Ettl Tobias, Schwarz-Furlan Stephan, Gosau Martin, Reichert Torsten E
Department of Oral and Maxillofacial Surgery, Regensburg University, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Germany.
Oral Maxillofac Surg. 2012 Sep;16(3):267-83. doi: 10.1007/s10006-012-0350-9. Epub 2012 Jul 29.
Salivary gland carcinomas are rare tumours of heterogeneous morphology that require distinctive surgical and adjuvant therapy.
Relevant studies were electronically searched in PubMed and reviewed for innovative and important information.
Recent insights in genetic alterations like chromosomal aberrations, expression of receptor tyrosine kinases, malfunction of tumour suppressor genes or DNA promoter methylations increased the knowledge about aetiology and pathogenesis. New histological subtypes are recognised, and a three-tiered grading system seems reasonable. Ultrasound remains the basic diagnostic imaging procedure. New developments comprise the diffusion-weighed magnetic resonance imaging, while fluorodeoxyglucose positron emission tomography/computed tomography shows good diagnostic accuracy in detecting distant metastases and local recurrence. Fine-needle aspiration cytology helps in differentiating a neoplasia from a non-neoplastic lesion while being unreliable in recognising malignancy. In contrast, additional core needle biopsy and/or intraoperative frozen section diagnosis increase the accuracy in diagnosing a malignant lesion. Conservative parotid surgery with nerve monitoring remains state-of-the-art. Free flaps or musculoaponeurotic flaps are proposed for prevention of Frey's syndrome. As parotid cancer often shows skip metastases, complete ipsilateral neck dissection (level I-V) is indicated particularly in high-grade lesions. Adjuvant radio(chemo)therapy increases local tumour control, whereas overall survival is not necessarily improved. Current results of systemic chemotherapy or targeted therapy in advanced tumour stages are disappointing.
Despite several developments, salivary gland carcinomas remain a heterogeneous group of tumours challenging both pathologists and clinicians.
涎腺癌是形态各异的罕见肿瘤，需要独特的手术和辅助治疗。
在PubMed上对相关研究进行电子检索，并对创新和重要信息进行综述。
近期对染色体畸变、受体酪氨酸激酶表达、肿瘤抑制基因功能异常或DNA启动子甲基化等基因改变的深入了解，增加了对病因和发病机制的认识。新的组织学亚型得到认可，三级分级系统似乎合理。超声仍然是基本的诊断成像方法。新进展包括扩散加权磁共振成像，而氟脱氧葡萄糖正电子发射断层扫描/计算机断层扫描在检测远处转移和局部复发方面显示出良好的诊断准确性。细针穿刺细胞学有助于鉴别肿瘤性病变与非肿瘤性病变，但在识别恶性肿瘤方面不可靠。相比之下，额外的粗针活检和/或术中冰冻切片诊断可提高恶性病变的诊断准确性。保留面神经的腮腺保守手术仍然是目前的标准术式。建议采用游离皮瓣或肌筋膜瓣预防味觉出汗综合征。由于腮腺癌常出现跳跃性转移，尤其是高级别病变，建议行同侧全颈清扫术（Ⅰ-Ⅴ区）。辅助放（化）疗可提高局部肿瘤控制率，但总生存率不一定提高。晚期肿瘤阶段全身化疗或靶向治疗的当前结果令人失望。
尽管有多项进展，但涎腺癌仍然是一组异质性肿瘤，对病理学家和临床医生来说都是挑战。
