Der Einfluss des Kapseldefektes als Risikofaktor für die Rezidivbildung beim pleomorphen Adenom der Glandula parotidea

Zusammenfassung

Hintergrund Ziel dieser Arbeit war es, verschiedene Aspekte des Kapseldefekts eines pleomorphen Adenoms zu beleuchten und den Einfluss dieses Faktors mithilfe der vorliegenden Daten und der relevanten Literatur auf das Rezidivrisiko zu analysieren.

Material und Methoden Es handelt sich um eine retrospektive Analyse aller Patienten, welche zwischen 2005 und 2020 bei einem pleomorphen Adenom der Glandula parotidea behandelt wurden. Es erfolgte eine erneute histopathologische Untersuchung der Paraffinblöcke aller Fälle sowie eine Analyse der patientenbezogenen Daten, des Ausmaßes des primären operativen Eingriffs und des Rezidivrisikos. Die Nachsorgeuntersuchung erfolgte im Sinne einer klinischen und sonografischen Untersuchung.

Ergebnisse Insgesamt wurden 845 Patienten in einer Datenbank erfasst. Hierunter fanden sich 7 (0,8 %) Rezidive, jedoch alle bei „in sano“ resezierten Tumoren. Positive Ränder zeigten sich in 37 Fällen (4,4 %). Bei 13 der 37 Fälle war dies intraoperativ festgestellt worden, wohingegen der Defekt bei 24 der 37 Fälle erst histopathologisch identifiziert wurde. Bei den 13 Fällen der makroskopischen Tumoreröffnung wurde in 2 Fällen bei der sonografischen Untersuchung der Verdacht auf ein unilokuläres Rezidiv des pleomorphen Adenoms gestellt, welches zunächst sonografisch kontrolliert wurde.

Schlussfolgerung Die positiven Ränder beim parotidealen pleomorphen Adenom scheinen nicht zwangsläufig zum vorprogrammierten Rezidiv zu führen.

Abstract

Objective Aim of this study was to enlighten various aspects of the capsular defect of a pleomorphic adenoma and to analyze its influence on recurrence rate with the help of our data and the relevant literature.

Material and Methods The clinical records and histopathological findings of all patients who underwent parotidectomy for pleomorphic adenoma between 2005 and 2020 were evaluated retrospectively. The histological slides of all tumours were critically re-evaluated for this study by an experienced head and neck pathologist. The records of the cases with a capsular defect were examined for information on age, gender, type of surgery and surgical outcome.

Results A total of 845 patients were included in the primary group. 7 (0.8 %) recurrences were detected, all of these were resected without a capsular rupture. Positive margins were found in 37 cases (4.4 %). In 13/37 cases the capsular defect was detected intraoperatively, whereas the defect was only identified histopathologically in 24 of the 37 cases. In the group of the intraoperative capsular opening, with a median follow-up of 62 months, the sonographic examination suspected a unilocular recurrence of the pleomorphic adenoma in two cases.

Conclusion The intraoperative capsule opening does not inevitably seem to lead to a pre-programmed recurrence.

Schlüsselwörter

Glandula parotidea - pleomorphes Adenom - Kapsel - Tumoreröffnung - Rezidiv - Rezidivrate

Key words

parotid gland - pleomorphic adenoma - capsule - capsule opening - recurrence - recurrence rate

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