下顎骨區唾液腺管癌－病例報告

Salivary Duct Carcinoma in the Mandible-A Case Report

施亦倫(Yi-Lun Shih) ； 陳玉昆(Yuk-Kwan Chen) ； 陳中和(Chung-Ho Chen)

《臺灣口腔顎面外科學會雜誌》 21卷4期 (2010/12) Pp. 321-332

https://doi.org/10.7104/TJOMS.201012.0321

摘要

唾液腺管癌爲一罕見之唾液線管的高度惡性腫瘤，腫瘤具侵才。性且預後很差。好發於腮線區，次爲頷下線。若發源於小唾液線，且爲顎骨內之異位腺體實爲罕見。本病例報導一位32歲男性，主訴左下顎後牙區感到不適約兩個月之久，臨床外觀及。內皆與明顯病灶或腫塊。環口X光片顯示左下第三大臼齒至下顎骨直支一約3×2公分、邊界明顯、單腔室放射線透過性影像，且初診後六個月，病灶持續性擴大。初步診斷爲含齒囊腫，手術的施行方式爲經口內作病灶切除及人工骨粉填補。術後病理報告證實爲下顎骨唾液線管癌，考量其極具侵犯性且邊緣殘留腫瘤組織，遂安排第二次手術，術式爲從口顎下切線，做下顎骨片段式切除，及淋巴切除術，並以骨板及人工關節頭重建，另加以顎間因定三週。術後傷。恢復良好，顎骨關係穩定無咬合異常的情況，但病患有輕度張口受限的問題。術後全身正子攝影檢查報告排除遠端轉移，或其他原發性病灶。本病例殊屬罕見，目前查詢文獻僅發表兩例，特提出報告及相關文獻回顧。

關鍵字

唾液腺管癌

並列摘要

Salivary duct carcinoma (SDC) is a rare but high grade malignant neoplasm of the salivary glands with aggressive behavior and a high mortality rate. The tumor is most often located in the parotid glands, followed by the submandibular glands. It is less common in the minor salivary glands and this kind of tumor in the mandible is even rare. The origin of the tumor in this case study was either from the retromolar gland or ectopic minor salivary gland which had occurred erroneously in the mandible. We present a 32-year-old man who suffered from painful sensation over his left posterior teeth for a period of two months. On clinical examination, there were no obvious lesion or swelling mass. Panoramic radiography revealed a well circumscribed, unilocular radiolucency about 30×20 mm in size lesion over the left lower 3rd molar which extended to the ramus area. Six months later, the lesion had gotten progressively larger. The initial diagnosis was a dentigerous cyst. Surgical excision and artificial bone graft used for the bony defect were carried out. The post-operative histology report confirmed salivary duct carcinoma. Considering it’s potentially behavior and the possibility of residual tumor tissue, another operation was scheduled. Via extra-oral approach, we applied segmental resection and lymphadectomy, and the mandibular defect was reconstructed with reconstruction plate and artificial joint. Three weeks post-op, the MMF was removed, and reveals that the wound had healed well and joint function was good without malocclusion. however, mild limitation of the mouth opening was found. The post-operative PET scan ruled out the possibility of a distant metastasis or other neoplasms. During follow-up of half a year, no recurrences were noted. Salivary duct carcinoma is very rare in the mandible, so we present this case for the purpose of further discussion.

並列關鍵字

salivary duct carcinoma