舌根恶性多形性腺瘤双颈淋巴结转移（附病例报告）

目的：研究舌根恶性多形性腺瘤（MPA）双侧颈淋巴结内癌转移的临床表现、诊断、治疗及预后。方法：对舌根恶性多形性腺瘤双侧颈淋巴结内癌转移病例,分析其临床表现、影像学表现、诊疗过程及组织病理学特征,并进行文献回顾。结果：本文病例为老年男性,首诊症状为颈侧上部无痛肿物,鼻咽镜检查发现舌根无痛性肿物,钳取活检为中分化鳞状细胞癌,行舌根肿瘤扩大切除及双侧改良根治性颈淋巴清扫术,术后病理为舌根恶性多形性腺瘤,恶性成分为鳞状细胞癌,可见淋巴管内瘤栓,双侧Ⅰ、Ⅱ、Ⅲ区颈淋巴结内癌转移（18/42）。术后放疗50Gy,随访1年,未见肿瘤复发与转移。结论：舌根MPA极罕见,双侧颈淋巴结内癌转移病例,经文献检索未见报告。手术彻底广泛切除原发灶并行颈清扫术,辅以放疗,预后良好。

Malignant pleomorphic adenoma of tongue base with bilateral cervical lymph node metastases

Objective： The aim is to study clinical feature, diagnosis, therapy and prognosis of malignant pleomorphic adenoma （MPA） of tongue base with bilateral cervical lymph node metastasis. Methods：We investigated the case of MPA of tongue base with bilateral cervical lymph node metastasis, especially the clinical features, procedure of diagnosis and treatment, pathological characteristics, etc. The literatures were reviewed. Results：The MPA case was a 66-year-old man. The main complain of the case was tumor in the right lateral upper neck, no pain. Then the tumor of tongue base was found by nasopharyngofiberoscope examination. Biopsy showed the tumor of tongue base was squamous cell carcinoma. Extensive resection of tongue base tumor and bilateral modified radical neck dissection were taken. Postoperative pathologic examination showed the original site was MPA with carcinoma embolus in lymph-vessel. Cervical lymph node metastasis was observed in 18 lymph nodes located in level Ⅰ , Ⅱ,Ⅲ of left and right neck respectively. Surgery was the main treatment method and postoperative radiotherapy was used. Local recurrence, regional lymph node metastases and distant metastases did not occur in one year follow-up. Conclusion： MPA of tongue base was exceedingly rare, which may represent the first report of this neoplasm arising in the tongue base with bilateral cervical lymph node metastasis. The prognosis would be satisfactory after extensive resection of tongue base tumor, bilateral modified radical neck dissection and postoperative radiotherapy.