■分泌性癌(SC)是一种罕见的口腔唾液腺肿瘤,显微镜下可以模拟腺泡细胞癌(ACC)和粘液表皮样癌(MEC)。唾液腺分泌性癌(SC)最近已在头颈部世界卫生组织的第四版中添加。这些肿瘤大多数位于腮腺,很少报道在颊粘膜的小唾液腺中。据报告,这项工作符合SCARE标准。
方法:42岁男性高血压,按职业划分的店主,没有成瘾史,没有拔牙或外伤,以左侧颊粘膜结节性病变为主诉5年。在临床检查中,足够的张口,有2.4×2厘米界限好的牙本质患者,结节状,非招标,左颊粘膜靠近上肺泡可见良性病变。覆盖的粘膜看起来正常,没有临床上可触及的颈淋巴结病。组织病理学显示唾液腺肿瘤有利于分泌性癌。MRI扫描显示左侧颊粘膜产生的分叶强化结节状病变,大小为2.3*1.3*1.7cm,靠近左上肺泡,不涉及任何骨髓浸润的皮质区域,双侧对称水平IIa反应性颈淋巴结。进行了广泛的局部切除和同侧选择性颈清扫[1、2、3级]。术后期间很顺利,没有观察到感觉异常的抱怨。最终组织病理学报告显示分泌性癌。来自I级的六个淋巴结中有两个对转移性癌呈阳性,没有额外的淋巴结延伸。肿瘤的最后阶段是pT1N2bMx。患者接受术后辅助放疗6周,共收到30份和6000厘格雷的总剂量。
■SC在临床上表现为无痛,无痛且症状持续时间长,粘膜正常。但组织病理学上有颈淋巴结转移。这改变了最终分期,并为该患者增加了辅助治疗。临床和病理诊断的差异可能是由于颊粘膜的小唾液腺中出现的SC的惰性临床行为。在目前的情况下,缺乏酶原颗粒和存在嗜酸性细胞浆和嗜酸性分泌物质的小细胞模式提示SC。
结论:本病例报告为一例罕见的颊粘膜小唾液腺SC,根据临床表现,这是缓慢的,但在最终的组织病理学报告中,它有宫颈淋巴结转移,改变了疾病的最终阶段,需要辅助放疗。尽管分泌性癌通常被认为具有良好的预后,并且被认为是低级别癌,复发和颈淋巴结转移的数量有限。但有时它们确实会转移到颈淋巴结,因此可以进行准确及时的颈淋巴结清扫术,以确定最终分期,并在需要时开始其他治疗方式,以获得更好的疾病结局。
UNASSIGNED: Secretory carcinoma (SC) is an uncommon salivary gland neoplasm of the oral cavity that microscopically may mimic acinic cell carcinoma (ACC) and mucoepidermoid carcinoma (MEC). Secretory carcinoma (SC) of the salivary gland has been recently added in fourth edition of the head and neck world health organization. Most of these tumors are located on the parotid gland with very few cases reported in the minor salivary glands of the buccal mucosa. This work has been reported in line with the SCARE criteria.
METHODS: A 42 years old hypertensive male, shop keeper by occupation, with no prior addiction history, no dental extraction or trauma, presented with complaint of nodular lesion on left buccal mucosa for five years. On Clinical examination, adequate mouth opening, dentulous patient with 2.4 × 2 cm well circumscribed, nodular, non-tender, benign looking lesion was observed on left buccal mucosa near upper alveolus. Overlying mucosa appeared normal with no clinically palpable cervical lymphadenopathy. Histopathology revealed salivary gland neoplasm favoring secretory carcinoma. MRI scan showed lobulated enhancing nodular lesion arising from left buccal mucosa of size 2.3 ∗ 1.3 ∗ 1.7 cm, close to left superior alveolus without involving any cortical areas of marrow infiltration, with bilateral symmetrical level IIa reactive cervical nodes. Wide local excision and ipsilateral selective neck dissection [level 1, 2, 3] was done. Post-operative period was smooth with no complain of paresthesia observed. The final histopathology report showed secretory carcinoma. Two out of six lymph nodes from level I were positive for metastatic carcinoma with no extra nodal extension. Final stage of the tumor was pT1N2bMx. Patient underwent post-operative adjuvant radiotherapy for period of 6 weeks, received total 30 fractions and total dose of 6000 centigray.
UNASSIGNED: SC behaved clinically an indolent being painless and having long duration of symptoms with normal overlying mucosa. But histopathologically there was cervical node metastasis. That changed final staging and added adjuvant treatment for this patient. The discrepancy in clinical and pathological diagnosis might be due to the indolent clinical behavior of SC arising in the minor salivary gland of buccal mucosa. In the present case, the absence of zymogen granules and presence of microcytic pattern with eosinophilic cytoplasm and eosinophilic secretory material were suggestive of SC.
CONCLUSIONS: This case report represents a rare case of SC of minor salivary glands of buccal mucosa, which was indolent as per clinical presentation but on final histopathological report it had cervical nodal metastasis that changed the final stage of the disease, for which adjuvant radiotherapy was needed. Although Secretory carcinomas are generally considered having a favorable prognosis and are regarded as low- grade carcinomas with limited number of recurrence and cervical nodal metastasis, but sometimes they do metastasize to cervical nodes for which accurate and timely intervention in the form of neck dissection may be performed to establish final staging and start additional treatment modality if required for better outcome of the disease.