Immunocytochemical localization of bone morphogenetic proteins (BMPs) in salivary gland pleomorphic adenoma

The localization of bone morphogenetic protein (BMP)-1, -2, -3 and transforming growth factor (TGF)-β in normal salivary gland and pleomorphic adenoma of the salivary gland has been examined immunocytochemically. Tumor cells with BMP immunostaining in pleomorphic adenoma were associated with some solid cellular and tubuloglandular patterns, and with stellate cells in the myxoid area. In addition, in the chondroid area of three pleomorphic adenomas, chondrocyte-like cells were positive for BMPs. It is speculated that BMPs secreted by the tumor cells play a role in the formation of the chondroid component in pleomorphic adenoma by inducing some tumor cells, probably neoplastic myoepithelial cells, to differentiate to chondrocytes by metaplastic change. No tumor cells specifically immunostained with TGF-β were found. TGF-β was positive in fibrous and hyalinized stroma. In the submandibular gland, only anti-BMP-1 antibody specifically reacted to apical portions of degenerated serous acinar cells.     

颌下腺转移性多形性腺瘤1例

本文报道1例罕见的转移性多形性腺瘤,患者女性,30岁,左颌下腺及右锁骨上包块术后病检结果与患者8年前左颌下腺肿块切除后病检结果一致,病理形态均表现为良性多形性腺瘤。并结合文献报道,对转移性多形性腺瘤的临床病理特征、发病机制及防治方法等进行讨论。     

腮腺区包块诊断分析

目的:提高对腮腺区包块的诊断水平。方法:收集5年间296例腮腺区包块的临床资料,对其一般情况、疾病构成、临床表现、诊断方法等进行分析。结果:男、女之比约1.19∶1,年龄最小1岁,最大83岁;多形性腺瘤80例,占腮腺区包块的27%,占腮腺区良性肿瘤的50%;Warthin瘤50例,占腮腺区包块的16.9%,占腮腺区良性肿瘤的31.3%;炎性包块27例,占腮腺区包块的9.1%。黏液表皮样癌14例,占腮腺区包块的4.7%,占腮腺区恶性肿瘤的29.2%;腺样囊性癌7例,癌在多形性腺瘤中7例,均占腮腺区包块的2.4%、腮腺区恶性肿瘤的14.6%;鳃裂囊肿6例,占腮腺区包块的2.0%;多形性腺瘤以40～49岁年龄组及50～59岁年龄组最多见(χ2检验,P<0.005),Warthin瘤以50～59岁年龄组、60～69岁年龄组、70～79岁年龄组最多见,且40岁以前其发病率为0(χ2检验,P<0.005);炎性包块可见于任一年龄组,且以60～69岁年龄组最多见(χ2检验,P<0.005)。结论:腮腺区包块涵盖的疾病复杂,表现多样,应结合其临床表现、B超、CT、MRI等影像学检查、细针吸细胞学检查、术中快速冰冻病理检查等综合考虑选择合适的治疗或手术方案。     

Synchronous mucoepidermoid carcinoma of tongue and pleomorphic adenoma of submandibular gland

Presentation with synchronous salivary gland tumors is rare, with the most typical combination being Warthin's tumor and pleomorphic adenoma of the parotid gland. Involvement of minor salivary glands in such occurrences is extremely uncommon. We report a case of simultaneous mucoepidermoid carcinoma of the tongue and pleomorphic adenoma of the submandibular gland in a 40-year-old woman. The submandibular mass was initially considered to represent regional lymph node tumor metastasis but later was shown to be an intraglandular primary neoplasm.     

Giant pleomorphic adenoma of the submandibular gland. Case report

Salivary glands are sites for a great variety of tumors. The parotid gland is the most common site followed by the submandibular gland. The pleomorphic adenoma represents the 60-70% of all tumors involving the major salivary glands, while the submandibular gland is involved in 8% of cases. The pleomorphic adenoma of the submandibular gland is rare and can present difficulty in diagnosis. The heterogeneous histology, a possible malignant transformation, an incomplete capsule that can determine a recurrence, are the most important characteristics of pleomorphic adenoma. A complete surgical removal of the tumor is the treatment of choice. In the case presented, the mass showed an unusual vascularization and remarkable dimensions.     

Pleomorphic adenoma of the palate

Pleomorphic adenoma is the most common mixed benign tumor of major salivary glands. Approximately 80% of these tumors arise in the parotid gland, whereas 7% arise in the minor salivary glands. The most common sites for minor salivary gland where pleomorphic adenoma arises are the palates followed by lips and cheek. We report a palate mass in a 46-year-old male patient. The initial cytologic diagnosis by fine-needle aspiration biopsy was pleomorphic adenoma. This report describes a case of pleomorphic adenoma regarding all distinctive diagnoses with the review of the literature.     

Palatal pleomorphic adenoma with florid squamous metaplasia: a potential diagnostic pitfall

We report a case of pleomorphic adenoma with extensive squamous metaplasia in the palate of a 52-year-old Chinese man. The dimensions of the tumor were 15x13x13 mm. More than 95% of the epithelial element in the tumor was composed of sheets of squamous cells with cyst formation. The pathogenesis, potential diagnostic pitfalls, proliferative activity and cytokeratin expression of this tumor are discussed.     

Carcinoma ex pleomorphic adenoma of the buccal region is composed of salivary duct carcinoma and squamous cell carcinoma components

A 73-year-old female presented with an asymptomatic mass in the left buccal region that she had first noticed 4 years earlier. The tumor, which was located in the buccal space, was clinically diagnosed as a salivary gland tumor and treated by excision. Histopathological examination revealed a capsule of connective tissue consisting of three different histopathological neoplastic areas in a large, fibrous, hyalinizing stromal background. The neoplastic lesion contained two malignant and one benign element, with histological characteristics consistent with squamous cell carcinoma (SCC), salivary duct carcinoma (SDC) and pleomorphic adenoma (PA). The SCC nests showed no continuity with the buccal mucosa. Both the SCC and SDC nests were surrounded by non-atypical myoepithelial cells, suggesting that both components may have developed from transformation of metaplastic luminal epithelial cells of PA. The tumor was diagnosed as a non-invasive carcinoma (SCC and SDC) ex pleomorphic adenoma (Ca-ex-PA). There was no evidence of recurrence 16 months after operation.     

Parotid benign tumors: comments on surgical treatment of 263 cases

263 patients with benign parotid gland tumors have been operated upon, from 1970 through 1980. Of this total number of tumors, according to their histopathologic examination, 185 corresponded to pleomorphic adenoma, 24 to Warthin's tumor, 10 to recurrent pleomorphic adenomas (at first operated on elsewhere) and 44 to miscellaneous tumors or tumor-like lesions (simple cyst, lymphoepithelial lesion, branchial cleft cysts, lymph node hyperplasia etc.). 25 cases of pleomorphic adenoma, operated on during the past 24 months, were not evaluated as far as recurrence is concerned, because their follow-up was insufficiently long. The operative procedures used by us for pleomorphic adenoma surgery were: (a) pericapsular (extracapsular) excision, with a margin of normal parotid gland tissue without preparation of the fascial nerve, for 98 small size and superficially sited pleomorphic adenomas (52.6%); (b) subtotal parotidectomy (superficial lobectomy) with preparation of the facial nerve for 78 tumors (42.5%); (c) total parotidectomy with preservation of the nerve for 9 tumors located on the deep lobe of the gland (4.9%). We did not see any permanent facial palsy, and not one case of recurrence.     

抑癌基因PTEN在腮腺肿瘤中的突变与缺失

目的：探讨抑癌基因PTEN在腮腺多形性腺瘤及腮腺粘液表皮样癌的发生、发展过程中的作用：方法：应用聚合酶链反应(PCR)及克隆、基因测序的方法来分析腮腺多形性腺瘤、腮腺粘液表皮样癌及正常腺体组织中PTEN基因第5、第6及第8外显子有无突变及缺失。结果：通过对PTEN基因3个外显子的克隆测序，发现有2例腮腺多形性腺瘤外显子8发生突变，其中1例引起编码的氨基酸发生变化；而腮腺粘液表皮样癌中均未发现有突变及缺失。结论：初步推断，在DNA水平抑癌基因PTEN在腮腺多形性腺瘤中存在突变，在其发生发展过程中可能起到一定的作用；在DNA水平抑癌基因PTEN在腮腺粘液表皮样癌的发生过程中可能不起重要作用。     

Wide excision of accessory parotid gland with anterior approach

Accessory parotid gland tissue has been described as salivary tissue adjacent to the Stensen duct that is distinctly separate from the main body of the parotid gland. Of all parotid gland tumors, 1% to 8% arise from the accessory parotid gland. Little is known about the accessory parotid gland, and it is seldom mentioned in the literature. Between 1999 and 2010, we have treated and followed 8 patients with tumors of the accessory parotid gland. There were 5 males and 3 females with a mean age of 35 years. They all presented with an asymptomatic cheek mass, and 4 of them underwent fine-needle aspiration. Ultrasound or computed tomographic scan was used in all patients. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. The mean follow-up time was 44 months (range, 6-120 months). Seven patients had benign disease. Four cases were pleomorphic adenoma, and the remaining 3 benign cases were parotid cyst, basal cell adenoma, and hemangioma. Only 1 patient had a malignant tumor that was a lymphoepithelioma-like carcinoma. In 7 cases, wide excision (excision of mass and accessory lobe of the parotid gland) was done because of the intra-accessory parotid gland lesion. One patient had concomitant superficial parotidectomy because the tumor was located very close to and has involved the parotid gland proper. There was no serious postoperative complication and recurrence. Prudent preoperative diagnostic evaluation and meticulous surgical approach are the keys to successful management of midcheek lesions. A wide excision of the accessory lobe of the parotid gland can be a definitive surgery in case of solitary tumor with an intact parotid fascia, and wide excision with anterior approach through a standard parotidectomy incision is preferred to a direct incision over the mass.     

Neck mass with marked squamous metaplasia: a diagnostic pitfall in aspiration cytology

Fine-needle aspiration cytology (FNAC) is a highly accurate tool for the diagnosis of pleomorphic adenomas; however, this common salivary gland neoplasm can be diagnostically challenging, causing pitfalls in cytodiagnosis. A 50-year-old woman suffered from a painless, slowly-growing mass in the right posterior upper neck for 5 months. FNAC from this mass revealed many discohesive parakeratotic cells and keratin flakes, and a few stromal elements. Under the impression of metastatic well-differentiated squamous cell carcinoma, the tumor mass was totally excised. Histology confirmed a pleomorphic adenoma with marked squamous metaplasia and frequent keratin pearl formations without the evidence of malignancy. Pleomorphic adenoma occasionally reveals focal squamous metaplastic changes, when extensive, it may be misdiagnosed as metastatic well-differentiated squamous cell carcinoma in FNAC, particularly in the neck region.     

谷胱甘肽过氧化物酶-3在腮腺多形性腺瘤中的表达及意义

目的 :研究谷胱甘肽过氧化物酶-3(glutathione peroxidase-3,GPX-3)基因及蛋白在腮腺良、恶性多形性腺瘤中的表达,以明确GPX-3与腮腺多形性腺瘤发生、发展的相关性,为临床预测腮腺多形性腺瘤的发生及恶变提供理论依据。方法:采用荧光定量PCR和蛋白免疫印迹法检测30例腮腺多形性腺瘤,30例腮腺多形性腺瘤的瘤旁2 cm腺体组织,以及10例恶性腮腺多形性腺瘤中的GPX-3 mRNA及蛋白的表达,对其相对表达量进行统计学分析。结果:GPX-3 mRNA和蛋白在腮腺良、恶性多形性腺瘤中的表达明显低于瘤旁腺体组织,且在腮腺恶性多形性腺瘤中的表达最低,差异有统计学意义(P<0.01)。GPX-3在腮腺多形性腺瘤中的表达与患者的年龄、性别及肿瘤大小无关,差异无统计学意义(P>0.05),且GPX-3在腮腺多形性腺瘤中的表达与肿瘤TNM分期及恶性成分比例有关,其差异有统计学意义(P<0.05)。结论:GPX-3在腮腺良性多形性腺瘤中低表达,且在腮腺恶性多形性腺瘤中的表达最低,提示GPX-3的低表达与腮腺多形性腺瘤的发生及恶变密切相关。     

Myxolipomatous pleomorphic adenoma: an unusual oral presentation

The first case of a myxoid variant of lipomatous pleomorphic adenoma arising in the intraoral minor salivary gland is presented. A well-encapsulated tumor was composed almost entirely of myxolipomatous tissue with honeycomb-like spindled cellular areas, which contained only a scant glandular element. Immunohistochemistry confirmed the myoepithelial nature of spindle cells intimately admixed with mucoadipose component. We propose the term myxolipomatous pleomorphic adenoma for this peculiar lesion.     

多形性腺瘤DNA含量的定量分析及意义

目的：探讨DNA含量与多形性腺瘤及其复发之间的关系。方法：用图像分析仪（ICM）对35例多形性腺瘤，5例术后复发的标本进行细胞核DNA测定。结果：多形性腺瘤中的肿瘤性上皮细胞、粘液样细胞和软骨样细胞与正常腺上皮细胞的DNA含量之间有显著性差异（P＜0．05），多形性腺瘤组和复发组之间也有显著性差异（P＜0．05）。结论：在多形性瘤中，DNA含量不仅与细胞类型密切相关，而且其早期的变化也有助于了解预后复发情况，因而可作为评价多形性腺瘤预后一种良好的参考指标。     

类肿瘤型舍格伦综合征诊断问题的初步探讨

目的：探讨类肿瘤型舍格伦综合征的特点和诊断方法。方法对２２例腮腺区类肿瘤型舍格伦综合征、５０例腮腺多形性腺瘤和２５例腮腺淋巴瘤,进行各项临床资料内容的卡方检验及逐步判别分析。结果（１）类肿瘤型舍格伦综合征好于４０－５９岁的女性,局部表现为涎腺区肿块,质中、表面光滑、有酸胀和时大时小现象,还有口干、眼干和关节酸痛等全身症状,抗炎治疗有效。（２）建立了类肿瘤型舍格伦综合征、多形性腺瘤和腺淋巴瘤的判别函     

Myoepithelioma. Review of the literature and report of a case with ultrastructural confirmation.

The myoepithelioma is a rare salivary gland tumor composed nearly exclusively of myoepithelial cells. A case occurring on the palate of a 22-year-old man is reported. Electron microscopic findings of occasional desmosomes, a basal lamina associated with the plasma memb;rane, and perinuclear cytoplasmic filaments confirmed the diagnosis. The myoepithelioma appears to resemble the pleomorphic adenoma clinically and may be a development variant of the pleomorphic adenoma.     

S-100蛋白和中间丝在涎腺多形性腺瘤中的表达

目的 观察Ｓ－１００Ａ１、Ｓ－１００Ａ４、Ｓ－１００Ａ６、Ｓ－１００Ｂ、Ｋ８．１２、ＫＬ１、波形蛋白（Ｖｉｍｅｎｔｉｎ）、胶质纤维酸性蛋白（ＧＦＡＰ）和神经元特异性烯醇化酶（ＮＳＥ）在涎腺多形性腺瘤中的表达，探讨Ｓ－１００蛋白新亚型的分布规律和作用机制以及肿瘤性肌上皮细胞的生物学特性。方法 将２３例正常涎腺和６０例涎腺多形性腺瘤常规石蜡包埋，制成４μｍ厚的连续切片，行ＨＥ和免疫组化染色。结果 在涎     

颌下腺多形性腺瘤及其复发的临床研究

目的:评价颌下腺多形性腺瘤及其复发的临床特点及原因。方法:对8例颌下腺多形性腺瘤复发的临床特点和24例颌下腺手术野术中脱落细胞学进行分析及检测。结果:本院颌下腺多形性腺瘤术后有3例复发(3/366例,0.8%),另5例复发性颌下腺多形性腺瘤均为外院转入我院。8例病例复发时间均在1年以上,其中1例第2次复发时间为第1次复发术后5个月。1例复发性颌下腺多形性腺瘤术中见瘤体深叶处存留少许腺细胞,7例无腺细胞残留。术中脱落细胞显示8例原发性肿瘤手术野冲洗前有3例检测到腺泡细,5例为血液细胞,冲洗后2例为腺泡细胞,6例为血液细胞,8例复发性肿瘤冲洗前后均为1例腺泡细胞,7例血液细胞。8例非瘤性病变冲洗前1例为腺泡细胞,7例血液细胞,冲洗后均为血液细胞,3组之间无显著性差异(P>0.05)。结论:颌下腺多形性腺瘤复发罕见,可能与细胞学穿刺及瘤旁腺泡有关。     

MR imaging of tumor-like swelling in the submandibular region

Tumor-like swellings in the submandibular region were evaluated in seven patients with MR imaging. Two cases of pleomorphic adenoma and two of sialoadenitis were selected as examples of submandibular gland lesions, while a plunging ranula, dermoid cyst and lymphadenitis were selected as examples of extraglandular lesions. The pleomorphic adenoma was connected with the remaining gland on T1-weighted images. The sialoadenitis showed changes in the size, signal intensity and homogeneity of the submandibular gland itself. On the other hand, extragland lesions showed zonal interpositions between the lesion and the submandibular gland, which showed either low or high signal intensity on T1-weighted images. On T1-weighted images, the intensity of all of the lesions was either lower than or the same as the normal submandibular gland. On the other hand, all lesions showed higher signal intensity, ranging from slight to very high on T2-weighted images. Sharp margins were seen in all lesions except one sialoadenitis. The sialoadenitis showed inflammatory infiltration into the surrounding tissue. A homogeneous internal pattern was observed in the case of cystic lesions, while an inhomogeneous internal pattern was noted in the pleomorphic adenoma and in the inflammatory lesions. Gd-DTPA enhanced the T1-weighted images in three cases. Pleomorphic adenoma and lymphadenitis were enhanced inhomogeneously, whereas the ranula was not enhanced.