Layfield L J, Reznicek M, Lowe M, Bottles K
Department of Pathology, University of Iowa College of Medicine, Iowa City 52245.
Acta Cytol. 1992 May-Jun;36(3):381-6.
Pleomorphic adenoma is the most common neoplasm of the parotid gland, generally presenting as a slowly enlarging, firm, well-circumscribed, painless nodule. Occasional cases have presented after a short period of rapid growth or have been associated with pain. The vast majority of these tumors are solid, but rare examples have been associated with cystic degeneration or hemorrhage. Spontaneous and tumor-associated infarction of the parotid has been reported, but these examples have been limited to infarctions of Warthin's tumors and postoperative infarctions of salivary glands. We present the case of a 48-year-old male with a one-year history of a painful, enlarging, left parotid mass associated with paresthesia of the tongue. Computed tomographic examination of the parotid demonstrated a left superficial lobe mass with a rim of enhancement and low attenuation center. Fine needle aspiration yielded necrotic debris and atypical squamous elements that were thought to be compatible with carcinoma. A superficial parotidectomy with intraoperative frozen section revealed a pleomorphic adenoma with extensive central necrosis. To our knowledge, this represents the first reported case of an infarcted pleomorphic adenoma and illustrates the potential for misinterpretation of these cytologic and radiologic findings as indicative of malignancy.
多形性腺瘤是腮腺最常见的肿瘤，通常表现为缓慢增大、质地硬、边界清晰、无痛的结节。偶尔有病例在短时间内快速生长后出现，或伴有疼痛。这些肿瘤绝大多数为实性，但罕见病例与囊性变或出血有关。腮腺的自发性和肿瘤相关性梗死已有报道，但这些病例仅限于沃辛瘤的梗死和唾液腺术后梗死。我们报告一例48岁男性，有一年左侧腮腺肿物伴疼痛、增大及舌感觉异常的病史。腮腺计算机断层扫描显示左侧浅叶肿物，周边强化，中心呈低密度。细针穿刺抽出坏死碎片和非典型鳞状细胞成分，考虑与癌相符。术中冰冻切片的浅叶腮腺切除术显示为多形性腺瘤伴广泛中央坏死。据我们所知，这是首次报道的梗死性多形性腺瘤病例，说明这些细胞学和影像学表现可能被误解为恶性的迹象。
