Gobishangar S, Raviraj S, Vinojan S, Dias S J T, Theepan J M M, Dinoshiga K
Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka; University Surgical Unit, Teaching Hospital, Jaffna, Sri Lanka.
Department of Surgery, Faculty of Medicine, University of Jaffna, Sri Lanka; University Surgical Unit, Teaching Hospital, Jaffna, Sri Lanka.
Int J Surg Case Rep. 2023 Oct;111:108865. doi: 10.1016/j.ijscr.2023.108865. Epub 2023 Sep 26.
Pleomorphic adenoma is the most common benign tumour of the parotid gland. It is commonly observed in middle-aged women. Usually, pleomorphic adenomas are asymptomatic with a slow-progressing tendency. There is a substantial risk of malignant transformation if left untreated. Imaging modalities and fine needle aspiration cytology are highly valuable preoperative diagnostic tools and aid in selecting therapeutic interventions. Surgical technique is chosen based on clinical grounds.
A 48-year-old woman presented with a painless extensive mass in the left-sided face. A provisional diagnosis of the benign parotid tumour was made based on clinical evaluation. Imaging studies and cytological assessment suggested pleomorphic adenoma of the left parotid gland, and left-sided total parotidectomy with facial nerve dissection was performed.
Pleomorphic adenoma involving the deep lobe of the parotid gland is rare. It typically grows slowly. If left untreated, it can present as a giant mass, as in our case. The extensive tumour mass can also involve adjacent structures, including facial nerve. Therefore, surgical dissection must be involved facial nerve and adjacent muscles.
Surgical dissection of giant pleomorphic adenoma is challenging and often leads to significant deformities postoperatively. Early intervention will improve surgical outcomes and quality of life.
多形性腺瘤是腮腺最常见的良性肿瘤。多见于中年女性。通常，多形性腺瘤无症状，呈缓慢进展趋势。若不治疗，恶变风险很大。影像学检查和细针穿刺细胞学检查是非常有价值的术前诊断工具，有助于选择治疗干预措施。手术技术根据临床情况选择。
一名48岁女性，左侧面部出现无痛性巨大肿块。根据临床评估初步诊断为腮腺良性肿瘤。影像学检查和细胞学评估提示左侧腮腺多形性腺瘤，遂行左侧腮腺全切除术并面神经解剖。
累及腮腺深叶的多形性腺瘤罕见。通常生长缓慢。若不治疗，可如本例一样表现为巨大肿块。广泛的肿瘤肿块还可累及包括面神经在内的相邻结构。因此，手术解剖必须涉及面神经和相邻肌肉。
巨大多形性腺瘤的手术解剖具有挑战性，术后常导致明显畸形。早期干预将改善手术效果和生活质量。
