2456例唾液腺肿瘤临床病理分析

目的探讨唾液腺肿瘤的发病、病理类型等临床特点。方法收集中山大学孙逸仙纪念医院口腔颌面外科1973年1月至2018年12月间确诊的唾液腺肿瘤病例2456例患者的相关资料,回顾分析其性别、年龄、病理类型、发病部位、良恶性构成比等特点。结果46年间收治的唾液腺肿瘤患者2456例,女性比例占41.9%,男性占58.1%,40~60岁年龄段为发病高峰,其中良性肿瘤1863例(75.9%),恶性肿瘤593例(24.1%),良恶性之比为3.1∶1。良性肿瘤构成比前2位是多形性腺瘤(58.7%)、Warthin瘤(33.6%),恶性肿瘤构成比前2位是黏液表皮样癌(27.7%)、腺样囊性癌(26.1%)。最常见的良性肿瘤多形性腺瘤的好发部位是腮腺、腭部、颌下腺,而恶性肿瘤中粘液表皮样癌则常见于腮腺和腭部的小唾液腺。本组资料中唾液腺肿瘤发病呈逐年递增的趋势,近10年病例占总病例数的53.3%。结论唾液腺肿瘤病人数量逐年增加;唾液腺肿瘤的总发生率男性高于女性;大唾液腺以良性肿瘤为主,小唾液腺恶性肿瘤多见;多形性腺瘤、Warthin瘤、黏液表皮样癌最常见;40~60岁是唾液腺良、恶性肿瘤高发年龄段。     

Brandwein病理评分系统与唾液腺黏液表皮样癌预后的关系

目的:探讨Brandwein病理评分系统中各指标与唾液腺黏液表皮样癌(MEC)术后复发和转移的关系,比较不同病理评分系统分级的病理分级与唾液腺MEC患者术后复发和转移的关系。方法:对33例唾液腺MEC患者的临床病理资料进行回顾性研究,应用寿命表法计算术后的复发率和转移率,用Kaplan-Meier方法对影响术后复发和转移的各因素进行分析,采用Cox比例风险回归模型筛选影响术后复发和转移的危险因素。采用Kaplan-Meier方法,对不同病理评分系统分级的患者3、5、10年复发率和转移率进行比较。结果:33例唾液腺MEC患者术后3、5、10年复发率和转移率分别为8.05%、13.07%、56.17%和7.05%、12.07%、34.20%。单因素分析表明,神经侵犯、病理分级B(按Brandwein病理评分系统分级)等10个因素是MEC患者术后复发的重要因素;组织坏死、临床分期等11个因素是MEC患者术后转移的重要因素。多因素分析表明,病理分级B(P=0.027,OR>1)是MEC患者术后复发的主要影响因素,组织坏死(P=0.004,OR>1)是唾液腺MEC患者术后转移的主要影响因素。病理分级A(按AFIP病理评分系统分级)中,高分化MEC患者10年复发率为25.15%;病理分级B中,高分化MEC患者术后10年内无复发患者。病理分级A中,中分化MEC患者中5年转移率为50.35%,10年转移率为100%;病理分级B中,中分化MEC患者5年、10年内无复发患者。结论:唾液腺MEC患者随着时间的延长,其术后复发率和转移率逐渐增加,术后患者应进行长期随访。病理分级B是患者术后复发的独立危险因素,组织坏死是术后转移的独立危险因素。病理分级B可能是比病理分级A客观性更强的分级方法。     

唾液腺黏液表皮样癌的预后及影响因素分析

目的分析唾液腺黏液表皮样癌患者术后预后情况,并探讨影响其预后的主要临床和病理因素。方法回顾性收集2001年1月—2016年2月在我院行手术治疗的78例唾液腺黏液表皮样癌患者的临床和病理资料,采用Kaplan-Meier法估算术后3、5、10年的生存率,采用Log-rank对数秩检验比较组间生存率差异,采用Cox比例风险回归模型进行多因素分析。结果1预后情况:78例唾液腺黏液表皮样癌患者术后3、5、10年的总体生存率依次为98.6%、89.6%和73.5%。2单因素分析结果:高分化组、无淋巴结转移组患者术后生存率明显高于中低分化组(Log-rank=10.03,P<0.01)、淋巴结转移组患者的值(Log-rank=8.57,P=0.01),且差异有统计学意义。3多因素分析结果:分化程度(HR=12.71;P=0.02)和淋巴结转移(HR=6.84;P=0.01)是影响唾液腺黏液表皮样癌患者术后预后的独立危险因素。结论分化程度、淋巴结转移是影响唾液腺黏液表皮样癌患者术后预后的重要临床、病理因素。对于低分化、淋巴结转移患者应采取综合治疗手段以提高术后预后。     

口腔乳头状唾液腺瘤1例临床病理分析

乳头状唾液腺瘤(sialadenoma papilliferum,SP)是一种无痛、乳头状外生性生长为特点的良性唾液腺肿瘤。在WHO最新的肿瘤分类中,SP被列为导管乳头状瘤。SP是一种罕见的唾液腺肿瘤,病变主要累及小唾液腺,以腭部最常见。本文报告1例罕见的发生于下颌磨牙后区的乳头状唾液腺瘤,并结合文献,探讨其临床和组织病理学特征。     

肾移植术后腮腺低分化黏液表皮样癌1例

黏液表皮样癌是唾液腺恶性肿瘤中最常见的肿瘤之一,而低分化黏液表皮样癌属于高度恶性肿瘤,较为少见。由于肾移植受者术后长期应用免疫抑制剂,故肾移植受者比普通人群更易发生恶性肿瘤,其中皮肤癌最为多见,而肾移植术后发生涎腺肿瘤较为罕见。本文报道了1名肾移植术后6年,患腮腺低分化黏液表皮样癌的男性患者。该患者接受了手术切除治疗后,达到出院标准,顺利出院。随访21个月后,病变无复发。     

唾液腺黏液表皮样癌术后生存资料分析

目的观察唾液腺黏液表皮样癌（MEC）术后生存率及不同临床分期患者的生存率，并确定影响术后生存的主要临床病理因素。方法对119例MEC按照临床流行病学关于预后研究的方法进行数据收集，乘积．极限法计算术后各时点的观察生存率，时序检验各临床病理因素对术后观察生存率的影响。结果119例唾液MEC患者术后总体的5、10、15年生存率分别为192．53％、87．52％、85．39％。年龄≥40岁、TNMm、Ⅳ期、低分化患者术后生存率分别显著低于年龄〈40岁、TNMI、Ⅱ期、高分化患者（P〈0．05），大唾液腺MEC男性患者术后生存率明显低于女性（P=0．008）。分化程度、TNM分期及术前症状是进入Cox比例风险回归模型的3个对术后生存率有显著影响的主要因素。结论高分化型唾液腺MEC属于预后相对较好的恶性肿瘤，分化程度、TNM分期是影响患者预后的重要临床病理因素。     

口腔颌面部肿瘤

颜面皮肤癌VEGF和NOS的表达与癌细胞增殖关系的研究／李晓光…∥中华老年口腔医学杂志．颌骨骨肉瘤临床及X线分析／曾曙光…∥广东牙病防治．口腔鳞癌4种新辅助化疗方案的成本-效果分析／杨凯…∥临床口腔医学杂志．p16和nm23基因在唾液腺肿瘤中表达的研究／龚莉…∥华西口腔医学杂志．     

357例老年人口腔颌面部肿瘤临床分析

随着人口结构日趋老龄化 ,因机体免疫机能低下 ,自身卫生保健不足等因素 ,肿瘤的发生率在老年人群中相应增高。为探讨老年人头颈部肿瘤患者的治疗特点 ,现将 1985年～ 1998年间我院收治的 35 7例 6 0岁以上老年人口腔颌面部肿瘤患者的临床资料进行粗浅的分析和讨论。1　临床资料 :性别及年龄 :　 35 7例中男性 2 16例、女性 141例。男∶女约 1 5∶1。其中 6 0岁～组 2 5 4例、70岁～组 95例、80岁～组 8例。发病与就诊时间 :　患者发现肿瘤至就诊时间最长 2 3年 ,最短 12天。肿瘤性质 :　经病理切片确诊 ,良性肿瘤为 2 2 3例 ,恶性肿瘤为 13…     

唾液腺腺样囊性癌474例临床病理分析

目的：分析474例唾液腺腺样囊性癌(adenoid cystic carcinoma, ACC)的临床病理特征。方法：回顾分析上海交通大学医学院附属第九人民医院口腔病理科诊断为原发性ACC的474例临床病理资料。采用SPSS18.0软件包对数据进行统计学处理。结果：474例ACC中,男女之比为1.03∶1(240∶234);发病年龄11~83岁,平均年龄52岁;腮腺和腭部分别是大小唾液腺中最常见的部位;病程1个月~37 a不等,平均21个月;64%的患者出现不同程度的症状;72%的患者就诊时TNM分期为Ⅱ期和Ⅲ期;组织学上,76%的患者表现为筛状/管状型。组织学类型为实体型者较筛状/管状型者更易发生颈淋巴结转移(P=0.016)。结论：ACC多见于中老年人,腮腺和腭部最常见。临床上多伴有不同程度的症状,组织学表现以筛状/管状型多见,实体型者更易发生颈淋巴结转移。     

影响唾液腺粘液表皮样癌患者术后生存的临床病理因素分析

目的　探讨影响唾液腺粘液表皮样癌患者术后生存的临床病理因素。方法　回顾经首次手术治疗且有完整随访资料的唾液腺粘液表皮样癌患者 70例的临床资料 ,对各项指标采用乘积限法 (Kaplan-Meier)估计各时点的生存率 ,同时进行序检验 (Logranktest)各组间差异 ,最后进入Cox比例风险模型 (CoxRegression)做多因素分析。全部资料通过SPSS软件完成。结果　 70例唾液腺粘液表皮样癌患者 ,术后 3、5、1 0年生存率分别为 90 6 6 %、88 85 %、86 6 3%。肿瘤直径小于等于 4cm、术前区域淋巴结无转移、临床处于早期 (Ⅰ、Ⅱ期 )、高分化、术后无复发和转移的患者生存期明显长于肿瘤直径大于 4cm、术前区域淋巴结有转移、临床晚期 (Ⅲ、Ⅳ期 )、低分化、术后出现复发及转移的患者。结论　TNM分类、临床分期、分化程度以及术后有无复发和转移是影响唾液腺粘液表皮样癌患者术后生存的重要因素.     

Survival after parotid gland metastases of cutaneous squamous cell carcinoma of the head and neck

Oral and Maxillofacial Surgery - Malignant tumours in the parotid gland can originate either from the gland itself or as a result of metastatic spread of other tumours, such as cutaneous squamous...     

Management of regional metastatic disease in head and neck cutaneous malignancy.1. Cutaneous squamous cell carcinoma

This overview is the first of 2 articles on the current evidence for management of the neck and parotid in cutaneous cancers of the head and neck. In this paper we discuss cutaneous squamous cell carcinoma (SCC) and review the latest evidence for management of the regional nodes.     

Surgical management of cutaneous squamous cell carcinoma of the head and neck

A retrospective audit was made of histological records and hospital case notes of patients who had cutaneous squamous cell carcinomas excised from the head and neck region at the Maxillofacial Units at St Richard's Hospital, Chichester and Southlands Hospital, Shoreham-By-Sea, UK. A total of 227 lesions were excised from 183 patients over a 5-year period between 1990 and 1995. The local recurrence rate was 4% (9/227) and 12 (7%) of the patients presented with or developed regional nodal metastases. Of the 183 patients, 177 (97%) were cured. These rates compare favourably with those of other published series of cutaneous squamous cell carcinoma managed by surgical techniques that did not follow the micrographical technique of Mohs. Certain characteristics may aid in the prediction of those cancers that may be more aggressive. It is important to evaluate each case in terms of histological grade and site and to design management plans to deal with each lesion in the most appropriate way.     

Multifocal cutaneous metastases from squamous cell carcinoma of hard palate

Distant metastases from oral squamous cell carcinoma are unusual, but generally occur in lungs, bone, and liver. Cutaneous metastasis is extremely rare, and it often reflects an advanced stage with sinister prognosis. The authors report an 81-year-old male patient with multifocal cutaneous metastases from a recurrent squamous cell carcinoma of the hard palate 5 months after primary treatment.     

Pulmonary lymphangitic carcinomatosis from head and neck squamous cell carcinoma

Pulmonary lymphangitic carcinomatosis (PLC) secondary to mucosal head and neck squamous cell carcinoma (HNSCC) is extremely rare, difficult to diagnose in the pre-symptomatic phase, and is rapidly fatal. We describe two cases of fatal PLC secondary to squamous cell carcinoma in whom a review of pre-treatment imaging (computed tomography of the chest) changes reported as unspecific were retrospectively felt to be consistent with pre-symptomatic PLC. Case 1, a 73-year-old male with T2N2bMx poorly differentiated squamous cell carcinoma of the right tonsil, died 6 weeks after chemoradiotherapy with curative intent. Case 2, a 65-year-old female with T4aN2bMx of the right body of the mandible, died within 6 weeks of radical surgery including free tissue transfer. A review of the literature showed that PLC secondary to HNSCC occurs in an older cohort of patients: mean age 69 years vs. other tumour groups 50 years. PLC secondary to HNSCC can behave in distinctly different ways, demonstrating similarity to either gastric adenocarcinoma or bronchogenic squamous cell carcinomas.     

miRNAs在头颈鳞状细胞癌中的研究

miRNAs是一组小的、非编码的、平均长度18—24个核苷酸大小的RNA,它在调节转录后基因的表达上发挥作用,在癌症发生、发展中起促进或抑制作用。目前miRNAs在头颈鳞状细胞癌中的研究也已成为热点,涉及癌转移、浸润、耐药等各个方面。     

Management of regional metastatic disease in cutaneous malignancy of the head and neck. 3. Merkel cell carcinoma

This is the third of three articles that give an overview of the current evidence for management of the neck and parotid in patients with cutaneous cancers of the head and neck. In this paper we discuss Merkel cell carcinoma (MCC) and review the latest evidence for management of the regional nodes.     

Expression of nitric oxide synthase-2 in cutaneous squamous cell carcinoma of the head and neck

Nitric oxide (NO) has a pivotal role in angiogenesis. The expression of NO synthase (NOS2) is down-regulated in basal cell skin cancer but we know of no studies that have investigated its expression in the more aggressive squamous cell skin carcinoma. This immunohistochemical study assessed NOS2 expression in 37 cases of head and neck squamous cell skin carcinoma. NOS2 expression was located in cells of the basal cell layer of epidermis, but was significantly increased in tumour epithelium. No correlations were found between NOS2 expression and tumour size or degree of tumour differentiation. The raised NO concentrations in these tumours may provide one explanation for their more aggressive behaviour than that of the slower-growing basal cell carcinoma.     

Cardiac metastasis of head and neck squamous cell carcinoma

Two patients with cardiac metastasis from head and neck cancer are reported. Cardiac metastasis located in the left atrium was detected on a follow-up computed tomography (CT) scan 15 months after partial glossectomy for a tongue carcinoma in a 60-year-old man. The diagnosis was confirmed as cardiac metastasis of squamous cell carcinoma (SCC) by surgical excision of the cardiac lesion. The patient died 3 weeks after surgery. In a 69-year-old man with a partial maxillectomy for primary soft palate cancer, a follow-up CT scan 5 months after surgery revealed a mass in the right atrium and ventricle, and multiple lung metastases. He died of heart failure 3 weeks after the diagnosis of cardiac metastasis. Information on these cases should add to knowledge about rarely encountered cardiac metastasis.