Papillary cystadenoma of the parotid gland: A case report

BACKGROUND Papillary cystadenoma is a rare benign epithelial tumor of the salivary gland,which is characterized by papillary structures and oncocytic cells with rich eosinophilic cytoplasm. We found only one case of papillary cystadenoma in nearly 700 cases of salivary gland tumors. Our case was initially mistaken for a tumor of the right temporomandibular joint(TMJ) capsule rather than of parotid gland origin. Preoperative magnetic resonance imaging(MRI) and computed tomography(CT) should be carefully studied, which allows for appropriate preoperative counseling and operative planning.CASE SUMMARY Here, we report an unusual case of a 54-year-old woman with a parotid gland papillary cystadenoma(PGPC) that was misdiagnosed as a tumor of the right TMJ capsule. She was initially admitted to our hospital due to a mass anterior to her right ear inadvertently found 5 d ago. Preoperative CT and MRI revealed a well circumscribed tumor that was attached to the right TMJ capsule. The patient underwent a resection through an incision for TMJ, but evaluation of an intraoperative frozen section revealed a benign tumor of the parotid gland. Then we removed part of the parotid gland above the temporal facial trunk. The facial nerve was preserved. Postoperative histopathological findings revealed that the tumor was PGPC. No additional treatment was performed. There was no recurrence during a 20-mo follow-up period.CONCLUSION The integrity of the interstitial space around the condyle in MRI or CT should be carefully evaluated for parotid gland or TMJ tumors.     

Imaging of the parapharyngeal space: anatomy and pathology

A multitude of histologic neoplasms occur within the boundaries of the parapharyngeal space. Contrast enhanced computed tomography and recently MRI have greatly enhanced the preoperative diagnosis of parapharyngeal space tumors. MRI is currently the modality of choice in evaluating masses originating in the parapharyngeal space or masses from adjacent spaces which grow into the parapharyngeal space. Gadolinium DTPA enhanced MRI of head and neck tumors is helpful for demonstrating neoplastic involvement of paranasal sinus, perineural tumor extension, or intracranial extension of neoplasms. Parapharyngeal space tumors are equally demonstrated by unenhanced MRI. The majority of tumors involving the parapharyngeal space are from the deep portion of the parotid gland or from minor salivary glands, and the majority of these tumors are benign mixed tumors. Based on the CT appearance and enhancement characteristics, it is difficult to accurately distinguish a minor salivary gland tumor from a neurogenic tumor. MR tissue signal characteristics alone cannot be reliably utilized in making this distinction. Internal carotid artery displacement remains the most reliable distinguishing feature. Minor salivary gland tumors will displace the internal carotid artery posterior and lateral, whereas neurogenic tumors will displace the internal carotid artery anterior and medial.     

Malignant solitary fibrous tumor of the greater omentum: A case report and review of literature

BACKGROUNDMalignant solitary fibrous tumors (SFTs) account for 15%-20% of all SFTs, and malignant SFTs arising from the greater omentum are extremely rare. Most malignant SFTs of the greater omentum are diagnosed via pathological examinations after surgery. In this study, we report a case of malignant omental SFT and review the published literature on this rare malignancy.CASE SUMMARYA 64-year-old female presented with an abdominal mass, and underwent exploratory surgery, during which a huge tumor originating from the greater omentum and intraperitoneal implants were identified and resected. The results of the pathological examination, immunohistochemistry staining, and gene sequencing led to the diagnosis of malignant SFT of the greater omentum. The patient died one and a half years later due to tumor recurrence and metastasis.CONCLUSIONThis is the first report of the application of gene sequencing in the diagnosis of malignant SFTs of the greater omentum.     

腮腺原发性黑色素瘤1例临床病理分析

腮腺原发性黑色素瘤是一种临床少见病例,目前国内外多为个案报道,黄冈市中心医院近年收治的1例病例。患者49岁,右耳下无痛性包块1年余,近半年包块逐渐增大,现增大迅速,伴右侧口角歪斜,CT检查显示右腮腺区内3.7 cm×1.9 cm团片状软组织密度影。大体检查见腮腺内2.5 cm质硬区,切面灰红色。HE镜下见肿瘤组织位于腮腺内,瘤细胞排列成片状、岛状、腺泡状,有大量较厚的纤维间隔,瘤细胞向腮腺内浸润性生长,部分瘤细胞围绕血管增生形成假菊形团样,可见明显片状出血坏死,形成小囊腔,有较多薄壁小血管,部分脉管内可见瘤栓形成,细胞较小,大小较一致,呈浆细胞样,瘤细胞内外可见少许粗大的黑色素颗粒。免疫标志HMB45,Melan-A,CD146,SOX10,S-100,vimentin均阳性表达,CK7,34ΒE12,P63,Calponin,CK,CEA均阴性表达,Ki-67增殖指数约30%。腮腺原发性黑色素瘤是一种少见的恶性肿瘤,其诊断需结合临床特点,病理组织学形态及免疫表型。     

Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor: A case report

BACKGROUNDDuodenal papillary tumor is a rare tumor of the digestive tract, accounting for about 0.2% of gastrointestinal tumors and 7% of periampullary tumors. The clinical manifestations of biliary obstruction are most common. Some benign tumors or small malignant tumors are often not easily found because they have no obvious symptoms in the early stage. Surgical resection is the only treatment for duodenal papillary tumors. At present, the methods of operation for duodenal papillary tumors include pancreatoduodenectomy, duodenectomy, ampullectomy, and endoscopic resection.CASE SUMMARYA 47-year-old man was admitted to because of a duodenal mass that had been discovered 2 mo previously. Electronic gastroscopy at another hospital revealed a duodenal papillary mass that had been considered to be a high-grade intraepithelial neoplasia. Therefore, we conducted a multidisciplinary group discussion and decided to perform a pancreas-preserving duodenectomy and a R0 resection was successfully performed. After surgery, the patient underwent a follow-up period of 5 yr. No recurrence or metastasis occurred. CONCLUSIONAccording to our experience with a duodenal papillary tumor, compared with pancreaticoduodenectomy, the use of pancreas-preserving duodenectomy can preserve pancreatic function, maintain gastrointestinal structure and function, reduce tissue damage and complications, and render the postoperative recovery faster. Pancreas-preserving duodenectomy for treatment of a duodenal papillary tumor is feasible under strict control of surgical indications.     

Characteristic sonographic findings of Warthin's tumor in the parotid gland

PURPOSE: The aim of this study was to define the characteristic sonographic features of Warthin's tumors in the parotid gland, thus enhancing the ability to make a preoperative diagnosis of this disease process. METHODS: We retrospectively evaluated the sonograms of Warthin's tumors of the parotid gland that had been confirmed by histopathologic examination of surgically excised specimens from patients treated at our institution over a 2-year period. We recorded the echogenicity, shape, margin, and internal structure of the tumors and categorized them into 2 groups on the basis of size (< 5 cm versus > or =5 cm in the largest diameter). RESULTS: Eighteen patients (16 men and 2 women) with a mean age of 57 years (range, 29-82 years) were included in the analysis. One patient had 2 tumors (1 in each parotid gland); the other 17 patients each had only 1 tumor. Our review of the sonographic findings revealed that all 19 tumors were hypoechoic compared with the normal parenchyma of the affected parotid glands. Most of the tumors were ovoid, had well-defined margins, and contained multiple irregular, small, sponge-like anechoic areas. Tumors that were 5 cm or greater in diameter had a higher proportion of cystic content than smaller lesions had and in some cases were composed almost entirely of cystic material. CONCLUSIONS: Our evidence suggests that the sonographic appearance of a Warthin's tumor in the parotid gland is distinctive: a well-defined round or ovoid hypoechoic mass containing microcystic anechoic areas. These sonographic features constitute useful criteria in the preoperative diagnosis of Warthin's tumor in the parotid gland, although sonographically guided fine-needle aspiration biopsy may be needed to confirm the diagnosis.     

内镜切除术与腹腔镜切除术治疗非微小胃间质瘤的对比研究

目的 对比分析内镜下切除和腹腔镜手术切除非微小胃间质瘤（直径大于1 cm且小于5 cm）的疗效及安全性。方法 回顾性分析2012年1月－2017年12月在苏州大学附属第一医院和苏州大学附属张家港医院行内镜下切除和外科腹腔镜手术治疗、并经术后病理及免疫组化确诊为非微小胃间质瘤患者的临床资料。根据手术方式将患者分为内镜切除组和腹腔镜手术组,比较两组患者术后住院时间、并发症、治愈性切除率等。结果 内镜切除组术后进食时间、术后排气时间、住院时间较腹腔镜手术组短,住院费用较腹腔镜手术组少,两组患者比较,差异有统计学意义（均P < 0.05）。术后对所有患者进行随访,内镜切除组平均随访时间为32个月,有1例出现复发;腹腔镜手术组平均随访时间为35个月,有1例出现复发,1例出现转移,两组患者比较,差异无统计学意义（P > 0.05）。结论 内镜下切除直径大于1 cm且小于5 cm的非微小胃间质瘤,具有肿瘤切除率高、术后恢复快、并发症少等优势,且与腹腔镜手术相比,复发率无明显差异。     

腮腺巨大多形性腺瘤一例

多形性腺瘤是最常见的唾液腺肿瘤,然而超过1 kg的腮腺巨大多形性腺瘤则极为罕见。该文报道了1例71岁男性腮腺巨大多形性腺瘤患者的诊治经过,该例患者因左侧耳下区渐大包块35年入院,入院完善相关检查后行包块探查切除术。术中见一大小约160 mm×130mm×140 mm的肿物,术后肿物称重1.55 kg,病理回示符合腮腺巨大多形性腺瘤。术后随访6月,患者左侧颌面部外观明显改善,无神经损伤症状。该例的诊治过程提示,腮腺多形性腺瘤瘤体巨大,手术过程中应注意避免损伤邻近神经血管,临床医师应加强对本病的认识,提升诊治水平。     

咽旁间隙的超声解剖及声像图研究

目的探讨咽旁间隙的超声解剖及正常声像图特点。方法观察经CT和MRI检查并提示咽旁间隙正常的健康人33例,采用超声沿下颌骨外缘检查咽旁间隙。结果超声表现前界为颌下腺的内侧缘,外界为腮腺的深面,后界为乳突的内侧缘,内界为咽侧壁。沿下颌骨外周缘超声可显示咽旁间隙,咽旁间隙声像图的横切面呈倒置三角形,除翼内外肌和穿过其内的神经难以显示外,咽旁前间隙的筋膜脂肪组织表现强弱相间的软组织层次结构,而咽旁后间隙则表现为片状弱回声区夹杂低回声小区。结论颌下腺、腮腺和乳突是超声检查咽旁间隙的3个重要解剖标志,认识咽旁间隙的正常超声图像对提高咽旁间隙病变诊断正确率具有重要的临床意义。     

Cellular solitary fibrous tumor in the mental area: a case report and literature review

Solitary fibrous tumors (SFTs) are rare benign mesenchymal tumors that occur mainly in the pleura. We herein report the first case of a cellular SFT located in the mental region of the head and neck in a 46-year-old woman. Facial computed tomography revealed a mass measuring 0.8 cm with clear boundaries in the right mental region. After excision of the mass, expert pathologists diagnosed a cellular SFT. To our knowledge, this is the first case of a cellular SFT identified in the subcutaneous tissue of the mental region of the head and neck. Because the postsurgical prognosis of SFTs is unpredictable, long-term follow-up and further studies are necessary to determine the characteristics of cellular SFTs in the head and neck region.     

The importance of postoperative radiotherapy against polymorphous low-grade adenocarcinoma of the parotid gland: case report and review of the literature

Polymorphous low-grade adenocarcinoma (PLGA) of the salivary gland is a disease entity that is a recently described form of adenocarcinoma. PLGA most commonly arises in the minor salivary glands. We report two cases of PLGA of the parotid gland. Case 1: A 52-year-old female visited the University of Tsukuba Hospital with a painless mass in the left parotid region. A superficial parotidectomy and postoperative radiotherapy were performed. The patient has been free from disease for 50 months. Case 2: A 55-year-old female initially noticed a painless slowly growing mass in the left parotid region. The tumor was removed with a superficial parotidectomy. The local recurrence was found 6 years after the initial surgery. The recurrent tumor was removed, and radiotherapy was administered thereafter. The patient has been free from the disease for 33 months since the last treatment. The treatment for the primary lesion is crucial for the prognosis since metastasis to the regional lymph node or to distant region is unusual in PLGA. Although surgical extirpation is the recommended modality for treatment of PLGA, wide resection with a safety margin is often difficult in the parotid gland because of the presence of the facial nerve. Our two cases were successfully treated with surgery and postoperative radiotherapy. Although our literature search revealed 32 previously reported cases of PLGA of the parotid gland, only five of the 32 cases were treated postoperative radiotherapy. We highlight the importance of postoperative radiotherapy for PLGA of the parotid gland.     

手术治疗腮腺混合瘤120例临床疗效观察

目的探讨不同手术方式对腮腺混合瘤的临床治疗效果。方法选取2009年1月～2011年12月,我院收治的120例腮腺混合瘤患者为临床研究对象,根据手术方式的不同将患者随机分为研究组和对照组,每组60例。对照组患者采用传统的全腮腺切除术进行治疗,研究组患者行保留腮腺导管区域性肿瘤切除术。对两组患者术后并发症发生情况以及术后主要面神经分支功能损伤情况进行比较分析。结果两组患者通过4～6个月的随访,均无复发。与对照组患者相比,研究组患者的皮下积液或涎瘘、面瘫、Frey综合征以及面部明显凹陷畸形等并发症的发生率均显著下降,且下颌缘支、颊支以及颧支等面部主要神经分支功能损伤情况均显著降低,差别均具有统计学意义(P<0.05)。结论区域性腮腺肿瘤切除术疗效确切,效果显著,可作为腮腺混合瘤患者目前最为理想的手术方式之一。     

Cystic teratoma of the parotid gland: A case report

BACKGROUNDTeratoma is a common tumor, but rarely occurs in the parotid region. Only nine cases have been reported in the current literature. Although it is generally detected in infancy or childhood, it is commonly asymptomatic. Computed tomography (CT) and magnetic resonance imaging (MRI) have important roles in the diagnosis of teratoma.CASE SUMMARYA 36-year-old man developed a lump located below the left auricular lobule 3 years ago. Physical examination revealed a nearly-circular tumor in the left parotid gland region with a defined border, firm texture, and significant movement. Calcification, fat, keratinized substances, and typical fat-liquid levels was observed on CT and MRI. A diagnosis of cystic teratoma of the parotid gland was established preoperatively and confirmed by postoperative pathology. Following surgery, the patient developed temporary facial paralysis. There was no recurrence of teratoma during the 15-mo follow-up period.CONCLUSIONWhen an asymptomatic mass in the parotid region is identified, parotid gland teratoma should be included in the differential diagnosis. Imaging examinations are helpful in the diagnosis.     

腮腺Warthin瘤的CT诊断及误诊分析

目的总结腮腺Warthin瘤的CT影像特征及其与腮腺混合瘤的鉴别要点,以提高影像定性诊断与病理符合率。方法收集有完整手术或穿刺病理记录的17例患者的资料,其中14例为腮腺Warthin瘤,3例影像报告Warthin瘤但病理证实为混合瘤病例。患者均采用常规平扫加多期动态增强扫描,观察病灶数目、形态特征、密度、强化特征及周围淋巴结情况。对所有病灶平扫、动脉期、延迟期CT值进行详细测量,并对病灶所在腮腺腺体CT值进行测量。结果14例Warthin瘤中,男11例,女3例;中位年龄64岁。单侧单发病例7例,单侧或双侧多发病例7例;位于浅叶后下部11例;边缘清晰13例;病灶最大径>3 cm 7例。平扫均为高密度病灶。密度均匀6例,密度不均8例。均匀强化2例,不均匀强化12例,延迟廓清11例。结论腮腺Warthin瘤是腮腺较常见肿瘤,其CT表现具有良性肿瘤的特征,好发于50岁以上男性,易出现单或双侧多发病灶,多期动态增强扫描表现出的延迟廓清有一定的特异性,密切结合临床资料,多可于术前做出定性诊断。     

Reconstruction of the chest wall after resection of malignant peripheral nerve sheath tumor: A case report

BACKGROUNDMalignant peripheral nerve sheath tumors (MPNSTs) are a group of rare and aggressive sarcomas that often arise from major peripheral nerves and represent a notable challenge to efficacious treatment. MPNSTs can occur in any body surface and visceral organs with nerve fiber distribution. The treatment options for MPNSTs include surgery, chemotherapy, and adjuvant radiotherapy. CASE SUMMARYA 26-year-old female cellist presented with chest pain on her left side when she squatted to lift the cello. One week later, a chest X-ray was performed and revealed fracture of the fourth rib on the left side. Three months later, the patient inadvertently touched a mass on the left side of the chest wall. Chest computed tomography (CT) three-dimensional reconstruction of the ribs revealed bone destruction of the fourth rib on the left side with a soft tissue mass shadow measuring 5.7 cm × 3.7 cm. CT-guided puncture biopsy of the tumor showed that heterotypic cells (spindle cells) tended to be nonepithelial tumor lesions. PET-CT demonstrated bone destruction and a soft tissue mass with avid 18F-fluorodeoxyglucose activity (SUV_max7.5) in the left fourth rib. The tumor of the left chest wall was resected under general anesthesia, and reconstruction of the chest wall was performed. The postoperative pathological report exhibited an MPNST.CONCLUSIONMPNSTs are relatively chemo-insensitive tumors. The mainstay of treatment for MPNSTs remains resection with tumor-free margins.     

Mucinous appendiceal neoplasm: A case report

BACKGROUNDPrimary appendiceal tumors are histologically diverse and have an insidious onset and few specific clinical manifestations. In the majority of cases, these tumors are discovered after appendectomy during pathological exam of the resected tissue. Treatment may include appendectomy (simple or radical) and right hemicolectomy depending on factors such as histological type, tumor size and lymph node/organ involvement. The aim of this case study is to describe a rare case of a giant appendicular mucocele and raise awareness of this condition and its management options and follow-up protocol.CASE SUMMARYWe present the case of a 43-year-old patient who presented to our emergency department with mild right lower quadrant pain. After the initial check-up and imaging exams, he underwent surgery, where a giant 20 cm × 13 cm appendicular tumor was found and resected. Appendicular mucocele was suspected due to the macroscopic appearance and was later confirmed by the pathological exam. The patient’s postoperative evolution was uneventful, and after discharge, he was included in our follow-up program.CONCLUSIONIn conclusion, mucinous appendiceal neoplasms embody a rare pathology; they are asymptomatic or have few, unspecific clinical signs and in many cases are discovered after appendectomy.     

Large leiomyoma of lower esophagus diagnosed by endoscopic ultrasonography–fine needle aspiration: A case report

BACKGROUNDBenign esophageal tumors are rare accounting for < 1% of esophageal tumors; two-thirds of which are leiomyomas. Esophageal leiomyoma is a benign tumor derived from mesenchymal tissue that is completely muscularly differentiated. Most esophageal leiomyomas are < 5 cm. Esophageal leiomyomas > 5 cm are rare. We describe a case of a large esophageal leiomyoma involving the cardia and diaphragm.CASE SUMMARYA 35-year-old woman presented to the doctor because of a choking sensation after eating. Physical examination showed no positive signs. Gastroscopy indicated an uplifted change in the cardia. Enhanced computed tomography revealed space-occupying lesions in the lower part of the esophagus and cardia, which were likely to be malignant. Positron emission tomography–computed tomography showed increased metabolism of soft tissue masses in the lower esophagus and near the cardia. Malignant lesions were considered, and mesenchymal tumors were not excluded. Endoscopic ultrasonography was performed to examine a hypoechoic mass in the lower esophagus, which was unclear from the esophageal wall. Clinical evaluation suggested diagnosis of esophageal and cardiac stromal tumors. Finally, histological specimens obtained by endoscopic ultrasonography– fine needle aspiration suggested leiomyoma. The patient underwent laparoscopic local resection of the tumor. The postoperative pathological diagnosis was leiomyoma.CONCLUSIONEndoscopic ultrasonography-fine needle aspiration is necessary for the diagnosis of gastrointestinal leiomyomas. It provides a strong basis for diagnosis of gastrointestinal tumors of unknown nature and origin.     

Malignant meningioma with jugular vein invasion and carotid artery extension: A case report and review of the literature

BACKGROUNDGrade II and III meningiomas [World Health Organization (WHO) classification] rarely have extracranial metastases via the blood circulation; however, we experienced a case with a metaplastic atypical meningioma and local de-differentiation that metastasized to the jugular vein, carotid artery and subclavian artery at the cervicothoracic junction. Such cases have seldom been reported before.CASE SUMMARYThe patient was a 30-year-old man who developed right neck masses with dysphagia, labored breathing, dizziness, and occasional earaches. Eight months earlier the patient was diagnosed with a right parietal lobe neoplasm and hemorrhage at a local hospital due to the sudden onset of headaches and left limb weakness, and the post-operative pathology was a metaplastic atypical meningioma (WHO grade II) with local de-differentiation (WHO III). Magnetic resonance imaging revealed a calcified mass at the root of the neck on the right and a large cystic mass in the right parapharyngeal space. Head and neck angiography showed that the right common carotid artery was compressed and completely occluded, and the jugular vein was enveloped by the tumor and occluded. A balloon occlusion test showed no perfusion in the right common carotid artery. Tumor resection, carotid artery ligation, and subclavian artery reconstruction were performed. The tumor was a malignant meningioma. Post-operatively, the patient had Horner''s syndrome and hoarseness.CONCLUSIONThis case highlights the importance of the link between a large cervical mass and a primary intracranial tumor. Malignant meningioma should not be considered merely as an intracranial metastasis spread through cerebrospinal fluid, it can also be transferred through the circulation to the parapharyngeal space and the cervical great vessels.     

MRI在诊断咽旁间隙病变中的价值

目的：总结咽旁间隙肿瘤的MRI特点,评价MRI对咽旁间隙肿瘤的鉴别诊断价值。方法：回顾分析经病理确诊的咽旁间隙肿瘤20例,全部行MRI检查,18例行增强MRI检查,结果：腮腺深叶来源肿瘤9例,良性混合瘤5例,恶性肿瘤4例,肿瘤与腮腺深叶间的脂肪间隙消失。颈内动脉无或向后稍移位,颈动脉鞘来源肿瘤10例,与腮腺深叶间的脂肪间隙存在,颈内动脉均明显向前移位,其中神经鞘瘤8例,迷走体瘤2例;后者可见明显流空,来自三叉神经的神经鞘瘤1例,与腮腺深叶的脂肪间隙存在,颈内动脉无移位。结论：咽旁间隙肿瘤主要来自腮腺深叶和颈动脉鞘,MRI是鉴别咽旁间隙肿瘤最可靠的影象学检查方法。