PDF(Pubmed)
Abstract：
Squamous cell carcinoma (SCC) of salivary glands, also referred to as epidermoid carcinoma, is a very rare neoplastic tumor. It occurs as metastasis of a cutaneous or mucosal squamous carcinoma of the head and neck or as a primary SCC. In the latter case, the most known risk factor is previous irradiation to the gland. Common clinical symptoms are represented by cervical swelling and hyposialia. The treatment is essentially surgical, most often supplemented by a radical neck dissection and postoperative radiation therapy. A 75-year-old male patient with a history of chronic smoking was consulted for a tumefaction in the right submandibular region evolving for three months. No cervical lymphadenopathy in the submandibular and superior jugulo-carotid areas was palpable. CT scan showed an enhancing heterogeneous process of the right cervical region, invading the mylohyoid and stylohyoid muscles. A biopsy-excision of the lesion has shown a keratinizing tumor with cytonuclear atypia, consistent with SCC. Radical resection of the mass was associated with the removal of the infiltrated skin. The cutaneous defect was repaired with a rhomboid flap. The patient was started on sessions of adjuvant radiotherapy and chemotherapy. Eight months postoperatively, the patient came for follow-up, with no signs of local disease. The EGFR protein is found in ~70% of salivary neoplasms and is considered as a factor of poor prognosis and rapid proliferation. PET CT is currently the best examination to detect the existence of a concomitant malignant lesion. Diagnosis of primary SCC (PSCC) of the submandibular gland is made on histopathology. Differential diagnoses include mucoepidermoid carcinoma, lymphoepithelial carcinoma and submandibular metaplasia. There is an increased prevalence of nodal involvement in the PSCC, which justifies neck dissection (regions I, II and III of the neck). The RAS mutation leading to resistance to anti-EGFR therapies may be assessed. This would allow for a treatment depending on molecular features for metastatic PSCCs. PSCC of major salivary glands is a very rare lesion with local and general aggressiveness. The diagnosis is based on a combination of clinical examination, MRI, fine needle aspiration and histological examination. Immunotherapy constitutes a ground of research to treat metastatic and advanced pathological cases.
摘要：
唾液腺鳞状细胞癌，也被称为表皮样癌，是一种非常罕见的肿瘤.它作为头颈部皮肤或粘膜鳞状细胞癌的转移或作为原发性SCC发生。在后一种情况下，最已知的危险因素是先前对腺体的照射。常见的临床症状表现为宫颈肿胀和脱位。治疗基本上是手术，最常辅以根治性颈清扫术和术后放射治疗。咨询了一名75岁的有慢性吸烟史的男性患者，在右下颌下区域进行了为期三个月的治疗。下颌下和上颈-颈动脉区域没有明显的颈淋巴结病。CT扫描显示右宫颈区域的非均匀过程增强，侵入舌骨和茎舌骨肌肉。病变的活检切除显示角化性肿瘤伴有细胞核异型，与SCC一致。根治性切除肿块与切除浸润的皮肤有关。用菱形皮瓣修复皮肤缺损。患者开始接受辅助放疗和化疗。术后八个月,病人来随访,没有当地疾病的迹象。EGFR蛋白存在于约70％的唾液肿瘤中，被认为是预后不良和快速增殖的因素。PETCT是目前检测伴随恶性病变存在的最佳检查。下颌下腺原发性SCC（PSCC）的诊断是根据组织病理学进行的。鉴别诊断包括粘液表皮样癌，淋巴上皮癌和颌下化生。PSCC中淋巴结受累的患病率增加，这证明了颈部解剖(区域I，颈部的II和III）。可以评估导致对抗EGFR疗法的抗性的RAS突变。这将允许根据转移性PSCC的分子特征进行治疗。主要唾液腺的PSCC是一种非常罕见的病变，具有局部和一般的侵袭性。诊断是基于临床检查的组合，MRI,细针穿刺和组织学检查。免疫疗法构成了治疗转移性和晚期病理病例的研究基础。
