臺灣博碩士論文加值系統

多型性腺瘤為最常見的良性唾液腺腫瘤，大約佔所有腮腺腫瘤中的 53%~77%，臨床表現主要為無痛增大。微觀下呈現表皮細胞與漿質兩個部分，並且在漿液性、軟骨性或混合性的漿質中，可看到管腔細胞與肌上皮細胞組成片狀、微囊腫狀、島狀或是絲狀的腫瘤細胞團塊。它的復發性大約介於0% ~17%之間。根據研究其復發性與包膜特徵有關，本篇研究利用細胞多寡性評估腫瘤細胞的侵襲性，並且試圖找到細胞多寡性與包膜特徵的相關性。

本研究的患者檢體，以台北醫學大學附設醫院病理科病例查詢系統資料庫，收集從2008年5月至2015年4月的病例。這些病例中的手術形式為切除術、淺層腮腺切除術或全腮腺切除術。所蒐集到的89個病例中，2例為惡性腫瘤，22例資料不夠完整，最後得到臨床資料完整的病例數目為65例。在剩餘的65個病例當中，其中2例因為細胞多寡性難以判讀而3例因為標本碎裂成多塊而排除，於是剩下60例。此60例中，去除因為病理切片不完整的11例，最後得到能夠分析包膜特徵與細胞多寡性關係的病例數為49例。

在分析完包膜特徵與細胞多寡性關係的49個病例後，我們得知腫瘤存在的時間越長細胞多寡性越低。手術邊緣乾淨與否與衛星結節的產生和細胞密度之間沒有相關性，只有包膜的完整與否和多型性腺瘤的細胞密度有關。

Pleomorphic adenoma is a common benign tumor of the salivary glands seen in daily clinical practices, composed of epithelial and stroma elements with 53%~77% prevalence for parotid tumors. The ductal and myoepithelial cells are organized into sheet, cyst-like, island or cord patterns within the myxoid, chondroid, or mixed stroma. A major clinical manifestation is neglected painless swelling with recurrence rate of 0~17%. Because of its relatively high recurrence rate, this study evaluated the relationships between the capsular characteristics and the cellularity of the pleomorphic adenoma.
Cases were collected from May 2008 to April 2015 in the database of the Pathological Department of Taipei Medical University Hospital. All specimens were excision, superficial parotidectomy or total parotidectomy. Of 89 patients, 24 were excluded due to 2 malignant transformation , and 22 due to inadequate data. Of 65 cases, we retrospectively reviewed clinical data and excluded 2 cases and another 3 specimens because of difficulty in evaluating the cellularity and broken to several pieces respectively. Of 60 patients, 11 were ruled out due to incompleteness of pathological sections. Finally, 49 cases were reserved to analyze the relations between the capsular characteristics and the cellularity of the pleomorphic adenoma.
Results revealed that the longer the tumor has existed in the body, the lower the cellularity is and then there is no relationship between the cellularity and the positive resection margin or presence of satellite nodules. However, integrity of the capsule is related with the cellularity of the pleomorphic adenoma.

目 次 IV
表 次 VII
圖次 VIII
第一章 緒論 1
第一節 研究動機與重要性 1
第二節 研究目的 3
第三節 研究假設 3
第四節 名詞解釋 4
第二章 文獻分析 9
第一節 多型性腺瘤的生長族群與臨床表徵 9
第二節 天生的抗癌系統(INNATE ANTI-CANCER SYSTEM) 11
第三節 多型性腺瘤的免疫染色分子與再發性的關係 14
第四節 多型性腺瘤的包膜特徵與其再發性的關係 20
第三章 研究方法與步驟 21
第一節 臨床資料的收集 21
3.1.1 病灶位置(Location) 21
3.1.2 大小(Size) 22
3.1.3 主訴(chief complaint) 22
3.1.4 病灶存在的時間(duration) 22
3.1.5 手術方式(operation type) 22
第二節 細胞多寡性(CELLULARITY)的判讀 23
第三節 包膜特性(CAPSULAR CHARACTERISTICS) 24
第四節 統計分析 25
第四章 結果分析 26
第一節 細胞多寡性與臨床資料的相關性 26
4.1.1 細胞多寡性與性別的相關性 26
4.1.2 細胞多寡性與位置的相關性 26
4.1.3細胞多寡性與主訴的相關性 27
4.1.4細胞多寡性與病灶存在的時間的相關性 28
4.1.5細胞多寡性與病灶大小的相關性 29
4.1.6細胞多寡性與手術形式的相關性 30
4.1.7細胞多寡性與年齡的相關性 31
第二節 細胞多寡性與包膜特性的相關性 32
4.2.1 細胞多寡性與包膜完整性(completeness of capsules)的相關性 32
4.2.2細胞多寡性與衛星結節存在與否(existence of satellite nodules)的相關性 32
4.2.3 細胞多寡性與邊緣乾淨與否的關係(clearance of margins )的相關性 33
第五章 討論 35
第六章 結論與未來研究方向 42
第七章 參考文獻 43
附錄 48

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