Clinical analysis of malignant pancreatic endocrine tumors:reports of 27 cases

To investigate clinicopathological features,diagnosis and treatment of malignant pancreatic tumors.Methods A retrospective clinical analysis was made in 27 cases of malignant pancreatic tumors admitted from 1989 to 2003.Results Tumors were surgically resected in 22 patients.Tumor infiltration into surrounding organs was found in 13 cases.Four patients had lymph nodes metastasis and 5 had liver metastasis.Two cases were found tumor embolus in vascular or lymph tube.Neural invasion was found in 3.Conclusion Malignant pancreatic tumors has good prognosis.Aggressive attempts of surgical management should be performed.6 refs,1 tab.

Relevance on the diagnosis of malignant lymphoma of the salivary gland

Malignant lymphoma originates from the lymphohematopoietic system.It can occur in any lymphoid tissue.Malignant lymphoma of the salivary gland is rare,but its incidence has increased in recent years.Its clinical-presentations are nonspecific,and it is often manifested as a painless mass in a salivary gland,which can be accompanied by multiple swollen cervical lymph nodes.Confirmation of the diagnosis before an invasive procedure is difficult.Clinically,malignant lymphoma of the salivary gland tends to be misdiagnosed,leading to an inappropriate treatment plan and the ultimate delay in the optimal treatment of the disease.This article reviews the pathogenesis,clinical features,imaging findings,diagnosis,treatment and prognosis of malignant lymphoma of the salivary gland.

Minor Salivary Gland Tumors: A Retrospective Study of 37 Cases

Salivary gland tumors represent 2% - 6.5% of all head and neck tumors. Since salivary gland tumors have various clinical features and histological types, it is often difficult to diagnose and treat them. The aim of this study was to conduct a retrospective clinical-statistical analysis of 37 minor salivary gland tumors (MSGTs) treated in the Department of Oral Surgery at Nihon University School of Dentistry at Matsudo over a 16-year period. The frequencies and distributions of sex, age, occurrence site, preoperative examination (fine needle cytology and/or biopsy), treatment, and prognosis of the tumors were analyzed and compared with previous reports. The average age at diagnosis was 58.1 years (range 22 - 91 years). The peak occurrence of tumors was in the sixties (10 cases, 27.0%), followed by the forties (8 cases, 21.6%) and the seventies (7 cases, 18.9%). The average age of patients with benign tumors was 56.8 years (range 22 - 91 years). For malignant tumors, the average age was 61.7 years (range 42 - 81 years). The male-female ratio was 1:2.1 for all minor salivary gland tumors, 1:2.4 for benign tumors, and 1.5:1 for malignant tumors. There were 27 (73.0%) benign and 10 (27.0%) malignant tumors. Pleomorphic adenoma (PA) was the most common tumor (24 (64.9%) cases). Most salivary gland tumors originated from the palate (21 cases, 56.8%);the second most common site was the buccal mucosa (14 cases, 37.8%). For most patients, an intraoral mass was the primary presentation, and the second most common symptom was swelling. Surgical treatment was performed for all cases, both benign and malignant tumors. There was one case of local recurrence of PA, as well as one of multiple lung metastases after surgery for adenoid cystic carcinoma. Diagnosis and treatment of MSGTs are often delayed because the patients have few symptoms, and it is difficult to distinguish benign from malignant tumors. More cases need to be examined in the future, and the diagnostic accuracy of imaging and histopathological diagnosis needs to be improved.

Adenoid Cystic Carcinoma of Parotid Salivary Gland—A Case Study

Adenoid Cystic Carcinoma (ACC) is an infrequent slow growing epithelial tumour constituting for around less than 1% of all the oral and maxillo-facial malignancies and almost 10% of all the salivary gland tumors. Parotid gland is the second most common site to be involved in the head and neck region along with submandibular gland, Palate being the most common site involved in the oral cavity. Key feature of these tumors include its asymptomatic presentation, indolent nature, typically showing infiltrative growth and peri-neural invasion. Herein, we report a case of adenoid cystic carcinoma of right parotid gland of a 33-year-old male who presented with complaint of painless slow enlargement of left parotid gland and facial muscle weakness. On Examination firm mass in the region of the left parotid gland as well as left facial paralysis was seen. Biopsy results and further management is discussed here within.

Effective chemotherapy for submandibular gland carcinoma ex pleomorphic adenoma with lung metastasis after radiotherapy: A case report

BACKGROUND Only a few cases of carcinoma ex pleomorphic adenoma arising in the submandibular gland have ever been reported,all with a poor prognosis. The standard treatment for salivary gland carcinoma ex pleomorphic adenoma is surgical resection combined with postoperative radiotherapy,but the necessity of chemotherapy as well as the most appropriate treatment regimen for patients with distant metastasis after radiotherapy remains controversial.CASE SUMMARY This report presents the case of a 73-year-old woman who suffered submandibular gland carcinoma ex pleomorphic adenoma. She accepted surgery to remove the mass; she was found to have lung metastasis after radiotherapy.Her condition was controlled by chemotherapy with liposomal doxorubicin plus cisplatin.CONCLUSION The positive clinical outcome in the patient reveals that this chemotherapy regimen may be an alternative treatment for such a condition.

Diagnosis of an extremely rare case of malignant adenomyoepithelioma in pleomorphic adenoma:A case report

BACKGROUND Pleomorphic adenoma(PA)is the most common type of salivary gland tumor,and its common sites are parotid gland,sinus,nasal septum and cleft palate.PA is an uncommon benign type of tumor occurring in the breast,and there are few reports of cases in Asia.CASE SUMMARY An 84-year-old woman found a mass in the upper outer quadrant of the right breast>1 year ago.The patient underwent a right breast lumpectomy and sentinel lymph node biopsy.The pathological diagnosis was PA in the upper outer quadrant of the right breast,and the malignant component was malignant adenomyoepithelioma.The postoperative course was uneventful,and no chemotherapy was administered.At 18 mo of follow-up,the patient is alive and well,with no evidence of recurrent disease.CONCLUSION Patients with breast PA should first undergo extended excision of breast masses followed by pathological examination.If malignancy is confirmed or the surgical margin is positive,modified radical mastectomy should be performed.

芪胶升白胶囊防治恶性肿瘤放化疗后骨髓抑制临床疗效Meta分析

目的系统评价芪胶升白胶囊防治恶性肿瘤放射治疗和化学治疗(简称放化疗)后骨髓抑制的临床疗效,为临床用药提供参考。方法采用计算机检索中国知网(CNKI)、万方(WanFang)、维普(VIP)、中国生物医学文献服务系统(SinoMed)、PubMed、Web of Science、The Cochrane Library等数据库中关于芪胶升白胶囊防治恶性肿瘤放化疗后骨髓抑制的随机对照试验(RCT),检索时限为自建库起至2023年4月22日。采用改良的Jadad量表对纳入文献进行质量评价,采用RevMan 5.4软件进行Meta分析。结果共纳入25项RCT,涉及患者2754例,其中试验组1466例,对照组1288例。Meta分析结果显示,予芪胶升白胶囊的试验组患者的总体骨髓抑制率[OR=0.27,95%CI(0.21,0.35),P<0.00001],Ⅲ-Ⅳ级骨髓抑制率[OR=0.23,95%CI(0.16,0.34),P<0.00001],白细胞[MD=1.18,95%CI(0.98,1.38),P<0.00001],血小板[MD=14.06,95%CI(12.95,15.16),P<0.00001],血红蛋白[MD=0.98,95%CI(0.87,1.09),P<0.00001],卡氏评分体系(KPS)评分改善率[OR=2.65,95%CI(1.90,3.70),P<0.00001],KPS评分[MD=6.13,95%CI(4.48,7.79),P<0.00001]的改善效果均显著优于对照组。结论芪胶升白胶囊可有效降低恶性肿瘤患者放化疗后的总体骨髓抑制率、Ⅲ-Ⅳ级骨髓抑制率,升高KPS评分、白细胞、血红蛋白、血小板,改善骨髓抑制情况。

303例颌下腺肿瘤临床病理分析

目的:了解颌下腺肿瘤的组织学类型、构成比及发病性别、年龄、体积、复发等临床病理特征。方法:对303例颌下腺肿瘤临床病理资料进行统计分析。结果:良性上皮性肿瘤216例(71.29%),恶性上皮性肿瘤79例(26.07%),软组织肿瘤6例(1.98%),淋巴造血系统肿瘤2例(0.66%)。多形性腺瘤、肌上皮瘤和Warthin瘤居良性上皮性肿瘤的前3位,腺样囊性癌、癌在多形性腺瘤中、黏液表皮样癌和腺泡细胞癌居恶性上皮性肿瘤的前4位。良、恶性上皮性肿瘤的男女比为0.79∶1和1.82∶1;平均年龄为37.5岁和47.8岁;平均直径为2.55 cm和3.43cm。颌下腺肿瘤复发率为6.93%,复发性多形性腺瘤占76.19%。结论:多形性腺瘤和腺样囊性癌分别是最常见的良、恶性上皮性肿瘤;良性上皮性肿瘤多见于女性,恶性上皮性肿瘤多见于男性;恶性上皮性肿瘤的发病年龄和体积均大于良性;多形性腺瘤易复发。

52例腮腺恶性肿瘤患者的临床分析

背景与目的：大涎腺中腮腺肿瘤的发病率最高。腮腺恶性肿瘤的病理学特征复杂、临床表现和预后也各有差异。本研究旨在分析腮腺恶性肿瘤的临床特点、治疗方法及预后因素。方法：回顾性分析1989—2011年暨南大学第二临床医学院肿瘤放疗科收治的52例腮腺原发恶性肿瘤患者资料，治疗方式均为手术加术后放疗。病理亚型有：黏液表皮样癌、腺样囊性癌、腺泡细胞癌、肌上皮癌、腺癌、鳞癌和未分化癌。结果：中位随访期62个月（14～191个月）。3年和5年局部控制率分别为98．1％和94．2％；3年和5年总生存率分别为89．0％和86．3％；3年和5年无局部区域复发生存率分别为90．3％和87．1％。单因素分析显示，T分期、淋巴结转移状况、临床分期、病理亚型、病理分化程度、手术方式及放射治疗剂量对预后有统计学意义。多因素分析显示，临床分期和病理分化程度是独立预后因素。结论：腮腺恶性肿瘤手术加术后放疗的综合治疗模式值得推荐，临床分期和病理分化程度是腮腺恶性肿瘤的独立预后因素。

涎腺淋巴上皮癌16例临床分析

背景与目的:涎腺淋巴上皮癌是一种少见的特殊类型的恶性肿瘤,有关该病的的单独报道甚少。本文拟对在我院治疗的涎腺淋巴上皮癌病例的临床特点、治疗及疗效作一总结分析。方法:回顾性分析1990年1月至2004年9月在我院经过病理确诊和治疗的涎腺淋巴上皮癌患者共16例的临床资料,应用Kaplan-Meier法进行生存分析。结果:16例涎腺淋巴上皮癌占我院同期涎腺恶性肿瘤的3.6%(16/443)。所有患者均为单侧腺体发病,发病年龄为15～57岁,男女比例为1∶1,本组患者均来自中国南方。除1例患者未行EB病毒血清学检查以外,其余患者EB病毒血清学检查示EBV-VCA-IgA阳性率为93.3%(14/15),EBV-EA-IgA阳性率为66.7%(10/15),EBV-DNA酶阳性率为86.7%(13/15)。16例患者均接受手术治疗,其中单纯手术治疗9例,手术+术后放疗5例,手术+术后放、化疗1例,手术+化疗1例。术后病理证实4例有同侧颈淋巴结转移者,转移率为25%(4/16)。1、3、5年生存率分别约为86.15%、48.46%、24.23%。结论:涎腺淋巴上皮癌分化差,但预后较好,在治疗上宜应采取彻底手术切除加术后辅助放疗。

412例腮腺恶性肿瘤回顾分析

目的:通过回顾性分析,总结腮腺恶性肿瘤的发病特点、临床及影像学表现。方法:收集解放军总医院口腔颌面外科、耳鼻咽喉、头颈外科及大连医科大学附属第一医院口腔颌面外科收治的腮腺恶性肿瘤病例412例,对其临床资料进行回顾分析。结果:构成比占前3位的腮腺恶性肿瘤分别为黏液表皮样癌、腺样囊性癌和腺泡细胞癌;412例腮腺恶性肿瘤中,73.1%有伴随症状或近期生长加快表现;58.0%的恶性肿瘤质地硬,66.2%活动度中等偏差,32.3%边界不清,36.8%有疼痛;74.2%CT显示肿瘤形态不规则,68.7%超声显示肿瘤形态不规则;细针吸取细胞活检和术中快速冷冻检查对腮腺恶性肿瘤的诊断符合率分别为83.7%和91.8%,术中快速冷冻检查对腮腺高度恶性肿瘤的诊断符合率为79.4%。结论:腮腺恶性肿瘤的病理类型复杂多样;综合考虑其发病特点、临床及影像学表现,有助于腮腺恶性肿瘤的诊断;细针吸取细胞活检和术中快速冷冻检查诊断腮腺恶性肿瘤有较高的准确性。

超声鉴别诊断涎腺肿瘤良恶性的特征分析

目的探讨超声鉴别诊断涎腺肿瘤良恶性的临床价值。方法回顾性分析我院经手术病理证实的121例诞腺肿瘤患者(124个病灶,良性111个,恶性13个)的超声资料,比较良恶性病灶最大径、纵横比、病灶数、回声均匀性、形态、边界、后方回声、囊性变、钙化灶及血流分级等指标;绘制受试者工作特征(ROC)曲线分析特征性超声指标预测肿瘤良恶性的诊断效能。结果良恶性病灶最大径、纵横比、病灶数、回声均匀性、形态、后方回声、囊性变及血流分级等指标比较差异均无统计学意义;仅边界和钙化灶方面比较差异均有统计学意义(均P<0.05)。边界指标诊断恶性肿瘤敏感性46.15%,特异性95.50%,准确率90.32%,曲线下面积为0.708;钙化灶指标诊断恶性肿瘤敏感性30.77%,特异性72.97%,准确率68.55%,曲线下面积为0.640。结论仅根据常规超声单一特征鉴别诊断涎腺肿瘤良恶性较为困难,当肿瘤出现边界不清和内部多发钙化灶时应考虑恶性可能。

大涎腺上皮性肿瘤212例临床分析

目的 总结大涎腺上皮性肿瘤的临床特点,指导临床实践。方法 按照WHO 1991年涎腺肿瘤组织学分类标准,对212例经病理确诊的大涎腺上皮性肿瘤进行回顾性临床分析,讨论良、恶性肿瘤的不同临床特征。结果 212例肿瘤中,腺瘤166例(78.3％),以多形性腺瘤为主;涎腺癌46例(21.7％),以腺样囊性癌最多见。腮腺是最主要发病部位。涎腺腺瘤临床多表现为无痛性肿块,涎腺癌常伴有疼痛和(或)神经麻痹等症状。结论 大涎腺良、恶性肿瘤具有不同的临床特征,有助于临床正确诊断。

口腔小涎腺肿瘤37例临床分析

目的分析口腔小涎腺肿瘤的临床特点,探讨其诊断方法和治疗原则。方法对1992～2006年间收治的37例小涎腺肿瘤的临床资料进行回顾性分析。结果37例口腔小涎腺肿瘤,良性肿瘤12例,占32.43%;恶性肿瘤25例,占67.57%。良性肿瘤中的混合瘤多见,占良性肿瘤的66.67%。恶性肿瘤中以腺样囊性癌为多,占恶性肿瘤的32.00%,手术加放疗者占恶性肿瘤的64.0%,5年生存率为75.0%。结论小涎腺肿瘤中恶性肿瘤多于良性肿瘤。外科手术是口腔小涎腺肿瘤的主要治疗方法。对于良性小涎腺肿瘤,足够的安全边界是减少复发的关键;对于恶性肿瘤,早期诊断及规范治疗是提高生存率的关键。术后辅助放疗可降低恶性肿瘤复发率。

鼻腔和鼻窦涎腺型肿瘤94例临床病理分析

目的分析鼻腔和鼻窦涎腺型肿瘤的临床病理特征、病理诊断及多形性腺瘤(PA)与腺样囊性癌(ACC)的鉴别诊断要点。方法收集和复习94例鼻腔和鼻窦涎腺型肿瘤的临床病理资料,通过HE及免疫组化染色观察其特征并进行回顾性分析。结果94例鼻腔和鼻窦涎腺型肿瘤患者中,涎腺型腺瘤21例,涎腺型癌73例。涎腺型腺瘤中PA 20例(95.2%);涎腺型癌中ACC 49例(67.1%)。免疫组化:GFAP在PA和ACC中的阳性率分别为100%(10/10)和10%(1/10),而Ki-67的阳性率分别为50%(5/10)和100%(10/10)。PA的GFAP阳性率明显高于ACC,差异极显著(P<0.01)。ACC的Ki-67阳性率高于PA,差异显著(P<0.05)。结论对于PA与ACC鉴别诊断困难的病例,可根据两者瘤细胞巢的结构,细胞成分、形态,腔隙结构、内容物等方面的区别,并结合免疫组化GFAP和Ki-67抗体染色结果对两者进行鉴别诊断。

唾液腺上皮性肿瘤1209例临床分析

目的:了解1990～2005年间唾液腺上皮性肿瘤的临床流行病学特点。方法:对南京大学医学院附属口腔医院1990年2月至2005年2月15年间收治的1209例唾液腺上皮性肿瘤患者进行回顾研究,对其病理类型、好发部位、年龄和性别等进行统计分析。结果:1209例患者中,良性肿瘤与恶性肿瘤之比为1.96∶1,男女之比为1∶1。良性肿瘤以多形性腺瘤最多见(76.75%),其次为Warthin瘤(14.75%);恶性肿瘤以黏液表皮样癌最常见(34.2%),其次为腺样囊性癌(26.2%)。良性肿瘤和恶性肿瘤的好发部位相同,均以腮腺最多,腭部小唾液腺和下颌下腺分列第2位和第3位;发病年龄主要集中于20～70岁之间。结论:唾液腺上皮性肿瘤可发生于任何年龄,良性多于恶性,多形性腺瘤是其最常见的病理类型。

以下肢深静脉血栓为首发症状的恶性肿瘤患者28例临床分析

目的分析以下肢深静脉血栓(DVT)为首发症状的恶性肿瘤患者的临床特点,探讨下肢DVT与肿瘤关系。方法回顾性分析2013年5月至2018年5月收治的342例特发性(无明显诱因)DVT患者的临床资料。结果住院及随诊期间诊断恶性肿瘤患者28例,占新诊断特发性DVT患者8.2%。结论特发性DVT患者,尤其是多发血栓、溶栓效果欠佳伴凝血功能异常的患者应高度警惕恶性肿瘤的发生。

涎腺沃辛瘤80例临床分析

通过对 80例沃辛瘤进行临床分析 ,探讨涎腺沃辛瘤的术式选择和治疗经验。结果发现 ,80例沃辛瘤多发于老年男性 ,发病部位全部为腮腺组织 ,多发于单侧 ,少数为双侧腮腺 ,手术方式不当肿瘤可复发。研究提示 ,对术前怀疑为沃辛瘤的患者 ,双侧腮腺区的仔细扪诊和B型超声检查非常必要 ,根据沃辛瘤的部位及数目应采用不同的手术方式。

涎腺恶性肿瘤治疗方法的研究进展

在口腔颌面部恶性肿瘤中,涎腺恶性肿瘤是一类较常见、发生率较高的恶性肿瘤。任何年龄都可发生涎腺恶性肿瘤,且性别发生率无显著差异。涎腺恶性肿瘤多为涎腺上皮组织来源的恶性肿瘤,可发生于大涎腺如腮腺、颌下腺和舌下腺,也可发生于小涎腺如腭腺等,具有组织分型多、细胞成分复杂等特点。近年来国内外针对涎腺恶性肿瘤在诊断治疗方面取得了一些进展,本文就涎腺恶性肿瘤的手术治疗、放射治疗、化学药物治疗、生物治疗等手段作一综述。

35例舌下腺肿瘤临床治疗分析

目的:探讨舌下腺肿瘤的发病情况、病理特征及治疗方法。方法:对1998～2011年南京大学附属口腔医院收治的35例舌下腺肿瘤病例临床资料进行回顾性分析。结果:35例舌下腺肿瘤患者中,男性10例,女性25例,男女比例1∶2.5;年龄19～71岁,平均48.8岁,恶性肿瘤28例,占80.0%,其中腺样囊性癌是主要的病理类型,有22例;良性肿瘤7例,占20.0%。恶性肿瘤患者中有23例行颈淋巴结清扫术,占82.1%。而舌下腺良性肿瘤患者,均采取局部切除肿瘤及舌下腺。结论:舌下腺肿瘤女性发病率高于男性;好发年龄为48.8岁;腺样囊性癌和粘液表皮样癌是舌下腺常见的恶性肿瘤,多形性腺瘤是常见的良性肿瘤;对于舌下腺恶性肿瘤患者,早期诊断、扩大切除及相应的颈淋巴结清扫术是改善预后的关键。对于舌下腺良性肿瘤,将肿瘤及舌下腺完整切除是足够的。