左顎下腺原發鱗狀細胞癌－病例報告

發生於大唾液腺的原發鱗狀細胞癌十分罕見，腫瘤來源大多由良性腫瘤轉變而來。一般好發於腮腺及顎下腺，男性比率大於女性，好發年齡約爲50-60歲。診斷須先排除黏液表皮樣癌及其他遠處惡性腫瘤的侵犯或轉移。腫瘤發生初期不易察覺，少有疼痛或不適感，故常延誤治療時機而導致極高的局部復發及遠端轉移比率。治療方式以手術廣泛性切除及術後輔助放射線治療及化學治療爲主。本文提出一位64歲男性，在左側頸部顎下區發現一無痛腫塊，術中冷凍切片爲惡性腫瘤，故接受廣泛性手術切除及舌骨上林巴廓清術，術後病理報告爲鱗狀細胞癌。經全身檢查並與發現其他相關遠處惡性腫瘤，故診斷爲左顎下腺原發鱗狀細胞癌。術後接受輔助性放射線及化學治療，至民國98年7月並與復發及遠端轉移，持續於門診追蹤中。

關鍵字

原發鱗狀細胞癌；唾液腺

並列摘要

Primary squamous cell carcinoma of the salivary gland is a rare, aggressive malignancy with poor prognosis, represented 0.9 to 4.70% of the salivary gland tumor. The diagnosis is made after excluding direct invasion from adjacent tumor in the head and neck or metastasis from oral or other distant primary carcinoma. The average age of the patients is between 50 to 60 years, with strong male predilection. We present a case of primary squamous cell carcinoma in the left submandibular region in a 64-year-old male. He presented with a 20- year history of a very slowly growing mass in the left submandibular region. The CT image showed some calcified granules and heterogeneous structure inside the left submandibular gland. The clinical impression was sialolithiasis or malignant tumor. The lesion was excised with safe margin and the upper neck dissection was performed, too. Histopathologically, the tumor was composed of squamous cell carcinoma with dyskeratosis, keratin pearl, central necrosis and perineural invasion was seen. The diagnosis was squamous cell carcinoma with no neck lymph node metastasis. After the surgery, systemic review showed no malignant tumor in the other part of the body. He received concurrent chemoradiotherapy after the surgery. Based on the clinical history, systemic examination and the histopathology, the final diagnosis is primary squamous cell carcinoma of the left submandibular gland. The patient is now being followed in our out patient department and no local recurrence and distant metastasis was noted.

並列關鍵字

primary squamous cell carcinoma ； salivary gland

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左顎下腺原發鱗狀細胞癌－病例報告

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