超声在诊断腮腺Warthin’s瘤中的应用价值

目的探讨腮腺Warthin’s瘤的超声表现与病理变化的关系。方法 30例经手术和病理证实的腮腺Warthin’s瘤患者,对其超声表现特征和病理结果进行对比分析。结果 30例腮腺Warthin’s瘤声像图上均表现为低回声。其中21例表现为均匀性低回声结节被线状高回声分隔呈"网络状"或"网管状",按压瘤体部分网管状内可见点状低回声流动;7例表现为均匀性低回声结节;2例表现为网格状结构或均匀性低回声合并囊性无回声。结论超声检查在腮腺Warthin’s瘤诊断中有重要价值,可为临床诊断提供可靠依据。

腮腺Warthin’s瘤的MRI表现

目的探讨腮腺Warthin’s瘤的MRI特征,提高MRI对腮腺Warthin’s瘤的诊断率。方法回顾性分析本院2005年8月～2012年5月期间经手术及病理证实的有完整MRI影像学资料的13例腮腺Warthin’s瘤患者共17个病灶的MRI影像学特征。13例患者中男性12例,女性1例,年龄38～82岁,中位年龄59岁。结果 13例患者中9例为单发病灶(9个病灶),4例为双侧病灶(8个病灶)。17个病灶中,位于浅叶者14个,其中13个位于腮腺后下极者,同时累及浅叶深叶者3个,无单独发生于深叶的病灶;病灶直径1～4cm,平均2.25cm;16个病灶边界清楚,2个病灶有分叶、呈结节状,1个病灶边界欠清,病理证实为炎症浸润;16个病灶个病灶包膜完整,1个病灶因炎症浸润包膜显示不完整;与肌肉信号比较,T1WI病灶呈等低信号,压脂T2WI表现为明显高信号,其中3个病灶信号均匀,其余14个病灶内因含囊性区而信号明显不均匀;17个病灶内均未见钙化灶。增强后扫描,17个病灶均有明显强化,其中14个病灶内囊性区无强化,实质成分明显强化,其余3个病灶呈均匀强化;17个病灶均出现对比剂注射后2min明显强化,4～5.5min后肿瘤信号明显减低。结论腮腺Warthin’s瘤具有其特征性MRI影像学表现,如果长期吸烟史的中老年男性患者,腮腺出现长T1、长T2边界清楚的圆形或卵圆形、包膜完整的占位灶,瘤灶内出现囊变区,增强后扫描病灶早期强化明显,无延迟强化特征,特别是当出现双侧腮腺发病或一侧腮腺多发占位灶时,应首先考虑到Warthin’s瘤的可能。

超声在腮腺多形性腺瘤和Warthin’s瘤诊断中的价值

目的 :探讨超声对腮腺多形性腺瘤和Warthin’s瘤的诊断价值。方法 :回顾性分析经手术病理证实的56例腮腺多形性腺瘤和54例Warthin’s瘤的临床资料,及其二维、彩色多普勒及超声弹性声像图资料,并进行统计学处理。结果:多形性腺瘤和Warthin’s瘤的性别、年龄、发病数目、发病象限、横纵径比值、形态、内部回声、特征性无回声、0级和Ⅲ级血流信号出现率、弹性评分分值等方面差异均有统计学意义(P<0.05);在发病部位、最大径、最小径、边界、内部强回声等方面差异均无统计学意义(P>0.05)。结论:腮腺多形性腺瘤和Warthin’s瘤的超声声像图有一定特征,结合临床病史可帮助对二者的鉴别诊断。

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.

10例腮腺Warthin’s瘤临床及CT误诊分析

Warthin＇s瘤即腺淋巴瘤（aderH）lymphoma）又称乳头状淋巴囊腺瘤（papillary cystadenoma lymphomatosum），多发于腮腺。笔者收集我院2008年5月-2012年1月间，腮腺Warthin＇s瘤术前临床、CT误诊10例，结合文献作误诊原因分析，

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.

增强MRI扫描全域直方图鉴别诊断Warthin’s瘤和腮腺癌的价值

目的探讨增强MRI扫描全域直方图各参数在Warthin’s瘤和腮腺癌鉴别诊断中的价值。方法腮腺肿瘤患者53例,其中Warthin’s瘤25例,腮腺癌28例,均行增强MRI扫描,图像导出后应用MaZda 4.6软件勾画感兴趣区,并生成全域直方图,比较Warthin’s瘤与腮腺癌患者全域直方图各参数差异,ROC曲线分析全域直方图各参数诊断腮腺癌的价值。结果 Warthin’s瘤患者全域直方图最大值(227.40±16.28)、均值(150.04±15.89)、偏度[0.110(-0.225,0.540)]、第50百分位数(Perc.50%)[(148.40±13.30)%]、Perc.90%[(187.68±22.12)%]、Perc.99%[(228.04±17.05)%]均小于腮腺癌患者[239.00±17.65、168.04±15.66、0.865(0.645,0.937)、(168.89±13.90)%、(206.21±10.48)%、(244.71±8.56)%](P<0.05),区域面积(346.37±21.75)、最小值(92.08±12.69)、变异度(297.73±26.06)、峰宽(448.83±20.16)、Perc.1%[(82.56±12.66)%]、Perc.10%[(111.32±11.25)%]与腮腺癌患者[347.01±18.68、97.96±19.96、298.76±15.77、444.79±29.15、(86.79±10.61)%、(118.68±19.13)%]比较差异无统计学意义(P>0.05);ROC曲线分析结果显示,最大值、均值、偏度、Perc.50%、Perc.90%、Perc.99%分别以235.50、152.50、0.625、156.50%、195.50%、240.50%为最佳截断值,诊断腮腺癌的AUC分别为0.762、0.802、0.862、0.856、0.784、0.826,且偏度、Perc.50%的AUC较大(P<0.05)。结论增强MRI扫描全域直方图可提供更多量化的肿瘤信息特征,且以偏度、Perc.50%在Warthin’s瘤与腮腺癌的鉴别诊断中价值较高。

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.

23例腮腺腺淋巴瘤的超声表现分析

目的探讨腮腺Warthin’s瘤的二维及彩色多普勒超声表现特点。方法回顾性分析23例经病理证实的Warthin’s瘤,患者术前常规超声影像资料。观察并记录肿块形态、大小、部位、包膜、边界、内部回声均匀度、有无分隔,、钙化及血供分布情况。结果腮腺Warthin’s瘤共26枚病灶,病灶最大径范围0.8～3.9cm,平均3.4cm。84.6%(22/26)的病灶为圆形或类圆形,80.8%(21/26)的病灶边界清晰,30.8%(8/26)的病灶回声均匀。其中低回声的占26.9%(7/26),接近无回声的占73.1%(19/26);46.2%(12/26)的病灶伴有分隔回声,所有病灶均无钙化。26.9%(7/26)的病灶仅周边探及血流信号,34.6%(9/26)的病灶仅内部探及血流信号,38.5%(10/26)病灶周边及内部均探及血流信号。结论腮腺Warthin’s瘤常规超声有一定特征性表现,可作为其术前评估的一线检查手段。

高频超声对三种腮腺良性肿瘤的诊断价值评价

目的:探讨高频超声对三种腮腺良性肿瘤的诊断价值评价。方法:选取在2019年7月~2021年7月期间我院收治的120例多形性腺瘤、基底细胞腺瘤和Warthin’s瘤患者,对3种肿瘤的超声表现特征进行观察比较,探讨超声特征对3种良性肿瘤的鉴别诊断价值。结果:3种肿瘤的直径、位置、均匀性、形态规则、血流信号分型和后方回声增强的对比具有明显差异(P<0.01)。相比较基底细胞腺瘤,Warthin’s瘤左侧占比明显更高,基底细胞腺瘤左侧占比低于Warthin’s瘤;多形性腺瘤后方回声增强,形态规则,血流信号Ⅱ~Ⅲ比重低于基底细胞腺瘤和Warthin’s瘤;基底细胞腺瘤均匀性高于多形性腺瘤和Warthin’s瘤,差异明显(P<0.05)。超声诊断多形性腺瘤、Warthin’s瘤和基底细胞腺瘤的准确率分别为79.17%、80.88%和75.67%。结论:在多形性腺瘤、Warthin’s瘤和基底细胞腺瘤的诊断中应用高频超声不但有较高的诊断准确率,而且可以对患者的肿瘤情况进行观察了解,对于患者的诊断治疗具有较高的指导价值。