Diffuse large B-cell lymphoma arising from follicular lymphoma with warthin’s tumor of the parotid gland-immunophenotypic and genetic features: A case report

BACKGROUND Warthin’s tumor(WT)is composed of several cysts that are lined with tall,bilayered oncocytic columnar cells and lymphoid stroma.Within WT,the two components rarely transform into carcinoma or lymphoma,and when it does,carcinoma is the most common type.Approximately 28 cases of lymphoma with WT have been reported,most of which were non-Hodgkin lymphomas,and only a few cases were Hodgkin lymphomas.In the present report,we studied a case of diffuse large B cell lymphoma(DLBCL)arising from follicular lymphoma(FL)with WT in the parotid gland and its immunophenotypic and genetic features.CASE SUMMARY A 67-year-old man presented with a slowly enlarging right cheek mass for 12 years,and the mass began to change in size over a 2-mo time period.Over time,the patient felt mild local pain and right cheek discomfort.His medical history included a hepatitis B virus infection for 20 years and 30 years of smoking.Gross examination of the excised specimen showed a gray-red and gray-white appearance and a soft texture lobulated external surface neoplasm that measured 9 cm×8 cm×7 cm and was well circumscribed by relative normal parotid gland tissue.In cross section,the cut surfaces of the neoplasm were multicystic and had a homogeneous scaly appearance.A small fluid was discovered in the cyst.Bilateral oxyphilic,cuboidal or polygonal epithelium cells and lymphoid intraparenchymal components were observed.Many medium-to large-sized lymphoid cells were observed diffusely in part of the neoplasm,and a few secondary lymphoid follicles were observed at the center or edge of the neoplasm.Immunohistochemical staining showed that the columnar oncocytic cells were positive for AE1/AE3;neoplastic cells located in coarctate follicular were positive for CD20,Pax-5,bcl-2 and bcl-6;and the adjacent diffusely medium-to large-sized lymphoid cells were positive for Pax-5,bcl-6,CD20,MUM-1,bcl-2 and CD79a.The bcl-6(3q27)break-apart rearrangement was observed,and an Epstein Barr virus test was negative in the tumor cells.The patient survived 6 months after being diagnosed without any treatment.CONCLUSION WT-associated lymphoma is a very rare neoplasm in the parotid gland.Most cases are B cell non-Hodgkin lymphomas and involve middle-age and older males.This case highlights the extremely rare association of DLBCL arising from FL with WT and the importance of deliberate evaluation of the WT intraparenchymal stroma.Molecular detection techniques have potential advantages in the diagnosis of lymphoma with WT.

Indications and Results of Parotidectomies in the Orl Department of the Idrissa Pouye General Hospital in Dakar. Concerning 31 Cases

Introduction: The parotid tumors are benign or malignant, primary or secondary neoformations developed at the expense of the parotid gland. The aim of the present study was to describe the indications and results of parotidectomies in the ENT department of the Idrissa Pouye General Hospital in Dakar. Patients & Methods: We conducted a retrospective study between January 1, 2004 and December 31, 2012, including all patients who had been consulted for a parotid tumor with or without histological evidence collected in the otolaryngology and anatomy-pathology department of the Idrissa Pouye General Hospital in Dakar. Results: We collected 31 patient files. The mean age was 47.45 years, with extremes of 16 and 74 years. Females predominated, with a sex ratio of 0.82. Swelling of the parotid region was the main reason for consultation in 100% of cases. Parotidectomy was the most frequently performed procedure, accounting for 41.93%. Benign tumors accounted for 72% of cases, the majority being pleomorphic adenomas (50%). The outcome was favorable in 67.74% of cases. Conclusion: Management of parotid tumors at HOGIP would be improved by informing and educating patients to consult early, and by upgrading the technical platform.

Different histological subtypes of parotid gland tumors: CT findings and diagnostic strategy

AIM:To present computed tomography(CT) findings of different histological subtypes of parotid gland masses in detail and to establish diagnostic strategy.METHODS:From January 2009 to November 2011,56 patients were collected through the histopathology and Picture Archiving and Communication Systems records,which revealed 5 basal cell adenoma(BCA),16 pleomorphic adenoma(PA),25 Warthin's tumor(War-T),3 Kimura's disease(KD) and 7 parotid carcinoma(PCa) cases.All the CT images were retrospectively analyzed by two radiologists in consensus,based on their description of morphology(location,number,size,margin and fibrous capsule) and enhancement patterns of masses.In addition,the diagnostic efficiency of diagnostic strategy is tested.RESULTS:War-T and BCA patients' mean age was 59.9 ± 12.6 years and 58.4 ± 18.2 years;the significant difference was seen in War-T vs PA and BCA vs PA.About 40% of War-Ts presented with bilateral multifocal lesions,a higher ratio than others.Seventy two percent of War-Ts were limited to the superficial lobe,followed by BCA 60% and PA 40%.Vessel facing sign and enlarged lymph nodes were both frequent in War-T,which respectively accounts for 84% and 76% of cases.Rapid contrast enhancement and decreases were unique for War-T.BCA and PA showed obvious delayed enhancement.The diagnostic strategy of parotid gland tumor had a good diagnostic efficiency,with high accuracy,sensitivity and specificity.CONCLUSION:Determination of the histological subtypes of parotid gland masses might be possible based on CT findings and clinical data.A diagnostic strategy with high diagnostic efficiency was established.

The value of MSCT in diagnosis of parotid benign tumor (An analysis of 84 cases)

Objective:The purpose of the study was to assess diagnostic performance of MSCT images in patients with parotid benign tumors and provide useful criteria for the characterization of their various pathological types preoperatively. Methods: Retrospectively analyzed clinical and imaging characteristics of 84 cases of pathologically confirmed primary parotid benign tumors. MSCT plain-scan and enhanced-scan were performed in all cases. After injection of 50 mL contrast material at a rate of 3.5 mL/s,spiral CT scans were obtained at arterial and venous phases with scanning delay of 30 s and 75 s,respectively. The attenuation change and enhancement patterns in the tumors were assessed. Quantitatively assess the increased CT number of the tumors in different enhanced-phases compared with the plain-scan and the ratio of increased CT number at venous phase scanning to that at arterial phase scanning also was calculated. Results:In all of 84 cases,40 cases were solitary pleomorphic adenomas,29 cases were adenolyphomas,6 cases were multiple tumors,2 cases were bilateral,15 cases were Basal cell tumor,and one of them had two small lesions. The diameter was 1–5 cm in most of cases,whose margin was smooth and clear,cystic changes in some cases. At two-phase scans,pleomorphic adenomas showed a pattern of slight enhancement and venous enhancement,adenolymphomas showed a pattern of strong enhancement at arterial phase scanning with a decrease at venous phase scanning,basal cell tumor showed a pattern of persistent strong enhancement with commonly significant cystic areas. The ratio of increased CT number was significant different between adenolymphomas and other pathological types. Conclusion: The evaluation of enhancement patterns at two-phase enhanced-scan MSCT is helpful in the differential diagnosis of parotid gland benign tumors.

CT and MRI findings of parotid Warthin’s tumors

Objective： The aim of the study was to investigate CT and MRI findings of parotid Warthin＇s tumors （parotid ad- enolymphomas）. Methods： CT and MRI findings of 14 patients with pathologically-confirmed Warthin＇s tumor （10 males and 4 females） were retrospectively analyzed. The average age was 56 years （range 44-77 years）. Twelve patients underwent CT plain scan, of which, 10 received the further enhancement; other 2 patients performed MR plain scan, of which, 1 was enhanced. The disease course ranged from 20 days to 4 years with the average of 22 months. Ten patients had the smoking history （71.4%）. Results： A total of 22 foal were found in all 14 patients, multiple in one parotid gland in 3 patients, single in one parotid gland in 9 patients and single in bilateral glands in 2 patients （one recurred the tumor in the contralateral gland 14 years after the surgery）. Sixteen （72.7%） foci or the main bodies [long diameter of 0.8-5.0 crn with the average of （2.3 ＋ 1.3） crn] were located in the posterior and interior role of the superficial lobe of the parotid gland. The foci were round or oval. The boundary was smooth in 21 （95.5%） loci and blurred in 3 loci which were proved by biopsy to be accompanied with infection. Fourteen foci （77.7%） with uniform density and 4 foci with nonuniform density were found in 12 patients under CT plain. A total of 15 loci in 10 patients were enhanced, 7 （46.7%） on significant enhancement, 5 （33.3%） on moderate enhancement and 3 on slight enhancement. The margin was enhanced slightly in 3 foci. In MR images, the signal of tumor was uniform or nonunifrom, TlWl showed low signal and T2Wl showed moderate or high signal. The envelope displayed signal shadow under plain scan and the enhancement was slightly. Conclusion： For middle or elder males with the smoking history, if they have the foci in the posterior and interior parts of the parotid gland which show clear boundary and significant enhancement, especially for multiple or bilateral foci, parotid Warthin＇s tumor should be considered firstly.

Sclerotherapy for the treatment of Warthin’s tumour of the parotid

Warthin’s tumour (WT) is the second most common benign salivary gland tumour of the parotid gland. Several treatments have been proposed. Surgery is considered the treatment of choice. We report a case of an 83-year-old woman who was treated using sclerotherapy and discuss the possible benefits of this method. To our knowledge this is the first report on sclerotherapic treatment of WT.

A Rare Case of Synchronous Bilateral Pleomorphic Adenoma of the Parotid Gland

Multiple parotid gland tumors are unusual. Warthin’s tumor is the most represented neoplasm in this condition. We present a case of bilateral synchronous pleomorphic adenoma affecting the parotid glands in a 28-year-old woman. Clinically, the lesions were similar to solitary pleomorphic adenoma. Both lesions were diagnosed by fine-needle aspiration cytology. A total parotidectomy for left tumor and surgical enucleation for the right tumor, respectively, were performed with no facial nerves injury. A review of the pertinent literature is included.

12例Warthin瘤样黏液表皮样癌影像学分析

目的:总结Warthin瘤样黏液表皮样癌(Warthin-like mucoepidermoid carcinoma,WT-MEC)的超声、CT和MRI表现,探讨其影像学特点,为临床术前诊断提供参考。方法:收集2017年1月—2021年12月上海交通大学医学院附属第九人民医院收治的12例经病理明确诊断的WT-MEC患者的临床信息和超声、CT、MRI资料,回顾性总结其具体特征。结果:12例WT-MEC患者中,男7例,女5例,平均年龄为(42.7±16)岁。7例行超声检查,6例行CT检查,2例行MRI检查。所有肿瘤均表现为腮腺内单发肿块。91.7%(11/12)的病灶(91.7%)边界清晰,83.3%(10/12)的病灶呈囊实性肿块。在超声上,71.4%(5/7)的病变表现为囊实性混合回声、85.7%(6/7)血流不丰富、85.7%(6/7)后方回声增强。在CT上,所有病变(6/6,100%)呈软组织密度肿块,不均匀强化(5/6,83.3%)。在MRI上,肿瘤在平扫T1WI呈低信号或等信号,T2WI呈高信号,增强T1WI呈不均匀强化。结论:WT-MEC多表现为单发、边界清晰、无钙化的囊实性肿块。肿瘤内多发、大小不等的囊性部分是其影像学特征。

三维超微血管成像测量的血管指数鉴别诊断腮腺多形性腺瘤与Warthin瘤的价值探讨

目的应用三维超微血管成像(3D-SMI)测量腮腺多形性腺瘤(PA)与Warthin瘤的血管指数(VI),探讨其在二者鉴别诊断中的价值。方法选取我院经手术病理证实的腮腺肿瘤患者88例,其中PA 51例,Warthin瘤37例,均行CDFI、二维超微血管成像(2D-SMI)、3D-SMI、超声造影(CEUS)检查,比较PA与Warthin瘤上述超声图像特征及定量参数的差异。分别建立基于CDFI参数、2D-SMI参数、CEUS参数鉴别诊断PA与Warthin瘤的回归模型;绘制受试者工作特征(ROC)曲线分析VI、CDFI模型、2D-SMI模型、CEUS模型鉴别PA与Warthin瘤的诊断效能。结果PA与Warthin瘤CDFI和2D-SMI血流方式及血流分级比较差异均有统计学意义(均P<0.001)。PA与Warthin瘤CEUS增强程度、是否均匀增强、峰值强度、峰值减半时间、120 s强度、曲线下面积、半下降斜率比较差异均有统计学意义(均P<0.05)。ROC曲线分析显示,VI、CDFI模型、2D-SMI模型、CEUS模型鉴别诊断PA与Warthin瘤的曲线下面积分别为0.924、0.750、0.806及0.883,其中VI与CDFI模型、2D-SMI模型的曲线下面积比较差异均有统计学意义(均P<0.05),VI与CEUS模型的曲线下面积比较差异无统计学意义。结论3D-SMI测量的VI在鉴别诊断腮腺PA与Warthin瘤中有一定价值,其诊断效能与CEUS相当,且显著优于2D-SMI和CDFI。

Factors influencing Frey syndrome after parotidectomy with acellular dermal matrix

BACKGROUND Frey syndrome,also known as ototemporal nerve syndrome or gustatory sweating syndrome,is one of the most common complications of parotid gland surgery.This condition is characterized by abnormal sensations in the facial skin accompanied by episodes of flushing and sweating triggered by cognitive processes,visual stimuli,or eating.AIM To investigate the preventive effect of acellular dermal matrix(ADM)on Frey syndrome after parotid tumor resection and analyzed the effects of Frey syndrome across various surgical methods and other factors involved in parotid tumor resection.METHODS Retrospective data from 82 patients were analyzed to assess the correlation between sex,age,resection sample size,operation time,operation mode,ADM usage,and occurrence of postoperative Frey syndrome.RESULTS Among the 82 patients,the incidence of Frey syndrome was 56.1%.There were no significant differences in sex,age,or operation time between the two groups(P>0.05).However,there was a significant difference between ADM implantation and occurrence of Frey syndrome(P<0.05).ADM application could reduce the variation in the incidence of Frey syndrome across different operation modes.CONCLUSION ADM can effectively prevent Frey syndrome and delay its onset.

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.

多模态超声在腮腺多形性腺瘤及Warthin瘤鉴别诊断中的应用

目的:分析多形性腺瘤(pleomorphic adenoma,PA)及Warthin瘤(Warthin tumor,WT)的常规超声(ultrasound,US)、剪切波弹性成像(shear wave elastography,SWE)及超微血管三维立体成像(3D-superb microvascular imaging,3D-SMI)特征,探讨US联合SWE及3D-SMI对PA与WT的鉴别诊断价值。方法:回顾性收集于2021年05月至2022年06月间于我院行US、SWE及3D-SMI检查,并经手术病理证实的符合纳入标准的腮腺肿瘤患者80例,共85个病灶,对腮腺肿瘤的US、SWE及3D-SMI超声特征进行分析,并采用受试者工作特征曲线比较US、US+SWE以及US+SWE+3D-SMI三种超声诊断方法对PA和WT的诊断效能。结果:病理结果显示54个PA,31个WT,PA组与WT组比较,在“钙化(χ^(2)=6.506)、内部低或无回声(χ^(2)=16.029)、网格回声(χ^(2)=24.070)、杨氏模量平均值(t=4.988)、内部血流信号丰富程度(χ^(2)=32.690)及血供模式(χ^(2)=26.908)”等差异有统计学意义(P均<0.05),联合US、SWE及3D-SMI的多模态超声对WT与PA诊断的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为80.65%、87.04%、84.71%、78.13%、88.68%,其曲线下面积大于US(0.838 vs 0.596;Z=4.990,P<0.001)。结论:联合US、SWE及3D-SMI有助于区分PA与WT,其诊断效能高于常规超声。

Intermittent facial spasms as the presenting sign of a recurrent pleomorphic adenoma

The intimate anatomical relationship of the facial nerve to the parotid parenchyma has a significant influence on the presenting signs and symptoms, diagnosis and treatment of parotid neoplasms.However, to our knowledge, hyperactivity of this nerve, presenting as facial spasm, has never been described as the presenting sign or symptom of a parotid malignancy.We report a case of carcinoma arising in a recurrent pleomorphic adenoma of the left parotid gland(i.e., carcinoma ex pleomorphic adenoma) that presented with hemifacial spasms.We outline the differential diagnosis of hemifacial spasm as well as a proposed pathophysiology.Facial paralysis, lymph node enlargement, skin involvement, and pain have all been associated with parotid malignancies.To date the development of facial spasm has not been reported with parotid malignancies.The most common etiologies for hemifacial spasm are vascular compression of the ipsilateral facial nerve at the cerebellopontine angle(termed primary or idiopathic)(62%), hereditary(2%), secondary to Bell's palsy or facial nerve injury(17%), and hemifacial spasm mimickers(psychogenic, tics, dystonia, myoclonus, myokymia, myorthythmia, and hemimasticatory spasm)(17%).Hemifacial spasm has not been reported in association with a malignant parotid tumor but must be considered in the differential diagnosis of this presenting symptom.

Atypical Cystic Parotid Gland Acinic Cell Carcinoma in a Child

Purpose: To describe the extremely rare occurrence of acinic cell carcinoma of the parotid in a young child. Materials & Methods: A 14-year-old boy presented with a left sided facial mass. It was initially thought to be a bug bite or perhaps a wrestling injury. However, it progressed rapidly overall several weeks. CT revealed a well-circumscribed, cystic, 3.9 × 2.8 × 3.2 cmmass centered in the deep lobe of the left parotid gland, also involving the superficial lobe and extending medially through the stylomandibular tunnel with a component extending to the stylomastoid foramen. There was no solid enhancing portion. There were several enlarged level II lymph nodes suspicious for nodal metastases. Results: The mass was biopsied and pathology was consistent with acinic cell carcinoma. Complete left parotidectomy and left selective neck dissection was performed, confirming the diagnosis. Conclusions: Salivary gland neoplasms are rare in children. Less than 5% of salivary gland tumors occur in children. Salivary gland neoplasms account for less than 8% of pediatric head and neck tumors. Approximately 1/3 of salivary gland tumors arising in childhood are malignant;most being mucoepidermoid. Acinic cell carcinoma of the parotid gland in children is extremely rare, especially in those under age 16, with only a few available case reports. This case was also unusual in that the lesion was predominantly cystic.

T_(1)-mapping鉴别腮腺常见肿瘤的初探

目的:探讨T_(1)-mapping和分段读出DWI(RESOLVE-DWI)在腮腺常见肿瘤鉴别诊断中的价值。方法:回顾性分析2018年6月-2022年8月经病理证实的169例腮腺常见肿瘤患者的T_(1)-mapping及分段读出DWI资料。其中,多形性腺瘤85例,Warthin瘤32例,恶性肿瘤52例。测量并比较三组肿瘤的T_(1)及ADC值,运用受试者工作特征(ROC)曲线评价T_(1)、ADC及二者联合(T_(1)+ADC)对腮腺肿瘤的鉴别诊断价值。采用Delong检验比较各参数的AUC的差异。结果:三组肿瘤的T_(1)值和ADC值的差异均有统计学意义(P<0.001);组间两两比较,差异均有统计学意义(P<0.001);多形性腺瘤的T_(1)值及ADC值最高;恶性肿瘤次之,Warthin瘤最低。T_(1)和ADC鉴别多形性腺瘤与Warthin瘤、多形性腺瘤与恶性肿瘤、Warthin瘤与恶性肿瘤的AUC分别为0.914和0.997、0.664和0.869、0.835和0.695,Delong检验显示2个参数AUC的差异均无统计学意义(P>0.05)。T_(1)+ADC鉴别多形性腺瘤与Warthin瘤、多形性腺瘤与恶性肿瘤的AUC均显著高于T_(1)(1.000 vs.0.914、0.873 vs.0.664,P均<0.001);T_(1)+ADC鉴别Warthin瘤与恶性肿瘤的AUC显著高于T_(1)(0.895 vs.0.835,P<0.001)和ADC(0.895 vs.0.695,P<0.001)。结论:T_(1)-mapping和RESOLVE-DWI有助于鉴别诊断腮腺常见肿瘤,二者联合诊断可提高鉴别诊断效能。

合成MRI定量弛豫参数对不同病理类型腮腺肿瘤的鉴别诊断

目的:探讨合成MRI定量弛豫参数对于腮腺常见肿瘤的鉴别诊断。方法:选择2022年5月至2023年1月郑州大学第一附属医院收治的腮腺肿瘤患者59例,均于治疗前行常规MRI和合成MRI,测量肿瘤全域弛豫参数[纵向弛豫时间(T1)、横向弛豫时间(T2)和质子密度(PD)]。比较腮腺多形性腺瘤组、Warthin瘤组和恶性肿瘤组T1、T2和PD。应用Bayes判别分析法对3种腮腺肿瘤进行分类。结果:腮腺多形性腺瘤、Warthin瘤和恶性肿瘤组T1、T2和PD的差异均有统计学意义(P均<0.001)。Warthin瘤组的T1和PD小于腮腺恶性肿瘤和多形性腺瘤组(P<0.05);腮腺多形性腺瘤组的T2大于恶性肿瘤和Warthin瘤组(P<0.05)。采用Bayes判别分析建立的诊断模型自身验证的准确率为61.0%,交叉验证的准确率为57.6%。结论:合成MRI定量弛豫参数对腮腺多形性腺瘤、Warthin瘤和恶性肿瘤的鉴别诊断有一定价值。

动脉自旋标记联合扩散张量成像对腮腺肿瘤的鉴别诊断价值

目的探讨应用动脉自旋标记(arterial spin labeling,ASL)和扩散张量成像(diffusion tensor imaging,DTI)评价多参数MRI在鉴别腮腺肿瘤中的临床价值。材料与方法回顾性分析滨州医学院附属医院2019年6月至2023年11月66名经手术病理证实的腮腺肿瘤患者,术前均行3D ASL和DTI,并测量肿瘤最大血流量(maximum tumor blood flow,TBFmax)和最小表观扩散系数(minimum apparent diffusion coefficient,ADCmin)、各向异性分数(fraction anisotropy,FA)。使用Mann-Whitney U检验或Kruskal-Wallis检验比较良性肿瘤(benign tumors,BT)和恶性肿瘤(malignant tumors,MT)的各参数值。使用受试者工作特征(receiver operating characteristic,ROC)曲线分析评估各参数和联合有差异的参数对腮腺肿瘤的诊断效能。结果66例腮腺肿瘤患者中,BT 55例[其中Warthin瘤(Warthin tumors,WT)15例,多形性腺瘤(pleomorphic adenomas,PA)23例,其他17例],MT11例。BT的FA值低于MT(0.13±0.06 vs.0.18±0.04,P=0.003)。PA的TBFmax值[(43.72±37.64)mL/(100 g·min^(-1))]低于MT[(92.56±58.26)mL/(100 g·min^(-1))](P<0.001)和WT[(145.26±64.54)mL/(100 g·min^(-1))](P=0.016)。PA的ADCmin值[(1.55±0.51)×10^(-3)mm^(2)/s]高于MT[(1.11±0.28)×10^(-3)mm^(2)/s](P=0.016)和WT[(1.03±0.53)×10^(-3)mm^(2)/s](P<0.001)。MT的FA值(0.18±0.05)高于PA(0.11±0.04)(P<0.001)和WT(0.12±0.02)(P=0.015)。FA鉴别腮腺BT与MT的曲线下面积(area under the curve,AUC)为0.78,敏感度、特异度分别为81.82%、70.18%。FA区分WT、PA与MT的AUC分别为0.85、0.87,敏感度分别为72.73%、100.00%,特异度分别为94.12%、65.22%。TBFmax、ADCmin鉴别WT与PA的AUC分别为0.90、0.85,敏感度分别为94.12%、95.65%,特异度分别为91.30%、82.35%。三者联合鉴别PA与MT的AUC可提高至0.98,敏感度为100.00%,特异度为86.96%。结论ASL联合DTI有助于鉴别诊断腮腺良恶性肿瘤,综合运用多参数各优势有助于区分WT、PA和MT。联合有差异的参数可显著提高区分PA与MT的诊断效能。

腮腺多形性腺瘤与Warthin瘤CT对照分析

目的探讨腮腺多形性腺瘤与腮腺Warthin瘤的CT表现,提高对两者的鉴别诊断水平。方法回顾性分析经手术、病理证实的22例多形性腺瘤23个肿块、25例Warthin瘤35个肿块的CT表现。结果 58个肿块均表现为类圆形或椭圆形高密度,边缘清楚,两者的发病年龄、部位、平扫CT值及与同层咬肌的密度比较、增强后CT值、净强化CT值、与血管的密切程度、最大横纵径比均有统计学意义(P<0.05)。结论在腮腺的良性肿瘤的鉴别诊断中,对于中老年男性,发生于后下象限,平扫与同侧咬肌密度相当或略高,中等或明显强化,与周围血管关系密切,纵椭圆形肿块提示Warthin瘤的诊断。

^(99m)TcO_4^-显像与MRI和CT对比评价腮腺Warthin's瘤的诊断价值

目的:对比分析^(99m)TcO_4^-唾液腺显像与常规MRI和CT在评价腮腺Warthin's瘤中的准确性。方法:对78例临床疑诊腮腺Warthin's瘤的患者进行^(99m)TcO_4^-唾液腺显像,同时对其中61例患者进行腮腺CT或MRI检查(以下简称常规检查组),与病理结果进行对照,分别得出各自的诊断效能。采用受试者工作特征曲线对比分析^(99m)TcO_4^-唾液腺显像组与常规检查组诊断的准确性,并用χ~2检验对比两组的诊断效能。结果:^(99m)TcO_4^-唾液腺显像的灵敏度、特异性、阳性预测值、阴性预测值分别为94.12%、85.19%、92.31%、88.46%,常规检查组的灵敏度、特异性、阳性预测值、阴性预测值分别为28.26%、53.33%、65.00%、19.51%,两者差异有统计学意义(P<0.05)。受试者工作特征曲线中^(99m)TcO_4^-唾液腺显像组的曲线下面积为0.929,常规检查组的曲线下面积为0.496。结论:^(99m)TcO_4^-唾液腺显像诊断腮腺Warthin's瘤准确性高,有重要的临床应用价值。

腮腺Warthin瘤上皮成分恶变为黏液表皮样癌5例临床病理分析

目的 探讨Warthin瘤上皮成分恶变为黏液表皮样癌的临床及病理学特点.方法 收集并分析5例Warthin瘤上皮成分恶变为黏液表皮样癌的病例,研究其临床特点、病理形态学特点、免疫表型以及组织化学染色特点,并复习相关文献.结果 5例患者中,男性3例,女性2例,年龄26 ～ 63岁,平均年龄45.6岁.临床均表现为腮腺区无痛性肿物.肿物呈结节状,其中2例有完整包膜,3例包膜不完整,包膜不完整区域与周围组织界限欠清;切面大多为实性、灰褐色.镜下黏液表皮样癌组织位于Warthin瘤瘤体内或肿瘤一侧,两者之间可见移行区.其中4例为低级别黏液表皮样癌,1例为高级别黏液表皮样癌.Warthin瘤嗜酸性上皮CK34βE12 、CK5/6和CK7（＋）,p63、CK20和CEA（-）;黏液表皮样癌黏液细胞CK7和CEA（＋）,CK5/6、p63 、CK34βE12和CK20均为（-）;Warthin瘤的基底细胞及黏液表皮样癌的表皮样细胞CK5/6、p63和CK34βE12均（＋）,而CK7、CK20和CEA（-）;Ki-67阳性指数在黏液表皮样癌区域高于Warthin瘤区域.黏液细胞PAS染色（＋）.结论 Warthin瘤上皮成分恶变为黏液表皮样癌极为罕见,有病理诊断主要依据组织学形态：明确的黏液表皮样癌形态及二者上皮成分移行.