Parotid Neoplasms

腮腺肿瘤
  • 文章类型: Journal Article
    背景:涎腺导管癌(SDC)是一种侵袭性癌症,皮肤转移是罕见的。此外,SDC继发于烫伤的皮肤转移更罕见,据我们所知,我们的案例代表了第一个这样的例子。考虑到手指在转移部位的受累,这可能会影响肢体功能和生活质量,我们提出这个病例来探讨烫伤可能导致远处复发的原因和更好的治疗方案。
    方法:一名被诊断为腮腺SDC的85岁男子因烧伤而在指尖发现肿大的肿块,6年后,他的初步治疗。
    方法:腮腺中SDC的皮肤转移和由于手术导致的左手拇指丢失。
    方法:提供放射治疗,瞄准手指上的群众,剂量为15Gy分3次,3个部分中的12Gy,双手在3个部分中为15Gy,左手仅在7个部分中为21Gy。
    结果:放疗2个月后肿瘤缩小,患者恢复良好。副作用包括指甲增生和甲沟炎。
    结论:本病例中烫伤与恶性肿瘤远处转移的关系有待进一步研究。考虑到手指在处理转移时的保留功能,建议放疗而不是手术。
    BACKGROUND: Salivary duct carcinoma (SDC) is an aggressive form of cancer, with cutaneous metastasis being a rare occurrence. Furthermore, cutaneous metastasis of SDC secondary to a scald is even rarer, and to the best of our knowledge, our case represents the first such instance. Considering the involvement of the fingers in the metastatic site, which may affect limb function and quality of life, we present this case to explore the reason why scald could lead to distant recurrence and better treatment options.
    METHODS: An 85-year-old man diagnosed with SDC in the parotid gland found enlarged masses at the fingertips as a consequence of a burn, 6 years after his initial treatment.
    METHODS: Cutaneous metastasis of SDC in the parotid gland and left thumb loss due to surgery.
    METHODS: Radiotherapy was offered, targeting at the masses on the fingers, with dose at 15 Gy in 3 fractions, 12 Gy in 3 fractions, 15 Gy in 3 fractions for both hands and additional 21 Gy in 7 fractions only for left hand.
    RESULTS: The tumors shrank after 2 months of radiotherapy and the patient recovered well. Side effects included nail hyperplasia and paronychia.
    CONCLUSIONS: Connections between scald and distant metastasis of malignant tumors in this case needed further investigation. Considering reserving function of the fingers while dealing with metastasis, radiotherapy is recommended rather than surgery.
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  • 文章类型: Case Reports
    腮腺的滤泡树突状细胞肉瘤是一种极其罕见的肿瘤,文献中只报道了6例。一名51岁的女性从右侧腮腺切除了3.0厘米的肿瘤。肿瘤表现出坚实的薄片,螺纹,束状图案,和合胞体外观,细胞边界模糊。淋巴细胞浸润散布在整个肿瘤中,局灶性明显的血管周围袖口。免疫组织化学,滤泡树突状细胞标志物CD21,CD23和CD35呈阳性.我们旨在增强对这种肿瘤的了解,并提醒病理学家注意该地区的这种罕见实体,以避免误诊。
    Follicular dendritic cell sarcoma of the parotid gland is an extremely rare tumor, with only six cases reported in the literature. A 51-year-old female had a 3.0 cm tumor resected from the right parotid gland. The tumor exhibited solid sheets, whorls, fascicular pattern, and syncytium appearance with an indistinct cell border. The lymphocytic infiltrate was sprinkled throughout the neoplasm, with focal prominent perivascular cuffing. Immunohistochemically, it was positive for follicular dendritic cell markers CD21, CD23, and CD35. We aim to enhance the understanding of this neoplasm and alert pathologists to this rare entity in this region to avoid misdiagnosis.
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    文章类型: Journal Article
    背景:马乔林溃疡(MU)是一种侵袭性皮肤恶性肿瘤,通常发生在患有慢性伤口如烧伤后瘢痕的患者中。
    方法:一名20岁男性在3个月大的时候在头皮上出现火焰烧伤,20年后在烧伤疤痕上出现了无法愈合的溃疡,通过辅助模具近距离放射治疗以足够的手术切缘进行治疗。治疗结束两个月后,他在正电子发射断层扫描(PET)阳性的双侧宫颈出现腮腺淋巴结转移,锁骨上,右枕下,和同时放化疗的肠系膜淋巴结。一个月后,患者出现了累及左侧腮腺区的溃疡性病变,PET显示腮腺浸润,但是具有其他先前吸收位点的分辨率。该患者接受了根治性腮腺切除术,选择性颈淋巴结清扫术和局部区域皮瓣重建手术治疗。在6个月的随访中,患者出现了广泛的局部复发和远处转移,并开始口服节拍治疗。在开始姑息性化疗后3个月随访时,患者病情稳定。
    结论:尽管及时进行多模式治疗,MU可能出现敌对的临床过程,无病间隔时间短和早期复发。
    Marjolin ulcer (MU) is an aggressive cutaneous malignancy that commonly occurs in those with a chronic wound such as post-burn scar.
    A 20-year-old male who sustained a flame burn over the scalp at 3 months of age developed a nonhealing ulcer over the burn scar 20 years later, which was treated with adequate surgical margins with adjuvant mold brachytherapy. Two months after completion of that treatment, he developed parotid nodal metastasis with positron emission tomography (PET)-positive bilateral cervical, supraclavicular, right suboccipital, and mesenteric lymph nodes that were treated with concurrent chemoradiation. One month later, the patient developed an ulcerative lesion involving the left parotid region with PET showing infiltration of the parotid gland, but with resolution of other previous sites of uptake. The patient was treated surgically with radical parotidectomy with elective neck dissection and reconstruction with locoregional flap. At 6-month follow-up, the patient developed extensive locoregional recurrence and distant metastasis and was started on oral metronomic therapy. The patient was alive with stable disease at 3-month follow-up after initiation of palliative chemotherapy.
    Despite timely multimodality therapy, MU may present with a hostile clinical course with a short disease-free interval and early recurrence.
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  • 文章类型: Journal Article
    腮腺是最大的唾液腺,位于胸锁乳突肌的前方,并位于下颌骨的支的侧面。该腺体中的肿瘤相对罕见,80%是良性的,20%是恶性的,主要表现为粘液表皮样癌。在头部和颈部区域,淋巴上皮癌(LEC)占恶性唾液腺肿瘤的0.4%。
    一名没有合并症的35岁男子因生长不确定的无痛右宫颈肿块而进入头颈外科专业服务机构。广泛的诊断调查显示对侧腮腺受累,伴有全身淋巴结肿大。因此,辅助放疗由治疗团队决定。
    该病例证实了该疾病可以呈现的异质性特征和独特行为,如双侧腮腺LEC所见。
    UNASSIGNED: The parotid is the largest salivary gland and is located anteriorly to the sternocleidomastoid muscle and laterally to the ramus of the mandible. Neoplasms in this gland are relatively rare, with 80% being benign and 20% malignant, primarily represented by mucoepidermoid carcinoma. In the head and neck region, lymphoepithelial carcinoma (LEC) accounts for 0.4% of malignant salivary gland tumors.
    UNASSIGNED: A 35-year-old man with no previous comorbidities was admitted to a Head and Neck Surgery Specialty Service for a painless right cervical mass of uncertain growth. Extensive diagnostic investigation revealed involvement of the contralateral parotid, associated with systemic lymph node enlargement. Thus, adjuvant radiotherapy was decided by the treating team.
    UNASSIGNED: This case confirms the heterogeneous features and distinctive behavior that the disease can present, as seen with bilateral parotid LEC.
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  • 文章类型: Journal Article
    背景:腮腺发育不全很少见,先天性,通常无症状的疾病。直到现在,只有24例单方面的,偶然发现,腮腺发育不全已被描述。这里,我们报道了首例单侧腮腺发育不全患者的同侧耳前肿瘤。手术期间,记录了大耳和面神经的位置。此外,我们对这种罕见的疾病进行了首次鼻内镜检查,以评估导管分支的数量,这可能表明腮腺组织的丰度。此外,我们寻找可以帮助在门诊环境中识别这些患者的鼻内镜特征性特征.
    方法:一名50岁的希腊男子无痛,右侧腮腺间隙的肿块逐渐扩大。磁共振成像显示右腮腺完全缺失,没有副腮腺组织。右腮腺被脂肪组织取代,放射科医生建议腮腺良性肿瘤。细针抽吸指示反应性淋巴结。内窥镜检查显示右腮腺导管内仅有两个分支。手术切除是通过常规的腮腺外侧切除术进行的。尽管腮腺组织发育不全,但这揭示了大耳和面神经的典型解剖位置。组织病理学显示为小淋巴细胞淋巴瘤。
    结论:对于腮腺发育不全患者,外科医生应该有信心切除腮腺间隙肿瘤。在鼻内镜检查期间观察到的分支减少可能表明腮腺发育不全。对于腮腺发育不全的肿瘤患者,医生应该比平时更加谨慎地观察和等待策略,因为肿瘤是良性唾液腺肿瘤的可能性可能比平常低。
    BACKGROUND: Parotid gland agenesis is a rare, congenital, usually asymptomatic disorder. Until now, only 24 cases with unilateral, incidentally found, parotid gland agenesis have been described. Here, we present the first reported case of an ipsilateral preauricular neoplasm in a patient with unilateral parotid gland agenesis. During surgery, the position of the greater auricular- and facial nerves was documented. Furthermore, we performed the first sialendoscopy for this rare disorder to assess the number of duct branches, which might be indicative of the abundance of parotid tissue. Moreover, we looked for sialendoscopic characteristic features that could aid in identifying these patients in the ambulatory setting.
    METHODS: A 50-year-old Greek man presented with a painless, slowly enlarging mass in the right parotid space. Magnetic resonance imaging revealed a complete absence of the right parotid gland without accessory parotid tissue. The right parotid gland was replaced by fatty tissue and the radiologist suggested a benign parotid tumor. Fine needle aspiration was indicative of a reactive lymph node. Sialendoscopy revealed only two branches within the right parotid duct. Surgical resection was performed through a conventional lateral parotidectomy. This revealed typical anatomic position of the greater auricular- and facial nerves despite the parotid tissue agenesis. Histopathology revealed a small lymphocytic lymphoma.
    CONCLUSIONS: Surgeons should feel confident to resect tumors of the parotid space in patients with parotid gland agenesis. Reduced branching observed during sialendoscopy might indicate parotid gland agenesis. Physicians should be even more cautious than usual with the watch and wait strategy in patients with tumors of parotid gland agenesis, since the probability of a tumor being a benign salivary gland tumor might be lower than usual.
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  • 文章类型: Journal Article
    NUT癌(NC)是一种高度侵袭性、具有t(15:19)易位的低分化癌,导致NUTM1基因的融合。而上消化道沿中线(头部,脖子,胸部,和纵隔)通常被报道为NC的主要部位,随后的病例出现在不同的地点。仅基于形态学实现明确的诊断是具有挑战性的;然而,可以使用对NUT抗体特异性的免疫组织化学(IHC)或通过证明特征性的BRD4::NUTM1融合来实现。准确和及时的诊断可以潜在地告知患者管理和指导治疗。虽然经常发现NC的组织学记录,对其细胞学特征的描述有限。一名39岁的男性,有鼻窦鳞状细胞癌(SCC)病史,通过细针穿刺细胞学(FNA)吸出右侧腮腺肿块。在我们机构审查的先前鼻窦病理学的组织学检查显示原始出现,单调,未分化的细胞具有明显的,突出的核仁.此外,有突发性角化的病灶,伴有明显的嗜中性粒细胞浸润。将SCC的初始诊断重新分类为NC,并通过NUTIHC和分子检测确认。尽管腮腺FNA最初提示多种小圆形蓝色细胞肿瘤的可能性,它表现出与鼻窦肿瘤的形态学相似性,导致转移性NC的诊断。NC的细胞形态学特征有限,可以与各种小的圆形蓝色细胞肿瘤重叠。正确的分类在靶向治疗时代尤其关键,考虑到针对BRD4的BET抑制剂的正在进行的开发和评估。
    NUT carcinoma (NC) is a highly aggressive, poorly differentiated carcinoma that harbors a t(15:19) translocation, leading to the fusion of the NUTM1 gene. While the upper aerodigestive tract along the midline (head, neck, thorax, and mediastinum) is commonly reported as the primary site of NC, subsequent cases have emerged in diverse locations. Achieving a definitive diagnosis based solely on morphology is challenging; however, it can be achieved using immunohistochemistry (IHC) specific to the NUT antibody or by demonstrating the characteristic BRD4::NUTM1 fusion. Accurate and timely diagnosis can potentially inform patient management and guide treatment. While histologic documentation of NC is commonly found, there is a limited description of its cytologic features. A 39-year-old male with a history of sinonasal squamous cell carcinoma (SCC) presented with a right parotid mass aspirated via fine needle aspiration cytology (FNA). Histologic examination of the previous sinonasal pathology reviewed at our institution revealed sheets of primitive-appearing, monotonous, undifferentiated cells with distinct, prominent nucleoli. Additionally, there were foci of abrupt keratinization, accompanied by a notable neutrophilic infiltrate. The initial diagnosis of SCC was reclassified to NC and confirmed through NUT IHC and molecular testing. Although the parotid FNA initially suggested the possibility of a variety of small round blue cell tumors, it exhibited morphological similarities to the sinonasal tumor, leading to the diagnosis of metastatic NC. Cytomorphologic features of NC are limited and can overlap with various small round blue cell tumors. Correct classification is especially pivotal in the era of targeted therapy, considering the ongoing development and evaluation of BET inhibitors targeting BRD4.
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  • 文章类型: Journal Article
    目的:本研究的目的是追踪大型队列中外科治疗的发展,在过去的22年中,在一个专门研究唾液腺病理学的单一机构检查其变化,并确定腮腺良性肿瘤的外科治疗可能转向较少根治方法的程度与面神经麻痹和Frey综合征发生率的变化相关。
    方法:回顾性临床研究。
    方法:对2000年至2022年在三级转诊中心接受腮腺良性肿瘤治疗的所有患者的记录进行了回顾性评估。手术方法分为四组:囊外夹层,腮腺部分切除术,浅表腮腺切除术和完全腮腺切除术。
    结果:本研究共纳入4037例患者。我们的分析表明,良性病变的腮腺切除术总数从71(2000)增加到298(2022),主要是由于囊外夹层的增加(从9个增加到212个)。较不根治性手术的表现增加与围手术期并发症的发生率显着降低相关。
    结论:我们的研究表明,多年来,根治程度较低的手术表现与更好的功能结局相关。
    OBJECTIVE: The aim of the study was to trace the development of surgical therapy in a large cohort, examine its changes at one single institution that has been specializing in salivary gland pathologies over the last 22 years, and to determine the extent to which a possible shift in the surgical therapy of parotid benign tumors towards less radical methods was correlated with a change in the incidence of facial palsy and Frey\'s syndrome.
    METHODS: Retrospective clinical study.
    METHODS: A retrospective evaluation of the records of all patients treated for benign parotid tumors at a tertiary referral center between 2000 and 2022 was carried out. Surgical methods were classified into four groups: extracapsular dissection, partial superficial parotidectomy, superficial parotidectomy and complete parotidectomy.
    RESULTS: A total of 4037 patients were included in the study. Our analysis demonstrated an increase in the total number of parotidectomies for benign lesions from 71 (2000) to 298 (2022), mostly due to the increase in extracapsular dissections (from 9 to 212). The increased performance of less radical surgery was associated with a significantly decreased incidence of perioperative complications.
    CONCLUSIONS: Our study showed that the increased performance of less radical surgery was associated with better functional outcomes over the years.
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  • 文章类型: Case Reports
    Robotic surgery is known as the \"third technological revolution\" in the field of surgery, and is an important milestone in the development of modern surgery. However, our country\'s innovative surgical robot industry is still in its early stages, and it is only being utilized in certain surgical fields. To explore the effectiveness of the application of domestic surgical robot in oral and maxillofacial surgery, the author successfully completed a case of benign parotid tumor resection with the assistance of a domestic autonomous robot. The operation was successful, facial nerve function was preserved, and postoperative wound healing was good.
    机器人手术被誉为外科学领域的“第三次技术革命”,是现代外科学发展的重要里程碑。然而我国创新型手术机器人产业尚处于起步阶段,仅用于部分外科领域。为了探讨国产手术机器人在口腔颌面外科应用的有效性,笔者在国产自主手术机器人辅助下顺利完成腮腺良性肿瘤切除1例,手术顺利,面神经功能保存完好,术后创口愈合良好。.
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  • 文章类型: Case Reports
    目的:评价光生物调节疗法(PBMT)治疗糖尿病难愈性创面的疗效和安全性。背景:难治性伤口是糖尿病最具有挑战性的临床并发症之一。研究表明,PBMT可以通过多种方式促进伤口愈合。方法:我们报道了一名55岁的男性患者,在腮腺分泌性癌手术后对810nm激光有反应,患有难治性糖尿病伤口。结果:PBMT后,难治性糖尿病创面逐渐愈合,无不良事件发生。随访5年,愈合的伤口保持稳定,没有复发的迹象。结论:PBMT可作为糖尿病患者难治性糖尿病伤口的治疗方法。
    Objective: To evaluate the efficacy and safety of photobiomodulation therapy (PBMT) in the treatment of diabetic patients with refractory wound. Background: Refractory wound is one of the most challenging clinical complications of diabetes mellitus. Studies have shown that PBMT can promote wound healing in many ways. Methods: We reported a 55-year-old male patient with refractory diabetic wound after secretory carcinoma of the parotid gland surgery responding to 810 nm laser. Results: After PBMT, the refractory diabetic wound healed gradually without adverse events. During follow-up 5-years, the healed wound remained stable and showed no signs of recurrence. Conclusions: PBMT can be potentially considered as a therapeutic method in diabetic patients with refractory diabetic wound.
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  • 文章类型: Review
    背景技术腮腺中的肿块通常指示腮腺瘤形成。Warthin肿瘤或多形性腺瘤是常见的鉴别诊断。不那么频繁,考虑了其他鉴别诊断和起源部位。神经鞘瘤很少见,头颈部良性肿瘤。甚至更罕见,这些肿瘤发生在面神经的腮腺内。在下文中,我们报道了2例患者在磁共振成像(MRI)中偶然发现右侧腮腺肿块。病例报告我们回顾了有关腮腺内面神经神经鞘瘤(IPFNS)的文献数据,并将其与我们病例的数据进行了比较。重点是临床病史等数据,临床症状,神经电描记术,和各种成像模式,如超声和MRI结合弥散加权成像。结论将面神经神经鞘瘤与其他肿瘤区分开来具有挑战性。患者病史,临床症状,磁共振弥散加权成像检查,和高分辨率超声成像是诊断的决定性因素,当怀疑IPFNS时,应进行诊断.IPFNS的诊断和治疗仍然具有挑战性。对于小肿瘤和面神经功能良好的患者,等待和扫描方法可能是一种选择。另一方面,与面神经功能受限相关的晚期肿瘤患者可从手术入路或立体定向放射外科手术中获益.
    BACKGROUND A mass in the parotid gland usually indicates parotid gland neoplasia. Warthin tumors or pleomorphic adenomas are common differential diagnoses. Less frequently, other differential diagnoses and sites of origin are considered. Schwannomas are rare, benign tumors in the head and neck region. Even more rarely, these tumors occur in the intraparotid course of the facial nerve. In the following, we report about 2 patients in whom a mass in the right parotid gland was found incidentally during magnetic resonance imaging (MRI). CASE REPORT We reviewed data from the literature on intraparotid facial nerve schwannomas (IPFNS) and compared them with those from our cases. The focus was on data such as clinical history, clinical symptoms, electroneurography, and various imaging modalities, such as ultrasonography and MRI combined with diffusion-weighted imaging. CONCLUSIONS It is challenging to distinguish facial nerve schwannomas from other neoplasms. Patient\'s history, clinical symptoms, MRI examination with diffusion-weighted imaging, and high-resolution ultrasound imaging are decisive factors for diagnosis and should be performed when IPFNS is suspected. Diagnosis and therapy for IPFNS remain challenging. A wait-and-scan approach could be an option for patients with small tumors and good facial nerve function. On the other hand, patients with advanced tumors associated with limited facial nerve function can benefit from surgical approaches or stereotactic radiosurgery.
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