ENCLAVOMAS — the high-quality new growths presented epithelial and mezenkhimopodobny by fabric components. Hl meet. obr. in sialadens.
The term «enclavomas» reflects earlier existing idea of features of a histogenesis of these new growths. In a crust, time this term is used more often for the characteristic of heterogeneity and complexity of their structure, than for the characteristic of a histogenesis, to-ry still it is represented disputable. Most of researchers are inclined to consider S. the lake epithelial, at the same time assign the leading role in formation of mezenkhimopodobny sites to myoepithelial cells (myoepitheliocytes). In this regard consider that more fully the essence of this new growth reflects the term «polymorphic adenoma» recommended to WHO.
Villages of the lake make 50 — 70% of epithelial new growths of big and 20 — 55% of tumors of small sialadens. From big sialadens of S. of the lake meet in parotid, from small more often — in palatal sialadens. Multiple tumors more than one sialaden are found seldom. Villages of the lake very seldom arise in the lacrimal, sweat glands, mucous glands of respiratory tracts. Pages the island meet more often at women at the age of 50 — 60 years. Extremely seldom come to light at newborns and it is rare at children.
Macroscopically the node of a tumor is accurately outlined, is more often than rounded shape, a dense or plotnoelastichesky consistence, quite often lobular look. In process of growth more expressed there is a capsule of a node. On a section fabric of a tumor of whitish color, it is frequent with characteristic cartilaginoid, translucent and mucous sites. At microscopic examination S. of the lake is heterogeneous, presented by a combination epithelial of mezenkhimopodobny sites. Epithelial sites consist of epithelial and myoepithelial cells. The epithelial cells creating ferruterous, tubular, two-layer structures can be small, a cubic form, with a small amount of cytoplasm or larger, a cylindrical form, with eosinophilic granular cytoplasm, i.e. are characterized by signs of differentiation in the direction of an epithelium of various departments of a sialaden. Epithelial elements are located in the form of nests and anastomosing among themselves tyazhy, in ferruterous structures large light myoepithelial cells are often surrounded with zones small extended or enough. The last on certain sites form solid fields. Epithelial sites without clear boundary pass in myxomatous and chondroid. Myxomatous sites are formed by the star-shaped cells which are located in mucous substance, chondroid — the isolated roundish cells in a chondroid matrix.
Wedge, current usually slow. The tumor sometimes reaches the considerable sizes, is painless. Skin and a mucous membrane over a tumor are kept, skin over a node is easily displaced. In some cases the period of slow growth is followed by a phase of bystry increase in a new growth.
In diagnosis the puncture biopsy with the subsequent tsitol is important. research. Rentgenol. the research (see Sialografiya) allows to specify the nature of defeat and its topography.
Treatment operational. At S.'s localization by the lake of the small sizes (to dia. to 20 mm) in the lower, upper poles or the rear edge, and also in a pharyngeal shoot (a zachelyustny shoot, or a deep part, T.) a parotid gland the resection of gland is possible.
The subtotal resection of a parotid gland in the plane of branches of a facial nerve is shown at the tumor which is located in the thickness of gland or occupying considerable department of its superficial part. A parotidectomy with preservation of branches of a facial nerve (see. Parotid gland, tumors ) make at S. the lake of the big sizes, tumors of a pharyngeal shoot (except for big new growths with parapharyngeal growth). The resection of a pharyngeal shoot of a parotid gland by means of outside submaxillary access is shown at S. of the lake of a pharyngeal shoot eminating in a cavity of a stomatopharynx, a nasopharynx and an oral cavity. At S. lakes of submaxillary gland excise a submaxillary fascial case together with gland. Villages of the lake of small sialadens exsect within healthy fabrics.
The main method of treatment of a recurrence of S. of the lake of a parotid gland is operational — an expanded parotidectomy with preservation of branches of a facial nerve and broad excision of a postoperative hem.
Forecast favorable, however at not radical operational treatment a recurrence is possible; in 2 — 4% of cases the malignancy of a tumor is noted.
Bibliography: Belousova N. V., Polyakov B. I. and Belous T. A. About the reasons of recuring of so-called enclavomas of parotid sialadens, Stomatology, t. 54, No. 6, page 24, 1975, bibliogr.; Tae to - r e y A. K. and With about and L. G N. Histologic classification of tumors of sialadens, the lane with English, M., 1976; Evans R. W. a. Cruickshank A. N of Epithelial tumors of salivary glands, Philadelphia, 1970; Lucas R. B. Pathology of tumors of the oral tissues, p. 298, Edinburgh a. o., 1976, bibliogr.
T. A. Belous.