Wang Li, Zhang Shi-Kun, Ma Ying, Ha Patrick K, Wang Zhi-Ming
Department of Oral and Maxillofacial Surgery, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
Department of Pathology, Shengjing Hospital of China Medical University, Shenyang 110004, Liaoning Province, China.
World J Clin Cases. 2019 Feb 6;7(3):366-372. doi: 10.12998/wjcc.v7.i3.366.
Papillary cystadenoma is a rare benign epithelial tumor of the salivary gland, which is characterized by papillary structures and oncocytic cells with rich eosinophilic cytoplasm. We found only one case of papillary cystadenoma in nearly 700 cases of salivary gland tumors. Our case was initially mistaken for a tumor of the right temporomandibular joint (TMJ) capsule rather than of parotid gland origin. Preoperative magnetic resonance imaging (MRI) and computed tomography (CT) should be carefully studied, which allows for appropriate preoperative counseling and operative planning.
Here, we report an unusual case of a 54-year-old woman with a parotid gland papillary cystadenoma (PGPC) that was misdiagnosed as a tumor of the right TMJ capsule. She was initially admitted to our hospital due to a mass anterior to her right ear inadvertently found 5 d ago. Preoperative CT and MRI revealed a well circumscribed tumor that was attached to the right TMJ capsule. The patient underwent a resection through an incision for TMJ, but evaluation of an intraoperative frozen section revealed a benign tumor of the parotid gland. Then we removed part of the parotid gland above the temporal facial trunk. The facial nerve was preserved. Postoperative histopathological findings revealed that the tumor was PGPC. No additional treatment was performed. There was no recurrence during a 20-mo follow-up period.
The integrity of the interstitial space around the condyle in MRI or CT should be carefully evaluated for parotid gland or TMJ tumors.
乳头状囊腺瘤是一种罕见的唾液腺良性上皮性肿瘤，其特征为乳头状结构和具有丰富嗜酸性细胞质的嗜酸性细胞。在近700例唾液腺肿瘤中，我们仅发现1例乳头状囊腺瘤。我们的病例最初被误诊为右颞下颌关节（TMJ）囊肿瘤，而非腮腺来源。术前应仔细研究磁共振成像（MRI）和计算机断层扫描（CT），这有助于进行适当的术前咨询和手术规划。
在此，我们报告一例不寻常的病例，一名54岁女性患有腮腺乳头状囊腺瘤（PGPC），最初被误诊为右TMJ囊肿瘤。她因5天前无意中发现右耳前方肿物而首次入住我院。术前CT和MRI显示一个边界清晰的肿瘤，附着于右TMJ囊。患者通过TMJ切口进行了切除，但术中冰冻切片评估显示为腮腺良性肿瘤。然后我们切除了颞面干上方的部分腮腺。保留了面神经。术后组织病理学检查结果显示肿瘤为PGPC。未进行额外治疗。在20个月的随访期内无复发。
对于腮腺或TMJ肿瘤，应仔细评估MRI或CT中髁突周围间隙的完整性。
