耳下腺上皮性悪性腫瘍の診断と治療

Abstract

Between May 1984 and March 1993,19 patients (male: 14, female: 5 average age 49.8)with malignant parotid gland epithelial tumors were treated in the Department of Otolaryngology. A clinical study of these tumor patients revealed the following:21% of all parotid gland tumors were malignant epithelial tumors. Most of the malignant parotid gland tumors were diagnosed by present history (rapid growth of tumor), symptom (local pain) and local findings (adhesion, facial palsy and cervical lymph node swelling). Therefore, we must be attentive to such signs on the initial examination of patients with parotid gland tumors.Total parotidectomy or extensive total parotidectomy was not necessary for all malignant epithelial tumors of parotid gland.All three patients who had preoperative facial palsy died of distant metastasis and intracranial invasion, although they underwent extensive total parotidectomy, radical neck dissection, postoperative irradiation and chemotherapy.There were three recurrent cases with i ntracranial invasion. When patients complained of double vision or nausea, we could not find obvious tumors in the surgical field, but Xray CT and MRI examination detected intracranial recurrence. This suggests that we must examine for intracranial invasion periodically with X-ray CT or MRI during the follow up period after therapy. When pathological diagnosis does not reveal the typical type of parotid gland tumor (for example squamous cell carcinoma), we must determine the primary region.