever needed. For imaging of treated head and neck cancer, PET scans have been found to generally offer higher sensitivity than MRI or CT. Combined PET/CT may be the modality of choice because it almost completely eliminates the false-positive and false-negative PET findings. Patients with head and neck cancer who are referred to tertiary care centers commonly arrive with cross-sectional images obtained at other institutions. Reinterpretation of these studies by dedicated radiologists frequently leads to changes in findings, which alter treatment and affect prognosis.     

腮腺肿瘤再手术时面神经的处理

目的探讨腮腺肿瘤再次手术时面神经的处理。方法对近6年来我院收治的36例腮腺肿瘤术后复发，再次手术时面神经的处理方式，进行回顾性分析总结。其中7例有2次以上腮腺肿瘤手术史，有病理记载恶性者9例，有面瘫者5例。结果再手术行腮腺浅叶加肿瘤切除22例，均保留神经。行全腮腺切除14例，其中5例切除面神经。术后病理报告恶性者11例。结论对良性病例术中应保留面神经。对恶性病例，再次手术时对面神经是否保留，不能以肿瘤大小而定，而应根据病理分类、肿瘤与面神经粘连程度而定。恶性病例术后行综合治疗。     

上皮源性腮腺恶性肿瘤的CT征象与病理对照研究

背景与目的:上皮源性腮腺恶性肿瘤种类繁多,CT为腮腺占位的常用影像学检查方法,本研究旨在通过回顾性分析上皮源性恶性肿瘤的CT征象,探讨CT在上皮源性腮腺恶性肿瘤的诊断价值.方法:对经病理确诊的29例上皮源性腮腺恶性肿瘤的CT征象,包括病灶的部位、形态、边界、强化程度、均匀性、邻近组织的浸润、淋巴结转移等进行回顾性分析,并与病理进行对照研究.结果:(1)腮腺低度恶性肿瘤组:共8例,4例为高分化粘液表皮样癌、3例为腺泡细胞癌、1例为上皮-肌上皮癌;3例病灶边缘清楚,3例病灶边缘部分欠清,2例病灶边缘不清;5例病灶形态规则,3例病灶形态不规则;8例病灶均呈明显强化,2例病灶内密度均匀,6例病灶内可见低密度区;所有的病灶均未见侵犯邻近肌群的CT征象,有3例出现淋巴结转移征象.(2)腮腺中高度恶性肿瘤组:共21例,5例为低分化鳞癌、8例为恶性混合瘤、2例为腺癌、1例为淋巴上皮癌、4例为粘液表皮样癌、1例为腺样囊性癌;5例病灶边缘清楚,7例病灶边缘部分欠清,9例病灶边缘不清;10例病灶形态规则,1l例病灶形态不规则;17例病灶呈明显强化,4例恶性混合瘤病灶呈轻度强化;9例病灶内密度均匀,12例病灶内可见低密度区;8例病灶侵犯邻近肌群,8例病灶与腮腺床的脂肪间隙消失,6例出现淋巴结转移征象.结论:上皮源性腮腺恶性肿瘤的CT征象在一定程度上和肿瘤的恶性程度存在相关性,但是,还须结合肿瘤的大小、肿瘤的病理组织学类型才能做出更精确的影像学诊断.     

Malignant mixed tumor of salivary origin: a clinicopathologic study of 146 cases.

A 30-year Memorial Hospital experience with 146 patients with malignant mixed tumor is reviewed. These comprised 5% of 2,743 patients who were treated for salivary neoplasms from 1939 through 1968. The tumors arose in the parotid gland in 108 patients, submaxillary gland in 23 patients, mucus or so-called minor salivary glands in 16 patients, and sublingual gland in one. In terms of our total experience, 11% of all submaxillary tumors proved to be of the malignant mixed variety as compared to 6% of parotid tumors and 3% of minor salivary tumors, respectively. Seventy-one patients (48%) had previously received therapy elsewhere. Results of treatment are presented and the factors which influenced the results are discussed.     

133例腮腺肿瘤的CT征象分析

背景与目的:腮腺肿瘤大多数生长缓慢,临床上难以估计其良恶性.本研究拟通过对腮腺肿瘤CT征象的分析,以提高CT对腮腺肿瘤的诊断准确率.方法:对经病理证实的133例腮腺肿瘤共157个病灶的CT征象进行回顾性分析,包括病灶的分布、轮廓、边界、强化程度、瘤内囊变坏死、邻近组织的受累情况等.结果:在157个病灶中,良性肿瘤110个(70.0%)、交界性肿瘤18个(11.5%)、恶性肿瘤29个(18.5%).80个(72.7%)良性肿瘤及14个(77.8%)交界性肿瘤位于腮腺浅叶,而恶性肿瘤位于深叶(7/29,24.1%)或跨深浅两叶(10/29,34.5%)的比例明显增加.99个(90.0%)良性肿瘤边缘清楚;交界性肿瘤8个(44.4%)边界清楚,10个(55.6%)部分边界不清;而恶性肿瘤边界部分不清(10/29,34.5%)及边界不清(11/29,37.9%)的比例明显增多.良性肿瘤多呈类圆形(68/110,61.8%)或椭圆形(23/110,20.9%),而恶性肿瘤则多表现为不规则形(14/29,48.3%).11个病灶(2个交界性肿瘤、9个恶性肿瘤)的邻近皮下脂肪受累.腮腺床受累仅见于恶性肿瘤;所有良性肿瘤均未见邻近组织受侵.结论:CT征象可以为腮腺肿瘤的良恶性鉴别诊断提供有价值的依据.位于浅叶、边界清楚、类圆形或椭圆形的腮腺肿瘤多为良性肿瘤;反之,多为恶性肿瘤.     

腮腺肿瘤手术20例临床分析

目的探讨腮腺肿瘤的手术方式、手术范围及预后。方法对1998--2004年间行解剖面神经的腮腺肿瘤切除术20例临床随访资料进行分析。结果腮腺浅叶切除术13例中,并发腮瘘1例;全腺叶切除术7例中,并发暂时性面瘫1例,无Frey综合征。随访10个月至6年无复发。结论腮腺良性肿瘤需行解剖面神经的浅叶及肿瘤切除术或全腮腺切除术;恶性肿瘤在面神经未受累时行保留面神经的腮腺全切术,术后辅以放疗,可以减少肿瘤复发和面瘫等并发症。     

Salivary duct carcinoma (cribriform salivary carcinoma of excretory ducts). A clinicopathologic and immunohistochemical study of 12 cases.

Salivary duct carcinoma (cribriform salivary carcinoma of the excretory ducts [CSCED]) is an uncommon malignant tumor which occurs predominantly in men (83% in this series; mean age, 61 years) and most often in the parotid gland (92% in this series). The outcome is unfavorable for most patients; of 11 of 12 patients with follow-up, 45% had local recurrence, 54% had distant metastasis, and 45% were dead of disease within 10 years of diagnosis (mean, 3 years). Metastases to lymph nodes were common (72%). Immunohistochemical studies on paraffin-embedded tissue revealed that most tumors reacted with antibodies known to mark adenocarcinoma: B72.3 (11 of 11) and Lewis Y (ten of ten). High and low molecular weight cytokeratins were present in most tumors (nine of ten and seven of nine cases, respectively), supporting the concept that these adenocarcinomas were of ductal origin. Parotid ducts adjacent to CSCED expressed B72.3 in six of nine cases studied, but parotid ducts from normal tissue (adjacent to benign mixed tumors or enlarged periparotid lymph nodes) rarely expressed this marker (one of 17 cases). The detection of B72.3 diffusely in parotid ducts, especially those with atypia, may imply the presence of malignant tumor nearby, which could be useful in evaluating limited tissue from the parotid. However, further studies are necessary to confirm the significance of this finding.     

Prior exposure to medical and dental x-rays related to tumors of the parotid gland

Findings from this population-based study in Los Angeles County suggest, for the first time, that tumors of the parotid gland are related to prior exposure to diagnostic medical and dental radiography. Responses to interviews with 408 patients with a parotid tumor (269 benign tumors and 139 malignant tumors) were compared to responses of 408 neighborhood controls. Cumulative exposure of the parotid gland from diagnostic radiography was associated with a dose-related increase in risk of malignant tumors (P for trend less than .05; relative risk for exposure to greater than or equal to 50 rad = 3.4; 95% confidence interval = 1.02-11.46). Benign tumors showed a weaker positive association, and exposure before age 20 to a major diagnostic examination (full-mouth or panoramic dental radiography or medical radiography to the head) increased risk (relative risk = 1.8; confidence interval = 1.13-2.91). This study also confirmed the association of malignant tumors with prior radiation treatment to the head or neck; 28% of these tumors are attributable to exposure of the parotid gland from diagnostic and therapeutic radiation.     

Tumors of the major and minor salivary glands

Surgery for salivary gland tumors requires technical skill, competence in head and neck anatomy, and a familiarity with a variety of tumors. Benign salivary tumors at all sites should be 100 percent curable, with a local recurrence rate of less than five percent; these local failures should be curable with further surgery. The majority of parotid tumors are benign. Sixty-two percent of patients with malignant parotid tumors will be alive at five years, 54 percent at 10 years, and 47 percent at 15 years. These survival rates for malignant parotid tumors are better than those for malignant tumors in the submaxillary and minor salivary glands and may be explained in part by the presence of a higher percentage of low-grade malignant tumors in the parotid gland. Since most submaxillary gland tumors are malignant, they are more dangerous than parotid tumors. A total of 80 percent of patients with submaxillary gland tumors die as a result of cancer. Almost all minor salivary gland tumors are malignant; curability relates to size, local extension, histology, and nodal metastases. Forty-five percent are alive at five years, and 21 percent at 15 years. Wide-field radical surgical excision is needed for malignant salivary tumors to minimize local recurrences and treatment failures. Future improvement in treatment results will be made possible by increased awareness of this group of tumors, earlier diagnosis when tumors are still small, more radical extirpation, and greater use of postoperative radiation therapy.     

腮腺恶性肿瘤外科治疗130例分析

[目的]探讨腮腺恶性肿瘤的手术方法、面神经处理及预后.[方法]回顾分析130例住院手术病例,其中初治85例、复治45例、术前面瘫18例.行腮腺及肿块切除保留面神经87例,腮腺、肿块及面神经切除33例,扩大切除10例.[结果] 5年生存率为76.2%.其中术前有无面瘫分别33.3%、81.3%(P＜0.01),有无颈淋巴结转移为54.2%、80.4%(P＜0.01).[结论]腮腺恶性肿瘤的预后因素主要是术前有无颈淋巴结转移、面瘫、肿瘤的临床分期及恶性程度,首次术式选择合理是减少局部复发的关键.     

The role of post-operative radiation therapy in the treatment of malignant tumors of the parotid gland

Twenty-nine patients treated with postoperative radiotherapy for malignant tumors of the parotid gland were reviewed at the Joint Center for Radiation Therapy. Most patients were treated between 5,000 and 6,500 rad. All were treated because of microscopic residual disease, extra capsular extension, or tumor close to the facial nerve. The overall results showed one in-field failure, two marginal recurrences, and eight patients failed distantly. Poor prognostic factors included high-grade, extracapsular extension, and nodal involvement. We conclude that patients with malignant tumors of the parotid should be treated with postoperative radiation therapy if any of the bad prognostic signs are present. This may enable the surgeon to spare the facial nerve and obtain local control results equal to or better than more radical surgical procedures.     

MRI征象在腮腺肿瘤定性诊断中的价值及其病理基础

背景与目的：腮腺肿瘤的病理类型非常复杂,MRI在其诊断中具有明显的优越性,但在诸多方面诊断标准仍不统一,需要大样本的病例分析以探讨MRI征象在其诊断中的价值及其病理基础。本文总结常见腮腺良、恶性肿瘤的MRI表现,以探讨各征象在腮腺肿瘤定性诊断中的作用。方法：收集132例腮腺肿瘤及其它病变患者(共140个病灶)的MRI资料,其中良性者89例,恶性者43例。112例经手术病理证实,17例经活检证实,3例经临床观察证实。对其中58例手术切除病灶完整者的标本行病理逐层切片检查,并将结果与MRI影像进行对照分析。MRI平扫采用TlWI、T2WI,其中108例共115个病灶同时行平扫和增强扫描。统计学分析采用X^2检验。结果：(1)常见腮腺良性肿瘤的MRI特征表现：所有行增强扫描的40个腺淋巴瘤均呈轻度增强,其中25例T2WI表现为低、等信号;22例混合瘤T2WI表现为高而不均匀信号;5例血管瘤可见异常增粗的血管结构;3例囊性淋巴管瘤的形状特别不规则并包绕邻近结构;4例脂肪瘤的信号类似于其它部位的脂肪瘤。(2)常见腮腺恶性肿瘤的MRI特征表现：8例混合瘤恶变的T2WI信号高而不均匀,且形状不规则,边界不清楚;7例腺样囊性癌以侵犯范围广泛为特征;8例粘液表皮样癌中,3例低度恶性者边界清楚,与良性肿瘤难区别,5例中、高度恶性者边界不清,易发生坏死及淋巴结转移;9例淋巴瘤均为继发,范围较广,可分辨出由多个结节组成;3例腺泡细胞癌内有TlWI和T2WI均为高信号的囊变区,形状规则或不规则。结论：常见腮腺良、恶性肿瘤在MRI表现上各有特点,对大多数病例用MN进行定性诊断是可能的。     

Nonlymphoid mesenchymal tumors of the parotid gland

Salivary gland tumors are uncommon and most of them are of epithelial origin. Mesenchymal tumors affecting the parotid are extremely rare, and we present a series of 19 cases. All parotid tumors (600 cases) treated at the Department of Head and Neck Surgery from A.C. Camargo Hospital, Brazil from 1953 to 2003 were reviewed and 19 cases of nonlymphoid mesenchymal origin were selected. The histological characteristics were reviewed and clinical features were obtained from the medical charts. 15 out of 19 were benign tumors, including 5 lymphangiomas, 5 neurofibromas, and one case each of schwannoma, lipoma, solitary fibrous tumor, meningioma and giant cell tumor. Four malignant tumors were classified as rhabdomyosarcoma, fibrosarcoma, Langerhans cell histiocytosis and endodermal sinus tumor. From the malignant cases, only the patient with fibrosarcoma died due the tumor, the other three are alive with no signs of recurrence. In our series of 600 cases of parotid gland tumors, nonlymphoid mesenchymal tumors corresponded to 3.16% (19 cases; 15 benign and 4 malignant). All cases were treated by surgery with no recurrences, except one case of fibrosarcoma whose patient died of distant metastasis.     

Nup88及其在恶性肿瘤防治中的研究进展

恶性肿瘤在全球范围内的患病率和死亡率正逐年上升。对于恶性肿瘤早期的患者,采用手术切除治疗可取得较好效果,但生活中绝大多数肿瘤患者发现并确诊时已经错过了最佳手术时机。目前对于中晚期患者尚无有效的治疗策略,基因靶向治疗是近年来肿瘤治疗研究的热点,也为恶性肿瘤治疗提供新的方法。基因靶向治疗的关键在于寻找特异性强的肿瘤基因,核孔蛋白88(nucleoporin 88,Nup88)基因具有很好的肿瘤组织特异性,其通过参与细胞核内外物质交流以及细胞有丝分裂过程促进肿瘤进展。本文就目前在基础研究中有关Nup88分子结构、作用机制以及在口腔癌、乳腺癌、胃癌、结直肠癌、子宫颈癌和子宫内膜癌中研究现状进行综述。     

Radiotherapy in epithelial tumors of the parotid gland: case presentation and literature review

A group of 113 patients irradiated for parotid tumor was studied retrospectively. Sixty-two patients were irradiated after superficial parotidectomy or enucleation of a pleomorphic adenoma. None of them had a recurrence after 5-15 years. Sixteen patients were irradiated postoperatively after surgery for a recurrence of pleomorphic adenoma. Only one of them had developed a recurrent tumor. Thirty-five patients with a malignant parotid tumor were treated by irradiation, 22 after surgery and 13 after biopsy only. Patients with a low malignancy tumor (10/11) and adenoid cystic carcinoma (6/12) responded better than patients with a high malignancy carcinoma (2/12). A tumor larger than 4 cm, facial nerve palsy, lymph node metastasis, and inoperability indicate a poor prognosis. With high dose radiotherapy it is possible to treat inoperable tumors successfully. Adenoid cystic carcinomas can respond well to irradiation alone.     

Squamous cell carcinoma arising in benign adenolymphoma (Warthin's tumor) of the parotid gland

Adenolymphoma of the parotid gland is a benign tumor occurring primarily in middle-aged males. Major texts of surgery and pathology state that this tumor is not malignant nor does it undergo malignant degeneration. This report demonstrates squamous cell carcinoma arising in a parotid adenolymphoma in a patient with no other malignancy or previous irradiation to the head and neck.