涎腺原发恶性肌上皮瘤19例的病理诊断分析

目的 探讨涎腺多结节形态原发恶性肌上皮瘤的病理特征。方法 光镜观察19例涎腺多结节形态原发恶性肌上皮瘤的组织学、细胞学结构,其中11例做Calponin、平滑肌肌动蛋白(SMA)、S-100、神经胶质酸性蛋白(GFAP)、细胞角蛋白、增殖细胞核抗原(PCNA)的免疫组化检测,3例做超微结构观察。结果 肿瘤上皮巢呈多结节生长,中央常伴坏死,肿瘤侵袭周围组织,细胞有异形,肿瘤细胞主要为上皮样细胞型,有较多肿瘤性基质形成。肌上皮性标记及部分细胞角蛋白、PCNA标记阳性。电镜下见肿瘤细胞内有肌微丝。结论 免疫组化染色及超微结构观察均支持肿瘤为肌上皮来源及恶性特征。     

36例良、恶性淋巴上皮病临床病理分析

目的：分析恶性淋巴上皮病（MLEL）、良性淋巴上皮病（BLEL）及与之相联系的黏膜相关淋巴组织型结外边缘区B细胞淋巴瘤（MALToma）的临床特点、病理学特征、发病机制、诊断、治疗及转归。方法：对13例MLEL、20例BLEL及3例MT进行免疫组化染色和HE染色观察，复习相关临床资料并随访。结果：MLEL的病理学特征为大量增生的淋巴组织中见成簇或条索状分布的肿瘤细胞，界限不清，核分裂像多见；免疫组化示CKpan全部阳性（13／13），Vim部分阳性（3／13），SMA部分阳性（2／13）；8例MLEL可随访资料中，术后1例死于复发，1例死于其他疾病，1例局部复发，5例未见复发或转移，随访3．5个月-4a。BLEL的病理学特点为腺实质萎缩，间质淋巴细胞浸润及形态温和的腺肌上皮岛；免疫组化示CKpan19例阳性，LCA17例阳性。UCHL-1、L2616例阳性。CK10 10例阳性．S-1002例阳性；12例可随访的BIEL中，2例术后复发诊断为MLEL，其余健在，随访3个月～6a不等。3例MT中。1例术后6个月复发，经再次手术并化疗后缓解；免疫组化L26、LCA、CD79、CD43均阳性；UCHL-1、CKpan、EMA均有2例阳性。结论：MLEL好发于腮腺，且女性多见，来源于唾液腺导管上皮。对已发生颈淋巴结转移的患者行原发灶一颈联合根治，术后放疗，少数MLEL可在BLEL基础上发生，故BLEL局部切除后应长期随访；MT为B细胞淋巴瘤，手术切除辅以适当化疗可获较好疗效。术中冷冻切片是本病目前最可靠的术中诊断手段。     

涎腺正常与肿瘤组织中p63、CK5、CK19、CEA及SmA的表达

目的:探索涎腺正常导管、腺泡及其上皮性肿瘤的组织起源.方法:采用免疫组化(二步法)检测正常涎腺组织14 例、多形性腺瘤14 例、基底细胞腺瘤8 例、腺样囊性癌18 例、黏液表皮样癌9 例、低分化腺癌2 例及腺泡细胞癌、乳头状腺癌、恶性多形性腺瘤、肌上皮癌各1 例中p63、CK5、CK19、CEA及SmA的表达.结果:正常涎腺基底细胞与肌上皮细胞层表达CK5,其中部分细胞表达p63,导管部分基底细胞也呈CK19阳性.多形性腺瘤、基底细胞腺瘤、腺样囊性癌与黏液表皮样癌具p63、CK5及CK19高阳性率, SmA阳性率分别为85.71%、1.25%、61.11%、0.00%.CEA阳性细胞见于11.11%腺样囊性癌与55.56%黏液表皮样癌.结论:正常涎腺导管和腺泡的腺上皮及涎腺上皮性肿瘤可能来源于导管、腺泡基底层内呈p63和CK5阳性细胞中的干细胞.     

腮腺恶性淋巴上皮病变（附2例报告）

目的探讨腮腺恶性淋巴上皮病变的临床病理特征、发病机制及鉴别诊断。方法对2例腮腺恶性淋巴上皮病变进行病理组织学观察与免疫组化检测,并复习文献34例进行讨论。结果该病的组织病理学特征为肿瘤细胞呈大小不等的团巢状分布,间质大量淋巴细胞浸润;免疫组化显示细胞角蛋白和上皮膜抗原阳性。结论腮腺恶性淋巴上皮病变是一种低分化鳞状细胞癌,好发年龄40～49岁,其形成与EB病毒感染有关。     

慢性牙周炎牙龈组织中细胞凋亡的研究

目的：观察慢性牙周炎牙龈组织中的凋亡细胞,并探讨其发生凋亡的机制。方法：采用透射电镜法观察牙龈组织凋亡细胞的超微结构、利用免疫组化方法检测20例慢性牙周炎患者及20例牙周健康者牙龈组织中凋亡蛋白Casepase-9、Cyt-C的表达并进行统计学分析。结果：慢性牙周炎患者牙龈组织中可观察到凋亡细胞,Case-pase-9、Cyt-C的阳性表达显著高于牙周健康组（P〈0.05）。结论：慢性牙周炎较牙周健康者龈组织发生明显的细胞凋亡现象,并依赖于线粒体途径。     

涎腺多形性腺瘤的组织发生学研究——用免疫组化法看多形性腺瘤

本文用自制的角蛋白和S-100蛋白抗体、细胞性角蛋白(低分子量)和波形丝蛋白单克隆抗体,对26例涎隙多形性腺瘤进行了PAP法免疫组化研究,结果显示:导管样结构的内层细胞、鳞状化生区、肌上皮片块及粘液样组织的部分细胞以及软骨样陷窝的周边均呈角蛋白阳性,导管样结构的外层细胞、肌上皮片块和粘液样组织及软骨样细胞均呈S-100蛋白阳性,波形丝蛋白在肌上皮片块及粘液软骨样结构的部分细胞呈阳性。本文将这些结果与正常涎腺的免疫组化结果相对比,经分析讨论得出:多形性腺瘤的组织发生主要与导管上皮有关。肿瘤内的肌上皮样细胞可能为固有肌上皮细胞的异常增殖分化,也可能为导管上皮在病变时化生而来,而粘液,软骨样结构主要为导管上皮通过肌上皮细胞的多向分化、形成所致。上皮细胞在发生肿瘤化时,其内的角蛋白抗原可能也同时发生着某种规律性的变化。了解这点,对进一步认识和研究涎腺上皮性肿瘤有重要意义。     

口腔黏膜下纤维化组织中β1整合素的免疫组化研究

目的：观察β1整合素在人口腔黏膜下纤维化（oral submucous fibrosis,OSF）组织中的形态学定位,并探讨β1整合素与OSF病变的关系。方法：用免疫组化技术和图像分析技术观察OSF早、中、晚期及正常口腔黏膜10例β1整合素定位分布。结果：OSF组织中β1整合素免疫阳性物质含量有超量表达,主要分布在上皮棘细胞、基底细胞、间质成纤维细胞、血管内皮细胞及平滑肌细胞,并且β1整合素在OSF各期表达的比较有显著性差异。正常黏膜组织中β1整合素免疫阳性颗粒表达极弱。结论：β1整合素与OSF的发生和发展有关。     

8例涎腺透明细胞癌临床病理分析

目的:探讨涎腺透明细胞癌(CCCs)生物学特性和组织来源。方法:收集8例涎腺透明细胞癌标本,采用免疫组化方法和文献回顾对涎腺透明细胞癌进行研究分析。结果:透明细胞癌EMA和CK8全阳性表达(8/8、100/100),Ck18和CK-HMW小部分阳性表达(各2/8、25/100),S-100仅1例阳性表达。SMA、Calpon in和P53无表达,bc l-2全阳性表达,PCNA阳性表达率为72.25%。结论:涎腺透明细胞癌是腺上皮性肿瘤,肿瘤细胞增殖活跃,是一种低度恶性肿瘤。     

口腔鳞状细胞癌组织中Periostin的表达及其在上皮间质转化中的作用

目的:观察Periostin在口腔鳞状细胞癌组织中的表达情况,及其在上皮间质转化(EMT)中的作用。方法:用免疫组化法检测59例口腔鳞状细胞癌组织(实验组)和15例正常口腔黏膜组织(对照组)中Periostin、E-cadherin、Vimentin表达情况,分析Periostin与E-cadherin、Vimentin间相关关系。结果:59例口腔鳞状细胞癌组织中Periostin、E-cadherin、Vimentin阳性表达率分别为71.2%、52.5%、39.0%, Periostin表达与肿瘤TNM分期、分化程度、淋巴结转移密切相关(P＜0.05);且Periostin与E-cadherin表达降低和Vimentin表达上调间均存在相关性(P＜0.01)。结论:Periostin可能通过调控上皮间质转化促进口腔鳞状细胞癌侵袭转移。     

细胞角蛋白18及其基因在牙源性角化囊肿衬里上皮中表达的意义

目的检测细胞角蛋白18（CK18）及其基因在牙源性角化囊肿（OKC）衬里上皮中的表达。方法选取32例OKC的衬里上皮组织,分别进行CK18、CK8和CK19单克隆抗体的免疫组织化学染色。对其中12例使用RT- PCR法检测CK18 mRNA,观察其在衬里上皮中的表达;同时使用CK18基因探针进行原位杂交,检测CK18 mRNA在衬里上皮细胞层的定位表达。结果在免疫组织化学染色中, 17例CK18蛋白在OKC衬里上皮的表层细胞层表达为弱阳性;27例CK18蛋白在棘细胞层上层染色为阳性;14例CK18蛋白在棘细胞层染色为阳性;所有标本基底细胞层染色呈阴性。RT- PCR法检测见4例CK18 mRNA表达为强阳性,8例表达为弱阳性。原位杂交法检测见8例CK18 mRNA在棘细胞层和棘细胞层上层呈阳性,4例在上皮基底细胞层和角化层呈阳性。CK8蛋白在所有32例OKC衬里上皮基底细胞层均有表达。CK19蛋白在23例OKC衬里上皮表层均有表达。结论CK18在OKC衬里上皮的表达由基底细胞层向棘细胞层迁移,CK18蛋白免疫组织化学染色阳性表达与CK18 mRNA原位杂交法阳性表达不同,提示CK18可能与衬里上皮的增殖活性有关,OKC衬里上皮中可能存在CK18蛋白和CK18 mRNA表达的调控因子。     

Differential expression of Notch receptors and their ligands in desmoplastic ameloblastoma

J Oral Pathol Med (2010) 39 : 552–558 Background: In mammals, the Notch gene family encodes four receptors (Notch1–4), and all of them are important for cell fate decisions. Notch signaling pathway plays an essential role in tooth development. The ameloblastoma, a benign odontogenic epithelial neoplasm, histologically recapitulates the enamel organ at bell stage. Notch has been detected in the plexiform and follicular ameloblastoma. Its activity in the desmoplastic ameloblastoma is unknown. Method: Notch1‐4 and their ligands (Jagged1, Jagged2 and Delta1) were examined immunohistochemically in 10 cases of desmoplastic ameloblastoma. Results: Ameloblastoma tumor epithelium demonstrated positive expression for Notch1 (n = 5/10), Notch3 (n = 8/10), Notch4 (n = 10/10), Jagged1 (n = 6/10) and Delta1 (n = 5/10), but no reactivity for Notch2 (n = 10/10) and Jagged2 (10/10). Expression patterns were distinct with some overlap. Positive activity was detected largely in the cell membrane and cytoplasm of peripheral and central neoplastic epithelial cells, and sometimes in the nucleus. Staining score was highest for Notch4. Stromal components namely endothelial cells and fibroblasts showed overexpression for Notch4 but were mildly or non‐reactive for the other Notch members and their ligands. Conclusions: These findings suggest that Notch receptors and their ligands may play differing roles during the development of the desmoplastic ameloblastoma with Notch4 probably playing a greater role in the acquisition of tissue‐specific cellular characteristics in the desmoplastic ameloblastoma.     

Desmoplastic ameloblastoma featuring basal cell ameloblastoma: a case report

The desmoplastic ameloblastoma is a histological variant of ameloblastoma. The neoplastic epithelial islands seen in desmoplastic ameloblastoma are small and ameloblastic cells are rare. Basal cell ameloblastoma is also a rare variant of ameloblastoma, in which the tumor is composed of more primitive cells and has even fewer features of peripheral palisading. This report describes the case of a 17-year-old female with an ameloblastoma in the right anterior maxilla. Orthopantomography and computed tomography showed a well-defined lesion in the right maxilla. A partial maxillectomy for tumor resection was performed under general anesthesia. Histologically, ameloblastic tumor cells were seen with dense collagenous stroma and the tumor cells showed primarily basal cell variants of ameloblastoma. After 7 years of follow-up, clinical and radiographic examinations have revealed no evidences of recurrence.     

促结缔组织增生型成釉细胞瘤细胞的体外培养与鉴定

目的：观察体外培养的促结缔组织增生型成釉细胞瘤细胞的生长特点。方法：对促结缔组织增生型成釉细胞瘤细胞用酶消化法进行体外培养，免疫组化证实其细胞来源，以倒置显微镜观察细胞形态及生长情况．并用流式细胞仪分析细胞周期，MTT法绘制细胞生长曲线。结果：促结缔组织增生型成釉细胞瘤为上皮来源，细胞在体外培养过程中包含2种形态的细胞，与实性成釉细胞瘤细胞在体外培养相比，存在较多梭形细胞，细胞生长缓慢，培养的各代细胞未见异倍体。结论：促结缔组织增生型成釉细胞瘤细胞在体外培养过程中包含较多的梭形细胞．可能与其较多的细胞间质有关。     

Cytokeratins expression of constituting cells in ameloblastoma

The purposes of this study were to investigate the distribution of cytokeratins in the different tissue types of ameloblastoma and to discuss the histogenesis of this tumor. CK19 and CK8, which are markers for odontogenic epithelium, reacted positively to the constituting cells in all types of ameloblastoma. This suggests that all types of ameloblastoma derive from odontogenic epithelium. However, the desmoplastic type diminished the odontogenic characteristics because the basal cells are negative to CK19. Immunoreactions of five kinds of cytokeratin revealed similar results in plexiform, follicular, acanthomatous, and granular cell types. The plexiform type is probably the original type of ameloblastoma; the other types have the characteristics of squamous epithelium, and the follicular, acanthomatous, and granular cell types can develop due to the differentiation of cells of the plexiform type into squamous epithelium.     

促结缔组织增生性成釉细胞瘤的X线分析

目的 总结促结缔组织增生性成釉细胞瘤的X线特点。方法 对病理确诊的15例促结缔组织增生性成釉细胞瘤的X线表现进行回顾性分析,并与一般型成釉细胞瘤对比观察。结果 促结缔组织增生性成釉细胞瘤主要位于前牙区和（或）前磨牙区（13／15）。X线有3种表现：①单房改变（7／13）,病变范围小且有密度不均小片状或条索状影像;②多房性皂泡状改变（2／13）,肿瘤内有较多致密条纹样直线或不规则状骨隔;③混合性改变（4／13）,病变区内可见似丛增生团块,边缘带伴有单囊状改变。该瘤组织学上以大量增生的纤维结组织间质中散在不规则、压缩状上皮岛或条索为特点。结论 促结缔组织增生性成釉细胞瘤为成釉细胞瘤的一种新的类型,具有特征性X线和组织学表现,X线方面应与骨化性纤维瘤和牙源性粘液瘤等鉴别。     

A immunohistochemical study of the peripheral ameloblastoma

AIM: Peripheral ameloblastoma (PA) is a rare variant of ameloblastoma occurring in the extraosseous region. With regard to the histogenesis of the tumor, two major sources of origin are considered: odontogenic epithelial remnants and the gingival epithelium. In this study, we examined the immunohistochemical profiles of cytokeratins (CKs) and Ki-67 labeling index (LI) of PAs, and discuss the histogenesis and the biologic behavior of the PA. MATERIALS AND METHODS: Eight cases of PA were retrieved from the pathology files of 212 cases of ameloblastoma that had been registered at our hospital. Immunohistochemical staining was performed in seven cases using monoclonal antibodies of six CKs (7, 8, 13, 14, 18, and 19) and Ki-67. RESULTS: All cases of PA expressed CK13, 14, and 19. CK18 was positive staining in six cases, and CK8 in five cases. This staining pattern was similar to that in intraosseous ameloblastomas (IAs). The mean of Ki-67 LI of PAs (1.91%) was significantly lower than that of IAs (4.82%) (P = 0.002). CONCLUSION: We consider that the PA originates from odontogenic epithelial remnants rather than from the gingival epithelium, and the Ki-67 LI of the tumor is a good prognostic indicator.     

Desmoplastic variant of ameloblastoma: report of two cases and review of the literature

BACKGROUND: The desmoplastic ameloblastoma exhibits important differences in anatomical distribution, histologic appearance and radiographic findings compared with the classic type of ameloblastoma. The purpose of this article is to assist the dental community in better understanding this variation in odontogenic tumor. CASE DESCRIPTIONS: The authors present two cases of desmoplastic variant of ameloblastoma localized in the anterior portion of the jaw. The tumors were expansile, destructive and painless. The radiographic findings showed diffuse, mixed (radiopaque/radiolucent) lesions with cortical bone destruction. Block excision was performed in both cases. Follow-up examination one and two years later disclosed no recurrence of tumor. CLINICAL IMPLICATIONS: The desmoplastic variant of ameloblastoma tends to infiltrate between bone trabeculae. Curettage leaves islands of tumor within bone, which later manifest as recurrences. Therefore, block excision is the most widely used treatment to avoid recurrence.     

Immunoprofile of a carcinosarcoma of the submandibular gland

Carcinosarcomas are a very rare group of true malignant tumors of the salivary gland. As the name indicates, the tumor is composed of an epithelial and a mesenchymal component, both malignant. We report a case of carcinosarcoma of the submandibular gland in an 86-year-old woman. The epithelial component showed a squamous carcinoma phenotype, whereas the mesenchymal component was morphologically similar to a fibrosarcoma. The epithelial component was strongly positive for CK13, CK14, and AE1/AE, and groups of positive cells were seen for CK19 and vimentin. The whole mesenchymal component was positive for vimentin, negative for cytokeratins, and focal cells were positive for smooth- muscle actin. Both components were strongly positive for P53 and Cyclin D1, and focally positive for MDM2. Rare multinucleated giant cells showed expression of CD68, and focal dendritical cells on carcinomatous nests were positive for S-100. The CK7, CK8, Factor XIIIa, c-erbB-2, P16, CDK-4, Rb1, and E2F-1 were not detected in these 2 groups of malignant cell populations.     

15例促结缔组织增生型成釉细胞瘤的临床病理分析

报告１５例促结缔组织增生型成釉细胞瘤,并结合文献报道的５０例ＤＡ进行临床病理分析。结果表明,促结缔组织增生型成釉细胞瘤发生率低,约占全部成釉细胞瘤的７．４％,肿瘤好发于颌骨前部和上颌骨,Ｘ线常表现为透射影,阻射影混杂存在。     

Ameloblastoma of the follicular, plexiform, and acanthomatous type in the maxillary sinus: a case report.

The ameloblastoma is a benign odontogenic tumor of epithelial origin. Histopathologically, it occurs in six patterns: plexiform, follicular, acanthomatous, granular cell, basal cell, and desmoplastic type. This report presents a rare case of an ameloblastoma in the maxillary sinus that consists of three types: follicular, plexiform, and acanthomatous. The diagnostic procedure, surgical therapy, and follow-up findings are described and discussed.