口腔に発生した巨大な多形腺腫症例
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- とよみ かやぬま
- 5 years ago
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1 mm CT 75mm MRI T1 T2 185
2 口 咽 科 26 2 武永芙美子 他5名 し て 手 術 を 予 定 し た が 術 前 検 査 に て HbA1c 11 6 JDS と重症の糖尿病が発見されたため 最初に当院 内科で血糖コントロールを行った後 2012年2月中旬に 図2 図1 初診時口腔内所見 腫瘤は口腔内に充満し 右上部に潰瘍を形成してい る 腫瘤のため 完全に閉口できない状態である 図3 造影 CT 所見 硬口蓋を基部とする長径 75mm の腫 瘤が描出されている 辺縁は境界明瞭 で内部は不均一な造影効果を示す MRI 所見 a T1 強調像 b T2 強調像 c Gd 造影 T1 強調像 T1 強調画像で低信号 T2 強調画像では低信号から軽度高信号が混在し ガド リニウムにより全体的に不均一に造影されている 186
3 巨大な口腔多形腺腫 図5 図4 手術所見 a 切除後の状態 切除した腫瘍の基部は40 30mm で 硬口蓋 右側に存在した 切除断端深部は 骨膜を含 めて摘出し さらに上顎骨皮質骨を一部鉗除 した b 欠損部をネオベール で被覆した状態 欠損部をネオベール で被覆し その表面に ボルヒール を散布して手術を終了した 口 咽 科 26 2 摘出腫瘍 a 表面平滑 大きさは mm 重量は 92g 基部は広基性で 骨膜と 共に切除されている b 割面は 淡黄色で充実性腫瘍である 経口的硬口蓋腫瘍摘出術を施行した 手術所見 経鼻挿管による全身麻酔下に硬口蓋の腫瘍 を基部で切除した 尾側は骨膜を含めて摘出し さら 図6 に 露出した上顎骨皮質骨の一部をリュール氏骨鉗子で 鉗除した 術中迅速病理診断は施行しなかった 欠損部 は比較的大きく 図4a 一次縫縮ができなかったた め ポリグリコール酸シート ネオベール とフィブ リン糊スプレー ボルヒール を併用して被覆し 図4 病理組織所見 HE 染色 200 導管上皮細胞が粘液の入った腺腔を囲む像を 呈し その周囲に筋上皮細胞が充実性 小胞 巣状に増殖して二相性構造を形成している 粘液腫様組織や軟骨腫様組織も混在してい る 悪性転化を示唆する所見はない b 手術を終了した 腫瘍は 表面平滑で 大きさは mm 重 量 は 92g 基 部 は 広 基 性 で 40 30mm であった 図5a 割面は淡黄色充実性であっ 織も混在しており 多形腺腫を示す組織像で あ っ た た 図5b 図6 悪性転化を示唆する所見はなく また口蓋骨と 病理組織所見 HE 染色では 内層が腺管上皮細胞 接する部分の断端に被膜外浸潤はなかった 外層が筋上皮細胞から成る二相性構造を形成する腺管状 術後経過 経過良好にて術後5日で退院となった 術 増殖を呈していた さらに 粘液腫様組織や軟骨腫様組 後3週で硬口蓋欠損部を被覆したネオベール は脱落 187
4 mm 40mm 56mm 188
5 26 2..,., MOOK.,, p Batsakis JG, Regezi JA, Bloth D. The pathology of head and neck tumors : salivary glands, part 3. Head Neck Surg 1979 ; 1 : ,,, carcinoma in pleomorphic adenoma.. Bhaskar SN, Weinmann JP. Tumors of the minor salivary glands : a study of twenty three cases. Oral Surg Oral Med Oral Pathol 1955 ; 8 : Cates HLC, Devine KD, DeSanto LW, et al. Glandular tumors of the palate. Surg Gynecol Obstet 1975 ; 140 : ,,,.,, p ,,,..,,,...,.,, p ,,..,,,..,,,..,,,. Therapeutic Research 2004 ; 25 : ,,,. Pharma Medica 2004 ; 22 :
6 26 2,,,.. A giant pleomorphic adenoma in the oral cavity Fumiko Takenaga, Tetsuro Wakasugi, Gunji Nagatani Shoko Takeuchi, Risa Takahashi and Hideaki Suzuki Department of Otorhinolaryngology, School of Medicine, University of Occupational and Environmental Health We report herein on a rare case of giant pleomorphic adenoma in the oral cavity. A 69 year old woman had been aware of an oral mass gradually increasing in size for 40 years, and presented with a 3 day history of repeated oral bleeding. When she was first seen by us on November 1, 2011, her mouth was filled with a huge mass arising from the hard palate, which hindered her from closing the jaw. Computed tomography revealed a well defined heterogeneously enhanced mass measuring 75mm at its greatest dimension. The mass showed low and heterogeneously high intensities in T1 and T2 weighted magnetic resonance imaging, respectively. The histopathological finding of a biopsy specimen indicated desmoma, and the patient underwent transoral resection of the tumor. The periostium of the hard palate was simultaneously removed, and the bone cortex was curetted. Because primary suturing of the surgical defect was unfeasible, the exposed bone surface was covered with a polyglycolic acid sheet and fibrin glue. The histopathological diagnosis was pleomorphic adenoma. The postoperative course was uneventful. The patient currently does not have dysarthria or difficulty in mastication/deglutition, and shows no evidence of recurrence 8 months after surgery. We should be aware that pleomorphic adenoma may grow into such a huge mass. We reviewed the clinical characteristics, diagnosis and treatment of pleomorphic adenoma in the oral cavity. Key words : pleomorphic adenoma, hard palate, minor salivary gland, polyglycolic acid sheet 190
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