Moonis G, Patel P, Koshkareva Y, Newman J, Loevner L A
Department of Radiology, Neuroradiology Division, Hospital of the University of Pennsylvania, Philadelphia, USA.
AJNR Am J Neuroradiol. 2007 Sep;28(8):1532-6. doi: 10.3174/ajnr.A0598.
Pleomorphic adenoma is the most common parotid neoplasm. It has a relatively high rate of recurrence after surgery. Imaging features of recurrent parotid pleomorphic adenoma have been infrequently reported in the radiology literature. In the present study, we reviewed our institutional experience with imaging of recurrent parotid pleomorphic adenomas.
Retrospective imaging and chart review of 24 patients (9 men, 15 women; age, 29-63 years) with recurrent pleomorphic adenoma of the parotid were performed. Images were reviewed as to the margins, site, multiplicity, signal intensity, and enhancement pattern of the recurrent lesions by 2 neuroradiologists.
We found a high incidence of multiple lesions in the operative bed, most of which were extremely bright on T2-weighted images; some of the lesions demonstrated a cystic appearance with peripheral enhancement. We also noted tiny lesions in the subcutaneous fat and in regions distant from the immediate operative bed.
Although recurrent disease is usually clinically apparent, sometimes prior surgical history is lacking or recurrence may be detected on routine surveillance imaging after initial surgery. The presence of solitary or multiple subcutaneous T2 hyperintense lesions in the operative bed, subcutaneous fat, and/or spaces adjacent to the parotid in patients with prior parotidectomy for pleomorphic adenoma is consistent with the diagnosis of neoplastic recurrence. The radiologist should maintain a high index of suspicion for recurrent pleomorphic adenoma with this characteristic imaging appearance.
多形性腺瘤是最常见的腮腺肿瘤。其术后复发率相对较高。复发性腮腺多形性腺瘤的影像学特征在放射学文献中报道较少。在本研究中，我们回顾了我院复发性腮腺多形性腺瘤的影像学经验。
对24例（9例男性，15例女性；年龄29 - 63岁）复发性腮腺多形性腺瘤患者进行回顾性影像学和病历审查。两名神经放射科医生对复发病变的边缘、部位、数量、信号强度和强化方式进行了评估。
我们发现手术床内多发病变的发生率较高，其中大多数在T2加权图像上呈极高信号；部分病变呈囊性外观并伴有周边强化。我们还注意到皮下脂肪及远离直接手术床区域有微小病变。
虽然复发性疾病通常在临床上较为明显，但有时缺乏既往手术史，或在初次手术后的常规监测影像中可检测到复发。对于既往因多形性腺瘤行腮腺切除术的患者，手术床、皮下脂肪和/或腮腺附近间隙出现孤立或多发的皮下T2高信号病变，符合肿瘤复发的诊断。放射科医生对具有这种特征性影像学表现的复发性多形性腺瘤应保持高度怀疑。
