Uryu Hideoki, Fujiwara Minako, Uchi Ryutarou, Yamamoto Hidetaka, Nakashima Torahiko
Department of Otorhinolaryngology, Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyouhama, Chuou-ku, Fukuoka 810-8563 Japan.
Pathology, Clinical Research Center, National Hospital Organization Kyushu Medical Center, 1-8-1 Jigyouhama, Chuou-ku, Fukuoka 810-8563 Japan.
Pathol Res Pract. 2023 Oct;250:154823. doi: 10.1016/j.prp.2023.154823. Epub 2023 Sep 15.
Lymphadenoma, a rare benign tumor recognized in the WHO salivary gland tumor classification of 2005, poses diagnostic and treatment challenges due to its rarity and distinct histopathological characteristics. We report a unique case of lymphadenoma in a 45-year-old male patient who presented with a hard, painless tumor in the right parotid gland that had been present since he was 15 years old. Distinctively, MRI and CT imaging revealed signs of infiltration into the surrounding muscle tissues, challenging the traditional notion of lymphadenomas as tumors with clear boundaries. The histopathological examination identified the characteristic epithelial and lymphoid cell proliferation, suggestive of a lymphadenoma. However, the possibility of sebaceous differentiation due to faintly pale cells within the epithelial component was inconclusive. The tumor's invasive nature and the high risk of facial nerve paralysis associated with surgical resection led to the patient's decision against treatment. Findings from this case underline the need for caution in diagnosing lymphadenoma, given its potential to show invasive images and the risks associated with a malignant diagnosis based solely on these images. Furthermore, the observations from this case present new insights into the FDG-PET findings of lymphadenoma, contributing to the overall understanding of this rare tumor's clinical implications. Future studies are warranted to provide more clarity on this condition.
淋巴腺瘤是2005年世界卫生组织唾液腺肿瘤分类中认可的一种罕见良性肿瘤，由于其罕见性和独特的组织病理学特征，给诊断和治疗带来了挑战。我们报告了一例独特的淋巴腺瘤病例，患者为一名45岁男性，自15岁起右侧腮腺出现一个坚硬、无痛的肿瘤。特别的是，MRI和CT成像显示有浸润周围肌肉组织的迹象，这对淋巴腺瘤是边界清晰的肿瘤这一传统观念提出了挑战。组织病理学检查发现了特征性的上皮细胞和淋巴细胞增殖，提示为淋巴腺瘤。然而，上皮成分中淡色细胞导致皮脂腺分化的可能性尚无定论。肿瘤的侵袭性以及与手术切除相关的面神经麻痹高风险导致患者决定不接受治疗。该病例的发现强调了诊断淋巴腺瘤时需要谨慎，因为它有可能显示侵袭性影像，且仅基于这些影像进行恶性诊断存在风险。此外，该病例的观察结果为淋巴腺瘤的FDG-PET检查结果提供了新的见解，有助于全面了解这种罕见肿瘤的临床意义。未来有必要开展更多研究以进一步明确这种情况。
