北京大学学报(医学版) ›› 2022, Vol. 54 ›› Issue (2): 335-339. doi: 10.19723/j.issn.1671-167X.2022.02.022

• 论著 • 上一篇    下一篇

腮腺微小肿瘤的临床病理研究

李炳雨,唐祖南,胡耒豪,章文博,于尧,俞光岩,彭歆()   

  1. 北京大学口腔医学院·口腔医院口腔颌面外科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔生物材料和数字诊疗装备国家工程研究中心,口腔数字医学北京市重点实验室,北京 100081
  • 收稿日期:2020-10-13 出版日期:2022-04-18 发布日期:2022-04-13
  • 通讯作者: 彭歆 E-mail:pxpengxin@263.net

Clinicopathologic analysis of micro and mini parotid gland tumors

LI Bing-yu,TANG Zu-nan,HU Lei-hao,ZHANG Wen-bo,YU Yao,YU Guang-yan,PENG Xin()   

  1. Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Research Center of Oral Biomaterials and Digital Medical Devices & Beijing Key Laboratory of Digital Stomatology, Beijing 100081, China
  • Received:2020-10-13 Online:2022-04-18 Published:2022-04-13
  • Contact: Xin PENG E-mail:pxpengxin@263.net

摘要:

目的: 探讨直径≤20 mm的体积微小的腮腺肿瘤临床病理特点,为临床诊疗提供参考依据。方法: 选择2012年12月至2020年4月于北京大学口腔医院口腔颌面外科手术治疗的腮腺肿瘤患者,收集术前CT检查肿瘤直径≤20 mm的患者相关临床资料,根据肿瘤直径大小分为直径11~20 mm组与直径≤10 mm组,对两组进行临床随访,比较一般情况、临床病理特点及预后。结果: 共收集原发性上皮性腮腺肿瘤患者2 067例,其中肿瘤直径≤20 mm者有685例(33.1%),男女性别比例为1 ∶1.93,平均年龄(45.3±13.8)岁(12~83岁),中位病程12个月(1周至30年)。685例中良性肿瘤635例(92.7%), 恶性肿瘤50例(7.3%),良恶性比例为12.7 ∶1;最常见的良性肿瘤为多形性腺瘤,最常见的恶性肿瘤为黏液表皮样癌。肿瘤直径≤10 mm的患者有74例,占肿瘤直径≤20 mm患者的10.8%(74/685)。肿瘤直径11~20 mm组(n=611)和≤10 mm组(n=74)患者的一般情况及病理学分型比较提示,两组在性别、年龄、病程上差异均无统计学意义(P>0.05)。直径11~20 mm组患者良性肿瘤占92.8%(567/611), 恶性肿瘤占7.2%(44/611), 良恶性比例为12.9 ∶1;直径≤10 mm组良性肿瘤占91.9%(68/74), 恶性肿瘤占8.1%(6/74),良恶性比例为11.3 ∶1,两者间差异无统计学意义(P>0.05)。对50例恶性肿瘤患者进行临床随访,中位随访时间为39.5个月(1~91个月),有2例患者局部复发,其中1例死亡,总体2年生存率为93.7%, 5年生存率为89.3%。结论: 直径≤20 mm的体积微小的腮腺肿瘤以良性多见,手术是主要治疗手段,其中的腮腺恶性肿瘤预后良好,应积极进行早期手术治疗。

关键词: 腮腺肿瘤, 肿瘤体积, 病理学, 临床

Abstract:

Objective: To investigate the clinicopathological characteristics of micro and mini parotid gland tumors and to provide reference for their clinical diagnosis and treatment. Methods: Patients with parotid gland tumors treated in the Department of Oral and Maxillofacial Surgery, Peking University School and Hospital of Stomatology from December 2012 to April 2020 were selected. Relevant clinical data of the patients with tumor diameter ≤20 mm detected by preoperative CT were collected to analyze the clinicopathological characteristics and prognosis of micro and mini parotid gland tumors. And the collected data were divided into two groups with diameter 11-20 mm and diameter ≤10 mm according to tumor diameter measured by preoperative CT. The clinicopathological differences between the two groups were statistically analyzed. Results: A total of 2 067 patients with primary epithelial parotid gland tumors were collected, and 685 patients with tumor diameter ≤20 mm were examined by CT, accounting for 33.1%. The ratio of male to female patients with micro and mini parotid gland tumors was 1 ∶1.93, the average age was (45.3±13.8) years (12-83 years), and the median course of disease was 12 months (1 week to 30 years). Among them, 635 cases (92.7%) were benign tumors, 50 cases (7.3%) were malignant tumors, and the ratio of benign to malignant was 12.7 ∶1. The most common benign tumor was pleomorphic adenoma, and the most common malignant tumor was mucoepidermoid carcinoma. The micro and mini parotid gland tumors were divided into 11-20 mm group (n=611) and ≤10 mm group (n=74), the clinical characteristics comparison of the two groups of gender ratio, average age, course of di-sease had no statistical difference (P>0.05). In the 11-20 mm diameter group, the percentage of benign and malignant tumor was 92.8% (567/611) and 7.2% (44/611) respectively, and the ratio of benign to malignant tumors was 12.9 ∶1. In the ≤10 mm diameter group, the percentage of benign and malignant tumor was 91.9% (68/74) and 8.1% (6/74) respectively, and the ratio of benign to malignant tumors was 11.3 ∶1. There was no significant difference between the two groups (P>0.05). Fifty patients with malignant tumor were followed up for the median follow-up period of 39.5 months (1-91 months). Local recurrence occurred in 2 patients with one death. The overall 2-year survival rate was 93.7% and the 5-year survival rate was 89.3%. Conclusion: The majority of micro and mini parotid gland tumors was benign lesion. There was a good prognosis for micro and mini parotid gland carcinoma. Early surgical treatment was recommended for micro and mini parotid gland tumors.

Key words: Parotid neoplasms, Tumor size, Pathology, clinical

中图分类号: 

  • R739.87

表1

直径11~20 mm及≤10 mm腮腺肿瘤患者的一般情况"

Items Diameter of tumor P
11-20 mm (n=611) ≤10 mm (n=74)
Gender (Male/Female) 215/396 19/55 0.103
Age/years 44.0±13.9 47.0±12.9 0.311
Course/months 12.0±38.8 11.0±35.7 0.386

表2

直径11~20 mm及≤10 mm腮腺肿瘤的病理类型"

Histological types Diameter of tumor Total (n=685)
11-20 mm (n=611) ≤10 mm (n=74)
Benign/Malignant ratio 12.9 ∶1 11.3 ∶1 12.7 ∶1
Benign, n(%)
Pleomorphic adenoma 383 (67.5) 39 (57.4) 422 (66.5)
Basal cell adenoma 96 (16.9) 21 (30.9) 117 (18.4)
Warthin tumor 70 (12.3) 0 70 (11.0)
Cystadenoma 7 (1.2) 2 (2.9) 9 (1.4)
Myoepithelioma 5 (0.9) 3 (4.4) 8 (1.3)
Non sebaceous lymphadenoma 3 (0.5) 0 3 (0.5)
Papillary cystadenoma 1 (0.2) 2 (2.9) 3 (0.5)
Oncocytoma 2 (0.4) 1 (1.5) 3 (0.5)
Total 567 (100.0) 68 (100.0) 635 (100.0)
Malignant, n(%)
Well-differentiated mucoepidermoid carcinoma 17 (38.6) 5 (83.3) 22 (44.0)
Intermediate differentiated mucoepidermoid carcinoma 2 (4.5) 0 2 (4.0)
Acinic cell carcinoma 10 (22.7) 0 10 (20.0)
Adenoid cystic carcinoma 4 (9.1) 0 4 (8.0)
Secretory carcinoma 3 (6.8) 0 3 (6.0)
Salivary duct carcinoma 2 (4.5) 0 2 (4.0)
Oncocytic carcinoma 2 (4.5) 0 2 (4.0)
Adenocarcinoma 1 (2.3) 0 1 (2.0)
Adenocarcinoma, NOS 1 (2.3) 0 1 (2.0)
Basal cell adenocarcinoma 0 1 (16.7) 1 (2.0)
CXPA 1 (2.3) 0 1 (2.0)
Squamous cell carcinoma 1 (2.3) 0 1 (2.0)
Total 44 (100.0) 6 (100.0) 50 (100.0)

图1

肿瘤直径≤20 mm的腮腺恶性肿瘤患者的生存曲线(n=50)"

[1] 俞光岩, 高岩, 孙永刚, 等. 口腔颌面部肿瘤[M]. 北京: 人民卫生出版社, 2002: 324-381.
[2] 陈志奎, 张秀娟, 黄静, 等. 高频超声诊断腮腺肿瘤[J]. 中国医学影像技术, 2011, 27(9):1775-1778.
[3] 张翔云, 保继荣. 腮腺区肿块影像学综合诊断的临床研究[J]. 广西医科大学学报, 2000, 17(2):231-232.
[4] Altin F, Alimoglu Y, Acikalin RM, et al. Is fine needle aspiration biopsy reliable in the diagnosis of parotid tumors? Comparison of preoperative and postoperative results and the factors affecting accuracy[J]. Braz J Otorhinolaryngol, 2019, 85(3):275-281.
doi: 10.1016/j.bjorl.2018.04.015
[5] 中国抗癌协会甲状腺癌专业委员会(CATO). 甲状腺微小乳头状癌诊断与治疗中国专家共识(2016版)[J]. 中国肿瘤临床, 2016, 43(10):405-411.
[6] 付鹏, 陈文, 崔立刚, 等. 2017版美国放射学会甲状腺影像学报告与数据系统应用价值探索[J]. 北京大学学报(医学版), 2019, 51(6):1067-1070.
[7] El-Naggar AK, Chan JK, Grandis JR, et al. WHO classification of tumors of head and neck tumours[M]. 4th ed. Lyon: IARC Press, 2017: 159-201.
[8] Wong DS. Signs and symptoms of malignant parotid tumours: An objective assessment[J]. J R Coll Surg Edinb, 2001, 46(2):91-95.
pmid: 11329749
[9] Cho HW, Kim J, Choi J, et al. Sonographically guided fine-needle aspiration biopsy of major salivary gland masses: A review of 245 cases[J]. Am J Roentgenol, 2011, 196(5):1160-1163.
doi: 10.2214/AJR.10.4256
[10] Rosai J. ROSAI & ACKERMAN外科病理学[M]. 北京: 北京大学医学出版社, 2014.
[11] Qin S. Guidelines on the diagnosis and treatment of primary liver cancer (2011 edition)[J]. Chin Clin Oncol, 2012, 1(1):10.
[12] 宋勇, 姚艳雯. 肺部小结节的诊断和治疗近况[J]. 中华肺部疾病杂志: 电子版, 2012, 5(4):295-299.
[13] Macmahon H. Guidelines for management of small pulmonary nodules detected on CT scans: a statement from the Fleischner Society[J]. Radiology, 2005, 237(2):395-400.
doi: 10.1148/radiol.2372041887
[14] 王俊, 刘彦国. 肺内小结节的诊治现状、问题和方向[J]. 中华胸心血管外科杂志, 2012, 28(7):385-386.
[15] 凌云, 张明琼, 李芳, 等. 高频彩超、钼靶联合MRI对降低乳腺微小癌漏诊误诊率的价值分析[J]. 检验医学与临床, 2016, 13(21):3004-3005.
[16] 薛杰, 曹小丽, 姜宏, 等. 甲状腺影像报告与数据系统联合超声弹性成像对甲状腺良恶性结节的诊断价值[J]. 中国医学影像学杂志, 2015, 23(5):351-355.
[17] Rago T, Santini F, Scutari M, et al. Elastography: New developments in ultrasound for predicting malignancy in thyroid nodules[J]. J Clin Endocrinol Metab, 2007, 92(8):2917-2922.
doi: 10.1210/jc.2007-0641
[18] 陈少卿, 刘钰, 黎军和, 等. 103例腮腺癌的治疗疗效和预后因素分析[J]. 中国肿瘤临床, 2014, 41(12):797-800.
[19] 皮正超, 李长青. 腮腺恶性肿瘤的术后放疗[J]. 中华放射肿瘤学杂志, 1995, 4(3):173-174.
[20] 温玉明, 陈润良, 王昌美. 腮腺多形性腺瘤腺体切除范围的病理依据[J]. 华西口腔医学杂志, 2003, 21(5):359-360.
[21] 俞光岩, 马大权. 腮腺肿瘤切除术的改进和发展[J]. 中华口腔医学杂志, 2007, 42(1):6-9.
[22] 高敏, 陈艳, 高岩, 等. 紧贴面神经的腮腺多形性腺瘤的临床病理特点及处理[J]. 北京大学学报(医学版), 2012, 44(1):43-46.
[1] 丁婷婷,曾楚雄,胡丽娜,余明华. 基于癌症基因组图谱数据库结直肠癌免疫细胞浸润预测模型的建立[J]. 北京大学学报(医学版), 2022, 54(2): 203-208.
[2] 薛江,张建运,时瑞瑞,谢晓艳,白嘉英,李铁军. 105例口腔颅颌面部纤维性结构不良的临床病理分析[J]. 北京大学学报(医学版), 2022, 54(1): 54-61.
[3] 魏慧,罗增,次旦央宗,白玛央金. 高原地区不同海拔高度腹型过敏性紫癜患者临床特征分析[J]. 北京大学学报(医学版), 2021, 53(6): 1072-1077.
[4] 宋志博,耿研,邓雪蓉,张晓慧,张卓莉. 肌肉骨骼超声在指导银屑病关节炎临床分型中的价值[J]. 北京大学学报(医学版), 2021, 53(6): 1061-1066.
[5] 刘梅歌,方朴,王严,丛璐,范洋溢,袁远,徐燕,张俊,洪道俊. 远端型遗传性运动神经病8例的临床、病理及遗传学特点[J]. 北京大学学报(医学版), 2021, 53(5): 957-963.
[6] 蒋艳芳,王健,王永健,刘佳,裴殷,刘晓鹏,敖英芳,马勇. 前交叉韧带翻修重建术后中长期临床疗效及影响因素[J]. 北京大学学报(医学版), 2021, 53(5): 857-863.
[7] 夏芳芳,鲁芙爱,吕慧敏,杨国安,刘媛. 系统性红斑狼疮伴间质性肺炎的临床特点及相关因素分析[J]. 北京大学学报(医学版), 2021, 53(2): 266-272.
[8] 高阳旭,孙青,李辉,谢瑶,姚红新,赵卫红. 儿童肝母细胞瘤多学科协作模式下的治疗效果及临床成本[J]. 北京大学学报(医学版), 2021, 53(1): 200-203.
[9] 甘雨舟,李玉慧,张丽华,马琳,何文雯,金月波,安媛,栗占国,叶华. 临床无肌病性皮肌炎与皮肌炎临床及免疫学特征比较[J]. 北京大学学报(医学版), 2020, 52(6): 1001-1008.
[10] 魏士雄,黎苏佳,刘毅. 幼年特发性关节炎成人后的临床特点及生物制剂治疗[J]. 北京大学学报(医学版), 2020, 52(6): 1014-1022.
[11] 程功,张霞,杨菲,程嘉渝,刘燕鹰. 以发热、关节炎、皮肤色素沉着为主要表现的血管免疫母细胞性T细胞淋巴瘤1例[J]. 北京大学学报(医学版), 2020, 52(6): 1150-1152.
[12] 刘毅,刘志坚,沈棋,吴静云,范宇,李德润,虞巍,何志嵩. 14例恶性潜能未定的前列腺间质肿瘤病例分析[J]. 北京大学学报(医学版), 2020, 52(4): 621-624.
[13] 郝一昌,颜野,张帆,邱敏,周朗,刘可,卢剑,肖春雷,黄毅,刘承,马潞林. 穿刺活检单针阳性的前列腺癌手术策略选择及经验总结[J]. 北京大学学报(医学版), 2020, 52(4): 625-631.
[14] 魏菱,邹东,陈虎,潘韶霞,孙玉春,周永胜. 一种数字化全口义齿的临床疗效评价[J]. 北京大学学报(医学版), 2020, 52(4): 762-770.
[15] 郑航慈,李晓桐,门鹏,马翔,王强,陈耀龙,翟所迪. 《严重过敏反应急救指南》临床问题与结局指标的收集和确定[J]. 北京大学学报(医学版), 2020, 52(4): 715-718.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 王新宇,崔哲,和清源,邓湘宁,郭歌,冯新恒,冯杰莉. 斑点追踪技术评价中国优秀男子举重运动员心脏的改变[J]. 北京大学学报(医学版), 2021, 53(5): 832 -837 .
[2] 刘云松,周倜,叶红强. 前牙美学修复的整体策略及细节剖析[J]. 北京大学学报(医学版), 2022, 54(1): 1 -6 .
[3] 张学武. 痛风关节炎治疗中几个备受关注的问题[J]. 北京大学学报(医学版), 2021, 53(6): 1017 -1019 .
[4] 娄雪,廖莉,李兴珺,王楠,刘爽,崔若玫,徐健. 类风湿关节炎患者外周血TWEAK基因启动子区甲基化状态及其表达[J]. 北京大学学报(医学版), 2021, 53(6): 1020 -1025 .
[5] 钟华,徐丽玲,白明欣,苏茵. 类风湿关节炎患者趋化因子CXCL9和CXCL10在骨侵蚀中的作用[J]. 北京大学学报(医学版), 2021, 53(6): 1026 -1031 .
[6] 郭应禄. 夯实人才培养,实现我国泌尿外科奋斗目标[J]. 北京大学学报(医学版), 2021, 53(4): 633 -634 .
[7] 蒋青,张雨. 新形势下运动损伤特点及细胞生物治疗的应用前景和挑战[J]. 北京大学学报(医学版), 2021, 53(5): 828 -831 .
[8] 刘承,马潞林. 前入路机器人辅助前列腺根治性切除术中改善排尿控制的经验[J]. 北京大学学报(医学版), 2021, 53(4): 635 -639 .
[9] 于妍斐,何世明,吴宇财,熊盛炜,沈棋,李妍妍,杨风,何群,李学松. 延胡索酸水合酶缺陷型肾细胞癌的临床病理特征及预后[J]. 北京大学学报(医学版), 2021, 53(4): 640 -646 .
[10] 王立新, 许晓, 倪耀丰, 孙海涛, 余日月, 魏世成. 载药脂质体修饰的聚醚醚酮植入物的抑菌和骨整合性能[J]. 北京大学学报(医学版), 2021, 53(4): 758 -763 .