口腔腺鱗狀癌－病例報告

Adenosquamous Carcinoma of Maxillary Gingiva and Palate-A Case Report

李俊瑩(Chun-Yin Lee) ； 李芳儀(Fang-Yi Lee) ； 蕭應良(Ying-Lyung Hsiao)

《臺灣口腔顎面外科學會雜誌》 23卷2期 (2012/06) Pp. 135-145

https://doi.org/10.7104/TJOMS.201206.0135

摘要

腺鱗狀癌在頭頸部為相當罕見，歸屬於高侵犯性之鱗狀上皮細胞癌，以其獨特病理特徵可同時分別存在腺癌及鱗狀上皮細胞癌這兩類惡性腫瘤。最常見的臨床特徵為口腔黏膜潰瘍，因其腫瘤本質的具高侵犯性及早期轉移的情形，預後相對較差。腺鱗狀癌的病因也尚未有定論。本病例是一位62歲女性，其主訴為4個月前拔除左上顎第二大臼齒後傷口未癒合，3個禮拜前發現在上顎左側牙齦具有無痛性表面潰瘍，大小約為3公分×2公分之不規則腫塊。過去病人並無抽菸、喝酒及吃檳榔等不良習慣。環口X光可見齒糟骨破壞，電腦斷層亦可見黏膜增厚及疑似頸部淋巴結轉移情形。初次切片為口腔鱗狀上皮細胞癌，最後手術病理報告更正為腺鱗狀癌，並可見同時出現並分隔開之鱗狀上皮細胞癌及深部腺癌兩種截然不同的腫瘤細胞表現。頸部亦有兩顆轉移之淋巴結。因腎上腺腫瘤手術緣故，延遲至術後2個月才開始接受化療及放射線治療目前仍持續追蹤治療中。診斷方面，腺鱗狀癌必須與粘液表皮樣癌做區隔，前者預後較差更須積極治療。本病例有部分檢體尚可觀察到上皮細胞癌轉化而成腺癌之證據。

關鍵字

腺鱗狀癌 ； 牙齦癌 ； 口腔

並列摘要

Adenosquamous carcinoma of the head and neck is a rare but aggressive variant of squamous cell carcinoma, which is characterized by mixed differentiation with both squamous cell carcinoma and true adenocarcinoma. The most common manifestation in oral cavity is a painful mucosa ulceration. Because of the aggressive feature and high rate of early metastasis and infiltrative nature, it attributes to poor prognosis. The histogenetic origin of adenosquamous carcinoma has been debated for years and is still undetermined. In our case, we report a 62 year-old female presented with an unhealed extraction wound of left upper second molar from 4 months ago and found a painless ulceration over the left maxillary gingiva during oral examination. The ulceration was measured about 3 cm x 2 cm in size with ill-defined border. No smoking, alcoholic consumption or betel nut chewing habits were told. Panoramic film showed bony destruction of alveolar ridge. Computed tomography showed infiltrative feature of mucosa and suspected lymph node metastasis. Initial biopsy result revealed squamous cell carcinoma. After surgical intervention, the final surgical report was adenosquamous carcinoma with distinct features of squamous cell carcinoma and adenocarcinoma. Two metastatic lymph nodes were found. Followed by surgery, she was planned to receive both chemotherapy and radiotherapy. The differentiation of adenosquamous carcinoma and mucoepidermoid carcinoma was crucial for diagnosis due to poor prognosis in the former and needed to be properly treated. The histological feature of mucoepidermoid carcinoma was not found in our case. Moreover, we found the suspected evidence of the histological origin of adenosquamous carcinoma. This may be enormously helpful for the determination of the origin of this neoplasm.

並列關鍵字

adenosquamous carcinoma ； gingival cancer ； oral cavity