Clinical difference between benign and malignant tumors of the hard palate

European Archives of Oto-Rhino-Laryngology - To determine the clinical characteristics and treatment results of benign and malignant tumors of the hard palate in our hospital. A total of 25...     

颈侧径路切除咽旁间隙良性肿瘤

目的分析颈侧径路咽旁间隙手术在良性肿瘤切除中的应用。方法回顾总结北京同仁医院2004年7月～2007年7月19例20次咽旁间隙良性肿瘤切除术。结果20次手术均在全麻下颈侧径路完成,无永久并发症发生。所有患者随访6（6～36）个月以上。19例中1例术后1年3个月复发,再次全麻经颈手术切除。结论颈侧径路是咽旁间隙良性肿瘤切除适用的术式,创伤小且效果好,所有良性肿瘤基本可行颈侧径路解决。     

Unusual benign tumors of the larynx: report of 17 cases

Rare benign tumours of the larynx (RBTL) form a heterogeneous group. The clinical picture is non-specific. Based on a series of 17 cases of RBTL treated in our department, we wish to draw attention to the diagnosis, treatment and clinical course of these tumours. The mean age of the patients was 37 years, with the male sex predominating. The presenting symptom was most commonly progressive dysphonia, while 5 patients were admitted in respiratory distress. Examination and special investigations revealed 8 cases of laryngocoele, 6 cases of angioma, 2 cases of schwannoma, and one of chondroma. Treatment was surgical, by an external approach in 10 cases and endoscopically in 7. The postoperative course was satisfactory. No long-term recurrences were encountered. Conservative surgery by an external or endoscopic approach has revolutionised the functional outcome in these benign tumours.     

甲状腺嗜酸细胞肿瘤28例诊治分析

目的 探讨甲状腺嗜酸细胞肿瘤的临床特点和治疗效果.方法 回顾性分析天津医科大学附属肿瘤医院头颈外科2001-2009年收治的28例甲状腺嗜酸细胞肿瘤患者临床资料.结果 患者中男6例,女22例;年龄18～72岁,中位年龄46.5岁.22例临床表现为甲状腺单发结节或肿块,6例表现为甲状腺多发结节.行单侧甲状腺腺叶切除11例,单侧甲状腺腺叶+峡部切除11例,甲状腺近全切除术4例,2例行腺叶+峡部切除及颈清扫术.术后病理:甲状腺嗜酸细胞腺瘤22例,嗜酸细胞癌6例,其中1例有颈淋巴转移.21例良性患者获得随访,随访时间6个月至7.5年,中位随访45个月,均未发现肿瘤复发;6例恶性患者均获得随访,随访时间3～8年,中位随访54个月,均未发现肿瘤复发或转移.结论 甲状腺嗜酸细胞肿瘤诊断依赖于病理学,部分病例有恶性可能,冰冻诊断有一定困难.手术是治疗嗜酸细胞肿瘤的有效手段.左旋甲状腺素片可起到抑制促甲状腺激素分泌的作用.     

Salivary gland tumors of the palate: the UCLA experience

A retrospective review of 38 patients with salivary gland tumors of the palate treated between 1961 and 1984 is presented. The majority of tumors were identified at an early stage. Most (23 of 38 cases) originated over the hard palate. The most common histological type was adenoid cystic carcinoma (22 cases). Twenty-five patients were treated with surgery alone, of whom, three had wide local excision. Thirteen patients received postoperative radiation therapy in addition to surgery. The local control was comparable for surgery alone and combined therapy (88% and 85%, respectively) although the combined therapy group was biased by more advanced disease, inadequate margins, and/or poorly differentiated histologies. Mucoepidermoid lesions had an excellent prognosis with local control of 100%. In contrast, there was a 23% recurrence rate for adenoid cystic carcinoma. Regional neck node metastasis was noted in 2% of the patients. This experience indicates that radical resection of palate salivary gland malignancy with adequate margins results in excellent local control. Adjuvant radiation therapy is recommended in cases where there is a question of adequate margins and in advanced lesions of high grade tumors.     

23例外伤后良性阵发性位置性眩晕临床分析

目的:比较外伤性良性阵发性位置性眩晕(t-BPPV)和特发性良性阵发性位置性眩晕(I-BPPV)患者的临床特点及预后的差异.方法:回顾性分析186例后半规管BPPV患者的临床资料,所有患者均经Dix-Hallpike试验诊断,并采用管石复位法(CRP)治疗,比较t-BPPV和I-BPPV患者的临床特点及转归.结果:186例BPPV患者中,23例符合t-BPPV诊断标准.t-BPPV患者男女发病比例为1:1,而I-BPPV为1:2.3(P<0.05);t-BPPV患者中8例(34.8%)经过1次CRP治疗后眩晕和眼震完全消失,而I-BPPV患者中139例(85.3%)经过1次CRP治疗后眩晕和眼震完全消失(P<0.05);在2年随访期间,有56.5%的t-BPPV患者和19.0%的I-BPPV患者复发(P<0.05).结论:引发t-BPPV的创伤性质多种多样,t-BPPV比I-BPPV的复发率高.     

Endoscopic treatment of benign tumors of the nose and paranasal sinuses: a report of 33 cases

BACKGROUND: The endoscopic approach can be used successfully for the treatment of benign tumors such as fibroosseous and vascular lesions, pleomorphic adenoma, glioma, meningioma, and schwannoma. METHODS: Thirty-three patients diagnosed with benign tumors of the nasal cavity and paranasal sinuses and treated using an endoscopic approach were reviewed retrospectively. The endoscopic approach was simple in 28 cases and associated with an external approach in 5 cases (because of an intracranial extension of the tumor in four patients and its location at the level of the anterior wall of the frontal sinus in the last case). RESULTS: The resection of the lesions was complete in 32 patients and subtotal in one case. The mean follow-up was 28 months and only two recurrences (6%) were observed in the juvenile angiofibroma group and in the case of the fibrous dysplasia associated to aneurysmal bone cyst, respectively, 20 and 24 months postoperatively. CONCLUSION: In selected cases, endoscopic surgery can be considered an effective treatment for the resection of benign tumors involving the sinonasal tract.     

腮腺良性肿瘤切除附143例报告

目的 分析腮腺良性肿瘤的外科治疗.方法 回顾分析1995年8月～2009年12月143例行腮腺良性肿瘤手术资料,其中腮腺浅叶肿瘤115例,深叶肿瘤28例.病理诊断Warthin瘤69例(占48.28%),混合瘤63例(占44.06% ).其中有5例为双侧.行腮腺浅叶区域切除术73例,腮腺浅叶切除术42例,腮腺部分浅叶切...     

Approach to bilateral benign paroxysmal positioning vertigo

BACKGROUND: Bilateral benign paroxysmal positioning vertigo (bBPPV) is rather rare, accounting for up to 10% in the reported benign paroxysmal positioning vertigo (BPPV) series. Inappropriate head positioning during testing in unilateral BPPV causes the otolith debris in the uppermost ear to move toward the cupula, resulting in an inhibitory nystagmus and mimicking bBPPV. PURPOSE: We analyzed the clinical data of patients with bilaterally positive Dix-Hallpike maneuver and compared them with the characteristics of patients with unilateral BPPV. We further tried to propose a simple schematic approach to the treatment of patients with bilaterally positive Dix-Hallpike maneuver. MATERIALS AND METHODS: Medical records of 232 patients treated for BPPV at our dizziness clinic during 1999 to 2003 were reviewed. An algorithm used for the treatment of patients with bilaterally positive BPPV is discussed. RESULTS: Twenty-eight patients with bilaterally positive Dix-Hallpike test were found. Sixteen were diagnosed with bBPPV, and 12 were diagnosed with unilateral mimicking bBPPV. Thirty patients with unilateral posterior canal BPPV served as control subjects. No difference in age, sex distribution, duration of symptoms, number of treatments per ear, and recurrence was found between bBPPV and unilateral BPPV. The female sex appeared to be predisposed for more treatments. The total duration of BPPV symptoms obtained by history was found to correlate with the number of recurrences after treatment. CONCLUSIONS: We conclude that bBPPV can be readily distinguished from unilateral mimicking bBPPV. Patients with bBPPV do not differ from patients with unilateral BPPV in clinical characteristics. The mechanism of otolith debris dislodgment appears to be the main cause of bilaterality, trauma being a more common trigger than other known causes of BPPV.     

Malignant salivary gland tumors of the palate.

Twenty patients with malignant salivary gland tumors of the hard and soft palate were seen at the University of Virginia Hospital from 1956 through 1975. The characteristics of the tumors, including symptoms and histology are reviewed and the results of treatment are analyzed. In particular, the place of radiotherapy in their management has been examined. Primary control by initial surgery alone was achieved in 60% (9/15) of the cases, and, when those patients who received radiotherapy for residual disease or salvage are included, the primary control was 94% (16/17). Five- and ten-year determinate survival rates were 88% and 67%, respectively. From this retrospective analysis and a review of the literature, it appears that radiotherapy has made a very positive contribution to the management of these tumors.     

Polymorphous low-grade adenocarcinoma of the palate: report of cases

OBJECTIVE: Polymorphous low-grade adenocarcinoma (PLGA) is a rare tumor that mostly affects minor salivary glands. The purpose of this study is to report six new cases followed-up during a long period. We also review the literature concerning clinical, histological and immunohistochemical features, as well as the proper management. METHODS: Malignant tumors of the salivary glands diagnosed in our department from 1990 to 1999 were reviewed. A total of 66 cases were registered. Six of these cases were diagnosed as PLGA. All cases satisfied the histopathological criteria for this entity, and at least 3 years follow-up was available. RESULTS: In the six cases the primary location was the mucosa of the palate. Hard palate was affected in 83.3% of the cases. There were no cases of extraoral PLGA in our series. Tumors were ulcerated in a 16.6% of the cases, and exofitic in the other 86.4%. Histologically, it was observed a tumoral proliferation of round clusters of uniform cells with round-to-oval clear nuclei and small nucleoli. All the cases underwent surgical management with local excision with surgical margins, five of them with bone extirpation associated. No recurrence was observed in four cases, whereas the remaining two cases showed recurrence in the follow-up. In one of the patients, lococervical recurrence appeared 12 months after the surgery, and this patient died after a few months. The remaining patients have been followed-up for 11, 7, 4 and 3 years postoperatively, with no evidence of recurrence. CONCLUSION: Our results for a long follow-up period support the idea for a low grade of malignancy and good prognosis of this tumor, but the appearance of recurrences many years after the surgery must induce us to be very careful and systematic with the follow-up.