Salivary gland tumors in an Iranian population: a retrospective study of 130 cases.

PURPOSE: Tumors of the salivary glands are uncommon, comprising 3% to 10% of head and neck neoplasia. In the absence of epidemiologic studies of these neoplasms in an Iranian population, we conducted a preliminary survey of 130 cases over the last 20 years in Hamedan, Iran. PATIENTS AND METHODS: The medical records and case notes of all patients with histologically confirmed salivary gland tumors were reviewed retrospectively from February 1984 to March 2003. This review found 89 patients with benign tumors and 41 patients with malignant tumors. The collection of data included gender, age, location, and histopathology of the tumor. Other recorded data included diagnostic procedures, operative reports, complications, additional treatment, and follow-up. RESULTS: We studied 78 females and 52 males with a mean age of 44.9 years. Patients with benign and malignant tumors presented with a mean age of 41.3 and 47 years, respectively. The frequency of benign tumors was 68.4% (n = 89) and 31.6% for malignant tumors (n = 41). Tumors were localized in the parotid gland (63%; n = 82), the submandibular gland (23%; n = 30), and in the minor salivary glands (14%; n = 18). The most common benign tumor was pleomorphic adenoma (65.4%; n = 85). Among malignant tumors, mucoepidermoid carcinoma was the most frequent (11.5%; n = 15), followed by adenocarcinoma (10%; n = 13). Greater than 63% of malignant tumors were treated surgically, and the remaining with combined therapy. Seven patients died over the follow-up period (6 with persistent disease), 5 were lost to follow-up, and 23 remained cancer-free. CONCLUSION: Between benign and malignant salivary gland tumors, frequency of pleomorphic adenoma and mucoepidermoid carcinoma was in keeping with studies reported previously. In other salivary gland tumors, however, diversity was obvious and showed significant difference, requiring further studies.     

Primary epithelial tumors of the lacrimal gland; a retrospective analysis of 22 patients

This study analyzed the clinical and histopathological aspects, treatment and prognosis of 22 patients with primary epithelial tumors of the lacrimal gland treated in a single institution over 25 years. 191 lacrimal gland lesions retrieved from the archives of the Department of Pathology, Erasmus University Medical Center, were retrospectively reviewed. The clinical and surgical pathology files of 22 primary epithelial neoplasms (16 benign; 6 malignant tumors) were studied. All benign tumors were pleomorphic adenomas; 50% of the malignant neoplasms were adenoid cystic carcinomas. The mean time from complaint to diagnosis was 3 years for benign tumors and 6 months for malignancies. Most benign tumors were treated by local excision; no recurrences occurred. Treatment of malignant tumors varied but generally involved extensive surgery with postoperative radiotherapy. 50% of these patients showed regional and/or distant metastasis. 33% of patients with malignancy died of their disease. Most primary epithelial tumors of the lacrimal gland are pleomorphic adenomas. They have a long duration of symptoms before diagnosis, are treated by limited surgery and recur infrequently. Malignant tumors have a short duration of symptoms, are sometimes mistaken for inflammatory disease, and are, even in case of aggressive surgery, characterized by a high rate of local recurrence and metastasis.     

Submandibular gland excision: 15 years of experience.

PURPOSE: The surgical management of submandibular gland diseases has always been a challenge because it carries a considerable risk of nerve injury. The aim of this study was to review a single institution's experience of a nonselected case series of submandibular gland excision over 15 years. MATERIALS AND METHODS: We retrospectively analyzed 258 unselected submandibular excisions of a tertiary university center for the histopathologic diagnosis and postoperative morbidity; 119 patients (46%) with sialolithiasis, 88 patients (34%) with sialadenitis, and 51 patients (20%) with submandibular tumors were operated. RESULTS: We found a high rate of malignant tumors (42%) in the group of submandibular gland tumors. A low rate of transient palsies of the mandibular branch of the facial nerve (9%) and lingual nerve (2%) was observed. One patient developed a permanent paresis of the mandibular branch (<1%). CONCLUSION: Our large series has shown that standardized submandibular sialadenectomy is a safe operation with a low rate of complications. Malignant disease is frequent in tumors of the submandibular gland.     

下颌下腺良性肿瘤功能性手术的研究进展

下颌下腺切除术是治疗下颌下腺良性肿瘤最常用的治疗方法,但术后皮肤瘢痕、潜在的面神经下颌缘支损伤和舌神经损伤,以及腺体摘除可能导致的口干等并发症将会不同程度地影响患者的生活质量.为此,下颌下腺功能性手术日益被采用和改进,以期提高术后生活质量.本文围绕下颌下腺手术的美观切口设计,内镜和机器人辅助手术技术的应用,以及下颌下腺...     

1612例老年唾液腺肿瘤构成比分析

目的:了解老年人唾液腺肿瘤疾患的构成现状,为临床早期诊断和治疗提供依据。方法:回顾分析我科2000年1月—2009年12月10年间(21c10s)老年人唾液腺肿瘤住院患者的临床资料,并与20世纪90年代(20c90s)、80年代(20c80s)统计数据进行比较。结果:伴随着老年口腔颌面-头颈肿瘤患者住院人数的迅速增加,老年唾液腺肿瘤患者总数亦呈明显上升趋势,尤其是良性肿瘤患者数量快速上升。沃辛瘤首次成为最常见的老年唾液腺良性肿瘤。恶性肿瘤中,腺样囊性癌继续位居首位,而癌在多形性腺瘤中上升为第3位,并位居腮腺恶性肿瘤之首。小唾液腺良、恶性肿瘤构成比接近1∶1;而腭腺良、恶性比例倒置为1.34∶1。腮腺区发病仍最多见,其次为腭腺和下颌下腺。女性患者构成比有下降趋势。结论:21c10s老年唾液腺肿瘤构成现状与20c90s及20c80s资料有所不同,临床诊治工作中应注意其相应变化。     

Actinomycosis originating in the submandibular gland: Report of a case

We report herein a very rare case of actinomycosis originating in the submandibular gland in which malignancy was suspected. A 56-year-old man visited our clinic with a chief complaint of painless mass in the right submandibular region. From the imaging diagnosis, we suspected malignant tumor in the submandibular gland. Under general anesthesia, right radical neck dissection and excision of the submandibular gland with the above mass were carried out. Histopathological diagnosis of actinomycosis in the submandibular gland was made. Because the focus exists within the gland, we consider this case as a primary submandibular gland actinomycosis. Two years postoperatively, the tumor has not recurred. On diagnosis, it is necessary to differentiate this disease with other benign or malignant tumors.     

腮腺包块136例临床分析

目的：通过对136例腮腺包块的临床分析,提高腮腺包块的诊断水平和治疗效果。方法：对1985～2004年收治的136例腮腺包块病例进行回顾性分析。其中良性肿瘤112例,恶性肿瘤18例,其它病变6例。所有包块均行手术治疗,对恶性肿瘤术后进行放化疗。结果：128例腮腺包块经手术治愈,3例良性肿瘤及5例恶性肿瘤复发。结论：腮腺包块的正确诊断对治疗方法的选择有重要指导意义。     

96例老年患者颌下腺肿瘤临床病理分析

目的：了解老年患者颌下腺肿瘤的组织学类型及临床病理特征。方法：对96例老年患者颌下腺肿瘤临床病理资料进行统计学分析。结果：良性上皮性肿瘤71例（73．96％）,恶性上皮性肿瘤25例（26．04％）。多形性腺瘤居良性上皮性肿瘤的首位,腺样囊性癌居恶性上皮性肿瘤的首位。良、恶性上皮性肿瘤的男女性别比为0．92：1和1．5：1：良性肿瘤平均年龄66岁、恶性肿瘤平均年龄69岁。颌下腺肿瘤复发率为4．17％,多形性腺瘤占75％。结论：多形性腺瘤和腺样囊性癌分别是最常见的良、恶性上皮性肿瘤;良性上皮性肿瘤多见于女性,恶性上皮性肿瘤多见于男性;多形性腺瘤易复发。     

Epithelial salivary gland tumors of children and adolescents in west China population: a clinicopathologic study of 79 cases

Objective:  Determine the clinical and histopathologic features of epithelial salivary gland tumors of children and adolescents.
Methods:  A total of 79 cases of epithelial salivary gland tumors of children and adolescents were retrieved from the files. Information about demographic, clinical, histopathologic characteristics, and follow-up status were analyzed.
Results:  Sixty tumors (75.9%) were benign and 19 (24.1%) malignant. The most common tumor overall was pleomorphic adenoma (PA). The parotid was the most frequently involved site (43.0%). PA was the most common type of benign tumor. The most common malignant tumor was mucoepidermoid carcinoma. Five patients with parotid PA and two cases with palate myoepithelioma showed local recurrences. One patient with mucoepidermoid carcinoma showed local recurrences and died from the tumor 3 years after the initial treatment. One patient with adenocarcinoma presented local and neck recurrences, and died 4 years after initial treatment.
Conclusions:  Our data showed that the salivary gland tumors in children and adolescents may be the higher incidence of benign tumors, especially of PA; the slightly higher tendency for female predominance; the higher incidence of parotid glands. Mucoepidermoid carcinoma was the most common malignant tumor, with majority of low grade. Initial treatment should be planned to excise the tumor completely with satisfactory margins. The neck dissections or postoperative radiotherapy were performed in patients with low differentiation malignancies, or patients who present nodal metastasis or with clinically suspicious regional metastasis.     

A case of carcinosarcoma arising in the submandibular gland

A 54-year-old man presented with an 8-year history of a hard asymptomatic mass of the left submandibular area. Total excision of the left submandibular gland with radical neck dissection was performed under a diagnosis of a submandibular tumor, probably a malignant mixed tumor. The pathologic diagnosis was carcinosarcoma consisting of carcinomatous and sarcomatous elements. The epithelial component was composed of squamous cell carcinoma, undifferentiated carcinoma, and adenocarcinoma. The nonepithelial component was composed of chondrosarcoma, osteosarcoma, spindle cell sarcoma, rhabdomyosarcoma, and liposarcoma. In the central area of the tumor, a few remnants of benign pleomorphic adenoma were identifiable. The finding suggested that in our patient, the carcinosarcoma arose from a preexisting pleomorphic adenoma. In view of the expected aggressive nature of the tumor, the patient was treated with postoperative radiotherapy of 60 Gy total, in 30 daily fractions of 2 Gy, and chemotherapy. He currently remains well and free of disease 24 months after treatment.     

64排螺旋CT灌注诊断涎腺肿瘤的临床应用研究

目的:评价64排螺旋CT灌注成像对涎腺肿瘤的临床诊断价值。方法:29例涎腺部肿瘤(腮腺22例,颌下腺6例,舌下腺1例;其中良性肿瘤17例,恶性肿瘤12例)行CT灌注检查,取得相应的灌注参数:血流量(blood flow,BF),血容量(blood volume,BV),平均通过时间(mean transit time,MTT)和表面渗透性(permeability surface,PS),并均经术后病理证实。结果:所有肿瘤的BF、BV、MTT和PS值明显高于正常涎腺组织(P<0.05),恶性肿瘤组BF、BV、PS值高于良性肿瘤组(P<0.05),MTT参数则在良、恶性肿瘤之间无统计学差异。结论:涎腺肿瘤的CT灌注成像是一种较为准确的定量分析肿瘤血流灌注状态的方法,具有较高的临床应用价值。     

31例青少年腮腺肿瘤临床和病理分析

目的 探讨青少年腮腺肿瘤的临床和病理特点,为其治疗提供临床证据. 方法 对31例10~19岁青少年腮腺肿瘤患者的临床和病理资料进行回顾性分析,并将其与同期收治的516例成人腮腺肿瘤患者的临床特点和组织病理类型加以比较. 结果 青少年腮腺肿瘤中恶性肿瘤比例高达38. 7%(12/31),但在成人仅占17. 0%(88/516). 31例青少年腮腺肿瘤中,良性肿瘤19 例,占61. 3%,其中以多形性腺瘤居多,占良性肿瘤的89. 5%(17/19);恶性肿瘤中以黏液表皮样癌居多,占恶性肿瘤的41. 7%(5/12). 31例肿瘤患者均接受手术治疗,其中2例恶性肿瘤术后放疗. 结论 青少年腮腺肿瘤的肿瘤病理类型与成人有明显不同,应当引起重视. 对于青少年腮腺肿瘤,应重视手术治疗的早期性和彻底性.     

儿童腮腺肿瘤52例临床分析

目的：总结儿童腮腺肿瘤的发病情况、临床病理特点及诊断治疗。方法：对1980．9．—1999．5．收治的52例16岁以下儿童腮腺肿瘤的病案资料进行回顾性分析。结果：52例儿童腮腺肿瘤中，良性肿瘤36例，占69．2％，恶性肿瘤16例，占30．8％；良性肿瘤中血管病最多，占良性肿瘤的41．1％，恶性肿瘤中粘液表皮样癌最多，占恶性肿瘤的56．2％。42例经手术治疗，其中16例恶性肿瘤术后进行放疗，10年生存率83．3％。结论：儿童腮腺肿瘤中脉管瘤最多见，实质性肿瘤中恶性肿瘤较多，手术治疗为主要治疗方法，总体上预后治疗好。     

CT灌注成像与细针穿刺细胞学检查在涎腺肿瘤诊断中的应用

目的:探讨CT灌注成像与细针穿刺细胞学检查对涎腺肿瘤良恶性的鉴别诊断价值.方法:36 例涎腺肿瘤(腮腺26 例,下颌下腺8 例,舌下腺1 例,腭部1 例)患者,术前均行细针穿刺细胞学检查和CT灌注扫描,并取得相应的灌注参数:血流量(blood flow,BF),血容量(blood volume,BV),平均通过时间(mean transit time,MTT)和表面渗透性(permeability surface,PS),所有涎腺肿瘤术后均行病理检查.结果: 36 例患者中,最终病理确诊为涎腺恶性肿瘤者13 例,细针穿刺细胞学检查对恶性肿瘤检测的敏感性为84.6 %(11/13),特异性为95.7% (22/23),符合率为91.7%(33/36).CT灌注成像恶性肿瘤组BF、BV、PS值均高于良性肿瘤组(P<0.05),而2 组之间的MTT参数则无统计学差异(P>0.05).其诊断恶性肿瘤的敏感性为92.3%(12/13),特异性为86.9%(20/23),符合率为88.9%(32/36).细针穿刺细胞学检查假阴性的涎腺恶性肿瘤可通过CT灌注成像检查得到正确诊断.结论:CT灌注成像能提供涎腺肿瘤微循环灌注方面的信息,有利于肿瘤良恶性的鉴别,与细针穿刺细胞学检查并联应用,能够明显提高涎腺肿瘤诊断的准确性.     

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。     

Chronic sclerosing sialadenitis of the parotid gland

Chronic sclerosing sialadenitis (Küttner's tumor) is a benign and chronic inflammatory condition of the submandibular gland that clinically cannot be easily distinguished from salivary malignant neoplasia. This is a report of a case of chronic sclerosing sialadenitis located as a solitary mass in an accessory parotid gland.     

A prospective study of salivary gland function in patients undergoing radiotherapy for squamous cell carcinoma of the oropharynx

OBJECTIVE: We sought to investigate the impact of head and neck cancer treatment on salivary function. STUDY DESIGN: The study was conducted on 54 patients with advanced squamous cell carcinoma with confirmed (n = 50) or suspected (n = 4) primary oropharyngeal localization who were treated with radiation alone or in combination with surgery or chemotherapy, or both. The following groups were considered in the evaluation: 1, the entire pool of patients; 2, those undergoing surgery and those not undergoing surgery before radiation; 3, those undergoing resection and those not undergoing resection of the submandibular gland. The flow rates, pH, and buffering capacity were determined before, during, and up to 12 months after the completion of radiation. RESULTS: Head and neck surgery, particularly when submandibular gland resection was performed, had a negative impact on salivary flow rates but did not influence pH or buffering capacity. Nonetheless, the effect of surgery on salivary flow rates decreased progressively and disappeared at 3 to 6 months after radiotherapy. More than two thirds of the salivary output was lost during radiation treatment. All patients were experiencing salivary dysfunction at 1 year after completion of radiotherapy, with average decreases of 93% (P < .0001) and 95% (P < .0001) for whole resting salivary flow and whole stimulated salivary flow, respectively, compared with the preradiotherapy values. The buffering capacity decreased to 67% of its preradiotherapy value, and whole stimulated saliva became acidic. CONCLUSIONS: The result of this study confirms that cancer treatment involving full-dose radiotherapy (RTH) to all major salivary glands for locally advanced squamous cell carcinoma of the oropharynx induces severe hyposalivation with alteration of salivary pH and buffering capacity. Head and neck surgery has a negative impact on salivary flow rates, especially when the submandibular gland is removed. However, surgery before irradiation is not a factor aggravating hyposalivation when postoperative radiotherapy includes all the major salivary glands.     

Cerebral radionecrosis following the treatment of parotid tumours: a case report and review of the literature

Radiotherapy is an accepted part of the treatment of malignant tumours of the parotid gland. The use of radiotherapy in benign parotid tumours, where spillage of tumour cells has occurred at operation, is more controversial. Radiotherapy to the parotid bed is not without morbidity. Complications may arise as a result of radiation damage to neighbouring structures and there is also potential to induce malignant disease. A patient, whose postoperative radiotherapy following resection of a pleomorphic salivary gland adenoma was complicated by cerebral necrosis, is discussed. The literature pertaining to morbidity of radiotherapy for parotid tumours is reviewed.     

A clinicopathologic study of 196 intraoral minor salivary gland tumours

We present a retrospective study of 196 patients with intraoral minor salivary gland tumours, 128 malignant and 68 benign, diagnosed from 1954 to 1993 in the A.C. Camargo Hospital, São Paulo, Brazil. Sixty-five percent of the cases occurred in the palate, followed by tongue (9.7%) and retromolar area (6.1%). Pleomorphic adenoma was the most common benign tumour, and mucoepidermoid carcinoma was predominant among the malignant tumours. Surgery was the main treatment method and postoperative radiotherapy and radiotherapy alone were used in 40 and 15 patients, respectively. Local recurrence was observed in two patients with pleomorphic adenoma and in eight patients with malignant tumours. Regional lymph node metastases occurred in four cases and distant metastases in five. Forty-six of 47 patients with benigh tumours who were followed up from 1 to 7 years were alive without disease. Twenty-four of 79 patients with malignant tumours who were followed up for at least 5 years died due to the tumour and 47 were alive without disease.     

术中液氮冷冻加术后放疗在治疗腮腺癌保留面神经中的应用

目的研究手术联合术中液氮冷冻和术后放疗治疗面神经与肿瘤紧贴的腮腺癌能否达到既局部控制肿瘤、又保留面神经功能的效果。方法分析9例采用手术联合术中液氮冷冻、术后放疗治疗腮腺癌保留面神经患者的临床病理资料,对患者进行2～19年的随访,平均随访时间9年,观察局部有无肿瘤复发。8例患者行House-Brackmann系统（HB系统）面神经功能评价,7例患者行神经电图（ENoG）检测,评估面神经功能恢复效果。结果在随访期间,9例患者中1例肿瘤复发伴颈淋巴结转移,行再次手术治疗,在首次治疗后6年无瘤生存。其余8例患者原发灶均无复发。6例患者分别在首次术后7年（2例）、10年、11年、15年、19年无瘤生存。2例患者分别于术后2年和2.5年死于肺心病和肺转移。8例患者面神经功能均得到恢复,4例达HBⅠ级,2例为HBⅡ级,2例为HBⅢ级。ENoG检查的7例患者的面神经各分支均能引出电生理反应。结论对于面神经与癌瘤紧贴,但可在完整切除癌瘤的前提下分离保留面神经的腮腺癌患者,当缺乏125I放射性粒子植入或192Ir后装组织内近距离放射治疗的条件时,手术联合术中液氮冷冻和术后放射治疗是可行的综合治疗方案。