Martínez-Madrigal F, Pineda-Daboin K, Casiraghi O, Luna M A
Department of Pathology, Instituto de Investigaciones Bio-médicas de Michoacán, Morelia, Michoacan, México.
Ann Diagn Pathol. 2000 Dec;4(6):347-53. doi: 10.1053/adpa.2000.19395.
Primary central salivary gland carcinomas of the mandible are uncommon neoplasms. Consequently, their proper diagnosis is often in doubt. We retrospectively studied the cases of 16 patients treated at The University of Texas M. D. Anderson Cancer Center and the Institut Gustave Roussy from 1950 to 1990. Patients ranged in age from 24 to 76 years (mean, 51 years). Nine patients were women and seven were men. Each case involved either the angle or the posterior body of the mandible. Swelling, pain, and trismus were the most frequent complaints. For all patients, radiography revealed a cystic defect resembling an osteolytic odontogenic lesion or metastasis. Five histologic types of carcinoma were diagnosed: seven cases of mucoepidermoid carcinoma (five low-grade and two high-grade), four cases of adenoid cystic carcinoma, two cases of adenocarcinoma, two cases of acinic-cell carcinoma, and one case of epithelial-myoepithelial carcinoma. All patients were treated with wide surgical excision. Eight patients received postoperative irradiation. Five patients with low-grade mucoepidermoid carcinoma, two with acinic-cell carcinoma, and one with epithelial-myoepithelial carcinoma were free of disease 2 to 15 years after initial treatment (mean, 6.2 years). Two patients with adenoid cystic carcinoma are living with lung metastasis. The remaining six patients died of their carcinomas within 4 years after initial treatment. Because of their unique morphology and clinical behavior, these tumors should be distinguished from other intraosseous neoplasms of the mandible, including those with clear-cell patterns.
下颌骨原发性中央唾液腺癌是罕见的肿瘤。因此，其正确诊断常常存疑。我们回顾性研究了1950年至1990年在德克萨斯大学MD安德森癌症中心和古斯塔夫·鲁西研究所接受治疗的16例患者的病例。患者年龄在24岁至76岁之间（平均51岁）。9例为女性，7例为男性。每例均累及下颌骨角部或体部后部。肿胀、疼痛和牙关紧闭是最常见的主诉。对所有患者而言，影像学检查显示有一个囊性缺损，类似溶骨性牙源性病变或转移瘤。诊断出5种组织学类型的癌：7例黏液表皮样癌（5例低级别和2例高级别）、4例腺样囊性癌、2例腺癌、2例腺泡细胞癌和1例上皮-肌上皮癌。所有患者均接受了广泛的手术切除。8例患者接受了术后放疗。5例低级别黏液表皮样癌患者、2例腺泡细胞癌患者和1例上皮-肌上皮癌患者在初始治疗后2至15年无疾病复发（平均6.2年）。2例腺样囊性癌患者伴有肺转移仍存活。其余6例患者在初始治疗后4年内死于癌症。由于这些肿瘤独特的形态和临床行为，应将其与下颌骨的其他骨内肿瘤区分开来，包括具有透明细胞形态的肿瘤。
