腮腺微小肿瘤的临床病理研究

doi:10.19723/j.issn.1671-167X.2022.02.022

摘要/Abstract

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

李炳雨,唐祖南,胡耒豪,章文博,于尧,俞光岩,彭歆. 腮腺微小肿瘤的临床病理研究[J]. 北京大学学报（医学版）, 2022, 54(2): 335-339.

LI Bing-yu,TANG Zu-nan,HU Lei-hao,ZHANG Wen-bo,YU Yao,YU Guang-yan,PENG Xin. Clinicopathologic analysis of micro and mini parotid gland tumors[J]. Journal of Peking University (Health Sciences), 2022, 54(2): 335-339.

图/表 3

表1

表2

图1

参考文献 22

[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.

相关文章 15

[1]	邢念增,王明帅,杨飞亚,尹路,韩苏军. 前列腺免活检创新理念的临床实践及其应用前景[J]. 北京大学学报（医学版）, 2024, 56(4): 565-566.
[2]	田宇轩,阮明健,刘毅,李德润,吴静云,沈棋,范宇,金杰. 双参数MRI改良PI-RADS评分4分和5分病灶的最大径对临床有意义前列腺癌的预测效果[J]. 北京大学学报（医学版）, 2024, 56(4): 567-574.
[3]	刘帅,刘磊,刘茁,张帆,马潞林,田晓军,侯小飞,王国良,赵磊,张树栋. 伴静脉癌栓的肾上腺皮质癌的临床治疗及预后[J]. 北京大学学报（医学版）, 2024, 56(4): 624-630.
[4]	赖展鸿,李嘉辰,贠泽霖,张永刚,张昊,邢晓燕,邵苗,金月波,王乃迪,李依敏,李玉慧,栗占国. 特发性炎性肌病完全临床应答相关因素的单中心真实世界研究[J]. 北京大学学报（医学版）, 2024, 56(2): 284-292.
[5]	徐训敏,邵校,姬爱平. 口腔急诊科死亡病例分析[J]. 北京大学学报（医学版）, 2024, 56(1): 185-189.
[6]	冯璐,翟佳羽,赵金霞. IgG4相关性疾病患者就诊情况及其临床特征[J]. 北京大学学报（医学版）, 2023, 55(6): 1028-1032.
[7]	薛子璇,唐世英,邱敏,刘承,田晓军,陆敏,董靖晗,马潞林,张树栋. 青年肾肿瘤伴瘤栓的临床病理特征及预后分析[J]. 北京大学学报（医学版）, 2023, 55(5): 802-811.
[8]	魏慧,次旦央宗,益西拉姆,白玛央金. 高原地区不同类型过敏性紫癜藏族患者发病的相关危险因素[J]. 北京大学学报（医学版）, 2023, 55(5): 923-928.
[9]	时云飞,王豪杰,刘卫平,米岚,龙孟平,刘雁飞,赖玉梅,周立新,刁新婷,李向红. 血管免疫母细胞性T细胞淋巴瘤临床与分子病理学特征分析[J]. 北京大学学报（医学版）, 2023, 55(3): 521-529.
[10]	马利加,胡攀攀,刘晓光. 脊柱转移癌伴软脊膜转移1例[J]. 北京大学学报（医学版）, 2023, 55(3): 563-566.
[11]	李挺. 建设当代临床病理学科[J]. 北京大学学报（医学版）, 2023, 55(2): 197-200.
[12]	周桥. 肿瘤病理学研究的进展和展望[J]. 北京大学学报（医学版）, 2023, 55(2): 201-209.
[13]	朱晓娟,张虹,张爽,李东,李鑫,徐玲,李挺. 人表皮生长因子受体2低表达乳腺癌的临床病理学特征及预后[J]. 北京大学学报（医学版）, 2023, 55(2): 243-253.
[14]	赖玉梅,李忠武,李欢,吴艳,时云飞,周立新,楼雨彤,崔传亮. 68例肛管直肠黏膜黑色素瘤临床病理特征及预后[J]. 北京大学学报（医学版）, 2023, 55(2): 262-269.
[15]	沈棋,刘亿骁,何群. 肾黏液样小管状和梭形细胞癌的临床病理特点及预后[J]. 北京大学学报（医学版）, 2023, 55(2): 276-282.

Metrics

Viewed

Full text

Abstract

Cited

Shared

Discussed

Items	Diameter of tumor		P
Items	11-20 mm (n=611)	≤10 mm (n=74)	P
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

Histological types	Diameter of tumor		Total (n=685)
Histological types	11-20 mm (n=611)	≤10 mm (n=74)	Total (n=685)
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)