腮腺黏液表皮样癌与人乳头瘤病毒感染的相关性研究

目的　探讨腮腺黏液表皮样癌的发生与人乳头瘤病毒（human papillomavirus,HPV）感染的相关性。方法　应用巢式PCR技术,采用通用引物对51例腮腺黏液表皮样癌组织中的HPV DNA进行检测,9例慢性腮腺炎组织作为对照组。结果　51例腮腺黏液表皮样癌组织中37例可检测出HPV DNA,阳性率为72.5%,慢性腮腺炎组织中HPV DNA阳性率为22.2%（2/9）,两者差异有统计学意义（χ2=8.517,P =0.004）。结论　腮腺黏液表皮样癌的发生可能与HPV感染有关。     

腮腺黏液表皮样癌预后及影响因素分析

目的 分析腮腺黏液表皮样癌的治疗效果及预后相关因素.方法 回顾性分析1992年1月～2008年6月我院治疗的81例腮腺黏液表皮样癌患者资料,应用SPSS 13.0软件包统计生存率及预后相关因素.结果 中位随访时间39个月(3～168个月),81例患者5年总生存率85.5%,疾病特异生存率90.8%,淋巴结转移率16.0...     

腮腺面神经鞘瘤的诊断治疗

目的探讨腮腺中面神经鞘瘤临床特点、治疗方法。方法对11篇腮腺面神经鞘瘤相关文献及本院1例个案进行分析总结。结果68例腮腺面神经鞘瘤中,除腮腺区均有肿块外,自觉症状约占40％（27/68）：术前B超、CT及MRI均无明显诊断意义;术前腮腺穿刺阳性15％（2／13）;术前误诊86％（43／49,余19例未报）：术中快速冰冻病理切片基本均能确诊（29／30）;68例中（5例未报,术前面瘫5例,1例术后面瘫复发）,术后39例不同程度周围性面神经瘫痪,占约69％（39／57）;包膜内切除瘤体24例,造成轻中重瘫痪15例,占约63％,术后6个月至7年随诊,中位数4年,只有4例恢复,其余不同程度恢复（Ⅳ级降为Ⅱ级）或残留永久性面瘫;肿瘤与面神经一同切除4例;术后随访30例,长达6个月～10年,中位数6年,未见肿瘤复发。结论腮腺中面神经鞘瘤临床上较罕见,治疗以外科为主。术前无特异性检查,术中快速冰冻病理检查具有显著的临床意义;术中应充分暴露肿瘤及面神经,尽量行包膜内切除瘤体,且不要盲目检查神经延续性,减少面神经损伤;一旦神经断离即行神经移植或标志神经断端为二期面神经吻合做准备,以尽快恢复或改善面神经功能;肿瘤术后复发可能性小。     

腮腺肉瘤样导管癌1例

患者,男,48岁,因发现左腮腺区无痛性肿块1年于2006年12月8日入院.1年前发现时肿块约绿豆大小,渐长大,无不适.入院体检:左侧腮腺浅叶前端可及3 cm×3 cm×2 cm大小,质韧、光滑、可移动无痛性肿块,双侧颈部未触及肿大淋巴结,无面瘫症.     

244例腮腺癌治疗评估

本文总结我科从１９６４年１月到１９９１年６月诊治２４４例腮腺癌患者的治疗经验。男性１４７例,女性９７例,３０～６０岁占６２．３％。首发癌１９２例,其中临床Ⅰ、Ⅱ期占５１．６％,Ⅲ、Ⅳ期占４８．４％;复发癌５２例。全组均采用外科手术治疗,其中１０１例术后加用放疗,面神经被肿瘤累及切除８２例（３３．６％）。行颈清扫术或腮腺旁淋巴结切除术１８２例,全组颈淋巴结转移率为３２．４％。５、１０年生存率分别为７５％和５９．４％,死亡１１１例,死于局部复发占５５％。作者认为手术是治疗腮腺癌的主要手段,对临床晚期、病理分化差、手术姑息患者应加用术后放疗,以提高局部控制率;面神经被肿瘤累及应予切除;对颈部淋巴结肿大可疑有转移病例应行治疗性颈清术,对病理分化差患者应行选择性颈清术。病理类型、临床分期、是否复发癌及首次治疗是否彻底是影响预后的主要因素。     

两种术式治疗腮腺混合瘤的临床观察

目的探讨保留腮腺导管区域性肿瘤切除术治疗腮腺混合瘤的可靠性和优越性。方法对59例临床诊断为腮腺混合瘤的病例分为A、B两组,A组行保留腮腺导管区域性腮腺肿瘤切除手术;B组行传统术式,术后经6个月至6年的随访,观察复发、并发症和腮腺功能等情况。结果两组均未发生肿瘤复发病例,两组手术患者术后并发症比较：皮下积液或涎瘘：A组0例（0％）,B组4例（14．8％）;面瘫：A组1例（3．13％）,B组7例（25．93％）,均在15d至6个月内恢复;Frey综合症：A组2例（6．25％）,B组11例（40．74％）;面部明显凹陷畸形：A组1例（3．13％）,B组9例（33．33％）。各并发症两组间差异具有统计学意义（P〈0．05）。结论保留腮腺导管区域性腮腺肿瘤切除手术治疗腮腺混合瘤是可靠的,且弥补了传统腮腺手术的不足,有一定的优越性。     

腮腺多形性腺瘤187例临床分析

目的 探讨腮腺多形性腺瘤的临床诊断、手术方式的选择及术后复发和并发症的防治。方法 对187例腮腺多形性腺瘤手术病例的临床资料进行分析,其中包膜外肿瘤切除+周围部分腮腺组织切除术86例,保留面神经的肿瘤切除+腮腺次全切除术72例,保留面神经的肿瘤切除+腮腺全切除术29例。结果 术后肿瘤复发12例,经二次手术无再复发。术后发生暂时性面瘫20例,其中颊支面瘫6例,下颌缘支面瘫10例,颧支、颊支、下颌缘支面瘫者4例,经激素、神经营养药、中医理疗等处理,面神经麻痹超过6个月且不能完全恢复者为永久性面瘫。本组永久性面瘫2例;出现涎瘘15例,Frey综合征36例。结论 腮腺多形性腺瘤的最后确诊必须依赖病理检查,以包膜外切除整个肿瘤,术中冰冻切片最为妥当,其手术方式的选择应根据肿瘤的大小、位置、与面神经的关系等来决定,术中面神经解剖是手术的关键,既能有效控制肿瘤的复发又能尽量避免并发症是手术的要点。     

原发性腮腺鳞状细胞癌的诊治

目的探讨原发性腮腺鳞状细胞癌（简称鳞癌）的临床特点、治疗和预后因素。方法回顾性分析中国医学科学院肿瘤医院头颈外科1990年1月～2008年8月24例原发性腮腺鳞癌,总结其临床资料、病理结果、生存情况和预后因素。结果Kaplan-Meier法计算全组5年生存率达35.9%,手术肉眼切净肿瘤的患者（n=18）5年生存率达47.9%。初治（n=15）和复发挽救（n=9）患者的5年生产率分别为44.2%和22.2%（P=0.132）,治疗失败的原因主要是局部区域复发。多因素分析提示二次治疗和肿瘤肉眼残存是预后不良的因素。结论原发性腮腺鳞癌恶性程度较高,首次治疗是关键,切除的肿瘤可获得较好的效果,肿瘤肉眼残存或二次治疗的患者预后较差。     

腮腺导管癌的临床病理特征分析--附1例报告及文献复习

目的:结合文献探讨腮腺导管癌的临床病理特征。方法:报道1例腮腺导管癌，就本病的临床生物学特征、病理、治疗及预后进行总结分析。结果:经手术及放疗后3个月复查，出现同侧颈部淋巴结转移。结论:腮腺导管癌是一类恶性度很高的恶性肿瘤，诊断主要依靠术后病理学及免疫组织化学检查，以局部广泛切除加颈廓清术为主，术后给予放疗。     

腮腺腺泡细胞癌临床诊治

目的研究腮腺腺泡细胞癌临床诊治方法。方法回顾性分析我院1g85～2007年收治的19例腮腺腺泡细胞癌诊治经过,4例行腮腺浅叶切除,3例行腮腺浅叶加部分深叶切除,5例行腮腺全切除术,6例行腮腺全切除术加颈清术,其中8例行术后放疗。1例外院活检术后仅行根治性放疗。术后随访1～20年。结果无1例死亡,有5N术后复发,复发率26．3％（5／19）。结论彻底的手术切除和术后放疗是腮腺腺泡细胞癌的主要治疗方法。     

Clinical analysis of acinic cell carcinoma in parotid gland

Objectives

Acinic cell carcinoma (AciCC) is a rarely encountered malignancy in parotid gland. Because AciCC is rare and was recently recognized as the entity of malignancy, AciCC has been difficult to study. We aimed to analyze the diagnosis and treatment experience for this malignancy in our hospital.

Methods

We retrospectively reviewed medical records of the 20 patients with AciCC of parotid gland diagnosed from 1990 to 2009. The preoperative computed tomography scan, preoperative fine needle aspiration cytology (FNAC) and intraoperative frozen section results were compared with the final diagnosis. The survival and recurrence were analyzed with the cancer stages and treatment modalities.

Results

There were 10 males and 10 females, with a mean age of 44.4 years, ranging 8-77 years. The AJCC tumor stage distributions of the patients were 70%, 15%, and 15% for stages I, II, and IV, respectively. The sensitivity of FNAC and intraoperative frozen section was 26.7% and 50.0% respectively. The 10-year survival rate was 90.9% with a mean follow-up of 111 months, ranging 17-251 months. The 10-year disease free survival rate was 74.2% and the mean duration of recurrence from initial surgery was 92.3 months.

Conclusion

AciCC of the parotid gland is a rare malignancy that has features of less aggressive behavior, and good prognosis. Intraoperative frozen section examination may be helpful in the diagnosis of AciCC of the parotid gland because of the low sensitivity of preoperative computed tomography scan and FNAC. Surgery with adjuvant postoperative radiotherapy is satisfactory for disease control.     

A rare malignancy of the parotid gland: oncocytic carcinoma

Oncocytic carcinomas are uncommon; they represent 11% of all oncocytic salivary gland neoplasms, 0.5% of all epithelial salivary gland malignancies and 0.18% of all epithelial salivary gland tumors. A 65-year-old woman was admitted to our ENT clinic with a history of a painless left preauricular mass. No lymph node was palpable on either side of her neck. Computed tomography demonstrated a 3×3-cm solid lesion in the left parotid gland. As oncocytes and atypical cells were seen at the cytologic examination of a fine-needle aspiration biopsy, this finding suggested a malignant epithelial tumor. Total parotidectomy by preserving the facial nerve was performed. The result of the pathologic examination was oncocytic carcinoma regarding histopathologic and immunohistochemical findings and especially the invasive growth pattern. We preferred a close follow-up to an elective neck dissection, and reserved the neck dissection for a recurrence. The prognosis of oncocytic carcinomas is not well known because of their low incidence. Further investigation of the prognosis of patients with oncocytic carcinoma of the parotid gland is warranted as more cases are reported.     

Metachronous bilateral mucoepidermoid carcinoma of the parotid gland

We report a very rare case of bilateral muco-epidermoid carcinoma of the parotid gland that underwent bilateral parotidectomy with neck dissections and radiotherapy. This case has done well for three years and suggests that metachronous bilateral mucoepidermoid carcinoma of the parotid gland, if treated as per the merits of each side, has a reasonable survival.     

Prognostic factors for parotid metastasis of cutaneous squamous cell carcinoma of the head and neck

BackgroundCutaneous squamous cell carcinoma (CSCC) develops on the head in 80% of cases. Parotid metastasis (PM) is rare, but treatment, which associates surgery and radiation therapy, is heavy and prognosis poor.Material and methodsAll cases of parotidectomy for PM of CSCC of the head and neck between 2005 and 2015 were studied retrospectively. Epidemiologic, oncologic and therapeutic data were analyzed. Overall and specific survival were calculated following Kaplan-Meier. Log-rank and Cox models were used to identify prognostic factors for PM.ObjectivesThe principal study objective was to identify factors for survival in PM from CSCC of the head and neck.ResultsThirty-five patients were included. Mean time to onset of PM was 13 months. Overall 1-, 2- and 5-year survival was respectively 70, 66 and 59%. Independent prognostic factors comprised immunodepression, age at treatment, positive CSCC margins, macroscopic facial nerve involvement, and metastatic cervical adenopathies.ConclusionThe study confirmed an association of several independent prognostic factors at the stage of parotid lymph-node metastasis, related to patient, primary CSCC and PM. Complete primary resection is essential to reduce the risk of PM. Intensified radiologic and clinical surveillance should enable early diagnosis.     

腮腺肿瘤手术57例临床体会

目的探讨腮腺肿瘤手术方式、手术范围与治疗效果的关系。方法对1997～2003年间面神经解剖行腮腺肿瘤切除术57例(腮腺浅叶切除术51例，全腮腺切除术6例，1例行功能性颈淋巴结清扫术，术后加放疗4例)的临床随访资料进行分析。结果腮腺浅叶切除术51例中，并发暂时性面瘫5例，持续性面瘫1例，全腮腺切除6例中，并发暂时性面瘫2例，持续性面瘫2例，无腮腺瘘及Frey综合征，随访6月～7年无复发。结论腮腺良性肿瘤应施行解剖面神经的腮腺浅叶及肿瘤切除，恶性肿瘤在面神经尚未累及时行保留面神经的腮腺广泛切除，术后辅以放疗，可以减少肿瘤复发和面瘫等并发症的发生。     

Lymphoepithelial carcinoma in parotid gland related to EBV infection: A case report

Lymphoepithelial carcinoma commonly occurs at the nasopharynx and rarely occurs at other sites in the head and neck region. It is well known to occur at limited patients of local area as Asia or Arctic Circle. Related to this point, it is pointed out that this tumor has strong relation with Epstein–Barr Virus (EBV) infection.In this time, we experienced to treat lymphoepithelial carcinoma with metastatic cervical lymph nodes occurring at parotid gland. The morbidity ratio of this tumor is less than one percent of all parotid gland tumors. Moreover, we proved the infection of EBV to tumor cell by in situ hybridization (ISH).Incidentally, because it is considered that this tumor has well sensitivity against irradiation or anti-tumor drugs, prognosis of this tumor is better than that of other head and neck tumors with different pathological type. Actually, we tried to perform chemotherapy twice in (Nedaplatin (CDGP) 60 mg/m² × day 2 and 5-FU 600 mg/m² × day 5) and to irradiate about 70 Gy dose against parotid gland and cervical lymph nodes. It could not find local recurrence or metastasis as of now after five years from treatment.