腮腺多形性腺瘤术后复发的生物学活性研究

目的探讨Ki-67、p16与腮腺多形性腺瘤术后复发生物学行为的相关性。方法应用EnVision免疫组织化学方法,检测Ki-67、p16在腮腺多形性腺瘤术后复发者第一次(复发前)手术、第二次(复发后)手术标本未复发者手术标本中的表达。结果Ki-67在复发者第一、二次手术与未复发者标本中的表达有显著性差异(P<0.05),在复发者第一、二次手术标本中的表达无显著性差异(P>0.05);p16在复发者第一次手术与未复发者标本中的阳性强度表达构成比有显著性差异(P<0.05)。结论腮腺多形性腺瘤术后复发与其自身的生物学活性有关。     

右侧腮腺腺淋巴瘤伴多形性腺瘤1例

患者,男,75岁。主因右侧耳屏前及下颌角区发现肿物3个月就诊。查体:右侧耳屏前可触及1.0cm×1.0cm×0.5cm大小的卵圆形肿物,右侧下颌角后侧见一约4.0cm×3.0cm×2.0cm大小的肿物,两肿物触之质中,均可活动。术中见:耳屏前约1.2cm×0.8cm×0.8cm的肿物,包膜完整,质中等。腮腺下极见一4.0cm×3.0cm×2.0cm的肿物,包膜完整,质地较软。病理检查肉眼所见:(腮腺下极)结节样肿物一个,大小3.5cm×2.8cm×1.5cm,包膜完整,切面灰红色,分叶状,质地较软;(耳屏前)肿物呈卵圆形,大小1.2cm×0.8cm×0.8cm,包膜完整,切面灰白色,质中等。镜下检查:(腮腺下极)肿…     

腮腺多形性腺瘤安全手术切缘研究进展

腮腺多形性腺瘤是最常见的涎腺肿瘤,约占所有涎腺肿瘤的60%～70%.该肿瘤以组织病理形态学多样性为特点,主要由包膜、上皮细胞、黏液间质及软骨样组织等成分组成.其标准处理方法是外科手术切除,手术治疗的原则是彻底切除原发部位的病灶.单纯肿瘤剜除术的复发率高达10%～45%,这种高复发率导致手术方式的改变,随着人们对该病的进一步研究认识及对面神经解剖的熟悉,许多学者研究发现包膜的组织病理学特征对多形性腺瘤的复发率有重要影响,剜除术后包膜浸润、伪足、卫星结节等残留导致术后复发.越来越多的学者开始接受腮腺浅叶切除术是腮腺浅叶多形性腺瘤的经典术式,术后的复发率在0.3%～4%.然而有少数学者主张常规行腮腺全切除术.理由是腮腺多形性腺瘤的多中心论.同时有学者研究发现腮腺囊外切除术和区域性切除术复发率与腮腺浅叶切除术相当,术后患者腮腺功能保留并且面貌改变小以及并发症发生率降低.在达到疗效的目的下降低并发症,保留腮腺功能,提高患者生存质量,是医患双方的共同愿望.但该术式的具体切除范围仍不明确.本文对腮腺多形性腺瘤的外科安全手术切缘研究进展予以综述.     

Caveolin-1在腮腺多形性腺瘤及瘤旁组织中的表达及临床意义

  目的   探讨窖蛋白-1（Caveolin-1,Cav-1）在腮腺多形性腺瘤（pleomorphic adenoma,PA）中的表达及临床意义。   方法   采用免疫组织化学法检测了9例正常腮腺、33例原发性PA距离瘤体中心（0 cm）及瘤旁组织中（分别距瘤体中心0.5、1.0、1.5和2.0 cm）Cav-1的表达,并进行统计学分析。   结果   Cav-1在所有正常腮腺样本（100%）均有表达,其主要在导管系统细胞质和细胞膜中表达;除6例距瘤体中心0.5 cm和1例距瘤体中心1.0 cm的样本外,其余瘤旁样本均有Cav-1表达,其表达模式基本上与正常腮腺类似;在PA中,有10例样本（30.30%）表达Cav-1,且在细胞核中显著表达。Cav-1在多形性腺瘤肿瘤组织中的表达最低,并随着与瘤体中心距离的远近,其表达量逐渐升高。Cav-1的表达在瘤体与瘤旁组织间均存在明显差异（P < 0.05）,但瘤旁组织1.0、1.5和2.0 cm间Cav-1表达无显著性差异（P>0.05）。   结论   在腮腺多形性腺瘤发生过程中,Cav-1中表达下调并出现了从细胞质、细胞膜到细胞核的转位现象。上述结果表明Cav-1在多形性腺瘤的发生发展中可能起着重要作用,其表达水平的变化可作为判定手术安全边缘的科学依据之一。      

腮腺多形性腺瘤与沃辛瘤MRI影像学特点的对比分析

多形性腺瘤和沃辛瘤是腮腺最常见的两种良性肿瘤。发生于腮腺的多形性腺瘤MRI平扫T1WI表现为等或稍低信号,T2WI表现为高信号,因含黏液其信号高于脑脊液;如发生坏死、囊变,T2WI表现为高低混杂信号;肿瘤有纤维包膜,T1WI和T2WI均表现为低信号,与正常组织分界清楚。沃辛瘤（腺淋巴瘤）内上皮成分嗜酸性并具有淋巴组织及密集排列的细胞核,故T2WI多以低信号为主,且信号均匀居多,可作为与混合瘤的鉴别点。本文研究发现腮腺多形性腺瘤与沃辛瘤在MRI成像上有不同的影像学特点,期望对临床工作有所帮助。     

腮腺多形性腺瘤及癌在多形性腺瘤中PINK1和Parkin的表达及临床意义

目的 探讨腮腺多形性腺瘤(PA)和癌在多形性腺瘤(CA-EX-PA)中线粒体自噬相关基因PINK1和Parkin的表达情况及其临床意义.方法 免疫组织化学法检测24例腮腺正常组织标本、32例PA组织和42例CA-EX-PA组织中PINK1和Parkin的表达情况,并结合临床病理因素进行分析.结果 PINK1蛋白在正常腮...     

腮腺复发性多形性腺瘤临床诊治分析（附67例）

目的:研究腮腺复发性多形性腺瘤的临床特点,总结其手术治疗经验。方法:对2010年6月至2018年6月期间我院收治的67例腮腺复发性多形性腺瘤病例进行回顾性分析,总结其临床病理特征、手术方式、术后并发症及随访情况,使用SPSS 22.0软件对数据进行χ2检验、t检验、Logistic回归分析。结果:40例初次手术行腮腺区肿物切除术者,其平均复发时间短于27例行腮腺浅叶切除或浅叶部分切除者［（17.18±5.39）个月 vs （20.89±6.63）个月,P＜0.05］。复发性多形性腺瘤可出现皮肤粘连（40.3%）、面神经粘连（73.1%）、多灶性病变（56.7%）、肿瘤包膜不完整（92.5%）以及镜下卫星结节（79.3%）等特征。主要的远期并发症为永久性面神经损伤(n=9,13.4%)及Frey综合征(n=18,26.9%)。随访期间术后再次复发7例,复发率13.0%,术中出现肿瘤破裂者,术后复发率较高（31.8% vs 0%,P＜0.05）。结论:腮腺多形性腺瘤初次肿物摘除术后复发常见,复发性肿瘤局部病变广泛,术后并发症常见,外科治疗应个体化,以腮腺浅叶切除为主,根据病变情况及患者意愿决定是否切除深叶;术中肿瘤破裂将增加术后复发风险,应尽量避免,术后还需密切随访。     

气管多形性腺瘤1例

1病例资料患者女,23岁。因"间断咳血一月余"来我院就诊。一月前因"感冒"后出现咳鲜血(约10mL)伴发热、咳嗽及咳痰,CT扫描示气管肿物,给予抗炎对症治疗后咳嗽、咳痰症状消失。由外院支气管镜活检,病理诊断为良性肿瘤,于2009年1月5日转入我院进一步诊治。支气管镜检查:主气道距隆突近3cm处见一肿物突向管腔,管腔明显狭窄。CT扫描见气管下段管腔内一类圆形团块影,边缘较光整,基底部与气管左后壁似有蒂相连。手术袖状切除部分气管及肿物后行气管成形术。     

影像组学在腮腺多形性腺瘤与腺淋巴瘤鉴别诊断中的应用

目的:探究影像组学在腮腺多形性腺瘤与腺淋巴瘤中的鉴别能力.方法:回顾性研究经病理诊断证实的52例多形性腺瘤与46例腺淋巴瘤患者CT平扫图像,利用MaZda纹理分析软件对肿瘤最大层面感兴趣区(ROI)进行分析,结合B11模块中的原始数据分析(RDA)、主成分分析(PCA)、线性判别分析(LDA)、非线性判别分析(NDA)...     

咽部多形性腺瘤临床病理观察及文献复习

目的：探讨咽部多形性腺瘤（PA）的形态学及免疫组化表型特征。方法：对1例咽部PA进行临床病理分析和免疫组织化学研究,并结合文献分析其对鉴别诊断的意义。结果：咽部PA由上皮、肌上皮及粘液样、软骨样或透明变样间叶成分组成;免疫组化染色示：CK7（＋）,CK20（-）,S-100（＋）,GFAP（＋）,CD57（＋）,p63（＋）。结论：咽部PA是一种起源于小涎腺的良性肿瘤,其独特的病理学特征和免疫表型特点,对其鉴别诊断有重要意义。     

Oncocytic pleomorphic adenoma of the parotid gland

A rare case of salivary gland pleomorphic adenoma, in which the majority of cells were oncocytic, is reported. The patient, a 53-year-old man, presented with a parotid gland mass that was otherwise asymptomatic. Surgical treatment consisted of a superficial parotid lobectomy. The specimen was prepared in standard fashion and studied by light and electron microscopy. The microscopic features were characteristic of salivary gland pleomorphic adenomas, however, both epithelial and "mesenchymal" elements were oncocytic. Such changes may occur focally in pleomorphic adenomas, but we were unable to find documentation of a wholly oncocytic variant in a review of the medical literature. From our clinical data and previous reports of pleomorphic adenomas with focal oncocytosis, it is concluded that such changes likely do not alter prognosis in affected patients. The possible significance of this lesion in regard to the histogenesis of salivary gland pleomorphic adenomas is discussed.     

Functional gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland

IntroductionGland-preserving surgery is often used for benign tumours in the parotid gland. Partial superficial parotidectomy via a periauricular incision may bring satisfactory cosmetic outcomes but the disease control outcome remains unrevealed. This study evaluated functional and disease control outcomes after gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland.MethodsThis longitudinal study included 248 consecutive patients with parotid pleomorphic adenoma who underwent the preservation of most normal parotid tissues and the facial nerve combined with the en-bloc resection of tumours via periauricular incision. Postoperative complications, subjective satisfaction, salivary function, and tumour recurrence were assessed in each patient. The secretory function of the salivary gland was measured using salivary scintigraphy at 6 months after surgery, and ultrasonography was regularly followed.ResultsMedian tumour size was 2.5 cm (range, 0.8–5.2 cm) and median operation time was 55 min (range, 39–88 min). All tumours were safely removed by gland-preserving surgery via periauricular incision without extension to Blair or hairline incision and tumour spillage. Temporary and permanent paralysis of the facial nerve was 14 (5.6%) and none of the study patients, respectively. Postoperative complications were minor and Frey's syndrome was found in 6 (2.4%) patients. The Secretary function of the affected gland was equal to that of the unaffected gland. No patients had a recurrence for a median follow-up of 78 months (range, 24–126 months).ConclusionsFunctional gland-preserving surgery via periauricular incision can treat pleomorphic adenoma in the parotid gland with satisfactory functional, cosmetic, and disease control outcomes.     

Radiation therapy in recurrent pleomorphic adenoma of the parotid

Twenty-nine patients were treated by excision and post-operative irradiation following recurrence of pleomorphic adenoma (mixed tumor) of the parotid. Eighteen of 20 (90%) patients with a first recurrence were controlled comparing favorably with series employing surgery only. Radiation therapy has a role to play as a surgical adjuvant in the management of these tumors, in particular when surgical difficulties are encountered and for second or subsequent recurrences.     

Radiotherapy for pleomorphic adenoma of the parotid gland.

A study was made of 187 patients with parotid pleomorphic adenoma treated by radiotherapy. This followed surgery but with incomplete removal or tumor spillage. In the early years of the study radiotherapy was given by radium needle implant done usually at the time of surgery, but from the late 1960s beam-directed external radiotherapy with a head shell was used most commonly. A 3-field technique or wedge pair was the standard technique. The median age was 46 with nearly half the patients (87/187) aged between 40 and 60, and the ratio of women to men was 1.4:1 (110:77). Median follow-up for all patients was 14 years. One hundred fifteen patients had radiotherapy immediately after their first operation with a recurrence rate of 0.9% (1/115). Of the 115 there were 2 cases of radionecrosis (1 major, 1 minor), 1 case of permanent facial nerve palsy, 1 Frey Syndrome (post-gustatory sweating), and 1 salivary fistula. Seventy-two patients had radiotherapy delayed until one or more recurrences had been surgically treated. Nine (12.5%) of these developed yet further recurrence after radiotherapy. There were 2 cases of radionecrosis (1 major), 4 cases of facial nerve palsy (3 of which were complete), 16 cases (22.2%) of Frey Syndrome, and 1 case of malignant change in a parotid tumor. In addition one squamous cell carcinoma developed at the site of a needle implant 25 years later. Recurrences after radiotherapy continued beyond 20 years of follow-up. Patients having unsatisfactory surgery due to spill at operation or residual tumor left behind should have radiotherapy immediately and not delayed until local recurrence occurs because of the increased morbidity and the higher incidence of yet further recurrence.     

Histopathologic studies on carcinoma in pleomorphic adenoma of the parotid gland

Five-hundred-eighteen cases of primary epithelial tumors of the parotid gland were examined. The incidence of carcinomas in pleomorphic adenoma was 9.3% (48 cases). In addition to cellular atypism, the following histological findings were thought to be important criteria for the diagnosis of carcinomas: (1) capsular invasion, (2) infiltration into adjacent organs, (3) proliferation of atypical cells within fibrous tissues and chondroid matrix in the area of pleomorphic adenoma, (4) vascular involvement, and (5) mitotic figures. Pleomorphic adenomas (282 cases) were found predominantly in females (70.8%), at the age of 30 to 49 (48.2%), whereas carcinomas in pleomorphic adenoma were more often found in males (70.8%) and at the ages over 50 (43.8%). Histologic types were composed mostly of undifferentiated carcinoma (56.2%) and adenocarcinoma (37.5%). The prognosis of the carcinomas, especially the undifferentiated type, was generally poor; about 45% of the cases either experienced recurrence or died within five years. Electron microscopy on this undifferentiated carcinoma revealed characteristic filamentous structure in the carcinoma cells, resembling that observed in myoepithelial cells. It was assumed that the undifferentiated carcinoma cells were of myoepithelial origin.     

Long-term results of local excision and radiotherapy in pleomorphic adenoma of the parotid

Three hundred and eleven patients with primary pleomorphic salivary adenoma of the parotid gland seen between 1950 and 1971 are reviewed. All were managed by a combination of surgery, usually local excision, and irradiation. The minimum follow-up is 10 years. Recurrence rates at 0-5 years and 5-10 years were 1 and 1.5%, respectively, and all recurrences in this period were histologically or clinically benign. This recurrence rate is similar to those reported after superficial parotidectomy. After 10 years, however, the recurrence rate rose, becoming maximal at 15-20 years (4%) and yielding a cumulative risk of recurrence of 8.0% at 20 years. The late recurrences were predominantly malignant tumors. One tumor was probably radiation-induced; the remainder were compatible with spontaneous malignant transformation of benign pleomorphic adenoma, although radiation may have increased the incidence. In the absence of a comparable purely surgical series, this cannot be determined. The recommendation is made that the management of these tumors should be primarily surgical with irradiation reserved for patients presenting surgical difficulties. In addition, prolonged follow-up is necessary since there is a significant incidence of late recurrence and such recurrence may be more likely to be malignant regardless of the primary form of management.     

Management of a large pleomorphic adenoma of the parotid gland.

The surgical management of an extensive pleomorphic adenoma arising within deep lobe of the parotid gland is presented.     

Surgical treatment of recurrences of pleomorphic adenoma of the parotid gland

From 1989 to 1999 a retrospective study was conducted on 7 patients with recurrent pleomorphic adenomas of the parotid gland who were referred to the MaxilloFacial Department of the University of Rome "La Sapienza" after having undergone surgery elsewhere. The mean time interval between the first operation and recurrences ranged from 15 months to 13 years, and the average time interval was 7.7 years. Implantability of the lesion and inadequate surgery that produced rupture of tumour capsule and tumour cells bleeding into surrounding glandular parenchyma, were the reasons for tumour recurrence. The instrumental examinations used for planning the surgical treatment to be applied and for studying the relations of recurrence with glandular parenchyma were CT (with contrast medium) or MR of head and neck. These patients underwent total parotidectomy with facial nerve preservation and no recurrence occurred in any patient. The results of this study underscore the importance of adequate surgical excision of initial recurrences as well as primary tumours to prevent tumour recidivism. Finally, tumour control rates and facial nerve preservation are enhanced with formal parotidectomy for recurrent tumour when feasible.