腭部复发性多形性腺瘤：一例病例报告

文献信息

中文摘要

背景： 多形性腺瘤是最常见的良性唾液腺肿瘤，常累及腭部的小唾液腺。尽管手术切除通常可治愈，但包膜不完整、假足样延伸和微小肿瘤沉积可能导致复发，复发可在初始治疗后多年发生。复发性腭部多形性腺瘤不常见，可能带来诊断和重建挑战。病例介绍：一名64岁男性因右侧硬腭后部无痛、缓慢增大的复发性肿块被转诊，六年前曾在另一机构切除多形性腺瘤。磁共振成像和增强计算机断层扫描显示一个边界清晰、强化的腭部病变，MRI测量约2.1 × 1.9 × 1.9 cm，CT测量1.8 × 2.2 × 1.9 cm，无邻近上颌骨破坏或颈部淋巴结肿大。切开活检符合多形性腺瘤。进行了广泛局部切除，包括肿瘤、周围腭部软组织和下方骨膜。使用面动脉肌黏膜瓣重建缺损。术后过程顺利，皮瓣愈合满意，言语和吞咽功能保留。随访六个月时，无临床复发证据或功能损害。结论：腭部复发性多形性腺瘤可在初次治疗后数年发生。完整手术切除并达到无肿瘤边缘以及适当重建至关重要。建议长期临床随访，因为可能发生晚期复发，罕见情况下可能发生恶性转化。

英文摘要

Background: Pleomorphic adenoma is the most common benign salivary-gland neoplasm and frequently affects the minor salivary glands of the palate. Although surgical excision is generally curative, incomplete encapsulation, pseudopod-like extensions, and microscopic tumor deposits may contribute to recurrence, which can occur many years after initial treatment. Recurrent palatal pleomorphic adenoma is uncommon and may present diagnostic and reconstructive challenges. Case Presentation: A 64-year-old man was referred with a painless, slowly enlarging recurrent mass of the right posterior hard palate, six years after excision of a pleomorphic adenoma at another institution. Magnetic resonance imaging and contrast-enhanced computed tomography demonstrated a well-defined enhancing palatal lesion measuring approximately 2.1 × 1.9 × 1.9 cm on MRI and 1.8 × 2.2 × 1.9 on CT, without adjacent maxillary bone destruction or cervical lymphadenopathy. An incisional biopsy was consistent with pleomorphic adenoma. Wide local excision was performed, including the tumor, surrounding palatal soft tissue, and underlying periosteum. The resulting defect was reconstructed using a facial artery musculomucosal flap. The postoperative course was uneventful, with satisfactory flap healing and preservation of speech and swallowing. At six months of follow-up, there was no clinical evidence of recurrence or functional impairment. Conclusions: Recurrent pleomorphic adenoma of the palate may develop several years after primary treatment. Complete surgical excision with tumor-free margins and appropriate reconstruction is essential. Long-term clinical follow-up is recommended because late recurrence and, rarely, malignant transformation may occur.