下頷腺的多型性腺瘤癌─病例報告

Carcinoma ex Pleomorphic Adenoma in Submandibular Gland-A Case Report

游淳凱(Chun-Kai Yu) ； 黃弘昌(Hong-Chang Huang) ； 涂曦丰(His-Feng Tu)

《臺灣口腔顎面外科學會雜誌》 31卷3期 (2020/09) Pp. 226-234

摘要

多型性腺瘤為唾液腺中最常見之良性腫瘤，多數發生於腮腺，而下頷腺大約只有5到10％的發生機率。多型性腺瘤癌與原發性或是復發性的多型性腺瘤有關，多數病患有長時間的多型性腺瘤或因多型性腺瘤而接受過手術的歷史。臨床表徵上，多型性腺瘤癌生長較為快速且容易伴隨疼痛的發生，若是發生於腮腺可能有顏面神經麻痺的症狀。術前檢查方面以影像學檢查及穿刺抽吸檢查為主，但因不易與多型性腺瘤做出區別，組織免疫染色檢查可協助做出鑑別診斷。目前的治療方式以手術切除搭配術後放射線治療為主。五年存活率約有44到76％、十年存活率約有31％。本病例報告為一86歲女性多年已發現左側頸部下頷下方有一腫塊，去年因胃癌於本院接受手術切除治療後，腫塊開始持續變大。經超音波導引穿刺切片後，免疫染色檢查為CK7（+）、CK20（-）、Ck5/6（-），病理學初步診斷為唾液腺惡性腫瘤。經手術切除病灶及淋巴結清除後，病理學診斷為下頷腺多型性腺瘤癌。病患術後傷口復原良好，術後持續定期回診追蹤並無復發之情形。本文提出此病例報告並進行相關的文獻回顧及討論。

關鍵字

多型性腺瘤癌 ； 下頷腺 ； 多型性腺瘤 ； 組織免疫學檢查

並列摘要

Pleomorphic adenoma is the most common benign tumor in salivary gland, and is especially common in the parotid gland. Pleomorphic adenoma in submandibular gland is about 5 to 10%. Carcinoma ex pleomorphic adenoma is a carcinoma arising from a primary or recurrent benign pleomorphic adenoma. Most cases have history of long time pleomorphic adenoma or surgical treatment. Carcinoma ex pleomorphic adenoma has physical symptom and sign as rapid growth mass with pain and facial nerve numbness while lesion is occurred in parotid gland. Physical and radiographic examinations include aspiration and computerized tomography (CT). It is difficult to take differential diagnosis from pleomorphic adenoma; therefor, immunohistochemistry should be taken. Current treatment of carcinoma ex pleomorphic adenoma is surgical excision with or without local radiation therapy. Five year survival rate is 44 to 76% while 31% of ten year survival rate. We reported a case of 86-year-old female patient who suffered a mass over left submandibular area for years. After she took surgical treatment of gastric adenocarcinoma last year, she noticed that the mass over left submandibular area became bigger. After sono-guided biopsy was performed and immunohistochemistry reported as CK7(+), CK20(-), Ck5/6(-), carcinoma of submandibular gland was suspect. Carcinoma ex pleomorphic adenoma was ruled out. After taking surgical treatment of wide excision and neck dissection in our hospital, pathologic report revealed carcinoma ex pleomorphic adenoma. Post-surgery regular observation was arranged in out-patient department. We report a case of carcinoma ex pleomorphic adenoma and review several published literature.

並列關鍵字

Carcinoma ex pleomorphic adenoma ； Submandibular gland ； Pleomorphic adenoma ； Immunohistochemistry