舌根部Adenoid Cystic Carcinomaの4症例

ADENOIDAL CYSTIC CARCINOMA AT THE BASE OF THE TONGUE, A REPORT OF FOUR CASES

　Ⅰ．緒言

　舌に発生する悪性腫瘍は，頭頸部のうちでも，第3位に位置するぐらい発生率が高く，とくに口腔に限ると第1位を占めている。しかし舌根部（解剖学的には中咽頭に属する）に発生する悪性腫瘍は，比較的少ないとされている^38）。

　また，舌の悪性腫瘍は，ほとんどが扁平上皮癌であるが，舌根部の場合の組織像はさまざまであり，とくにadenoid cystic carcinomaはきわめて稀とされている。本邦報告例としては1例^17）みるにすぎない。しかも悪性経過をとるにもかかわらず，発育が緩慢であるため，誤つて良性腫瘍と考え処置し，そのために一層予後を悪くしていることが多い。

The authors report 4 cases of adenoid cystic carcinoma that occurred at the base of the tongue treated at the Osaka University Hospital.

Case 1. A woman, aged 52, complained of mass at the base of her tongue. By means of biopsy the diagnosis of adenoidal cystic carcinoma was made. By UICC classification this case may be listed as T₂N₀M₀. The patient is treated with radical dis-section of the tumor supplemented by irradiation of 5,000 R of Co⁶⁰. The patient is still alive at present, 4 years and 4 months after the operation. But in the meantime she had had three recurrences with recently established lung metastasis.

Case 2. A man, aged 34, complained of a mass at the base of the tongue which had been there for the past 10 years with gradual enlargement in size. Histopathological diagnosis is mixed tumor and T₁N₀M₀. After surgical removal of the tumor the patient is still alive without any sign of metastasis.

Case 3. A woman, aged 40, complained of left cervical mass without any other symptoms. A tumor was located at the base of the tongue. Radiotherapy showed no effect. The patient was operated with radical neck dissection (T₂N₀M₀). The patient is alive 1 year and 9 months after the operation.

Case 4. A woman, aged 63, complained of sore throat for the period of 1 month. A tumor was found at the base of the tongue (T₃N₀M₀). Biopsy showed an adenoidal cystic carcinoma. The patient was treated with surgical operation supplemented by irradiation therapy of Co⁶⁰ in 6600 R. One years later the patient is alive without any sign of metastasis.

The authors come to final conclusions as follow:

1. The present type of tumor is quite frequently met with among woman.

2. Although histopathological findings of these tumor are quite characteristic, they have often been confused with mixed tumors.

3. The slowness of growth in these tumors is another characteristic feature.

4. The treatment is effected by surgical removal of the tumor with extensive neck dissection.

5. Because of frequent recurrences and distant metastasis, a long term observation of the patient is quite essential.