鼻中隔多形性腺瘤5例报告并文献复习

多形性腺瘤又称混合瘤,主要发生于大涎腺,以腮腺最多见.发生于鼻部的多形性腺瘤临床上少见,我科2001至2012年共收治5例鼻中隔多形性腺瘤,现报道如下. 1 资料与方法 1.1 临床资料5例中男2例,女3例;18～55岁(平均33岁);病程0.5～3年,平均1.7年.病变均发生于鼻中隔前中部,其中3例位于鼻中隔左侧面,2例位于右侧面.主要症状为单侧鼻塞、流涕,间歇性涕中带血或鼻出血,无外鼻畸形,无明显头痛和眼球突出.鼻腔检查可见肿瘤呈圆形,直径2 ～3 cm,灰白色或粉红色,表面类似桑椹状,富于血管,稍具弹性,质脆,触之易出血.鼻内镜下可见肿物有宽蒂来自鼻中隔,后界位于后鼻孔缘,下鼻甲和中鼻甲受压变薄.     

Pleomorphic adenoma of nasal septum

The pleomorphic adenoma is the most common benign tumour of the major and minor salivary glands. We report a 40-year-old female patient, who presented with progressive swelling and deformity of the left side of her nose for last 2 years. On a lateral rhinotomy a mass (4 cm X3 cm in size) was found to be arising from the cartilaginous part of the nasal septum. The mass was emicleated from its capsule and the walls excised. The histopathological examination revealed it to be pleomorphic adenoma.     

Pleomorphic adenoma of the nasal septum

Despite the common occurrence of pleomorphic adenoma of major salivary glands, intranasal pleomorphic adenoma are rare. We present a ease of pleomorphic adenoma of the nasal septum along with a brief review of literature. The histological nature of this lesion in comparison to other salivary gland tumours and the importance of an accurate diagnosis has been stressed.     

Pleomorphic adenoma of the nasal septum

The authors described the case of mixed salivary gland tumour in the nasal septum. This localisation is extremely rare. Only several cases were described in Polish literature.     

Pleomorphic adenomas of the nasal cavity

The authors presents three cases of pleomorphic adenoma of the nasal cavity treated in the ENT Department, Medical University of Gdańsk in years 1974-2002. That material was also extended in analysis of fourth case treated in our Department and described earlier. In that group were three men and one woman in age of 31-62 years. The most common symptoms were unilateral nasal obstruction, headache or feel of expansion in the nose lasted from 3 months to 10 years. In three cases the tumor was localized in the nasal septum and in one case on the lower nasal concha. All cases were treated surgically--in three cases the lateral rhinotomy was performed and in one case--subperichondral excision of the tumor. In none of cases the recurrence was observed. The authors reviewed polish references and found four cases of these tumor localized in the nasal cavity. This material extended of our cases served to the attempt of epidemiological-clinical evaluation of these tumors.     

鼻及鼻窦多形性腺瘤15例报告

目的：探讨鼻及鼻窦多形性腺瘤的临床特点和治疗方法。方法：15例鼻及鼻窦多形性腺瘤患者，行上颌窦根治术2例，用圈套器作鼻息肉切除术2例，鼻侧切开术10例，上颌骨切除术1例。结果：首次术后无复发7例，复发6例，种植性复发1例，恶变(癌肉瘤)1例。6例复发者再次手术后无复发2例，复发2例，恶变2例；1例种植性复发者行放疗60Gy无效死亡。结论：鼻及鼻窦多形性腺瘤误诊率高，复发率高，多次手术易恶变；治疗的关键在于首次手术采用大术野彻底清除病灶，如怀疑是该肿瘤则术中应作快速切片，术前尽量不做活检以防瘤体破裂；预后与肿瘤复发和恶变有关。     

Pleomorphic adenoma of the nasal septum.

Pleomorphic adenoma is the commonest benign tumour of the major salivary glands. It can also occur in minor salivary glands, mainly in the oral cavity, but also in other sites in the head and neck both within and outwith the upper aerodigestive tract. We present a rare case of pleomorphic adenoma of the nasal septum with consideration of the clinical management and a review of the literature.     

“Pleomorphic adenoma of nasal septum”

Mixed salivary tumours have been found to arise almost everywhere in the upper alimentary and respiratory tract like lips, tongue, floor of mouth, tonsils, cheek, alveolar ridge, soft and hard palate, pharynx and larynx. It is, however, uncommon in the nasal cavity. Most commonly pleomorphic adenoma arises from nasal septum. Macroscopically they present as a intranasal mass without any specific feature. Diagnosis is essentially by histopathological examination. Their theories of origin have been discussed along with the treatment.     

Pleomorphic adenoma of the submandibular gland: clinicopathological and immunohistochemical features of 60 cases in Brazil

The submandibular gland is involved in only 5% to 10% of the salivary gland tumors, and pleomorphic adenoma (PA) is the most common tumor affecting it. This study describes the clinicopathological features and immunohistochemical expression of Ki-67 and p53 in 60 cases of submandibular salivary gland PAs. Most of the patients were in the third and fifth decades of life and 37 (62%) of them were women. Tumor sizes varied from 1 to 10 cm and the mean time between symptom onset and treatment was 52 months. Only 1 patient experienced local recurrence, 3 years after treatment. Histologically, most tumors consisted chiefly in a chondromyxoid stroma. Stroma-rich PAs were larger than stroma-poor ones (P<.02). All PAs were found negative for Ki-67 and p53. These results show that PAs of the submandibular gland are histologically similar to PAs of other salivary glands, and that they have a low proliferative rate and a good prognosis.     

Pleomorphic adenoma of the nasal cavity: a case arising from the wall of the maxillary sinus

INTRODUCTION: Pleomorphic adenoma is a common and benign tumour, originating from sero-mucous glands. Location in the nasal cavity and particularly on the medial wall of the maxillary sinus is very rare. PATIENTS AND METHODS: One patient with a pleomorphic adenoma of the nasal cavity and a review of literature are reported in order to describe the diagnostic and therapeutic management of this tumour. RESULTS: A 63-year-old woman was referred to our institution for evaluation of an unilateral nasal tumour. Clinical and radiological studies revealed an intra-nasal tumour, slightly lytic in nature, arising from the mucosa of the medial wall of the maxillary sinus. More than 2 years after complete excision of the tumour using an endoscopic procedure, the nasal cavity was free of tumour. DISCUSSION: Pleomorphic adenoma of the nasal cavity is a rare and benign tumour, usually presenting as a unilateral nasal tumour. Prognosis of this tumour is mainly linked to recurrences in cases of incomplete resection and to possible metastasis, such as an eventual malignant evolution. The gold standard treatment is complete surgical resection. After a complete imaging study for patient selection (CT scan and MRI), endonasal endoscopic surgery seems to be a reliable therapeutic treatment. CONCLUSION: Intra-nasal pleomorphic adenoma originates from nasal seromucous glands. Radiological study reveals a slightly lytic tumour developed from the septum of the medial wall of the maxillary sinus. Resecton can be performed with endoscopic endonasal surgery as long as the orbital bony framework and the ethmoidal roof are free of tumour. Whatever technique is employed, long term follow-up has to be used to detect any recurrence.     

Pleomorphic adenoma of the nasal septum: a case report

Pleomorphic adenomas arise most commonly in the major salivary glands; the minor salivary glands are affected in only 8% of the cases. Intranasal pleomorphic adenoma being extremely rare originates most commonly from the nasal septum. We present a case of a 55-year-old man who presented with complaints of right-sided nasal obstruction and occasional nasal bleed for the last 6 months. Examination showed a mucosa-covered, fleshy 2 x 2 x 1.5 cm mass in the right nasal cavity. Computed tomogram showed right-sided polypoidal mass with attachment to the cartilaginous nasal septum without any erosion of the surrounding structures. The clinical presentation, gross and microscopic appearance, and treatment of intranasal pleomorphic adenoma is briefly discussed.     

Pleomorphic adenoma originated from the inferior nasal turbinate

Although pleomorphic adenoma is the most common benign neoplasm of the salivary glands, it has also been reported to be present in the neck, ear, mediastinum, external nose and nasal cavity. Intranasal localization of this lesion is very rare and mainly originates from the nasal septum. From wherever the lesion originates, the main treatment modality should be surgical. We presented a very rare case of intranasal pleomorphic adenoma originated from the inferior nasal turbinate. Due to the expansile nature of the lesion, a midfacial degloving approach was preferred.