Jalaeefar Amirmohsen, Saffar Hana, Shirkhoda Mohammad, Garajei Ata, Sharifi Amirsina
Department of General Surgery, Subdivision of Surgical Oncology, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran.
Department of Anatomical and Clinical Pathology, Cancer Institute, Imam Khomeni Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran.
Int J Surg Case Rep. 2023 Oct;111:108822. doi: 10.1016/j.ijscr.2023.108822. Epub 2023 Sep 14.
Although pleomorphic adenoma (PA) is the most common neoplasm of both minor and major salivary glands, its presence in the buccal surface of upper lip is rare.
A 70-year-old male presented with a chief complaint of recent rapid growth of a mass in the buccal aspect of the upper lip. A well-circumscribed mass measuring 3 × 2 cm with intact overlying mucosa without regional lymphadenopathy was evident. Core needle biopsy report was suggestive of PA. Complete excision of the tumor was performed. The defect was large and primary closure was not possible. Reconstruction with FAMM flap was planned. After 4 weeks, the flap was covered with epithelia and created a satisfactory result.
The definite diagnosis of PA is based on histopathological examination. The following features help to differentiate PA from other tumors; tubuloalveolar and gland-like structures, islands of cuboidal or polygonal cells in a chondroid, hyalinized, fibroadipose or mucinous hypocellular stroma which are stained positively for periodic acid-Schiff and Alcian. Despite these characteristics, differentiation of PA from dermal mixed tumor may be challenging especially when the specimen is from the upper lip. The main advantages of FAMM.F are being thin and pliable flap, having wide arc of rotation; being suitable for reconstruction of mucosal defects; resistance against postoperative radiotherapy and easy harvesting.
The FAMM flap is a reliable reconstruction technique for medium-sized intraoral defects with limited morbidity to the donor site. It provides functional reconstruction of the oral cavity with a low risk of post-operative complications.
多形性腺瘤（PA）是小唾液腺和大唾液腺最常见的肿瘤，但其在上唇颊面出现的情况较为罕见。
一名70岁男性，主要诉求是上唇颊侧肿物近期迅速生长。可见一个边界清晰、大小为3×2 cm的肿物，其上覆盖的黏膜完整，无区域淋巴结肿大。粗针穿刺活检报告提示为多形性腺瘤。对肿瘤进行了完整切除。缺损较大，无法进行一期缝合。计划采用FAMM皮瓣进行重建。4周后，皮瓣被上皮覆盖，效果满意。
多形性腺瘤的明确诊断基于组织病理学检查。以下特征有助于将多形性腺瘤与其他肿瘤区分开来；管状腺泡和腺样结构，在软骨样、透明变性、纤维脂肪或黏液性低细胞间质中有立方或多边形细胞岛，对过碘酸希夫染色和阿尔辛蓝染色呈阳性。尽管有这些特征，但将多形性腺瘤与皮肤混合瘤区分开来可能具有挑战性，尤其是当标本来自上唇时。FAMM皮瓣的主要优点是皮瓣薄且柔韧，旋转弧度大；适合重建黏膜缺损；对术后放疗有抵抗力且易于切取。
FAMM皮瓣是一种可靠的重建技术，适用于中等大小的口腔内缺损，供区发病率有限。它能为口腔提供功能重建，术后并发症风险低。
