口腔病理科 On-Line KMU Student Bulletin
原文題目(出處)： Metastasizing pleomorphic adenoma of the parotid gland (Br J Oral Maxillofac Surg 2007;45:65-7)
原文作者姓名： T.Sabesan , P.L.Ramchandani , K.Hussein
通訊作者學校： Department of oral and maxillofacial surgery, Department of
Histopathology, Poole General Hospital, Longfleet Road, Poole, Dorset BH15 2JB,UK
報告者姓名(組別)： 實習H組 曾上純
報告日期： 96/07/10
前言
Pleomorphic adenoma 又 稱 作 benign mixed tumor, 占 唾 液 腺 良 性 腫 瘤 中 絕大多數比例(40-70%),既然是良性腫瘤,理論上不會有轉移情形出現,然而少數發 生轉移,這些metastasise pleomorphic adenoma通常有以下特性: (1) 於primary tumor出現的多年後才被發現有轉移的情況;(2)有單一或多個局部復發情形;(3)最 常轉移到的地點是骨頭或肺部。
個案 本文即將討論這少數的特例 Age / Gender 61 / ♂ Physical condition Fit , Well Previously condition 28 yrs ago
‧L’t superficial parotidectomy for pleomorphic adenoma
‧healed well and symmetrical facial expression with
uneventful subsequence
Presently condition Painless swelling over L’t supraclavicular fossa for 10 months
Physical examination ‧Mobile,nontender,rubbery nodule in normal color aboub 2cm in diameter
‧MRI Æ no abnormality
‧CT Æ no abnormality
Histological examination Benign pleomorphic adenoma within lymph node
討論
(1) 這 種 腫 瘤 發 生 轉 移 的 例 子 很 少 , 臨 床 上 診 斷 出 primary 與 metastasis pleomorphic adenoma中間早已間隔一段很長的時間,不過90%的metastasis pleomorphic adenoma會在primary site處出現復發情形,此乃轉移型的典型特 色。轉移型最常出現的位置是在骨頭或肺部。
(2) 臨床上或組織影像區分不出primay與metastasis之間的差異,因此有學者建議 從細胞分化程度來做區分,但未被國際接受。有學者則認為之所以會發生轉 移型pleomorphic adenoma在於primary tumor 的部份細胞透過血型性路徑或 淋巴路徑到達他處,形成遠端轉移或局部復發。實驗上也證實這類想法:將人 類pleomorphic adenoma cell轉殖到裸鼠體內,結果發現tumor cell即使在它處 也生長良好。臨床上則發現,若有將primary pleomorphic adenoma清除乾淨, 其預後相當良好也無復發情形出現。種種結論都佐證當初的推論,因此,將 tumor徹底清除且避免手術過程中將tumor cell透過血液路徑或淋巴路徑移轉
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口腔病理科 On-Line KMU Student Bulletin
到他處,乃預防pleomorphic adenoma發生轉移的不二法門。
題號 題目
1 Which statement about pleomorphic adenoma is incorrect?
(A) Most common salivary neoplasm
(B) Tumor over deep lobe of the parotid, local enucleation should be suggested and preservation of the facial n. is necessary
(C) Submandibular tumors are best treated by total removal of the gland with the tumor (D) Risk of recurrence appears to be lower for tumors of minor salivary gland
答案(B) 出處：oral & maxillofacial pathology 2nd edition
題號 題目
2 Which statement about pleomorphic adenoma is incorrect?
(A) Is a painless, slowly growth ,firm mass, initial mobile but becomes less mobile if it get bigger and bigger
(B) Palate is most common site for major salivary gland tumor
(C) Is a well circumscribed, encapsulated tumor, but the capsule may be incomplete or show infiltration by tumor cell
答案(B) 出處：oral & maxillofacial pathology 2nd edition
補充:
Pleomorphic adenoma
age 30-50 young adult
gender Slightly Female
site Major salivary gland (大多數)
Superficial lobe of parotid gland Æswelling over preauricular
Minor salivary gland (少數) Palate is most common
Æsmooth surface, dome shaped mass
Clinical features
◎ painless, slowly growth ,firm mass
◎ initial mobile Æ mass越變越大則less mobile Histologic
features ◎ well circumscribed, encapsulated tumor
◎ glandular epi. & myoepithelial cells within stroma background
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