涉及颅底咽旁间隙肿瘤的治疗

目的:探讨涉及颅底咽旁间隙肿瘤处理的有效方法.方法:对2000年3月～2005年7月36例涉及颅底咽旁间隙肿瘤患者资料进行回顾性分析.采用的手术入路分别是:经颈侧切开入路15例,经颈-腮腺入路10例,下颌骨外旋入路4例,上颌外旋入路5例,眶颧入路2例.结果:36例肿瘤中,5例为恶性肿瘤,其余皆为良性肿瘤.31例良性肿瘤皆完整切除.5例恶性肿瘤中有2例为鼻咽黏膜下型鳞状细胞癌颅底咽旁间隙转移,经颈侧切开探查病理确诊后放射治疗,1例随诊3年无复发;1例随诊5年,复发带瘤生存;1例侵犯颅底的恶性神经纤维瘤术后3年复发,放弃治疗死亡;1例侵犯颅底的恶性神经鞘膜瘤术后已随诊3年余,健在;1例腮腺深叶黏液表皮样癌,已随诊2年余,健在.36例中,术后声嘶者3例伴呛咳1例,4例发生Horner综合征;2例发生舌偏斜,3个月后好转.结论:不同的涉及颅底咽旁间隙肿瘤有不同的临床特点,应根据各自的临床特点选择适当的处理方法.     

Salivary gland neoplasia in childhood

Salivary gland tumours, benign or malignant, are rare in childhood and as a result may be misdiagnosed and treated inappropriately. Ten children with salivary gland tumours have been treated by the author over a period of 18 years. Four tumours were benign and six malignant. Treatment in all cases was by surgical excision. There has been one recurrence, treated by further surgery, in an acinic cell carcinoma. Three cases had inadequate surgery or biopsy before referral. These findings reflect other series, which demonstrate that a solid tumour in a salivary gland in childhood is more likely to be malignant than to be benign.     

Ceruminous gland tumours: a reappraisal.

Ceruminous glands should no longer be regarded as purely apocrine glands, but as apoeccrine glands with both apocrine and eccrine modes of secretion. We present two cases of pleomorphic adenoma of ceruminous glands, among the rarest of such tumours. The use of such terms as 'ceruminoma' and 'hidradenoma' should finally be abandoned, and 'ceruminous gland tumour' used instead as a generic term. Classification should be based on Wetli's prototype (adenoma, pleomorphic adenoma, adenoid cystic carcinoma and adenocarcinoma), with the addition of benign eccrine cylindroma and syringocystadenoma papilliferum; the inclusion of mucoepidermoid carcinoma should await full validation. Wide local excision is necessary for all tumours, with only follow-up for histologically benign neoplasms. Malignant tumours need early aggressive surgery and radiotherapy. If marginal invasion cannot be assessed histologically, then adenoma and adenocarcinoma cannot be distinguished and we suggest that the tumour be reported as 'of uncertain malignant potential'. Long-term studies are needed to confirm or refute the view that all ceruminous gland tumours are potentially malignant.     

Epidemiological study of salivary gland tumours

Tumours located in the salivary glands form the most heterogeneous group in all human oncological pathology. They show various epidemiological, clinical and evolutionary characteristics which separate them from other neoplasms of the head and neck. In this paper, we have carried out a study on their epidemiological aspects, collecting 80 cases diagnosed in the ENT Service of the University Hospital Complex of Santiago over 17 years. The incidence was 1.22 cases per 100,000 inhabitants per year. The frequency was higher in males (58.75%) and in the 7th decade of age. A predominance was noticed in females under 40 years of age and in males over this age, but the differences were not statistically significant. The most frequent site was the parotid gland, and we could not find any case in the sublingual gland. In 52.5% of cases the tumour was benign, pleomorphic adenoma being the most prevalent. Among malignant tumours, the epidermoid carcinoma stood out in our series. The prevalence of benign tumours in females and of malignant tumours in males was clear, with significant differences. We compare our results with the data published in the literature.     

Prognostic indicators for malignant tumours of the parotid gland

The best treatment of malignant parotid tumours still remains to be defined, and a better knowledge about the tumour features that predict the treatment result is needed. The histological classification of parotid tumours may present difficulties on account of their great morphological diversity. In a series of 152 patients with a malignant tumour of the parotid gland, the prognostic factors and treatment results were investigated over a 25-year period. Treatment consisted of surgery, radiation therapy or a combination (49%, 13% and 38% respectively). Crude 5-year survival was 50% with significant differences related to stage (stage I, 65%; stage II, 50%; stage III, 21%; and stage IV, 9%). With respect to histopathology, the adenoid cystic carcinomas and the acinic cell carcinomas had the best prognosis (76% and 67% 5-year crude survival and 53% and 67% 10-year crude survival respectively). There was a significant difference in crude survival between well/intermediate and poorly differentiated tumours (P = 0.007). In a Cox hazard regression analysis including 136 patients and using death from cancer as the end-point, the following parameters were independent prognostic predictors: T-classification (P = 0.002), M-classification (P < 0.0001), N-classification (N+versus N0) (P = 0.005), local invasion (P = 0.003) and histological differentiation of the tumour (P = 0.03). The TNM system is a good predictor of treatment outcome for malignant parotid tumours. The use of a combination of clinical and histological factors will assist the design of treatment strategies for parotid gland tumours.     

腮腺良性肿瘤的手术方式与术后复发和并发症

目的;研究腮腺良性肿瘤手术方式与复发和术后并发症的关系。方法 在１９８７～１９９７年手术治疗腮腺良性肿瘤５５例（单纯肿瘤除２０例,腮腺浅地切除２８例,全腮腺切除７例）的临床随访资料进行分析。结果 单纯肿瘤切除中肿瘤复发６例,并发持续性面瘫１例,腮腺浅叶切除中复发１０例,并发暂时性面瘫４例腮腺瘘２例,Ｆｒｅｙ综合征２例,腮腺全切除中复发１例,并发暂时性面瘫２例,持续性面瘫１例,腮腺瘘２例,Ｆｒｅｙ综     

The Firm Salivary Mass In Children

The firm salivary gland mass arising in a child is uncommon, representing only 3.2% of all such salivary tumors at the University of Iowa. However, the fact that 57.1% of these tumors are malignant demands thorough diagnostic evaluation by the head and neck surgeon. Histologic diagnosis is strongly recommended. In view of the fact that most of these tumors have a favorable prognosis, lateral parotid lobectomy or total sub-mandibular gland excision represent both an effective diagnostic and adequate therapeutic procedure for benign and low-grade malignancies. High-grade malignancies necessitate adjunctive therapy which is based on the biologic behavior of the particular histologic type.     

Tratamiento quirúrgico de los tumores de glándulas salivales

Introduction and objectivesSalivary gland tumours account for 3% of head and neck tumours. The aim of this study is to analyze our series of tumours of the salivary glands requiring surgical treatment at our centre from 2004 to 2007.Material and methodsThis study is a retrospective review of 49 patients diagnosed as having tumours of the major and minor salivary glands or ectopic salivary tumours, and surgically treated at our hospital between 2004 and 2007. We reviewed their clinical characteristics, imaging findings, fine-needle cytology results, surgical charts (sub-maxillectomies, parotidectomies, palatal tumour excisions and cervicotomies), final pathology findings, and course with at least one year follow-up.ResultsForty-nine salivary tumours were treated, including 43 parotid tumours (87%), 3 sub-mandibular tumours (6%), 1 palatal tumour (2%) and 2 ectopic tumours (4%). Sixteen percent of the tumours were malignant. Fine-needle cytology sensitivity was 40%, whereas specificity was 100%. Out of 43 parotidectomies, 40 (93%) were primary parotidectomies, and 3 were revision parotidectomies. Most parotidectomies (81%) were superficial or partial and 8 (19%) were total. Parotidectomy complications are similar to those described previously in the literature: permanent facial palsy in superficial or partial parotidectomy (5%), wound dehiscence or necrosis (13%), post-operative bleeding (4%), fever or wound infection (7%), sialoceles (44%) and Frey's syndrome (2%).ConclusionsParotid tumours are the most common salivary gland tumours. Most of them are benign, but Warthin's tumour is more frequent than usual in our series. Early and late complications from parotidectomy are uncommon, although sialocele is a common transitory complication in our series.     

Incidence of salivary gland malignancies in 12 year time period in ENT Department Medical University in Poznan

Neoplasm of salivary gland constitutes about 3% of all tumours of head and neck. Within the category we can differentiate tumours of a very different histological structure. What lies behind such great differences in the changes within the salivary glands is complex embryogenesis of the glands. This work aims at the assessment of the frequency of occurrence of malignant neoplasm in parotid gland and submandibular gland based on the material collected at the ENT Department of the Medical University in Poznan in the years 1995-2006. In the 12-year period, 103 patients suffered from malignant neoplasm. 82 tumours were diagnosed in paroid gland and respectively 21 - in submandibular gland. No neoplasm was identified in sublingual gland. It was concluded, that trends in occurrence of neoplasm of salivary glands, assessed on the basis of the number of patients operated in the years 1995-2006 show that the number of malignant neoplasm cases remains on the same level. The analysis of the epidemiological differences based on the comparison of the groups of patients treated for salivary gland neoplasm in the years 1995-2000 and 2001-2006 has shown that with regard to malignant neoplasm such parameters as sex, age, duration of symptoms, diameter of the tumour and level of advancement have not differed much from each other in the analyzed periods. Epidemiological differences were identified in respective histological structures in the two periods analyzed: adenoid cystic carcinoma was in fact more frequent in the years 1995-2000 than in the years 2001-2006 (58.8% versus 24.1%). On the other hand, metastasis to the salivary glands was less frequent in period I than in period II (11.8% and 27.6% respectively), so was cancer in mixed tumour (2.9% and 17.2%). Facial nerve paralysis was statistically more frequent in highly malignant tumours than in comparison to tumours malignant only to a slight extent.     

Review of accessory parotid gland tumors: Pathologic incidence and surgical management

Objective

The current study presents our experience with accessory parotid gland masses and reviews the literature on accessory parotid tumor incidence and surgical management. Based on our results, we advocate a standard parotidectomy approach with routine facial nerve dissection at the time of excision.

Study Design

We performed a retrospective chart review and comprehensive literature review on incidence of accessory parotid gland neoplasms.

Methods

A retrospective chart review of all patients with mid-cheek masses treated by the senior author was conducted from January 2003 to January 2009. The tumor size at presentation, FNA biopsy, pathologic diagnosis, and surgical treatment were recorded for 13 patients.

Results

In the case series, 54% of lesions were benign (n = 7) and 46% were malignant (n = 6) including benign pathologies of 4 pleomorphic adenomas, 2 lymphadenitis, 1 monomorphic adenoma and malignant pathologies of 2 mucoepidermoid carcinoma, 2 B-cell lymphomas, 1 adenocarcinoma, and 1 myofibrosarcoma. Surgical intervention was performed on all patients with standard parotidectomy incision for accessory parotid mass excision after identification and tracing of facial nerve and its branches.

Conclusion

The present study provides support for a standard parotid incision with identification of the facial nerve at the time of surgical incision as this resulted in successful excision of accessory parotid tumors with favorable cosmetic results and without facial paralysis or tumor recurrence. Literature review of 152 cases of accessory parotid gland lesions, revealed a pooled incidence of 70% benign and 30% malignant.     

Parotid gland mucoepidermoid carcinoma in a 4-year-old child

Salivary gland tumors account for less than 5% of the head and neck neoplasms. Among them, mucoepidermoid carcinoma is the most common malignant salivary gland tumor. About 45% of mucoepidermoid carcinomas occur in the parotid gland, and appear around the fifth decade of life, being unusual in children under 10 years. We report a case of a parotid mass arising in a 4-year-old female, who had no lateral adenopathy. After histological examination, the diagnosis was of a low-grade mucoepidermoid carcinoma of the parotid gland. Three years after surgery no recurrence was observed. As a conclusion, although rare, the presence of a parotid mass with progressive growth in children could correspond to a neoplasm.     

颌下区原发性恶性肿瘤

１９５９～１９８９年我院共收治原发于颌下区的恶性肿瘤６５例，其中腺样囊性癌１８例，恶性混合瘤１６例，腺癌１４例，未分化癌１０例，鳞癌７例。总的３年、５年生存率为６０．０％和４２．９％。颌下腺恶性肿瘤有包膜外侵犯与无包膜外侵犯，二者的３年、５年生存率分别为５９．５％、３０．３％和８３．３％、７２．７％。淋巴结阳性者预后差，与无淋巴结转移相比，其３年、５年生存率为４４．０％、１１．１％和８８．５％、７９．２％。Ｔ分期越大预后越不好。死亡原因主要是局部。颈部复发和肺转移。治疗以手术为主。如果肿瘤局限，无包膜外侵犯可做颌下或区域清扫。病变范围广并有颈淋巴结转移者，则需行区域广泛切除及颈清扫。手术切缘不净、术后复发、分化差或病期晚者，宜综合治疗。     

Mucoepidermoid carcinoma of the parotid gland in children: A 10-year experience

OBJECTIVE: To determine the presentation, pathologic features, treatment outcome, and prognosis of mucoepidermoid carcinoma of the parotid gland in children. DESIGN: Retrospective clinical and histopathologic study with institutional review board approval. SETTING: Tertiary pediatric medical center. PATIENTS: Seven children (4 girls and 3 boys) presented with mucoepidermoid carcinoma of the parotid gland between 1994 and 2004. MAIN OUTCOME MEASURES: Clinical presentation, pathologic features, treatment outcome, complications, local recurrence, distant metastasis, and overall survival. RESULTS: All patients presented with an asymptomatic parotid mass. Initial treatment in 7 patients included total parotidectomy (n = 3), superficial parotidectomy (n = 3), transoral enucleation (n = 1), and supraomohyoid neck dissection (n = 1). Four patients required additional surgical procedures because of a close and/or positive margin, including revision parotidectomy (n = 2), total parotidectomy (n = 1), superficial parotidectomy (n = 1), and supraomohyoid neck dissection (n = 1). One patient required postoperative radiation therapy. No evidence of local recurrence or distant metastasis was noted with a mean follow-up of 3.4 years. CONCLUSIONS: Mucoepidermoid carcinoma of the parotid gland is very rare in children. Clinical stage and histologic grade are the main prognostic factors. Complete excision (superficial or total parotidectomy) with preservation of facial nerve is the treatment of choice. Neck dissection should be considered when there is clinical evidence of regional metastasis, high TNM stage, high histologic grade, and involvement of regional nodes. Because of the possibility of long-term adverse effects in pediatric patients, radiotherapy should be used only in selected cases. Long-term follow-up is essential to rule out late recurrence.     

术中快速冰冻切片在136例腮腺肿瘤中的诊断价值

目的通过分析和比较腮腺肿瘤术中快速冰冻切片和术后最终病理诊断结果,评估术中快速冰冻切片在腮腺肿瘤诊断中的意义。方法对136例腮腺肿瘤行术中快速冰冻切片诊断肿瘤的性质与最终病理诊断进行对比分析。结果 136例腮腺肿瘤中经最终病理诊断,良性肿瘤97例,恶性39例;快速冰冻切片诊断鉴别出恶性肿瘤的准确率为95.6%。39例恶性肿瘤中最终病理诊断为恶性程度较高类型肿瘤12例,经快速冰冻切片诊断的准确率为76.9%。结论快速冰冻切片在腮腺手术中可提供一种快速准确诊断良、恶性肿瘤的的手段,并为临床判断腮腺恶性肿瘤恶性程度提供一定的参考,应作为腮腺手术术中的常规检查手段。     

Salivary gland neoplasms in children.

Of 29 patients, aged 3 to 16 years, with nonvasoformative salivary gland tumors, 21 had malignant tumors. Mucoepidermoid carcinoma was the most common; adenocarcinoma, adenoid cystic carcinoma, and acinic cell carcinoma were equally represented. Pleomorphic adenoma was the exclusive benign lesion, occurring in eight patients. Mean follow-up for patients with malignant lesions was 13.6 years (minimum, 3.5 years). Absolute 2- and 5-year survival rates were 100% and 90%, respectively. Mean follow-up for benign lesions was 15.9 years; none recurred. Superficial or total parotidectomy is the treatment of choice for malignant parotid neoplasms. Benign parotid lesions are adequately controlled with parotidectomy based on extent of disease. Facial nerve sacrifice can often be avoided. We advocate postoperative radiotherapy for high-grade lesions or those with adverse prognostic factors, such as soft-tissue extension and perineural invasion.     

基质金属蛋白酶及其抑制剂在腮腺肿瘤中的表达

目的 :探讨基质金属蛋白酶 (MMP)及其组织抑制剂 (TIMP)与腮腺肿瘤的临床相关性。方法 :采用ABC法进行免疫组织化学染色 ,观察MMP 2、MMP 9及其TIMP 1,TIMP 2在 6 0例腮腺良性和恶性肿瘤中的表达 ,比较它们与临床特征的相关性及其各因子间的相关性。结果 :①腮腺恶性肿瘤有淋巴结转移和远处转移时TIMP 2的表达下调 (P <0 .0 1) ;②在腮腺良性肿瘤中 ,6 0岁以上患者MMP 2的表达明显增强 (P <0 .0 1) ;③MMP 2与MMP 9,MMP 9与TIMP 1,MMP 2与TIMP 2呈线性正相关性 (P <0 .0 5 )。结论 :在腮腺恶性肿瘤中 ,MMP 2与TIMP 2之间的平衡失调可能更为重要 ,TIMP 2表达的下调可作为肿瘤早期转移和浸润的标志之一。     

Diagnostic value of needle biopsy and frozen section histological examination in the surgery of primary parotid tumors

The necessity of fine-needle aspiration biopsy (FNAB) in the diagnosis and treatment of parotid gland lesions is still controversial. We examined the accuracy of cytology and histology in a review of 128 parotid gland tumors who underwent surgery with FNAB, n = 102 and/or frozen section examination (FS), n = 94. The diagnostic sensibility and specificity for malignant or benign lesions was respectively 81.5% and 97.5% for FNAB and 75% and 100% for FS as compared with definite histology (110 tumors were benign and 18 malignant). Insufficient material for FNAB evaluation was found in 12 patients mainly with small tumors (p = 0.043) or with tumors located in the deep process of the parotid gland (p = 0.029). Surgery was inappropriate (superficial lobe resection for malignant tumor) because of 4 false negative FS diagnoses. FNAB offers valuable information in the diagnosis of nonsurgical lesions and permits to avoid FS if FNAB identify a benign lesion. FS remains mandatory if FNAB evaluation is not possible or suggests a neoplastic tumor.     

Ultraschalldiagnostik bei Erkrankungen der Parotis

Summary Ultrasonography of the parotid gland with a high resolution B-mode grey-scale scanner is rather accurate in predicting the dignity of pathologic alterations of the gland. Using a 5 MHz transducer information is given about shape, size and borderings especially of benign and malignant tumours. Contrary to benign tumours, inflammatory or malignant processes are not sharply limitated. Further differentiation is given by the echo pattern. Normal parotid tissue is homogeneous in appearance and in a middle-grey scale, whereas solid, cystic or inflammatory alterations are presented in different grey scales and/or inhomogeneously.     

Metastatic carcinoma of the parotid gland. Review of the literature. Report of two cases

The great majority of parotid gland tumours are benign. Metastatic malignant ones are scarce in number. The source of these metastasis are growths localized either in head and neck or distant tumours spreading on intra- or periparotid lymph nodes. Two cases of metastatic parotid growths diagnosed and treated last year are reported. Bibliographic review of the topic.