摘要
目的探讨大涎腺腺样囊腺癌(ACC)的常规超声、超声造影特征,为临床早期诊断提供依据。方法收集2010年1月至2015年12月因颌面部肿块就诊于浙江省肿瘤医院头颈外科,后经手术及病理证实的17例大涎腺ACC患者的常规超声及超声造影特征。结果 17例大涎腺ACC来源于颌下腺者12例(70.6%),腮腺者5例(29.4%)。病程3~240个月,平均病程为(42.9±62.1)个月。原发14例(82.4%),复发3例(17.6%),复发时间为36~132个月,平均复发时间为(70.7±43.2)个月。9例(52.9%)患者伴面颊部疼痛,1例合并嘴角偏斜,1例合并张口受限,1例合并舌活动障碍。17例均为形态欠规则的低回声结节,3例(17.6%)回声均匀;14例(82.4%)回声不均。11例肿块(64.7%)边界清晰,6例(35.3%)边界不清。4例(23.5%)肿瘤内未见明显血流信号(0级),11例(64.7%)肿瘤内血流信号Ⅰ~Ⅱ级,2例(11.8%)Ⅲ级。大涎腺ACC超声造影均表现为快进、向心性、高增强,增强不均匀,内可见低增强、无增区,增强后边界不清晰。17例ACC均累犯面神经,其中3例(17.6%)合并舌神经侵犯;4例(23.5%)合并脉管瘤栓;4例(23.5%)浸润横纹肌组织;1例合并下颌骨受累;1例(5.9%)合并颈部淋巴结转移。16例(94.1%)组织病理类型为筛孔型,1例(5.9%)为实质型。结论大涎腺ACC更易发生于颌下腺,面神经侵犯率高,常伴有面颊部疼痛及面神经功能障碍。ACC常规超声具有一定的特征性,超声造影具有涎腺恶性肿瘤特征,同时结合其临床特征表现,能显著提高大涎腺的超声诊断率。大涎腺ACC术后远期复发率高,应长期超声随访。
Objective To investigate the characterization of adenoid cystic carcinoma（ACC） in major salivary glandby conventional and contrast-enhanced ultrasound（CEUS）.Methods The conventional and contrast-enhanced ultrasound images of 17 ACC in major salivary gland with pathological confirmation were retrospectively reviewed.Results 12（70.6%） cases in 17 were found in submandibular,while 5 cases（29.4%） were in parotid.All the patients complained a mass,52.9% had cheek pain,and 17.6% had hadfacial nerve or lingual nerve paralysis;these symptoms had been present from 3 to 240 months（mean duration was 42.9±62.1 months）.14 cases（82.4%） were primary focuses,and 3 cases（17.6%） were recurrences with recurrence time from 36 to 132 months（mean recurrence time was 70.7±43.2 months）.All lesions were hypoechoic with irregular shape,and only 17.6% had a homogeneous echotexture,64.7% heterogeneous.64.7% of all tumors were well-defined.On CDFI,blood flow signal hadn？t detected in 23.5% patients,and 64.7% hadintermediate（＋ and ＋＋） grades of vascularity.Only 11.8% had the highest grade of vascularity（＋＋＋）.The CEUS images of ACC in major salivary showed slow fill-in,centripetal,higher enhancement,inhomogeneous enhancement,poorly defined margins and after enhancing the size unchanged.No enhancement orlow enhancement area were common in the AC.Facial nerve invasion can be seen in all cases,including 3 cases（17.6%） of lingual nerve invasion,4 cases（23.5%） of blood vessel invasion;4 cases（23.5%） of striated muscle infiltration;1 case with mandibular involvement;1 case（5.9%） with cervical lymph node metastasis.94.1% of ACC in major salivary gland were cribriform patterns,and 5.9% were solid patterns.Conclusions ACC in major salivary gland are more likely to happen in the submandibular gland,which has especially high tendency of facial nerve invasion and cheek pain.Conventional Ultrasound and CEUS imaging characteristics can be used to differentiate ACC from other tumors in major salivary gland,which would help clinicians to diagnose.The clinical course is characterized by very late recurrences;consequently,longer following-up with ultrasound is proposed.
出处
《中华医学超声杂志（电子版）》
CSCD
2017年第1期57-60,共4页
Chinese Journal of Medical Ultrasound(Electronic Edition)
基金
浙江省中医药科技计划项目(2013ZA025)
关键词
囊腺癌
超声检查
涎腺
Cystadenocarcinoma
Ultrasonography
Salivary
