Iguchi Hiroyoshi, Wada Tadashi, Yamamoto Hidefumi, Yamada Kei, Matsushita Naoki, Okamoto Sachimi, Teranishi Yuichi, Koda Yuki, Kosugi Yuki, Yamane Hideo
Department of Otolaryngology and Head & Neck Surgery, Osaka City University Graduate School of Medicine, Osaka.
Nihon Jibiinkoka Gakkai Kaiho. 2013 Dec;116(12):1300-7. doi: 10.3950/jibiinkoka.116.1300.
Accessory parotid gland tumors are relatively rare; hence, adequately detailed clinical analyses of these tumors are difficult to perform at a single institution. In this report, we describe the findings for 65 patients [29 men, 36 women; median age, 51 (9-81) years] with accessory parotid gland tumors, consisting of 4 cases documented by us and 61 cases previously reported by other Japanese authors. Approximately 50% of the patients were treated in an otolaryngology department, while the remaining patients were treated in plastic surgery, oral surgery, or dermatology departments. In 4 patients, the results of preoperative fine-needle aspiration cytology indicated that the tumor was benign; however, the postoperative histopathology results revealed malignant tumors. The frequencies of malignant and benign tumors were 44.6% (n = 29) and 55.4% (n = 36), respectively. Mucoepidermoid carcinoma and pleomorphic adenoma were the most frequent types of malignant and benign accessory parotid gland tumors, respectively. Among the various surgical methods that were used, such as direct cheek and intraoral incisions, a standard parotidectomy incision was the most preferred treatment approach for these tumors. Recently, an endoscopic approach has also been found to yield satisfactory results. An optimal approach should be selected after evaluating the advantages and disadvantages of these methods. No definite guidelines are available regarding the choice of elective neck dissection and postoperative radiation therapy for malignant accessory parotid gland tumors. Although tumor resection (plus elective neck dissection) and postoperative radiation therapy have been frequently performed for various kinds of malignant accessory parotid gland tumors to date, additional studies are needed regarding the criteria for selecting elective neck dissection and postoperative radiation therapy. Since the malignancy rate for accessory parotid gland tumors is higher than that for parotid gland tumors, the possibility of malignancy (especially mucoepidermoid carcinoma and carcinoma ex pleomorphic adenoma) should be considered when resecting accessory parotid gland tumors, even if the results of preoperative fine-needle aspiration cytology indicate that the tumor is benign.
副腮腺肿瘤相对罕见；因此，在单一机构对这些肿瘤进行充分详细的临床分析很难开展。在本报告中，我们描述了65例副腮腺肿瘤患者的研究结果[29例男性，36例女性；中位年龄51（9 - 81）岁]，其中包括我们记录的4例以及其他日本作者先前报告的61例。约50%的患者在耳鼻喉科接受治疗，其余患者在整形外科、口腔外科或皮肤科接受治疗。4例患者术前细针穿刺细胞学检查结果显示肿瘤为良性；然而，术后组织病理学结果显示为恶性肿瘤。恶性和良性肿瘤的发生率分别为44.6%（n = 29）和55.4%（n = 36）。黏液表皮样癌和多形性腺瘤分别是最常见的恶性和良性副腮腺肿瘤类型。在使用的各种手术方法中，如直接面颊和口内切口，标准腮腺切除术切口是这些肿瘤最常用的治疗方法。近来，内镜手术方法也被发现能产生令人满意的效果。应在评估这些方法的优缺点后选择最佳方法。对于恶性副腮腺肿瘤的选择性颈清扫术和术后放疗的选择，目前尚无明确的指南。尽管迄今为止，肿瘤切除（加选择性颈清扫术）和术后放疗已常用于各种恶性副腮腺肿瘤，但在选择性颈清扫术和术后放疗的选择标准方面仍需进一步研究。由于副腮腺肿瘤的恶性率高于腮腺肿瘤，在切除副腮腺肿瘤时，即使术前细针穿刺细胞学检查结果显示肿瘤为良性，也应考虑恶性的可能性（尤其是黏液表皮样癌和多形性腺瘤恶变）。
