下頷腺的唾液腺管道癌：罕見病例報告及文獻回顧

Salivary Duct Carcinoma of the Submandibular Gland: A Rare Case Report and Review of Literature

唾液腺管道癌是一種罕見但具高度侵犯性的惡性腫瘤。此腫瘤細胞病理型態上與侵襲性乳管癌相似。作者在此報告一名長在下頷腺之唾液腺管道癌病例。這位63歲男性發現在右側下頷腺處有一腫塊。手術後顯微檢查發現唾液腺管腔上皮增生伴有粉刺型壞死。免疫組織化學染色呈現CK7與EMA異常增加。綜合以上發現與高度惡性唾液腺管道癌最相符合。病患在接受下頷腺切除術後也做了輔助性放射線治療，但卻在兩年之內發生了腫瘤遠處轉移。因此我們發現手術後加做輔助性放射線治療似乎是不夠的。全身性治療的必要性也需要納入考慮。

Salivary ductal carcinoma (SDC) is a salivary gland malignancy that is highly aggressive with a poor prognosis, but it is extremely rare. The tumor cells resemble invasive ductal carcinoma of the breast pathologically. The authors describe herein a case of high-grade salivary duct carcinoma arising from the submandibular gland. The patient was a 63-year-old male who had a firm mass around the right submandibular region. Microscopic examination showed intraductal proliferation of salivary duct-type epithelium with a comedo-type necrosis pattern. Immunohistochemical analysis revealed an abnormal increase of CK7 and EMA in tumor cells. The overall features were most comparable with those of high-grade salivary duct carcinoma. After undergoing submandibulectomy and adjuvant radiotherapy (RT), the patient developed multiple distant metastases within two years. We found adjuvant radiotherapy alone after operation seemed to be insufficient. The necessity of systemic treatment should also be considered.