第207课 病例探析（55）—（右侧腮腺区）腺样囊性癌

患者，女，51岁，发现右侧腮腺包块4年余，病灶缓慢长大，伴面部疼痛半年余。

The patient, female, 51 years old, was found to have a right parotid gland mass for more than 4 years, with slow growth of the lesion, accompanied by facial pain for more than half a year.

 

（右侧腮腺区）腺样囊性癌(right parotid region) adenoid cystic carcinoma    

       腺样囊性癌(adenoid cystic carcinoma,ACC),又名圆柱瘤,是头颈部较少见的恶性肿瘤,是一种由上皮细胞和肌上皮细胞组成，最常发生在涎腺组织,发病率居涎腺肿瘤的第2位,是小涎腺最常见的恶性肿瘤，大涎腺以腮腺常见,其次为颌下腺,舌下腺少见。小涎腺主要分布在腭、鼻腔、鼻窦、舌、气管等。ACC主要有缓慢生长,弥漫浸润,易沿神经、血管播散,局部易复发,晚期可远处转移等特点；ACC的复发病变与原发灶常有相似的影像学特征。ACC易复发,并且易转移至肺、骨,其预后和复发的相关因素包括:肿瘤的分期,是否有神经、血管的浸润,淋巴结的受累等。

        Adenoid cystic carcinoma (adenoid cystic carcinoma, ACC), also known as cylindrical tumor, head and neck is a rare malignant tumor, is a kind of composed of epithelial cells and myoepithelial cells, it most commonly occurs in the salivary gland tissue, the incidence of salivary gland tumors of the second, is the most common malignant tumor of minor salivary glands, salivary glands with parotid gland, followed by the submandibular gland, sublingual gland. The minor salivary glands are mainly distributed in palate, nasal cavity, sinus, tongue and trachea. ACC is characterized by slow growth, diffuse infiltration, easy spread along nerves and blood vessels, local recurrence and distant metastasis. Recurrent ACC lesions and primary lesions often have similar imaging characteristics. ACC is prone to recurrence and metastasis to lung and bone, and its prognosis and recurrence related factors include: tumor stage, whether there is nerve, vascular infiltration, lymph node involvement, etc.

      主要CT征象：多表现为病变区域软组织肿块，形态不规则，肿瘤内部可出现囊变及坏死，密度不均匀，颅底上骨性孔管（圆孔、卵圆孔、）的异常扩大，翼颚窝前后径增宽，蝶骨翼破坏消失，增强扫描病灶可有不均匀强化。

       Main CT features: mostly presented as a soft tissue mass in the lesion area with irregular shape, cystic degeneration and necrosis can occur inside the tumor, with uneven density, abnormal enlargement of the bone pore tube (round hole, oval hole,) on the skull base, widening of the front and back diameter of the pterygoid fossa, destruction of the sphenoid wing, and uneven enhancement of the lesions by enhanced scanning.

鉴别诊断

      1、多形性腺瘤：亦好发于涎腺,边界多清晰,无骨质破坏。恶性多形性腺瘤多为多形性腺瘤切除术后复发、恶变,手术次数越多恶变概率越高,与腺样囊腺癌较难鉴别；

       1. Pleomorphic adenoma: it also occurs in salivary glands, with clear boundaries and no bone destruction. Malignant polymorphous adenomas are mostly recurrent and malignant after polymorphous adenomas resection, and the more the operation times, the higher the probability of malignant transformation, which is more difficult to distinguish from adenoid cystic adenocarcinoma.

        2、横纹肌肉瘤：多见于青少年,进展快,短期内可蔓延到颅面部广泛结构；

        2. Rhabdomyosarcoma: common in adolescents, with rapid progression, can spread to a wide range of craniofacial structures in a short time;

       3、慢性炎症：多呈不均匀混杂密度影,范围较ACC局限,骨质多无破坏,不易累及血管、神经。

       3. Chronic inflammation: with heterogeneous density shadows, the range is more limited than ACC, and the bone is not damaged, which is not easy to involve blood vessels and nerves.