Submandibular gland (pleomorfic adenoma) excision video

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tümörlerinin % 6,8 ile 14,5‘inin submandibüler bezde
görüldüğü bildirilmiştir. Submandibüler bez yerleşimli ve malignite riski
taşıyan kitlelerin belirlenmesi için operasyon öncesi
yapılan değerlendirmelerde, kitlenin sahip olduğu
radyolojik görüntüleme özelliklerinden ve İİAB'den
faydalanılabilmektedir. İİAB'nin tükürük bezi
neoplazilerini saptamadaki sensivitesi %73-94,
spesifitesi ise %75-91 arasında değişen oranlarda
bildirilmektedir. Ancak submandibüler bez
kitlelerinde İİAB'nin yeri ile ilgili geniş seriler
bulunmamaktadır. Radyolojik görüntüleme
yöntemleri ve İİAB bulguları ile benign-malign ayrımı net olarak yapılamayan ya da malignite riski
taşıyan hastalarda ise peroperatif donuk kesit
inceleme yapılması önerilmektedir. Donuk kesit
inceleme uygulanacak olan cerrahinin kapsamının
belirlenmesi açısından yarar sağlamaktadır. Donuk
kesit inceleme ile benign özelliklerin ortaya konması
durumunda, submandibüler bez ablazyonu
submandibüler bez pleomorfik adenomlarında yeterli
tedavi olmaktadır.
Pleomorfik adenom, tüm tükürük bezleri
benign tümörleri arasında en sık karşılaşılan tümör
olmasına karşın submandibüler bezde nadir olarak
görülmektedir. Literatüre göre pleomorfik
adenomların % 4,8 ile 18,3'ü submandibüler bezde
yer almaktadır. Olgu sayısının genel dağılıma göre
çok olmaması nedeni ile bu konu daha çok olgu
serileri ve tanı yöntemlerine ilişkin çalışmalar ile
incelenmektedir.
The submandibular gland is involved in only 5% to 10% of the salivary gland tumors, and pleomorphic adenoma PA is the most common tumor affecting it. This study describes the clinicopathological features and immunohistochemical expression of Ki-67 and p53 in 60 cases of submandibular salivary gland PAs. Most of the patients were in the third and fifth decades of life and 37 62% of them were women. Tumor sizes varied from 1 to 10 cm and the mean time between symptom onset and treatment was 52 months. Only 1 patient experienced local recurrence, 3 years after treatment. Histologically, most tumors consisted chiefly in a chondromyxoid stroma. Stroma-rich PAs were larger than stroma-poor ones . All PAs were found negative for Ki-67 and p53. These results show that PAs of the submandibular gland are histologically similar to PAs of other salivary glands, and that they have a low proliferative rate and a good prognosis.

Salivary gland tumors, which represent 1% to 4% of all human neoplasias, affect the parotid gland in more than 70% of cases, with the submandibular gland 5%-10, the sublingual gland 1%, and the minor glands 5%-15% sharing the rest.1 Pleomorphic adenoma PA, the most common salivary gland tumor, accounts for 60% to 70% of all parotid gland neoplasias, 40% to 60% of all submandibular gland neoplasias, and 40% to 70% of all minor salivary gland neoplasias. Pleomorphic adenoma is characterized by great histological diversity, and myoepithelial cells are considered responsible for the production of the extracellular matrix.

The expression of genes related to cell proliferation and oncogenesis seems to be associated with the prognosis of some oral tumors. The expression of Ki-67, assessed by immunohistochemical methods, has been correlated with the mitotic activity, histological grade, and clinical behavior of tumors, including salivary gland tumors. In addition, the mutation of the tumor suppressor gene p53 is the most common genetic alteration found in human cancers.

• Category

  Salivary Gland Cancer