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上唇部多形性腺瘤一例

2018-06-02 甘丽 周娟 山西医药杂志

患者女,25岁, 因“上唇部无痛性包块近半年”于2015年3月入院。

【一般资料】

患者女,25岁,

【主诉】

因“上唇部无痛性包块近半年”于2015年3月入院。

【现病史】

患者约半年前无明显诱因发现上唇一“樱桃”大小包块,无明显疼痛及其他伴随症状,后于我科门诊就诊,建议行手术切除,当时未行治疗。病程中无疼痛,无发热,半年来该包块未见明显增大,无消长史。为明确诊断与治疗,门诊以“上唇肿物”收治入院。

【体格检查】

颌面部观左右基本对称,上唇近鼻底处可见轻度隆起,表皮完整不红,局部皮温不高,可触及一约1.0cm×1.0cm×0.8cm大小的包块,质韧,边界清楚,与周围组织无明显粘连,基底活动,触压疼痛不明显,张口咬合无异常,口内上唇黏膜完整不红,口内牙齿未见明显异常,双侧颌下及颈部其他区域淋巴结未扪及明显肿大。

【治疗】

患者入院后,完善各项常规术前检查,排除手术禁忌证,于全身麻醉下行“上唇肿物切除术”,术中见肿物包膜完整,呈实性,与周围正常组织无粘连。术后病理诊断:(上唇)多形性腺瘤。术后切口一期愈合,术后随访1年,无复发。

【讨论】

多形性腺瘤又名混合瘤,是涎腺肿瘤中最常见的一种。大涎腺中最常发生于腮腺,颌下腺次之,舌下腺极少见;发生于小涎腺者以腭部多见,其次为唇、颊、舌等部位。任何年龄均可发病,但以30~50岁为多见,女性多于男性。多形性腺瘤通常为无痛渐进性肿块,其生长缓慢,界限清楚,大小不定,发生在口内小涎腺者直径约1~2cm。圆形或不规则形,扪诊呈结节状,质地中等,一般可活动。患者常无明显自觉症状,偶有轻微不适感,当肿瘤出现迅速增大,疼痛,肿块固定,或伴有疼痛神经麻痹、表面皮肤破溃等症状时,应考虑恶变。多形性腺瘤在组织学上不同于一般良性肿瘤,它的包膜常不完整且厚薄不一,其特征是组织像具有多形性或“混合性”特征,即肿瘤性腺上皮细胞和变异肌上皮细胞,形成导管、条索、片块结构,常可见到鳞状细胞化生,并与黏液样组织和软骨样组织混杂在一起。间质结缔组织不多,有时可见玻璃样变、钙化或骨化。根据上皮细胞和黏液软骨样基质所占的比例,Seifert和Donath将多行性腺瘤分为两型:细胞丰富型和基质丰富型,前者容易癌变,后者容易复发。仅依据病史和临床表现,很难做出正确诊断,当多形性腺瘤发生于唇部时应与黏液腺囊肿、皮脂腺囊肿、神经纤维瘤、脂肪瘤和黏液表皮样癌等疾病相鉴别。其确诊的主要依据是组织病理学结果以及免疫组织化学结果。多形性腺瘤的治疗以手术切除为主,因其常有包膜不完整或瘤细胞包膜外浸润,尽管为良性肿瘤,但有较高的复发率,任何破坏包膜或未完整切除的治疗都可能因肿瘤细胞残留而复发,因此应避免做术前切取活组织检查,应在术中做冰冻切片活检或术后病理检查。手术切除时不能作单纯的肿瘤摘除,即剜除术,而应在肿瘤包膜外正常腺体组织处切除。术中需注意不要切破包膜,更不要做分块切除,以免肿瘤细胞种植引起术后复发。腮腺多形性腺瘤手术应保留面神经;下颌下腺多形性腺瘤应包括下颌下腺一并切除;小涎腺多形性腺瘤应在肿瘤外线约0.5cm处连同表面黏膜一并切除。

原始出处:

甘丽, 周娟. 上唇部多形性腺瘤一例[J]. 山西医药杂志, 2017, 46(10):1255-1255.

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    2018-06-02 非洲妇女主任

    挺罕见.唇部混合瘤

    0

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    2018-06-02 虈亣靌

    学习了.获益匪浅.感谢分享

    0

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