Saha Mehul, Kudva Adarsh, Sharma Swati, Singh Radhika
Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Manipal Academy of Higher Education, Manipal, India.
Department of Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India.
J Oral Maxillofac Pathol. 2024 Jul-Sep;28(3):478-482. doi: 10.4103/jomfp.jomfp_13_24. Epub 2024 Oct 15.
Polymorphous adenocarcinoma (PAC) is a low-grade malignant tumour of minor salivary glands of the oral cavity, which rarely presents with invasive features. Low metastatic and excellent survival rates are some of its favorable features. A 36-year-old woman reported with swelling, pain, and mobility of teeth in the left upper inner cheek region. Contrast enhanced computed tomography (CECT) revealed a large, lobulated, heterogenous mass in the left retro-maxillary region with a few enlarged left cervical lymph nodes (levels IB and II). After surgery, the final histopathology report gave a definitive diagnosis of PAC with certain invasive characteristics - perineural invasion, infiltration into skeletal muscle, and depth of invasion of 10 mm, which recurred in a different location 1.5 years later. A few predictable features of PAC include incidence in elderly women, asymptomatic presentation, occurrence in the posterior hard of soft palate, very low incidence of nodal or distant metastases, perineural spread, skeletal muscle infiltration, and low rates of recurrence with good survival outcomes. However, in our case, the patient appeared to present with a relatively aggressive form of PAC, considering her young age, symptomatic presentation, uncommon anatomic location in the retro-maxilla, cervical nodal metastasis, perineural and skeletal muscle infiltration, and local recurrence within a short period. Although PAC is a low-grade tumour with excellent prognosis, it may occasionally present with invasive characteristics, and early diagnosis and prompt management with strict adherence to post-operative regimens and follow-up is of prime importance to prevent any untoward outcomes.
多形性腺癌（PAC）是口腔小唾液腺的一种低级别恶性肿瘤，很少出现浸润性特征。低转移率和高生存率是其一些有利特征。一名36岁女性报告左上内侧颊部区域出现肿胀、疼痛和牙齿松动。增强计算机断层扫描（CECT）显示左上颌后区域有一个大的、分叶状的、不均匀的肿块，左侧颈部有几个肿大的淋巴结（IB区和II区）。手术后，最终病理报告明确诊断为具有某些浸润性特征的PAC——神经周围浸润、浸润至骨骼肌以及浸润深度为10毫米，1.5年后在不同部位复发。PAC的一些可预测特征包括老年女性发病率、无症状表现、发生于软硬腭后部、淋巴结或远处转移发生率极低、神经周围扩散、骨骼肌浸润以及复发率低且生存结果良好。然而，在我们的病例中，考虑到患者年轻、有症状表现、上颌后区域不常见的解剖位置、颈部淋巴结转移、神经周围和骨骼肌浸润以及短期内局部复发，该患者似乎表现出一种相对侵袭性的PAC形式。尽管PAC是一种预后良好的低级别肿瘤，但它偶尔可能会出现浸润性特征，早期诊断并严格遵循术后方案进行及时治疗和随访对于预防任何不良后果至关重要。
