大涎腺肿瘤108例临床分析

目的　对大涎腺肿瘤的临床特点和病理学特点进行分析 ,探索大涎腺肿瘤的发生发展规律并讨论诊断和治疗中存在的一些问题。方法　对 1990～ 1998年间收治的经组织学确诊的 10 8例大涎腺肿瘤的临床和病理特点进行回顾性综合分析 ,对诊断和治疗中存在的问题提出见解。结果　 10 8例大涎腺肿瘤中 ,良性肿瘤 81例占 75 % ,恶性肿瘤2 7例占 2 5 %。良性肿瘤中又以多形性腺瘤和囊肿为多见 ,分别占良性肿瘤的 72 .84%和 2 7.16%。舌下腺囊肿占舌下腺肿瘤的 75 % ,腮腺多形性腺瘤占腮腺肿瘤的 5 9.46%。结论　大涎腺肿瘤的发生发展有一定的规律可循。术前穿刺细胞学检查和涎腺X -线造影对诊断和治疗方案有指导意义。摘除舌下腺是根治舌下腺囊肿的最有效的办法 ,肿瘤摘除加腺体的部分或全部切除是防止多形性腺瘤复发的关键因素     

腭部小涎腺肿瘤的临床诊断与治疗分析

目的　探讨腭部小涎腺肿瘤的临床诊治特点。方法　对经病理确诊的 12 8例原发性腭部小涎腺肿瘤进行临床分析。结果　 12 8例中良性肿瘤 5 3例 ( 4 1.4 % ) ,以多形性腺瘤多见。恶性肿瘤 75例 ( 5 8.6% ) ,恶性以黏液表皮样癌多见 ,腺样囊性癌次之。所有病例均经外科手术治疗 ,恶性肿瘤 3年生存率 82 .5 % ,复发率 2 3 .8%。结论　外科手术是腭部小涎腺肿瘤主要治疗方法 ,局部复发是恶性肿瘤病人死亡的主要原因。     

腭部腺源性肿瘤87例临床分析

目的　分析腭部腺源性肿瘤的病原特征、诊断方法和处理原则。材料与方法　收集我院 87例腭部腺源性肿瘤的资料并进行临床及病理分析。结果　本组腭部腺源性肿瘤 87例 ,其中男性 33例 ,女性 5 4例 ,男女比为 1∶1 6 3,发病年龄 10～ 72岁 ,平均年龄42岁 ,35～ 5 5岁占 76 %。原发部位以软硬腭交界处最多 ,占 5 3%。多形性腺瘤、粘液表皮样癌和腺样囊性癌的发病率明显高于其他肿瘤 ,占本组病例的 82 7% ,恶性肿瘤稍多于良性 ,良恶性比约为 1∶1 2 3。结论　资料分析提示腭部腺源性肿瘤中恶性稍多于良性 ,多形性腺瘤、粘液表皮样癌和腺样囊性癌占了绝大部分 ,而好发于大涎腺的良性肿瘤Warthin′s瘤罕见于腭部。治疗原则是以手术为主结合放疗、化疗。     

涎腺肿物120例临床分析

涎腺肿物是颌面部常见疾病,其病理类型十分复杂。不同类型的肿物其病理特点及生物学行为均不同。故其治疗和预后也不相同。临床资料我科自１９９０年至１９９８年间共收治涎腺肿物１２０例,其中男６１例,女５９例。年龄从１０岁到８０岁。其中腮腺肿物８５例,占７０．...     

颞浅动脉灌注化疗治疗上颌区小涎腺恶性肿瘤的近期疗效

目的对35例采用颞浅动脉逆行插管灌注化疗的原发于上颌骨区的小涎腺恶性肿瘤病例进行研究。对化疗疗效、毒副反应及影响化疗近期疗效的因素进行分析。方法上颌骨区小涎腺恶性肿瘤患者35例,T312例,T423例;M032例,M13例(肺转移2例,纵隔转移1例)。化疗方案采用顺铂(cisplatin),吡柔比星(pirarubicin),5-氟尿嘧啶(5-fluorouracil)。其中7例患者因病变累及双侧上颌骨,而采用了双侧颞浅动脉插管颌内动脉灌注化疗。结果所有患者经颞浅动脉插管颌内动脉灌注化疗1周期后,PR22例(62.9%),NC9例(25.7%),PD4例(11.4%)。无CR病例。毒副反应以血液毒性为主。未见其他毒性反应。无因毒性反应而延迟手术的病例。结论本文资料表明,颞浅动脉灌注化疗治疗原发于上颌骨区的小涎腺恶性肿瘤具有良好的临床疗效,RR62.9%。吡柔比星(THP)与PDD及5-Fu有协同增效作用可能是本组病例疗效较高的原因之一。对转移患者,灌注区原发病灶缩小大于转移灶,提示动脉灌注化疗的高效性。病理类型、既往手术或放疗史是影响化疗效果的重要因素。     

鼻咽部小涎腺肿癌

Minor salivary gland tumors of the nasopharynx are rare. Among them, adenoid cystic carcinoma was most frequently seen. In this paper, 16 cases of minor salivary gland tumor of the nasopharynx admitted to our hospital during the past 27 years are reported. Patients' age ranged from 23 to 74 years with an average of 38.2 years in the women and 45.6 years in the men. Patients with malignant tumor often complained of headache, epistaxis, hearing and sight loss etc. Nasopharyngeal masses were found in all In some cases, paralysis of one or more cranial nerves was demonstrated by neurological examination and destruction of the base of skull by X-ray tomography. Of 16 cases, only 1 had benign mixed tumor and the rest suffered from malignant diseases (2 malignant mixed tumors and 13 adenocarcinomas). Radiotherapy was the main treatment. Some patients received surgical resection plus radiotherapy. 75% of the patients survived over 5 years.     

小涎腺圆柱瘤型腺癌临床病理学观察

 本文报导36例头颈部小涎腺圆柱瘤型腺癌病例。这些恶性肿瘤缓慢无痛性生长,术后易复发,但患者常带瘤生存多年。筛状结构是典型的病理组织学特征。病理学分型可分为筛状形和实体型两类,但似乎与预后关系不明显。最重要的预后因素为手术标本切缘有无癌组织。作者推测了瘤团内“微囊肿”和“腺管”样结构的组织发生。     

头颈部腺样囊性癌58例临床分析

头颈部腺样囊性癌５８例临床分析黄光武，农辉图，邝国乾蒋一强，韦政清广西医科大学第一附属医院（南宁·５３００２１）腺样囊性癌（ａｄｅｎｏｉｄｃｙｓｔｉｃｃａｒｃｉｎｏｍａ简称ＡＣＣ）是较少见的恶性肿瘤之一、多发生于涎腺，也可发生于头颈部其他部位。为了提...     

16例涎腺肌上皮肿瘤临床病理及免疫组化分析

[目的]探讨涎腺肌上皮肿瘤的临床病理特征、免疫组化表达以及鉴别诊断.[方法]16例涎腺肌上皮肿瘤进行病理组织形态学及免疫组化观察.[结果]良性肌上皮瘤12例,恶性肌上皮瘤4例,组织形态均可分为上皮样细胞型,梭形细胞型,浆细胞样细胞型及透明细胞型.良、恶性肌上皮瘤的免疫组化染色S-100蛋白阳性率分别为91.7%(11/12),100%(4/4);SMA阳性率为66.7%(8/12),50%(2/4);Calponin阳性率91.7%(11/12),75%(3/4).[结论]涎腺肌上皮肿瘤的瘤细胞形态多样;S-100蛋白、SMA及Calponin等的免疫组化染色有助于诊断和鉴别诊断.     

胆囊腺鳞癌5例临床病理分析

报告5例胆囊原发性腺鳞癌，对临床病理形态学和免疫组化进行分析．目的是提高对其认识．以提高诊断水平。     

涎腺淋巴上皮癌5例临床病理分析

目的:探讨涎腺淋巴上皮癌的临床病理学特征.方法:对5例涎腺淋巴上皮癌的临床特征、组织学形态和免疫组织化学表型进行观察,并对相关文献进行复习.结果:4例肿瘤发生在腮腺,1例发生于左颌下腺.其中1例继发于良性淋巴上皮病变.临床主要表现为局部包块,活动度差,伴有疼痛.组织学特点:涎腺组织中淋巴组织及纤维组织增生,淋巴样间质中见上皮样肿瘤细胞团呈片状、岛状、条索状和巢状浸润,淋巴细胞呈多少不一浸润肿瘤组织,肿瘤细胞核呈泡状,可见淋巴滤泡形成.免疫组化检测,瘤细胞AE1/AE3(+),EMA(+),p63(+),CK5/6(+),S-100(-),SMA(-),Vimentin(-),LCA(-),肿瘤间质淋巴细胞表达CD3(+)或CD20(+);原位杂交检测,瘤细胞EBER(+).结论:涎腺的淋巴上皮癌作为独立的肿瘤实体,有其特征,免疫表型呈AE1/AE3(+),EMA(+),p63(+),CK5/6(+),需与良性淋巴上皮病变等鉴别.     

口腔小涎腺肿瘤的诊断和治疗

目的分析口腔小涎腺肿瘤的临床特点，探讨其诊断方法和治疗原则。方法对我院1994—2004年收治的119例口腔小涎腺肿瘤患者的临床资料进行分析。结果在119例口腔小涎腺肿瘤中，良性肿瘤有48例，占40．3％；恶性肿瘤有71例，占59．7％。良性肿瘤以多形性腺瘤最常见，占77．1％；恶性肿瘤以腺样囊性癌最常见，占43．7％；小涎腺肿瘤以腭部最为好发，占58．8％。通过统计分析，TNM分期、治疗方法、病理类型是影响患者生存率的主要因素，与发病部位、年龄、性别无关。结论外科手术是口腔小涎腺肿瘤的主要治疗方法。对于良性小涎腺肿瘤，足够的安全边界是减少复发的关键；对于恶性肿瘤，早期诊断及规范治疗是提高生存率的关键，对于中晚期患者除根治性手术外，还必须进行放射治疗。     

检测涎腺混合瘤细胞核AgNORS数目对临床的实用价值

本文研究了３０例涎腺混合瘤细胞核内银染核仁组成区蛋白（ＡｇＮＯＲＳ）的数目。其结果显示在１５例手术后二年有复发的病例中,其ＡｇＮＯＲＳ数目为５～９个／核,平均７０２个／核。但在手术后二年没有复发的病例中,其ＡｇＮＯＲＳ数目为２～５３个／核,平均３３３个／核。二者之间有极显著差异。本文还研究了ＡｇＮＯＲＳ数目与细胞分化程度及肿瘤成分的关系。这对于涎腺混合瘤术后是否需进一步治疗提供了有力的证据,具有较高的临床实用价值。     

涎腺淋巴上皮癌临床病理观察

目的:探讨涎腺淋巴上皮癌的临床病理学特征和鉴别诊断.方法: 对5例涎腺淋巴上皮癌的临床特征、组织学形态和免疫学表型进行观察.结果: 3例肿瘤发生于耳垂下,2例发生于下颌下区.临床主要表现为局部包块,活动度差,伴有疼痛.组织学特点为肿瘤细胞较大,多角形、卵圆形,细胞核泡状,肿瘤细胞呈片状、岛状、索条状,间质为成熟的淋巴细胞和浆细胞.免疫组化:5例肿瘤细胞CK(pan)、EMA、EBV均为(+);而S-100、CgA、CD68、LCA、Vimentin、SMA均为(-);间质细胞CD3、CD20、CD43均为部分 (+). 结论: 涎腺淋巴上皮癌非常少见,是一种分化差,但是预后尚可的肿瘤,确诊依赖组织学和免疫组化检测.手术广泛全切和术后辅助放疗是本病的最佳治疗措施.     

Multiplexed single-cell analysis of FNA allows accurate diagnosis of salivary gland tumors

Diagnosing salivary gland tumors (SGTs) through fine-needle aspiration (FNA) biopsies is challenging due to the overlapping cytomorphologic features between benign and malignant tumors. The authors developed an innovative, multiplexed cycling technology for the rapid analyses of single cells obtained from FNA that can facilitate the molecular analyses and diagnosis of SGTs. Antibodies against 29 protein markers associated with 7 SGT subtypes were validated and chemically modified via custom linker–bio-orthogonal probes (FAST). Single-cell homogenates and FNA samples were profiled by FAST cyclic imaging and computational analysis. A prediction model was generated using a training set of 151,926 cells from primary SGTs (N = 26) and validated on a separate cohort (N = 30). Companion biomarker testing, such as neurotrophic tyrosine receptor kinase (NTRK), was also assessed with the FAST technology. The FAST molecular diagnostic assay was able to distinguish between benign and malignant SGTs with an accuracy of 0.86 for single-cell homogenate samples and 0.88 for FNA samples. Profiling of multiple markers as compared to a single marker increased the diagnostic accuracy (0.82 as compared to 0.65-0.74, respectively), independent of the cell number sampled. NTRK expression was also assessed by the FAST assay, highlighting the potential therapeutic application of this technology. Application of the novel multiplexed single-cell technology facilitates rapid biomarker testing from FNA samples at low cost. The customizable and modular FAST-FNA approach has relevance to multiple pathologies and organ systems where cytologic samples are often scarce and/or indeterminate resulting in improved diagnostic workflows and timely therapeutic clinical decision-making.     

Genomic landscape of salivary gland tumors

Effective treatment options for advanced salivary gland tumors are lacking. To better understand these tumors, we report their genomic landscape. We studied the molecular aberrations in 117 patients with salivary gland tumors that were, on physician request, tested in a Clinical Laboratory Improvement Amendments (CLIA) laboratory (Foundation Medicine, Cambridge, MA) using next-generation sequencing (182 or 236 genes), and analyzed by N-of-One, Inc. (Lexington, MA). There were 354 total aberrations, with 240 distinct aberrations identified in this patient population. Only 10 individuals (8.5%) had a molecular portfolio that was identical to any other patient (with four different portfolios amongst the ten patients).The most common abnormalities involved the TP53 gene (36/117 [30.8% of patients]), cyclin pathway (CCND1, CDK4/6 or CDKN2A/B) (31/117 [26.5%]) and PI3K pathway (PIK3CA, PIK3R1, PTEN or AKT1/3) (28/117 [23.9%]). In multivariate analysis, statistically significant co-existing aberrations were observed as follows: TP53 and ERBB2 (p = 0.01), cyclin pathway and MDM2 (p = 0.03), and PI3K pathway and HRAS (p = 0.0001). We were able to identify possible cognate targeted therapies in most of the patients (107/117 [91.5%]), including FDA-approved drugs in 80/117 [68.4%]. In conclusion, salivary gland tumors were characterized by multiple distinct aberrations that mostly differed from patient to patient. Significant associations between aberrations in TP53 and ERBB2, the cyclin pathway and MDM2, and HRAS and the PI3K pathway were identified. Most patients had actionable alterations. These results provide a framework for tailored combinations of matched therapies.     

39例扁桃体肿瘤的临床分析

目的:探讨扁桃体肿瘤的诊断、鉴别诊断及临床治疗。方法:回顾性分析39例扁桃体肿瘤的临床病例资料。结果:病理证实,良性肿瘤16例,占41%,恶性肿瘤21例,占54%,交界性病变2例,分别为鳞状上皮轻度异型增生1例和淋巴组织异型增生1例。结论:熟悉和掌握扁桃体良、恶性肿瘤的临床特点及发病规律,全面、精准的术前检查,恰当的治疗方案是正确诊治此病的关键。     

Benign salivary gland tumors: A cytogenetic study of 21 cases

Cytogenetic findings of 21 benign salivary gland tumors, including 14 pleomorphic adenomas, 5 Warthin's tumors, 1 myoepithelioma, and 1 cystadenoma, are reported. The present study confirms that pleomorphic adenomas characteristically have highly specific rearrangements involving only a few chromosome regions (3p21, 8q12 and 12q13–15) which suggests their specific role in the mixed tumors genesis. Warthin's tumors also show nonrandom numerical and structural alterations that were concurrent in one of the cases studied. To our knowledge no cytogenetic data are available in myoepitheliomas and cystadenomas. The former reveals a normal karyotype and the latter shows only clonal numerical alterations (gain of chromosomes 2 and 18). © 1995 Wiley-Liss, Inc.