Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan.
Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan;
In Vivo. 2024 May-Jun;38(3):1454-1458. doi: 10.21873/invivo.13590.
BACKGROUND/AIM: First bite syndrome (FBS) is a symptom of severe pain at the beginning of a meal that lessens as the meal progresses. It is a common postoperative complication of parapharyngeal space tumors and is rarely reported as the first symptom of parotid carcinoma. The parapharyngeal space is considered a difficult area for approach; hence, preoperative histopathology is often challenging. However, there are hardly any reports on the approach of performing biopsies under computerized tomography (CT) guidance.
A 28-year-old woman presented to our hospital with the chief complaint of pain in the left parotid region since the past year. Contrast-enhanced magnetic resonance imaging of the parotid gland revealed a 10-mm high-signal area on T2-weighted images extending from the deep lobe of the left parotid gland to the parapharyngeal space, which could not be visualized on ultrasound. She was suspected to have a malignant tumor because of the presence of a parotid tumor with FBS. Therefore, she underwent CT-guided fine-needle aspiration cytology (FNAC) and was diagnosed with adenoid cystic carcinoma. The patient underwent left parotid tumor resection and left cervical dissection, and her pain during feeding improved postoperatively.
In a patient with parotid tumor extending into the parapharyngeal space with FBS as the initial symptom, CT-guided FNAC was successfully used to diagnose parotid carcinoma. Symptoms of pain, including FBS, should be considered in cases of malignancy. CT-guided FNAC is effective for lesions that cannot be visualized by ultrasound, such as those in the parapharyngeal space.
背景/目的：第一口综合征（FBS）是指在进食开始时出现严重疼痛，随着进食的进行而减轻的症状。它是咽旁间隙肿瘤的一种常见术后并发症，很少有报道将其作为腮腺癌的首发症状。咽旁间隙被认为是一个难以接近的区域；因此，术前组织病理学检查常常具有挑战性。然而，几乎没有关于在计算机断层扫描（CT）引导下进行活检的方法的报道。
一名 28 岁女性因左侧腮腺区疼痛一年余就诊于我院。腮腺的增强磁共振成像显示 T2 加权图像上有一个 10mm 高信号区，从左侧腮腺深叶延伸至咽旁间隙，超声无法显示。由于存在 FBS 的腮腺肿瘤，她被怀疑患有恶性肿瘤。因此，她接受了 CT 引导下细针抽吸细胞学检查（FNAC），并被诊断为腺样囊性癌。患者接受了左侧腮腺肿瘤切除术和左侧颈淋巴结清扫术，术后进食时疼痛得到改善。
对于以 FBS 为首发症状的腮腺肿瘤延伸至咽旁间隙的患者，CT 引导下 FNAC 成功用于诊断腮腺癌。在恶性肿瘤的情况下，应考虑疼痛等症状，包括 FBS。CT 引导下 FNAC 对超声无法显示的病变（如咽旁间隙的病变）有效。
