Malignant Myoepithelioma of Soft Palate: A Case Report

軟顎之惡性肌上皮瘤：病例報告

林佳輝(Chia-Hui Lin) ； 林立青(Li-Ching Lin) ； 張慶雄(Ching-Hsiung Chang) ； 胡渝昌(Yu-Chang Hu) ； 陳建勳(Chien-Hsun Chen) ； 林奎利(Khuei-Li Lin) ； 郭珍妮(Jenny Que) ； 梁頌文(Chung-Man Leung)

《放射治療與腫瘤學》 16卷2期 (2009/06) Pp. 157-163

https://doi.org/10.6316/TRO/200916(2)157

摘要

惡性肌上皮瘤為一罕見之腫瘤，大部分發生在腮腺，且佔所有惡性唾液腺腫瘤不到1%。這裡我們報告一位軟顎之惡性肌上皮瘤的病例。一位36歲女性，有長達4年的軟顎無痛腫塊之病史，於1998年5月來本醫院求診，經切片檢查初步診斷為多形性腺瘤。不過於1998年9月經腫瘤切除後確定診斷為肌上皮瘤。於2001年發現右側頜下腺部位有淋巴腫塊，並接受細針抽吸細胞學檢查，結果診斷為由鼻咽轉移過來的未分化鱗狀上皮細胞癌。於是該病患接受同步放射線與化學治療，並於2001年12月治療結束。經過四個月後，仍有殘餘的淋巴腫塊，經手術切除後，病理診斷為惡性肌上皮瘤。在2005年1月的電腦斷層檢查發現上頜部鼻竇與顎部有腫瘤，經過手術切除後，確定為惡性肌上皮瘤之復發。在2007年10月的電腦斷層檢查發現上頜部鼻竇有腫瘤，經過手術切除後，確定為局部復發。該病患於手術後接受放射線治療28次，總劑量為50.4格雷，並於2008年1月治療結束。經過8個月後，電腦斷層檢查發現右側杓會厭襞部位有腫瘤，經過手術切除後，確定為惡性肌上皮瘤之復發。手術後到2009年2月的最後一次門診追蹤期間，都沒有發生腫瘤復發。

關鍵字

惡性肌上皮瘤 ； 軟顎 ； 唾液腺腫瘤

並列摘要

Malignant myoepithelioma, a rare tumor mostly located in the parotid gland, accounts for less than 1% of salivary gland neoplasms. Here, we report a case of malignant soft palate myoepithelioma. A 36-year-old woman had a painless mass over the soft palate for 4 years: she first visited our hospital in May 1998; received a biopsy; and was initially diagnosed with pleomorphic adenoma. After local excision of the tumor in September 1998, the myoepithelioma was confirmed. Lymph nodes over the right submandibular area were subsequently identified in 2001. Using fine needle aspiration, undifferentiated squamous cell carcinoma of nasopharyngeal origin was ascertained. The patient underwent a course of concurrent chemoradiotherapy ending in December 2001. Four months later, residual lymph nodes were excised. The tumor cells were diagnosed as malignant myoepithelioma. A CT scan in January 2005 showed a mass lesion in the right maxillary sinus and palate. Wide excision confirmed the diagnosis of recurrent malignant myoepithelioma. A further CT scan in October 2007 showed a mass involving the right maxillary sinus. After wide excision, local recurrence was confirmed. Local radiotherapy in a dose of 50.4 Gy in 28 fractions was initiated and ended in January 2008. Eight months later, a CT scan asserted a mass in the right aryepiglottic fold. After excision, recurrent malignant myoepithelioma was confirmed. This patient was free of the disease in the last OPD follow-up in February 2009.

並列關鍵字

Malignant myoepithelioma ； soft palate ； salivary gland tumor