耳上腺癌症例の検討

DOI 被引用文献5件 参考文献18件

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  • Carcinoma of the parotid gland

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We reviewed 29 cases of previously untreated parotid gland carcinomas experienced between 1967 and 1999 at Tenri Hospital. The average follow-up time was 6 years. Cases were staged according to the UICC classification of 1997 (stage I, 17; stage II, 3; stage III, 2; and stage IV, 7), and the pathologic materials of all cases were reviewed and classified according to the WHO's histological classification of 1991 (mucoepidermoid carcinoma, 12; acinic cell carcinoma, 8; adenoid cystic carcinoma, 4; carcinoma in pleomorphic adenoma, 3; squamous carcinoma, 1; and sahvary duct carcinoma, 1).<BR>Our philosophy of the management for carcinoma of the parotid gland is as follows. 1) First, total parotidectomy is performed preserving the facial nerve where possible. 2) If the facial nerve is invaded by tumor, it is sacrificed until malignant cells are negative in the margin. 3) Only the cases with a high grade malignancy and/or with positive margins are irradiated postoperatively. Actuarial analysis indicated that 5-and 10-year survival was 78.5%, and 5-year local control was 72.8%. This result is satisfactory and our philosophy should be continued.<BR>Fine-needle aspiration cytology diagnosed carcinomas of the parotid gland with 50% sensitivity. Histologic false-negative cases were the carcinoma with low malignancy (acinic cell carcinoma and mucoepidermoid carcinoma). Most of the false-negative cases could be diagnosed correctly using intra-operative histologic diagnosis from frozen sections, and were treated appropriately. Proper treatment of the carcinoma of the parotid gland requires both fine-needle aspiration and frozen section.<BR>Preoperative facial nerve palsy occurred in 3 cases and their prognosis was very poor. In contrast, the prognosis of the cases with facial nerve invasion, which did not show preoperative facial nerve palsy, was not necessarily bad. Preoperative facial nerve palsy, rather than facial nerve invasion, is the more negative prognostic factor of the carcinoma of the parotid gland.

収録刊行物

  • 口腔・咽頭科

    口腔・咽頭科 12 (3), 361-367, 2000

    日本口腔・咽頭科学会

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