Department of Otolaryngology-Head and Neck Surgery, Dankook University, Cheonan, Korea.
Clin Exp Otorhinolaryngol. 2009 Dec;2(4):193-7. doi: 10.3342/ceo.2009.2.4.193. Epub 2009 Dec 31.
This study was undertaken to confirm the clinical characteristics of recurrent pleomorphic adenoma (RPA), and to identify those factors that affect the development of malignant transformation (MT) from RPA.
The medical records of 270 patients, who were operated upon for parotid PA, were retrospectively reviewed. The pathologic specimens of a selected series of 23 patients were reviewed for histologic subtype and microscopic multi-nodularity.
Mean age of initial operation in RPA without MT (RPA(-MT)) group was significantly lower than that of primary PA group. Mean age of the revision operation in RPA with MT (RPA(+MT)) group was significantly greater than that of RPA(-MT) group. Mean interval from operation to recurrence shortened after each revision operation. The risk of MT and additional recurrence increased significantly with recurrence. In RPA(-MT) group tumor recurrence occurred in 21.4% of patients despite a clear resection margin.
The risk factors for MT may be an age of over 45 yr and multiple recurrences. However, younger patients are more at risk of recurrence. A clear resection margin cannot guarantee a cure in RPA, and it seems that parotid pleomorphic adenomas slowly gain malignant characteristics after repeated recurrences.
本研究旨在确认复发性多形性腺瘤（RPA）的临床特征，并确定影响 RPA 发生恶性转化（MT）的因素。
回顾性分析 270 例腮腺多形性腺瘤患者的病历资料。对选定的 23 例患者的病理标本进行组织学亚型和微观多结节性回顾分析。
无 MT 的 RPA（RPA(-MT)）组的初次手术平均年龄明显低于原发性多形性腺瘤组。有 MT 的 RPA（RPA(+MT)）组的再次手术平均年龄明显高于 RPA(-MT)组。每次再次手术后，从手术到复发的平均间隔时间缩短。随着复发，MT 和额外复发的风险显著增加。尽管切缘清晰，RPA(-MT)组仍有 21.4%的患者发生肿瘤复发。
MT 的危险因素可能是年龄超过 45 岁和多次复发。然而，年轻患者更有复发的风险。明确的切除边界并不能保证 RPA 的治愈，似乎腮腺多形性腺瘤在反复复发后逐渐获得恶性特征。
