腮腺淋巴上皮瘤样癌的诊断与治疗

目的:探讨腮腺淋巴上皮瘤样癌(LELC)的诊断与治疗,进一步提高诊治率.方法:收集我科18例经病理证实的腮腺LELC,回顾性总结和分析本病的临床表现、诊断、治疗及预后.结果:18例腮腺LELC患者中,均为单侧腺体发病;除2例未做EB病毒血清学检查外,其余患者血清学检查结果显示EBV-VCA-IGA阳性率为93%(15/16);EBV-EA-IGA阳性率为75%(12/16);EBV-DNA酶阳性率为63%(10/16).18例均接受原发灶切除及同侧颈淋巴清扫术.其中腮腺全叶加面神经切除2例,其余均为保留面神经的腮腺浅叶切除术6例;腮腺大部分切除术5例;腮腺全切除术5例;颈上、中部淋巴颈清扫术14例;根治性淋巴清扫术4例,颈淋巴结转移率67%(12/18).所有患者接受术后放疗50～70 Gy.全组病例1年以上随访,术后2～4年4例局部复发而行再次手术,1、3、5年生存率分别约为94%(17/18)、72%(13/18)、50%(9/18);死亡原因主要为远处转移和肿瘤复发.结论:腮腺LELC的发生与EB病毒感染可能有密切关系,组织病理学表现酷似未分化型鼻咽癌,确诊前需常规行鼻咽活检以排除转移病灶,腮腺LELC颈淋巴结转移率较高,局部侵袭强,治疗上除行局部广泛切除外还应作颈淋巴结清扫,术后辅助放射治疗.

Diagnosis and management in parotid lymphoepithelioma-like carcinoma

Objective:To study the diagnosis and treatment of parotid Lymphoepithelioma-like carcinoma(LELC),and improve the rate of the diagnosis and treatment.Method:Eighteen cases with parotid LELC confirmed pathologically were collected in our department,and the clinical presentation,diagnosis,treatment and prognosis were retrospectively summarized and analyzed from 1982 to 2002.Result:All of these LELC patients were found in unilateral side.all cases received Epsterm-Barr virus serological test except 2 cases because of refusing,and the testing result displayed: EBV-VCA-IGA positive rate in 93%(15/16);EBV-EA-IGA in 75%(12/16);EBV-DNA enzyme in 63%(10/16).Of 16 cases with facial nerve reserved,parotid superfacial lobectomy were undertaken in 6 cases,resecting a majority of parotid in 5 cases,whole lobectomy in 5 cases.Facial never resection and whole lobectomy in 2 cases due to facial nerve trunk involved.Functional neck lymph dissection in superior and middle part was undertaken in 14 cases and radical neck lymph dissection in 4 cases,total neck lymph node metastasis rate was 67%(12/18).All of patients received radiotherapy to 50~70 Gy.The follow up were over 1 year,and local recurrence occurred in 2~4 years after operation for 4 cases and had to undergo reoperation.The 1,3,5 years survival rates of the 18 cases were 94%(17/18),72%(13/18) and 50%(9/18),respectively.The chief causes of death were distant metastasis and local recurrence.Conclusion: There maybe be close relationship between occurrence of LELC and Epsterm-Barr virus infection.Its histopathologic feature is similar to undifferentiated nasopharyngeal carcinoma and nasopharynx biopsy must be demanded before confirming diagnosis for eliminating metastasis focus.The neck lymph node metastasis rate of LELC is high and local invasion is strong.It is important to undergo enlarged local resection,neck lymph dissection and postoperative radiotherapy.