颈部罕见巨大涎腺多形性腺瘤1例

涎腺多形性腺瘤（pleomorphic adenoma）又称涎腺混合瘤（mixedtumor）,是最常见的涎腺上皮肿瘤,其中80％～90％发生于腮腺,其次为下颌下腺和舌下腺。虽然绝大多数为良性,但仍有恶变倾向,其恶变率为2％～9％啦’。可发生于任何年龄段,以30～50岁最多见,女性多于男性。现报告1例巨大涎腺多形性腺瘤如下。     

Lacrimal gland pleomorphic adenoma: a review of 52 cases, 15-year experience

Background: Lacrimal gland (LG) tumours are rare neoplasms. Pleomorphic adenoma (PA) is the most common histologic variant, representing ～20% of all LG tumours. PA tends to recur leading to great morbidity.

Aims: We carried out this study to share our experience and provide recent data on the clinical aspects, radiologic findings, management and outcome after treatment.

Methods: We realised a hospital-based retrospective case review including data collected from 52 patients, managed over 15 years.

Results: The mean age was 39.8?±?2 years. Unilateral painless proptosis was the most constant sign (51.9%). CT-scan showed predominantly isodense lesions (96.2%), with regular borders (94.2%), measuring on average 2?cm. MRI showed isointense lesions on T1-weighted images in 96.2% of cases. No pre-operative biopsy was done. Surgical management was mainly external lateral orbitotomy (94.2%). There was no recurrence, considering a mean follow-up period of 12.6 years. Size of tumour at the time of diagnosis increased with age (r = +0.36, p?=?.01).

Conclusions: Clinical and radiologic characteristics are consistent with literature. Older patients seem to present larger tumours. We believe that biopsy is not necessary if appropriate imaging is done. Complete, intact resection is generally sufficient to minimise the risk of recurrence.     

Unusual chordoma of the neck region simulating salivary gland pleomorphic adenoma

We report a 34-year-old woman with a cervical chordoma consisting of an intraspinal and extraspinal portion. The extraspinal component of the tumor invaded the deeper structures of the left side of the neck, and was subjected to repeated partial removal. It was misinterpreted as pleomorphic adenoma of salivary gland origin, whereas the intraspinal portion was a neurilemmoma with unusual mucous degeneration.     

Non-vestibular head and neck schwannomas: a 10-year experience

Schwannomas are rare and slow growing tumours, arising from Schwann cells which provide myelin; less than 1 % of them degenerate into a malignant state. Although most studies are based on acoustic schwannomas, the majority of these tumours are non-vestibular and extracranial. Up to 45 % of them can be localised in head and neck districts, where they represent a diagnostic challenge because they are in differential diagnosis with lipoma, brachial cyst, paraganglioma and adenopathy. Between February 2002 and September 2012 our experience considers 18 patients affected by schwannomas localised in the neck in 14 cases, in the oral cavity in 2 cases, in the upper lip in 1 case and finally in the nose in 1 case. A painless neck mass was the major symptom referred, as well as dysphonia and oral pain. Ultrasound scan with fine needle aspiration biopsy was done in half of the group and was diagnostic in 30 %, whereas magnetic resonance imaging was diagnostic in 77 %, confirming its primary role in diagnostic work-up. The surgical approach was mainly by cervical incision and the intraneural extracapsular enucleation was the technique used without nerve injury in 89 % of cases. Follow-up period was 6–120 months and no evidence of relapse was registered.     

Giant pleomorphic adenoma in accessory salivary gland

Giant pleomorphic adenoma is the most common neoplasm of salivary glands, specially of parotitis. Less frequently derives from minor salivary glands and, in the case, its size is small. We report one case of pleomorphic adenoma of great mass seated in a palatine salivary gland and avail the opportunity to review these sort of tumors.     

Management and prognostic factors of recurrent pleomorphic adenoma of the parotid gland: personal experience and review of the literature

The aim of this study was to investigate the management and prognostic determinants of recurrent pleomorphic adenoma (RPA). A retrospective analysis was performed to examine the clinical features, the prevalence of surgical complications, and new recurrences of RPA. Tumor recurrence rate was estimated by the Kaplan–Meier method, and the prognostic value of some of the variables was tested by univariate analysis using the log rank test. The study focused on 33 patients, 18 female (54.5%) and 15 male (45.5%), aged 12–71 years (median 41). A total or extended total parotidectomy was performed in 16 cases (48.5%), a superficial parotidectomy in 10 cases (30.3%), and a local excision in 7 cases (21.2%). In ten patients (30.3%), a branch or the trunk of the facial nerve was deliberately sacrificed. Major complications included one unexpected definitive paralysis of the marginal mandibular branch of the facial nerve and 14 cases of Frey syndrome. Follow-up varied from 2 to 25 years (median 10.5 years), and there were 11 new recurrences (33.3%) within a period varying from 1 to 16 years (median 6 years). The estimated tumor recurrence rates were 14.1 ± 6.6% at 5 years, 31.4 ± 9.4% at 10 years, 43.0 ± 10.8% at 15 years, and 57.2 ± 14.8% at 20 years. Presence of a multinodular lesion and the type of intervention performed were significantly associated with a higher probability of recurrence. RPAs are prone to new recurrences, especially when multinodular and treated with a local excision. Surgical treatment should include facial nerve resection in selected cases. Follow-up for the patient’s lifetime is warranted.     

Extracranial head and neck schwannomas--a 10-year review

OBJECTIVES: To present our experience in managing a large case series of extracranial schwannomas highlighting presenting features, diagnostic difficulties, and outcomes associated with surgical treatment of these tumours. METHOD: A retrospective case note study of 31 patients with a diagnosis of extracranial schwannoma seen in the Department of Otolaryngology, Head and Neck Surgery at Southmead Hospital, a tertiary referral centre and University hospital between 1 June 1993 and 30 May 2003. RESULTS: The commonest anatomical location was in the neck (42%) and an isolated neck lump was the commonest presentation (77%). Pressure symptoms were the next most common mode of presentation, and were often a helpful indicator of the nerve of origin. The nerve of origin was identified in 47% of patients who underwent surgery. Immunohistochemistry was a useful tool in the diagnosis of these tumours and magnetic resonance imaging was the preferred imaging technique to delineate their extent. The most significant postoperative morbidity was associated with the schwannomas of the vagus nerve, sympathetic chain, hypoglossal nerve, glossopharyngeal nerve and the facial nerve. CONCLUSION: Schwannomas can present in a wide variety of sites within the head and neck region and therefore it is important that otolaryngologists and head-neck surgeons are familiar with the more common sites of presentation and the potential difficulties associated with the diagnosis and management of these tumours. Adequate imaging should be carried out preoperatively to gain as much information as possible about the individual tumour and allow informed patient counseling regarding to potential risks and morbidity of surgical intervention.     

Intranasal sphenoethmoidectomy: 10-year experience and literature review

We believe that complete intranasal sphenoethmoidectomy is the procedure of choice for massive nasal polyposis and polypoid sinusitis. The anatomy is complex, visualization with conventional matters is limited, and the potential complications can be severe. Nevertheless, with thorough underlying knowledge of the anatomy and proper training consisting of cadaver dissection and supervised surgery, a safe, effective technique can be mastered. Two hundred and thirty sphenoethmoidectomies done in 87 patients over the past 10 years are reviewed. The initial recurrence rate was 25%. There was a 3% incidence of serious complications. These results are comparable to those in the literature. While recognizing the potential complications of this difficult procedure, we believe that it can be performed safely and effectively by properly trained surgeons and that an effort should be made to extend proper instruction to otolaryngology residents.     

Carcinoma ex pleomorphic adenoma of the salivary gland: an immunohistochemical study

The proliferative activity of the tumor cells and the expression of tumor-associated genes and sex steroid hormone receptors were investigated immunohistochemically in ten cases of carcinoma ex pleomorphic adenoma (Ca-ex-PA) of the salivary glands. These were analyzed in benign and malignant components separately, and then were compared with ten cases of the other malignant tumors [adenocarcinomas, not otherwise specified (ACN) and salivary duct carcinomas (SDC)] and ten cases of pleomorphic adenomas (PA). The results obtained in this study were as follows: (1) malignant component of Ca-ex-PA showed a higher incidence of PCNA and Ki67 than benign component of Ca-ex-PA. A significant difference between benign component of Ca-ex-PA and PA was not observed. (2) A significant difference in the incidence of p53, c-erbB-2, EGFR overexpression was observed only between malignant component of Ca-ex-PA and benign component of Ca-ex-PA. (3) The incidence of PCNA, Ki67, p53, c-erbB-2 overexpression in malignant component of Ca-ex-PA showed the highest data among the four groups. These results suggest that Ca-ex-PA acquired the particular biological behavior in contrast to the other salivary neoplasms in the long-standing process while PA undergoes malignant transformation.     

原发多中心性腮腺多形性腺瘤1例并文献复习

<正>多形性腺瘤(pleomorphic adenoma,PA)又称混合瘤(mixed tumor,MT),是腮腺最常见的良性肿瘤,约占腮腺肿瘤的60%~70%,而同侧腮腺原发多中心多形性腺瘤极为罕见。查阅大量国内外文献,鲜有关于此病的详细描述[1-3]。我科于2012年12月4日诊断1例右侧腮腺原发多中心性多形性腺瘤,现结合既往相关文献报道,对其病因、临床特点、诊断及治疗方法进行讨论,报告如下。     

Clear cell carcinoma arising in pleomorphic adenoma of the minor salivary gland

Malignant change arising in pleomorphic adenoma of the salivary glands is uncommon, with a reported incidence of 2-10 per cent. Only one case where a pleomorphic adenoma became a clear cell carcinoma appears to have been published in the English literature. An additional case of clear cell carcinoma arising in pleomorphic adenoma of a minor salivary gland is reported and the relevant literature discussed.     

Simultaneous primary pleomorphic adenoma in parotid gland and minor salivary gland in the parapharyngeal space

The majority of salivary gland tumours present as a single mass in one gland. Sometimes multiple primary neoplasms can be seen in more than one salivary gland. The most common tumour is Warthin's tumour. Multiple primary pleomorphic adenomas are extremely rare. Most of them are in the major salivary glands. The author reports the first case of simultaneous pleomorphic adenomas in the parotid gland and minor salivary gland at the parapharyngeal space.     

Adenocarcinoma ex pleomorphic adenoma of the head and neck: Report of five cases

OBJECTIVE: Adenocarcinoma ex pleomorphic adenoma is a rare tumor, and thus the management of the tumor has not been established. METHODS: The retrospective review of the clinical records at Okayama University was performed. RESULTS: We present five cases of adenocarcinoma ex pleomorphic adenoma of the head and neck, including a rare case with nasopharyngeal adenocarcinoma ex pleomorphic adenoma. There was no response to chemotherapy with nedaplatin and 5-FU, but the nasopharyngeal adenocarcinoma ex pleomorphic adenoma showed a remarkable regression after the administration of docetaxel. CONCLUSION: The combination therapy that includes docetaxel may be a promising treatment for adenocarcinoma ex pleomorphic adenoma of the head and neck.     

Carcinoma on pleomorphic adenoma in cervical salivary heteropia. Handling of one case and literature review

The presence of salivary tissue outside of the salivary glands, a term called "salivary heterotopia," is not very common. The co-existence of carcinoma expleomorphic adenoma in a salivary heterotopia in the upper third of the neck can be considered unusual. We present an infrequent and clinically unsuspected case of carcinoma expleomorphic adenoma in the upper third of the neck and independent of the salivary glands. The tumour developed within heterotopic salivary tissue, with the histopathological study of the surgical extract being decisive for its diagnosis. The cervical salivary embryogenesis of heterotopias and their oncogenesis is analyzed. Their clinical signs are reviewed to indicate the difficulty in distinguishing the different types of diagnosis from other primary or metastatic tumours so as to assist in choosing the therapy to follow.     

A cytochemical study on the salivary gland pleomorphic adenoma (mixed tumor) and the fetal and adult salivary gland

We studied the pleomorphic adenoma of the salivary gland ultrastructurally and cytochemically [Mg2+-activated adenosine triphosphatase (Mg2+-ATPase)], compared it with normal human fetal and adult salivary glands, and evaluated the histogenesis of this tumor. In the adult salivary gland, reaction products shows Mg2+-ATPase activity were localized in the plasma membranes of myoepithelial cells adjacent to the acinar cells or intercalated duct cells. However, in the salivary gland of the 16-week fetus, they were seen along all adjoining plasma membranes of the cells of terminal buds and duct-like structures. The present case of pleomorphic adenoma comprised two histological components: solid and myxomatous areas. Reaction products were seen along adjoining plasma membranes of both light and dark cells in solid areas.     

A cytochemical study on the salivary gland pleomorphic adenoma (mixed tumor) and the fetal and adult salivary gland

Summary We studied the pleomorphic adenoma of the salivary gland ultrastructurally and cytochemically [Mg²⁺-activated adenosine triphosphatase (Mg²⁺-ATPase)], compared it with normal human fetal and adult salivary glands, and evaluated the histogenesis of this tumor. In the adult salivary gland, reaction products showing Mg²⁺-ATPase activity were localized in the plasma membranes of myoepithelial cells adjacent to the acinar cells or intercalated duct cells. However, in the salivary gland of the 16-week fetus, they were seen along all adjoining plasma membranes of the cells of terminal buds and duct-like structures. The present case of pleomorphic adenoma comprised two histological components: solid and myxomatous areas. Reaction products were seen along adjoining plasma membranes of both light and dark cells in solid areas.