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腮腺,恶性肿瘤

(2009-07-25 23:31:32)
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Parotid, Malignant Tumors

腮腺,恶性肿瘤

Author: Scott Vanderheiden, MD, Consulting Radiologist, Radia Medical Imaging, Providence Everett Medical Center, Colby Campus

作者:Scott Vanderheiden ,医学博士,放射学家顾问,放射医学成像,埃弗雷特省医疗中心,科尔比校园
Contributor Information and Disclosures 投稿信息披露

Updated: Apr 20, 2009更新日期: 2009年4月20号

Introduction导言

Background背景

Parotid is a Greek word that means near the ear . Parotid glands are the largest of the salivary glands. They are paired glands that contain both mucus and serous cells and a ductal network. 1腮腺是一个希腊词指在耳朵附近。腮腺是最大的唾液腺。它们是成对腺体包含黏液和浆液性细胞和管道网络。 1

Pathophysiology病理生理学

Most primary tumors of the parotid glands arise from 1 of 2 histologic cell subtypes: epithelial tumors arising from ductal cells and glandular tumors from salivary unit cells.大多数原发肿瘤的腮腺起源于2个细胞亚型之一:上皮性肿瘤来源于导管上皮细胞和腺肿瘤细胞来源于唾液腺细胞。

 

 

Parotid, malignant tumors. Axial T1-weighted MRI demonstrates a low-signal-intensity mass in the left parotid gland. Pathology indicated mucoepidermoid carcinoma. 腮腺,恶性肿瘤。MRI检查轴向T1加权显示左侧腮腺低强度信号肿块。病理示黏液表皮样癌。

 

Parotid, malignant tumors. Axial contrast-enhanced CT scan shows an infiltrative mass involving the left parotid gland. Pathology indicated a parotid carcinoma. 腮腺,恶性肿瘤。轴向增强CT扫描显示,左腮腺浸润性肿块。病理示腮腺癌。

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The most common metastases to the intraparotid lymph nodes are from melanoma and squamous cell carcinoma of the head and neck.最常见的转移到腮腺内淋巴结的是黑色素瘤和头部和颈部的鳞状细胞癌。

Frequency发生率

United States美国

Malignant tumors of the parotid gland are rare. The incidence of salivary gland tumors is 1-2 cases per 100,000 people. Of these, 85% occur in the parotid gland, representing 0.6% of tumors in the body. 腮腺恶性肿瘤是罕见的。涎腺肿瘤的发病率是每10万人中1-2例。其中, 85 %发生在腮腺,占机体肿瘤的0.6 %。

Only 20% of parotid neoplasms are malignant. The most common malignant parotid neoplasm in adults is mucoepidermoid carcinoma, which represents almost one third of all malignant tumors. 只有20 %的腮腺肿瘤是恶性的。 成年人最常见的恶性腮腺肿瘤是粘液表皮样癌,占所有恶性肿瘤的近三分之一。

Mortality/Morbidity死亡率/发病率

Depending on the histologic type and tumor grade, the morbidity and mortality can vary greatly. Some benign tumors can be aggressive locally and recur following their removal. Morbidity is proportional to the degree of invasion at the time of detection. 根据不同的病理类型和肿瘤分级,发病率和死亡率的差别很大。有些良性肿瘤可局部侵犯和术后复发。发病率和发现时的侵袭程度成正比。

  • Some malignant tumors are slow growing with high 5-year survival rates in patients. Poor prognostic signs are the following: (1) high-grade tumor, (2) lymph node or distant metastasis at diagnosis, (3) facial nerve paralysis, (4) skin involvement, (5) high tumor stage, (6) deep lobe involvement, and (7) recurrent tumor. 一些恶性肿瘤的患者肿瘤生长缓慢有高5年生存率。具以下情况预后不良: ( 1 )高分化肿瘤, ( 2 )诊断时有淋巴结或远处转移, ( 3 )面神经麻痹, ( 4 )侵犯皮肤, ( 5 )高肿瘤分期, ( 6 )侵及深叶,和( 7 )复发肿瘤。
  • Pain does not indicate that a neoplasm is malignant; however, in patients with known malignancy, pain is a poor prognostic sign.疼痛不提示肿瘤是恶性;然而,在已知的恶性肿瘤患者,疼痛是一种预后不良的迹象。

Race种族

Eskimos are at increased risk for undifferentiated lymphoepithelial carcinoma.爱斯基摩人未分化的淋巴上皮癌风险高。

Sex性别

Overall, parotid tumors are slightly more common in women than in men.总体而言,腮腺肿瘤女性比男性略更常见。

Age年龄

Most parotid tumors occur in patients aged 30-70 years. Parotid tumors are more likely to be malignant in children (approximately 35%) than in adults. 大多数腮腺肿瘤发生在年龄30-70岁。腮腺肿瘤发生在儿童的恶性的可能性(大约35 % )高于成年人。

  • The most common malignant parotid tumors in adults are the following: (1) mucoepidermoid carcinoma, (2) adenoid cystic carcinoma, and (3) malignant mixed tumor.最常见的成人恶性腮腺肿瘤如下: ( 1 )黏液表皮样癌, ( 2 )腺样囊性癌,以及( 3 )恶性混合瘤。
  • The most common malignant parotid tumors in children are the following: (1) mucoepidermoid carcinoma, (2) acinic cell carcinoma, and (3) undifferentiated carcinoma. 在儿童最常见的恶性腮腺肿瘤如下: ( 1 )黏液表皮样癌, ( 2 )腺泡细胞癌,以及( 3 )未分化癌。

Anatomy解剖

The parotid gland is enveloped by the superficial layer of the deep cervical fascia. The gland is artificially divided into the superficial (80%) and deep (20%) lobes, which are separated by the facial nerve. The deeper portion of the gland lies between the anterior border of the sternocleidomastoid and the posterior belly of the digastric muscles. Most of the gland is located posterior and lateral to the ascending ramus and angle of the mandible. The Stensen duct drains the ductal system of the parotid and enters the oral cavity near the upper second molar tooth. Several lymph nodes normally are present within each gland. 腮腺由颈深筋膜的浅层包绕。人为地以面神经为界把腺体分成浅叶( 80 % )和深叶( 20 % )。腮腺的深部介于胸锁乳突肌的前缘和后部的二腹肌后腹。腮腺大部分位于下颌骨的上升支侧部和下颌角的后部。腮腺胆道系统通过 Stensen导管进入口腔上部第二臼齿附近。淋巴结通常存在在每个腺体。

Presentation表现

A typical parotid malignancy is a painless, unilateral enlargement of the gland The purpose of radiologic examination is to define the size and anatomy of the mass, differentiate the intraglandular origin from extraglandular origin, determine its benign and malignant characteristics, and provide important preoperative information such as the location of the facial nerve. 典型的腮腺恶性肿瘤是无痛性,单侧腺体增大。  放射学检查2的目的是确定肿块的大小和解剖关系,区分腺内来源还是腺外来源,确定其良恶性的特点,提供了重要的术前信息像面神经的关系。 2

The workup begins with a history and physical examination.该病情的检查始于病史和体格检查。 FNA of the mass may be performed.可进行肿块细针穿刺大众。 The accuracy of FNA for diagnosis depends strongly on the quality of the specimen and the experience of the cytopathologist.活检诊断的准确的依赖于标本的质量和细胞病理学家的经验。cytopathologist 。 Bartels et al reported no increase in accuracy by adding FNA to cross-sectional imaging study.巴特尔斯等人报告增加活检并不能增加横断面成像研究的准确性。

Preferred Examination首选检查

CT and MRI are the modalities of choice for imaging parotid neoplasms. Both have sensitivities that approach 100%. Both modalities have the ability to depict the entire gland and concomitantly show the contralateral gland. CT和MRI是腮腺肿瘤的检查形式。两者的敏感性均接近100 % 。 3这两种形式都可描述整个腺体,同时显示对侧腺。 3

Each modality has special benefits and limitationsMRI is the preferred modality for uating a painless parotid mass. CT is well suited for uating recurrent, tender parotid masses that can be inflammatory. Plain radiographs or CT demonstrate invasion the earliest. Nuclear medicine studies lack the resolution to show bony invasion. Most malignant tumors are cold on scintigraphy. Combining fine-needle aspiration (FNA) with MRI offers no greater accuracy compared with that of either test alone. .每个形式具有特殊利益和局限性。MRI在评估无痛腮腺肿块较优。CT是非常适合用于评估复发、可能是炎症的痛性腮腺的肿块。X线或CT可最早提示侵犯。核医学对骨侵犯缺乏分辨率。闪烁扫描术中恶性肿瘤为冷显像。 4 , 5细针穿刺(活检)与MRI结合比单独检查精确度高。 45

Limitations of Techniques技术局限性

On CT or MRI, many malignant tumors, such as acinic cell carcinomas or low-grade mucoepidermoid carcinomas, appear indistinguishable from benign tumors, such as pleomorphic adenomas.对CT或MRI ,许多恶性肿瘤,如腺泡细胞癌或低度粘液癌,似乎不易区分良性肿瘤,如多形性腺瘤。

Differential Diagnoses鉴别诊断

Branchial Cleft Cysts 鳃裂囊肿
Cystic Hygroma 囊性水瘤
Liposarcoma, Soft Tissue 脂肪肉瘤,软组织
Parotid, Pleomorphic Adenoma 腮腺,多形性腺瘤
Schwannoma, Cranial Nerve 神经鞘瘤,颅神经

Other Problems to Be Considered其他需要考虑的问题

Malignant or premalignant parotid neoplasms 恶性或癌前腮腺肿瘤

Carcinoma ex pleomorphic adenoma多形性腺瘤癌
Malignant mixed tumor恶性混合瘤
Mucoepidermoid carcinoma粘液表皮样癌
Adenoid cystic carcinoma腺样囊性癌
Acinic cell carcinoma腺泡细胞癌
Polymorphous low-grade adenocarcinoma多形性低度恶性腺癌
Salivary duct carcinoma涎腺导管癌
Basal cell adenocarcinoma基底细胞腺癌
Adenocarcinoma, not otherwise specified腺癌,除非另有规定
Clear cell carcinoma透明细胞癌
Epithelial myoepithelial carcinoma上皮肌上皮癌
Sebaceous neoplasm of salivary gland origin皮脂腺涎腺肿瘤起源
Primary squamous cell carcinoma原发性鳞状细胞癌
Metastasis转移
Lymphoma淋巴瘤

Benign neoplasms 良性肿瘤

Warthin tumor or adenolymphoma沃辛瘤或腺淋巴瘤
Oncocytoma嗜酸细胞瘤
Oncocytic papillary cystadenoma嗜酸细胞乳头状囊腺瘤
Myoepithelioma肌上皮瘤
Sialadenoma papilliferum Sialadenoma汗腺瘤
Inverted ductal papilloma倒导管乳头状瘤
Lipoma脂肪瘤
Schwannoma and neurofibroma神经鞘瘤和神经纤维瘤
Hemangioma血管瘤

Granulomatous diseases 肉芽肿疾病
Sarcoid Sarcoid 肉样瘤
Tuberculosis结核病
Cat scratch disease猫抓病
Actinomycosis放线菌

Vascular and lymphatic malformations 血管和淋巴管畸形

Arteriovenous malformation动静脉畸形
Hemangioma血管瘤
Lymphangioma淋巴管瘤

Other considerations 其他情况

Inflammatory disease炎症性疾病
Parotid cysts腮腺囊肿
Sialadenosis Sialadenosis 唾液腺病
Hyperplasia or hypertrophy of salivary glands增生或肥大的唾液腺
Sj?gren syndrome干燥综合征
Mikulicz disease or sicca syndrome Mikulicz病或干燥综合征

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