一位52歲男性以右耳下腫脹及壓痛表現之病例報告

A Case Report of Painful Swelling and Tenderness Under the Right Ear of a 52-Year-Old Man Patient

耳下腫脹及壓痛在耳鼻喉科為常見主訴，相關診斷會聯想急性腮腺炎、深層頸部感染或腮腺良性或惡性腫瘤等，原發性腮腺鱗狀細胞癌雖然罕見亦可能發生，無法排除。本文個案為一位52歲男性，因右耳下腫脹及壓痛約四週就醫，進行病史收集、身體評估和實驗室檢驗，因檢查結果高度懷疑為惡性腫瘤，故安排頸部超音波引導下的組織穿刺，細胞學檢查確診為右側腮腺鱗狀細胞癌，影像學檢查確認是原發性腫瘤，排除其他癌症轉移，術前癌症分期cT3N0M0。就醫第十天安排了右側全腮腺切除和部分頸部淋巴結清除手術，術後併發右側顏面神經麻痺，安排復健科行物理治療；術後癌症分期pT3N2bM0，安排術後化學放射治療。原發性腮腺鱗狀細胞癌缺乏早期診斷的特異性症狀，故當發現症狀時多為疾病晚期。因此，建議臨床醫護人員應警覺病患若有耳下腫脹及壓痛時，可將原發性腮腺鱗狀細胞癌納入鑑別診斷中，並迅速安排頸部超音波檢查，並評估是否需進一步穿刺細胞學檢查，及早確認診斷及介入醫療處置。

Swelling and tenderness below the ear are common presenting complaints in otolaryngology. Differen¬tial diagnoses typically include acute parotitis, deep neck infections, and benign or malignant parotid tumors. Although primary squamous cell carcinoma of the parotid gland is rare, it should be consid¬ered in the differential diagnosis. We report the case of a 52-year-old man who presented with painful swelling and tenderness below the right ear for approximately four weeks. After a detailed medical history, physical examination, and laboratory evaluation, malignancy was strongly suspected. Ultra¬sound-guided fine-needle aspiration of the parotid mass was performed, and cytological examination confirmed SCC of the right parotid gland. Imaging studies confirmed that the tumor was primary, ruling out metastasis from other cancer sites. Preoperative cancer staging was cT3N0M0. On the tenth day of admission, the patient underwent a right total parotidectomy with selective neck lymph node dissection. Postoperatively, right-sided facial nerve palsy developed, and physical therapy was initiat¬ed by the rehabilitation team. Final pathological staging after surgery was pT3N2bM0, and adjuvant chemoradiotherapy was subsequently administered.. Because primary parotid squamous cell carcino¬ma lacks specific symptoms in early stages, most cases are diagnosed at an advanced stage. Therefore, clinical healthcare providers should maintain a high index of suspicion for this malignancy in patients presenting with painful swelling below the ear. Prompt neck ultrasonography and fine -needle aspira¬tion cytology are recommended to facilitate early diagnosis and timely therapeutic intervention.