Tahiri Ilias, El Houari Othman, Loubna Taali, Hajjij Amal, Zalagh Mohammed
Otorhinolaryngology, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.
Otolaryngology - Head and Neck Surgery, Mohammed VI University of Health Sciences (UM6SS), Casablanca, MAR.
Cureus. 2022 Aug 8;14(8):e27785. doi: 10.7759/cureus.27785. eCollection 2022 Aug.
Squamous cell carcinoma (SCC) of salivary glands, also referred to as epidermoid carcinoma, is a very rare neoplastic tumor. It occurs as metastasis of a cutaneous or mucosal squamous carcinoma of the head and neck or as a primary SCC. In the latter case, the most known risk factor is previous irradiation to the gland. Common clinical symptoms are represented by cervical swelling and hyposialia. The treatment is essentially surgical, most often supplemented by a radical neck dissection and postoperative radiation therapy. A 75-year-old male patient with a history of chronic smoking was consulted for a tumefaction in the right submandibular region evolving for three months. No cervical lymphadenopathy in the submandibular and superior jugulo-carotid areas was palpable. CT scan showed an enhancing heterogeneous process of the right cervical region, invading the mylohyoid and stylohyoid muscles. A biopsy-excision of the lesion has shown a keratinizing tumor with cytonuclear atypia, consistent with SCC. Radical resection of the mass was associated with the removal of the infiltrated skin. The cutaneous defect was repaired with a rhomboid flap. The patient was started on sessions of adjuvant radiotherapy and chemotherapy. Eight months postoperatively, the patient came for follow-up, with no signs of local disease. The EGFR protein is found in ~70% of salivary neoplasms and is considered as a factor of poor prognosis and rapid proliferation. PET CT is currently the best examination to detect the existence of a concomitant malignant lesion. Diagnosis of primary SCC (PSCC) of the submandibular gland is made on histopathology. Differential diagnoses include mucoepidermoid carcinoma, lymphoepithelial carcinoma and submandibular metaplasia. There is an increased prevalence of nodal involvement in the PSCC, which justifies neck dissection (regions I, II and III of the neck). The RAS mutation leading to resistance to anti-EGFR therapies may be assessed. This would allow for a treatment depending on molecular features for metastatic PSCCs. PSCC of major salivary glands is a very rare lesion with local and general aggressiveness. The diagnosis is based on a combination of clinical examination, MRI, fine needle aspiration and histological examination. Immunotherapy constitutes a ground of research to treat metastatic and advanced pathological cases.
涎腺鳞状细胞癌（SCC），也称为表皮样癌，是一种非常罕见的肿瘤性肿瘤。它可表现为头颈部皮肤或黏膜鳞状癌的转移灶，也可为原发性SCC。在后一种情况下，最常见的危险因素是既往对腺体的放射治疗。常见的临床症状为颈部肿胀和唾液分泌减少。治疗主要为手术治疗，多数情况下需辅以根治性颈清扫术和术后放射治疗。一名有长期吸烟史的75岁男性患者因右侧下颌下区肿物3个月前来就诊。下颌下区及颈内静脉上区未触及颈部淋巴结肿大。CT扫描显示右侧颈部有一个强化不均匀的病变，侵犯了下颌舌骨肌和茎突舌骨肌。对病变进行活检切除显示为一个有细胞核异型性的角化肿瘤，符合SCC。肿物的根治性切除包括切除受浸润的皮肤。皮肤缺损用菱形皮瓣修复。患者开始接受辅助放疗和化疗。术后8个月，患者前来复诊，无局部疾病迹象。表皮生长因子受体（EGFR）蛋白在约70%的涎腺肿瘤中存在，被认为是预后不良和快速增殖的一个因素。正电子发射断层显像（PET）CT目前是检测是否存在合并恶性病变的最佳检查方法。下颌下腺原发性SCC（PSCC）的诊断基于组织病理学检查。鉴别诊断包括黏液表皮样癌、淋巴上皮癌和下颌下化生。PSCC中淋巴结受累的发生率增加，这使得颈清扫术（颈部I、II和III区）成为必要。可评估导致对抗EGFR治疗耐药的RAS突变。这将有助于根据转移性PSCC的分子特征进行治疗。大涎腺PSCC是一种非常罕见的具有局部和全身侵袭性的病变。诊断基于临床检查、磁共振成像（MRI）、细针穿刺抽吸和组织学检查相结合。免疫疗法是治疗转移性和晚期病理病例的一个研究方向。
