涎腺肿瘤中雌,孕激素受体的表达及意义

用酶联亲合组化法在石蜡切片上对４４例涎腺肿瘤组织中的ＥＲ和ＰｇＲ进行检测。结果表明，多形性腺瘤ＥＲ（＋）率为３３．３３％，ＰｇＲ（＋）率为８．３３％；涎腺癌ＥＲ（＋）率为６８．７５％，ＰｇＲ（＋）率为５３．３３％，这些肿瘤尤其是涎腺癌可能是激素依赖性。阳性颗粒在多形性腺瘤多出现在细胞核中，在涎腺癌多出现在细胞浆内。另外，在粘液表皮样癌中ＥＲ和ＰｇＲ表达与肿瘤分化程度呈正相关，并且粘液样细胞对ＥＲ和ＰｇＲ均不表达，表皮样细胞和中间型细胞表达与否和表达强度基本一致。     

涎腺肿瘤中细胞凋亡及其调控基因的表达

目的：探讨涎腺肿瘤中细胞财亡及调控基因p53、bcl-2、c-myc间的关系。方法：采用脱氧核糖核酸末断转移酶介导的dUTP缺口末端标记（TUNEL）技术，免疫组织化学染色和HE染色对18例多形性腺瘤和52例恶性涎腺肿瘤中细胞凋亡和bcl-2、p-53、c-myc蛋白表达进行观察和比较。结果：恶性涎腺肿瘤的凋亡细胞指数明显高于多形性腺瘤（P＜0．05），恶性涎腺肿瘤中bcl-2、p53和c-myc蛋白表达率及表达强度明显高于多形性腺瘤（P＜0．05）。结论：细胞凋亡的调控基因异常在涎腺肿瘤中可能起重要作用，bcl-2和c-myc蛋白的共同作用可抑制细胞凋亡。     

Salivary Gland Neoplasms in Children

We reviewed 20 children with salivary gland neoplasms treatedat the National Cancer Center Hospital between 1964 and 1990.Retrospective analyses of pathological features and the clinicalcourses of these cases constituted the bases of the presentstudy. The age of onset was late childhood in 19 cases, rangingfrom 9 to 20 years, but one patient was 1 year old. Approximatelyhalf (55%) the neoplasms were malignant. Histologically, allthe benign neoplasms were pleomorphic adenomas (nine cases)and the most common malignant neoplasm was mucoepidermoid carcinoma(six cases, 55%), followed by adenocarcinoma (three cases, 27%),adenoid cystic carcinoma (one case, 9%) and malignant mixedtumor (one case, 9%). Recurrences of pleomorphic adenomas occurredonly in the three patients initially treated with enucleation;meanwhile, five patients treated with superficial parotidectomy,and one with submandibular glandectomy, had no recurrence. Recurrencesof malignant tumors occurred in all six patients initially treatedwith enucleation only and in one with superficial parotidectomybut not in two patients treated with total parotidectomy. Inseven patients treated with prophylactic neck dissection, nometastasis was identified pathologically. The results supportno enucleation of the tumor being applied at the first operationfor curing both benign and malignant salivary gland tumors.The indication for radical neck dissection appears to be limited.     

Fine Needle Aspiration Cytology Utility in Salivary Gland Tumor Diagnosis

We aimed to improve the diagnostic accuracy of tumors by using immunocytochemistry (IHC) on destained smears to correlate the cytological findings with histopathology and/or IHC for final evaluation of results. We have done a randomized and prospective double-blind study. Forty-six clinically suspected patients of salivary gland tumor were enrolled for study. Those with non-neoplastic\ inflammatory salivary gland pathologies and swellings other than salivary gland origin were excluded from the study. The Fine needle aspiration cytological (FNAC) diagnosis of all the patients was compared with the corresponding histopathology. Sensitivity and specificity of FNAC in diagnosing malignancy were 91.3 and 100 %. Diagnostic accuracy of FNAC for malignant tumors was 95.65 %. In our study kappa value came out to be 0.88 (p value <0.00), which indicated an excellent agreement between histological and cytological typing of salivary gland tumors. FNAC is a highly sensitive and specific technique for diagnosis of salivary gland tumors. Histopathology however is the gold standard for diagnosis, classification and grading of tumors. Immuno-cytochemistry can act as adjuvant in diagnosing salivary gland tumors, however it did not help in improving the diagnostic accuracy of FNAC in our study. Considering an excellent agreement between cytology and histology, a type specific diagnosis can be reached on FNAC of salivary gland tumors.     

涎腺多形性腺瘤的倍体分布及与基因治疗的关系

目的:探讨涎腺多形性腺瘤的DNA含量及倍体分布与HSV-tk基因治疗的关系.方法:采用流式细胞仪测定50例涎腺良性多形性腺瘤DNA含量和倍体分布并结合临床资料进行分析;应用腺病毒介导的HSV-tk基因分别转染培养中良性及交界性多形性腺瘤细胞;RT-PCR方法检测基因表达;四唑蓝比色(MTI)法测定HSV-tk系统对二倍体及异倍体肿瘤细胞的杀伤作用.结果:10例正常涎腺组织皆为二倍体;涎腺良性多形性腺瘤异倍体率20.0%;30岁以下年龄,病程在2年以内及瘤体直径＞5cm者异倍体率明显增高(P＜0.05).二倍体肿瘤细胞转染HSV-tk/GCV基因后3、5天,细胞存活率分别为78.3%和37.7%.异倍体肿瘤细胞转染HSV-tk/GCV基因后3、5天,细胞存活率分别为27.6%和27.2%,二者细胞存活率有显著性差异(P＜0.05).结论:1)涎腺多形性腺瘤异倍体检出率与患者的年龄,病程及瘤体直径有密切关系;2)HSV-tk/GCV在治疗后的3、5天对异倍体肿瘤细胞杀伤作用明显高于二倍体肿瘤.     

涎腺恶性肿瘤174例疗效观察

目的 分析影响涎腺恶性肿瘤治疗疗效的因素.方法 本文回顾总结收治的涎腺恶性肿瘤174例患者的临床资料,患者先行接受手术治疗,术后大部分患者加用60Co、X线外照射28 ～76 Gy.结果 全组总的5a生存率为66.3％,10 a生存率为57.5％,15 a生存率为46.4％,20 a生存率为11.2％.术后放疗、手术完全切除、病变在腮腺和早期患者的预后较好,其5 a生存率高于单纯手术、肿瘤残留、病变在其他涎腺和晚期患者,差异均有统计学意义(P均＜0.05).结论 涎腺恶性肿瘤以手术加放疗为宜,疗效与手术是否完全切除、病变部位及分期有关.     

涎腺上皮性肿瘤针吸细胞学检查

目的:探讨涎腺上皮性肿瘤的细胞学特征,以提高针吸细胞学确诊率.方法:对253例有组织学对照的涎腺上皮性肿瘤细针吸取细胞学诊断标本进行分析.结果:针吸细胞学诊断涎腺上皮性肿瘤的总准确率为95.7%,其中良性准确率为98.1%(203/207例),恶性准确率为84.8%(39/46例).同一类型的涎腺上皮性肿瘤中常有不同的细胞学特征,少数高分化涎腺癌可呈良性细胞学表现.结论:针吸细胞学对涎腺上皮性肿瘤的诊断具有较好的敏感性和特异性,镜下缺乏组织学结构及针吸成分少是造成误诊的主要原因.     

Small cell undifferentiated carcinoma of salivary gland origin: an ultrastructural study.

A case of small cell carcinoma of salivary gland was studied by light and electron microscopy. Light microscopy showed sheets of small uniform cells with scanty cytoplasm and pyknotic nuclei. Electron microscopy showed two distinct cell types; an electron-lucent epithelial-appearing cell, and a denser cell with processes containing bundles of filaments and other features suggesting myoepithelial differentiation. Neurosecretory granules were absent. These findings support a salivary duct origin, and are evidence against a neurendocrine derivation for this tumor.     

Salivary Gland Tumors in Turkey: Demographic Features and Histopathological Distribution of 510 Patients

The aim of this study was to evaluate the demographic and clinicopathologic data of salivary gland tumors managed at a tertiary referral medical center in Turkey. The data of 510 patients with salivary gland tumors managed during the period of January 1984 to May 2012, were reviewed. Only primary neoplasms derived from salivary glands were included. Out of 510 neoplasms, 352 (69.0 %) were classified as benign and 158 (31.0 %) were classified as malignant. There was a male predominance and male:female ratio was 1.23 (281/229). The most common location was parotid gland (372/510, 72.9 %) followed by minor salivary glands (97/510, 19.0 %) and submandibular gland (40/510, 7.9 %). The malignancy rates were 21.5, 40.0, and 56.7 % in parotid, submandibular, and minor salivary glands locations, respectively. The most common location for minor salivary gland neoplasms was oral cavity (61/97, 62.9 %). Pleomorphic adenoma (PA) was the most common histopathological type (45.3 %) in the whole study group and also among pediatric patients. The most common malignant neoplasms were adenoid cystic carcinoma (39/510, 7.6 %) and mucoepidermoid carcinoma (5.7 %). Salivary gland tumors are more common in men. The malignancy rate is almost three times higher in neoplasms derived from minor glands when compared to parotid gland. PA is the most common histopathological tumor type in all locations and in all age groups.     

Expression of Ki67 and CD105 as Proliferation and Angiogenesis Markers in Salivary Gland Tumors

Objective: To investigate the association between CD105 and tumor cell proliferation in salivary gland tumors.Methods: In this study, 59 samples of salivary tumors from Khalili Hospital archive, including 20 cases ofpleomorphic adenoma (PA), 20 cases of mucoepidermoid carcinoma (MEC) and 19 cases of adenoid cysticcarcinoma, as well as 10 cases of normal salivary gland tissue, were reviewed by immunohistochemistry (IHC)for CD105 and Ki67 staining. Results: CD105 positive vessels were absent in normal salivary gland tissue inthe vicinity of tumors (51.6% of all tumors were positive). There was a statistically significant difference infrequency of CD105 staining between PA and malignant tumors and between four groups of different lesions(p<0.000) being highest in MEC. Intratumoral microvessel density was also elevated in malignant neoplasms(2.61±3.1) as compared to PA (0.46±0.6). Normal salivary glands did not express Ki67. There was a statisticallysignificant difference in frequency and percentage of Ki67 immunoreactivity in malignant neoplasms (86.5% and10.7±10.8 respectively) compared to PA (50% and 0.78±0.2) and among the four groups values were highest inMEC (p<0.000). Conclusion: n this study, it was observed a higher rate of angiogenesis and cellular proliferationwas noted in malignant tumors compared to benign tumors, but no correlation was observed between these twomarkers.     

Galectin-3 Serum Levels Could Help Clinicians Screen for Salivary Gland Tumor Patients

analysis was performed on serum specimens from 105 patients with salivary gland cancer and 56 healthy persons.Methods: Enzyme-linked immunosorbent assay (ELISA) was used to measure levels of galectin-3 (GAL-3). Serumlevels were compared between patients with salivary gland tumors and healthy control. A total of 105 patients wereenrolled in the study (55 men, 50 women). Result: Mean age was45.5 years. Thirty-nine patients with malignant and66 cases with benign tumors were compared with 56 healthy participants with a mean age of 51.7. No statisticallysignificant differences were observed when comparing GAL-3 serum levels between malignant and benign salivary glandtumor patients, but a statistically significant difference was found between case and control patients with p-values of0.02. Serum levels of galectin-3 protein were elevated in patients with salivary gland cancer compared with the healthypopulation. Conclusion: The difference between benign and malignant tumor patients was significant, but revealedno clinic pathological characteristics in malignant tumors. To the best of the authors’ knowledge, this is the first timea study suggests that GAL-3 serum levels could help clinicians screen for salivary gland cancer.     

Recurrent Salivary Gland Cancer

Salivary gland cancer is the most diverse cancer in the body consisting of up to 24 different pathologic subtypes. Although these cancers arise within a common group of glands in the head and neck region, these diverse cancers differ substantially in clinical behavior. As a result, salivary cancers are often categorized as low, intermediate, or high-risk for recurrence and metastasis based on histopathologic subtype and tumor stage. Appropriate risk classification of a given salivary tumor provides a useful guide to the physicians who determine the appropriate treatment regimen. Low-risk tumors can be treated successfully with surgery alone, whereas intermediate and high-risk tumors often require multimodality therapy. Recurrent salivary cancer should be considered high-risk by definition, especially if previously treated with appropriate therapy, and therefore requires aggressive multimodality therapy in order to achieve adequate local control and disease-free survival.     

涎腺黏液表皮样癌中p16、p15的表达及相关性研究

[目的]研究p16、p15在正常涎腺组织和黏液表皮样癌中的表达,探讨其在黏液表皮样癌发生、发展中的作用及临床意义.[方法]应用免疫组化S-P法检测10例正常涎腺组织、45例黏液表皮样癌中p16、p15蛋白的表达.[结果]黏液表皮样癌中p16、p15的阳性表达率分别为62.2%、73.3%,显著低于其在正常涎腺组织中的表达(100%)(P＜0.05),且随肿瘤分化程度的降低而递减并具有显著性差异,其中p16的阳性率与淋巴结转移有关.p16、p15两基因在黏液表皮样癌的表达中呈显著相关性(P＜0.05).[结论]p16、p15的失表达与黏液表皮样癌的发生和发展关系密切,p16基因的异常可能是更为直接的因素.     

147例涎腺肿瘤针吸细胞学与病理组织学诊断对照分析

目的总结涎腺常见肿瘤的针吸细胞学特征、诊断与鉴别诊断,提高细胞学的确诊率。方法回顾性分析147例针吸细胞学诊断的涎腺常见肿瘤,并与病理组织学进行对照。结果针吸细胞学诊断涎腺肿瘤的总符合率为91.84%,其中良性肿瘤定性诊断符合率为97.83%,准确率88.04%;恶性肿瘤定性诊断符合率为96.36%,准确率为78.18%。结论针吸细胞学诊断涎腺肿瘤准确率较高,它能为临床治疗提供可靠依据,是一项简便而有价值的诊断方法。     

涎腺多形性腺瘤106例诊治体会

目的 探讨涎腺多形性腺瘤的临床特点、诊断方法及治疗原则。方法 对我科近14年来收治的106例涎腺多形性腺瘤的临床资料进行回顾性分析。结果 106例涎腺多形性腺瘤中，以腮腺最为常见，占52％，颌下腺、腭部、上唇次之，分别为36．8％、8．5％、2．7％。本组共复发4例。结论 细针抽吸细胞学活检可作为涎腺多形性腺瘤的常规术前检查，治疗的成功与否关键在于第一次的手术方式。     

Oncocytoma of the lung.

A tumor diagnosed as an oncocytoma was removed from the lower right lung of a 22-year-old patient. Specimens from the formalin fixed tumor were studied by light microscopy and by electron microscopy. Large numbers of mitochondria were observed in all the tumor cells at the ultrastructural level despite many artefacts due to fixation. The presence of two tumor cell types "typical" oncocytes and "condensed" oncocytes were demonstrated by electron microscopy. This appears to be the second pulmonary oncocytoma in which mitochondrial hyperplaxia has been demonstrated. The tumor was similar to previously reported cases of salivary gland oncocytomas.     

HSV-tK与IL-2基因对涎腺多形性腺瘤细胞的杀伤作用

目的:观察腺病毒介导的单纯疱疹病毒胸苷激酶基因(HSV-tK)和白细胞介素-2基因(IL-2)联合杀伤人涎腺多形性腺瘤细胞的效果.方法:采用腺病毒介导的HSV-tK基因和IL-2基因联合转染人涎腺多形性腺瘤细胞;采用逆转录聚合酶链式反应(RT-PCR)检测转染后细胞的基因表达;采用四唑盐比色(MTT))法测定tK与IL-2基因对肿瘤细胞的杀伤作用及旁观者效应:采用光镜观察基因治疗后肿瘤细胞的形态学变化.结果:单独转染HSV-tK/GCV及IL-2基因5天后,涎腺多形性腺瘤细胞的存活率分别为37.7%和66.0%:联合转染5天后,细胞的存活率降至21.5%,与前二者相比差异有显著性(P＜0.05).结论:HSV-tK和IL-2基因联合使用对涎腺多形性腺瘤的杀伤作用高于上述基因单独使用的杀伤作用.     

涎腺区病变细针吸取细胞学诊断

１１４例涎腺区病变进行了细针吸取细胞学诊断。７９％为良性（包括６２例肿瘤及２８例其他病变），２１％为恶性（２４例）。与术后组织学诊断进行比较，总符合率为９３．９％，误诊率为６．１％，均为假阴性。对涎腺区肿瘤细胞学特点进行描述，对误诊原因进行分析。     

Malignant Salivary Gland Tumors and Epstein-Barr Virus (EBV) Infection: A Systematic Review and Meta-analysis

Background: Salivary gland tumors are rare head and neck tumors with lymphoepithelial carcinoma (LEC) as a particularly infrequent variant. This study was an evaluation of the incidence of EBV infection in malignant salivary gland tumors with the emphasis on tumor type and geographical area. Methods: Five databases (PubMed, ScienceDirect, Scopus, Web of Science and Cochrane library) were searched for data on the prevalence of EBV in malignant salivary gland tumors. A random-effects meta-analysis was conducted with Comprehensive Meta-Analysis software version 2.0 (CMA 2.0) using the event rate (ER) for estimation of the incidence of EBV in the salivary gland tumor patients. Publication bias was lacking as assessed through funnel plot analysis with the Begg’s and Egger’s tests (P>0.05). Results: Out of 618 studies searched in databases, 19 reported the prevalence of EBV in malignant salivary gland tumors and were included in the present meta-analysis. The pooled ER of all studies was 44% [95%CI=21.5-69.2%] with extreme heterogeneity that for the studies in America was 44.2% [95%CI=4.1-93.6%], in Asia (249 patients) was 70% [95%CI= 33.4-91.6%] and in Europe was 11.8% [95%CI=7.4-85.5%] with extreme heterogeneity for three subgroups. The pooled ER for patients with undifferentiated carcinoma was 86.7% [95%CI=71.5-94.4%] compared with 6.6% [95%CI=2.5-16.5%] for other carcinomas. Conclusions: The incidence of EBV infection in malignant salivary gland tumors in Asia was greater than in Europe and America and the higher presence of EBV infection in LEC cases implies that EBV may be a major factor in its etiology or pathogenesis. Genetic, environmental and other geographic factors may also be involved.     

Salivary gland carcinosarcoma: immunohistochemical, molecular genetic and electron microscopic findings

Salivary gland carcinosarcoma, or true malignant mixed tumor, is a very rare and extremely aggressive neoplasm. The clonality and clonal origin of this tumor are discussed controversially. We report a carcinosarcoma of the left parotid gland in a patient who subsequently died of cutaneous, lymphatic and pulmonary metastases. Immunohistochemical staining, electron micrograph analysis, loss of heterozygosity (LOH) analysis and sequence analysis were performed on this tumor with an adenocarcinomatous and a predominant spindle cell-like component. While smooth muscle actin was undetectable by immunohistochemistry, cytoplasmatic myoepithelial structures could be detected by electron microscopy. LOH analysis at 12 genomic locations detected complete deletion of one allele at 17p13.1, 17q21. 3, and 18q21.3 indicating allelic loss in both components of the tumor. Double strand sequencing of the remaining allele of the p53 tumor suppressor gene revealed a wild-type allele. Based on our results, we favor the hypothesis of monoclonal origin of this salivary gland carcinosarcoma with a common stem cell that could be the myoepithelial cell and an inactivated tumor suppressor gene on chromosome 17 other than p53.