150例涎腺癌的临床分析

分析150例涎腺癌,发生在腮腺61例,颌下腺14例,舌下腺5例,和小唾腺70例。病理分型:癌在多形性腺瘤中49例,腺癌25例,腺样囊性癌24例,粘液表皮样癌22例,腺泡细胞癌22例,鳞状细胞癌5例,乳头样囊腺癌2例,未分化癌1例。150例涎腺癌3、5、10年生存率为80.7％、69.4％、52.1％。腺泡细胞癌和粘液表皮样癌预后较鳞状细胞癌、腺癌和未分化癌好。生存率根据部位,小唾液腺和腮腺肿瘤最高,舌下腺和颌下腺最低。术后放疗和化疗,对涎腺癌,生存率是重要的,涎腺癌复发率为27.6％,颈淋巴结转移率为9.2％。     

裸鼠体内原位移植法筛选粘液表皮样癌高转移细胞

目的：筛选高转移人涎腺粘液表皮样癌细胞。方法：用人涎腺粘液表皮样癌细胞Mc3经裸鼠涎腺移植、鼠间原位移植、细胞培养技术获取所需细胞,用相差显微镜、电子显微镜、细胞计数法、染色体显示法、流式细胞术、软琼脂克隆形成法以及癌细胞裸鼠尾静脉注射法研究其生物学特性。结果：经4次鼠间原位移植,肺转移率为3／10。取转移灶行细胞培养,获得形态均一、生长旺盛的上皮样细胞,命名为M3SP4。M3SP4细胞所致肺肿瘤显示粘液表皮样癌组织学特征,细胞染色体为亚二倍体,仍保持人类染色体形态。M3SP4与Mc3形态相似,群体倍增时间（h）分别为23.9和25.9,S期细胞（％）分别占细胞周期26.8和15.3,克隆形成率（％）分别为54.6和30.2,经尾静脉注射后M3SP4细胞引起的肺转移结节比Mc3多35％。结论：M3SP4是转移力强于Mc3的人涎腺粘液表皮样癌细胞系,Mc3细胞经裸鼠涎腺移植、鼠间原位移植后转移力有所提高。     

影响唾液腺粘液表皮样癌患者术后生存的临床病理因素分析

目的　探讨影响唾液腺粘液表皮样癌患者术后生存的临床病理因素。方法　回顾经首次手术治疗且有完整随访资料的唾液腺粘液表皮样癌患者 70例的临床资料 ,对各项指标采用乘积限法 (Kaplan-Meier)估计各时点的生存率 ,同时进行序检验 (Logranktest)各组间差异 ,最后进入Cox比例风险模型 (CoxRegression)做多因素分析。全部资料通过SPSS软件完成。结果　 70例唾液腺粘液表皮样癌患者 ,术后 3、5、1 0年生存率分别为 90 6 6 %、88 85 %、86 6 3%。肿瘤直径小于等于 4cm、术前区域淋巴结无转移、临床处于早期 (Ⅰ、Ⅱ期 )、高分化、术后无复发和转移的患者生存期明显长于肿瘤直径大于 4cm、术前区域淋巴结有转移、临床晚期 (Ⅲ、Ⅳ期 )、低分化、术后出现复发及转移的患者。结论　TNM分类、临床分期、分化程度以及术后有无复发和转移是影响唾液腺粘液表皮样癌患者术后生存的重要因素.     

口底区域淋巴组织清扫术在舌癌根治术中的应用

目的:为减少舌癌患者术后复发率及转移率,探讨口底区域淋巴组织清扫术的范围、术式及其临床意义。方法:收集随访2000年5月～12月本科舌癌手术患者20例(原发灶T2或T3,未明显侵犯口底,颈部N0)。同期舌-(颌)-颈联合根治术,术中于颏孔前断离并外展下颌骨,以利直视下彻底清扫同侧口底中间带淋巴组织,达到完整舌-(颌)-颈根治。同期调查我院和外院舌癌手术后患者20例(术中口底中间带淋巴组织保留或未彻底清扫)作为对照,比较两组患者复发率与颈部淋巴结转移率。结果:实验组局部无1例复发,对侧淋巴结转移2例(T3),转移率10%。对照组口底或下颌下复发7例,对侧颈淋巴转移5例,复发转移率60%。P<0.05,有统计学显著性差异。结论:传统非连续性颈清扫并不能清除所有可能受累的淋巴结。对T2以上的舌癌患者,宜在传统的颈清术式基础上,断离、外展下颌骨,行同侧口底中间带组织的彻底清扫。     

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目的    探讨舌下腺恶性肿瘤的发病情况、病理特征、治疗方式及疗效特点。方法    对1979—2010年中国医科大学附属口腔医院及中国医科大学附属第一医院收治的34例经病理确诊的舌下腺恶性肿瘤病例临床资料进行回顾性分析。结果    34例舌下腺恶性肿瘤患者中,男15例,女19例;年龄20～86岁,平均52.12岁;40～60岁年龄段为22例（64.71%）;病理类型中腺样囊性癌居首位（70.59%）;治疗方式主要是局部扩大切除+颈淋巴结清扫术;3、5、10年存活率分别为82.35%、76.47%、47.06%。结论    舌下腺恶性肿瘤女性患者发病率略高于男性;腺样囊性癌和黏液表皮样癌是舌下腺常见的恶性肿瘤;首次正确选择术式,且术后辅助放化疗是降低复发和转移的主要因素。     

裸鼠脊髓转移灶粘液表皮样癌细胞系Ms的建立及生物学特性

目的：建立Mc3细胞的脏器转移细胞系。方法：采用瘤细胞尾静脉注射法、组织块细胞培养法．从裸鼠体内获得Mc3细胞系脊髓转移细胞亚系。用染色体最示、细胞形态及细胞致瘤性观察证明其性质；用细胞生长曲线、流式细胞仪测定增值速度。结果：从50只受试课鼠中获得一只截瘫的裸鼠．取其脊髓组织行原代及传代培养获得细胞并建立细胞系．传代50次以上．生长稳定．倍增时间为13 h．s期细胞占22．7％．染色体众数为61，保持人类染色体形态、细胞形态与其母细胞相似．相差显微镜观察活细胞晕”铺路石”样外观。裸鼠肺内转移肿瘤组织切片显示为粘液表皮样癌．将该细胞命名为Ms。结论：Ms细胞系是Mc3细胞系在裸鼠体内的脊髓转移细胞亚系．其生物学性质与Me3细胞小不同     

腮腺腺鳞癌1例报告及文献复习

腮腺腺鳞癌是一种罕见的高度恶性肿瘤,本文报告1例发生于61岁男性患者的腮腺腺鳞癌,并结合文献对其临床和病理特征、诊断和治疗等进行讨论。     

Pulmonary metastases of malignant tumors of the oral and maxillofacial region. Analysis of 70 cases

Records of 685 cases of malignant tumors in the oral and maxillofacial regions were collected. Pulmonary metastases occurred in 70 of these cases. The metastatic rate was 10.2%. Roentgenographic appearances of pulmonary metastases were divided into 3 types: (1) Multiple ball-like lesion (78%); (2) Single ball-like lesion (14%); (3) Irregular lesion (8%). When metastasis was single, diagnosis was made according to the location of the metastasis and comparison between and old recent roentgenograms. Pulmonary metastasis was more frequent in tumors of the submandibular gland (34.5%), the base of the tongue (33.3%), and the sublingual gland (27.3%). Adenoid cystic carcinoma (47.8%) and adenocarcinoma (26.5%) might readily develop pulmonary metastasis. Pulmonary metastasis was rare in squamous cell carcinoma (2.5%). The metastatic rates were 3.9%, 5.4%, 6.5%, and 7.1% in stage I, II, III and IV, respectively. The period between the occurrence of pulmonary metastasis and initial treatment was from 1 month to 8 years and 5 months, with a mean of 33.8 months. The period between the occurrence of pulmonary metastasis and death of the patient was from 1 month to 8 years and 8 months, with a mean of 21.4 months.     

Salivary gland tumours: an epidemiological review of non-neoplastic and neoplastic pathology

Salivary gland tumours (SGT) demonstrate geographical variation. The primary objective of this study was to determine the types, frequency, distribution, and demographics of non-neoplastic and neoplastic salivary gland pathology at Waikato Hospital, New Zealand (NZ) over a 10-year period. Following this we conducted a 10-year retrospective review of SGT epidemiology from international literature. In total 825 patients were identified, 31% (256/825) with non-neoplastic salivary gland pathology, 34% (284/825) with benign neoplastic pathology, 14% (118/825) with primary malignant lesions, 18% (146/825) with metastatic SGTs, and 3% (21/825) with lymphoma. Patients had a mean (range) age of 58 (3–102) years, were predominantly male (58%, 476/825), and NZ European (65%, 536/825). Tumours were most prevalent in the parotid gland (85%, 484/569), of which 44% (211/484) were malignant. Pleomorphic adenoma was the most common benign (71%, 203/284) and overall (36%, 203/569) tumour, while mucoepidermoid carcinoma (25%, 29/118) and squamous cell carcinoma (SCC) (73%, 106/146) were the most common primary malignant and metastatic SGTs, respectively. Our literature review identified 18 studies consisting of 33,933 patients, of whom 71% (24,013/33,933) had benign SGTs. Pleomorphic adenoma (68%, 16404/24013) and mucoepidermoid carcinoma (29%, 2826/9621) were the most common benign and malignant SGTs, respectively. Low numbers of non-neoplastic and metastatic SGTs were reported in the literature. This research provides a greater understanding of differences in their global distribution. Consistent with previous literature, pleomorphic adenoma and mucoepidermoid carcinoma were the most common benign and malignant SGTs. In NZ, we found high rates of malignant SCC to the parotid gland, consistent with the epidemiology of non-melanoma skin cancer in the country.     

转化生长因子β1在人涎腺黏液表皮样癌高低转移细胞系中的表达

目的探讨转化生长因子(TGF)βl在人涎腺黏液表皮样癌高、低转移细胞株的差异表达。方法应用基因芯片技术、反转录(RT)-PCR、免疫组化、免疫印迹杂交等方法从基因水平和蛋白水平检测TGF-βl的表达。结果基因芯片技术、RT-PCR、免疫组化、Western blot结果都证实TGF-β1在人涎腺黏液表皮样癌脊髓转移株高表达,在低转移株不表达。结论TGF-β1的表达上调可能与人涎腺黏液表皮样癌转移有关。     

nm23基因在涎腺恶性肿瘤中表达的意义

为了探讨ｎｍ２３基因在涎腺恶性肿瘤中表达的意义，作者应用免疫组织化学方法检测了４０例涎腺恶性肿瘤ｎｍ２３基因表达情况，并分析了ｎｍ２３基因表达变化与涎腺恶性肿瘤的临床病理及其转移的关系。结果发现，ｎｍ２３低表达者其肿瘤转移率为８１８％，而ｎｍ２３高表达者其肿瘤转移率只有３４％，两者差异有高度显著性（Ｐ＜０．００５）；ｎｍ２３低表达与肿瘤大小、部位、病理类型无显著相关性（Ｐ＞０．０５）。结果表明ｎｍ２３基因在抑制涎腺恶性肿瘤转移方面起重要作用。     

Unilateral, clinically T2N0, squamous cell carcinoma of the tongue: surgical outcome analysis

To determine the survival rate and analyse the predicting factors of recurrence in patients with unilateral, clinically T2N0 squamous cell carcinoma (SCC) of the tongue which does not cross the midline, a retrospective analysis of 32 such consecutive, previously untreated, cases was performed. All patients were initially treated by surgery between January 1992 and May 2004. All patients had neck dissections: 12 continuous, 20 discontinuous, 24 bilateral and 8 unilateral. Fourteen patients (44%) received adjunctive postoperative radiotherapy. Occult metastatic rates were 34% and 4% in ipsilateral and contralateral neck, respectively. Patients with pN0 cancer had a better 5-year disease-specific survival rate than those with pN+ cancer (85% versus 41%, P=0.005). Twelve patients (38%) had recurrences after the initial treatment. The recurrence rate was significantly higher in patients with pathologic nodal metastasis, peroral resection of the primary tumour or discontinuous neck dissection. The results suggest that the most effective surgical methods for treating unilateral T2N0 SCC of the tongue which does not cross the midline are: pull-through approach for primary lesion instead of peroral approach; continuous rather than discontinuous neck dissection and ipsilateral elective rather than bilateral routine elective neck dissection.     

PTEN抑癌基因对黏液表皮样癌实验性裸鼠肺转移的抑制作用

目的　探讨外源野生型PTEN抑癌基因对人高转移性黏液表皮样癌M3SP2细胞系实验性裸鼠肺转移能力的影响。方法　用脂质体介导方法将PTEN抑癌基因导入M3SP2细胞系 (M3SP2 -PTEN细胞 ) ,转染空载体的细胞系作为对照M3SP2 -pBp细胞 ) ,应用裸鼠肺转移实验测定癌细胞的体内转移能力 ,并进行组织学观察。结果　对照组裸鼠肺转移结节数为 (2 4 0± 1.2 )个 ,组织学观察瘤细胞转移灶体积大 ,细胞生长活跃 ,可见较多核分裂。实验组裸鼠肺转移结节数量减少为 (8 5± 3 4 )个 ,转移抑制率为 6 5 6 % ;组织学观察可见转移灶数量少、体积小 ,并有较多的坏死和凋亡细胞。结论　转染野生型PTEN抑癌基因能降低人高转移性黏液表皮样癌细胞转移能力。     

TGF‐β1 regulates the invasive and metastatic potential of mucoepidermoid carcinoma cells

J Oral Pathol Med (2011) 40 : 762–768 Background: Patients with mucoepidermoid carcinoma exhibit poor long‐term prognosis because of the lack of therapeutic strategies that effectively block tumor progression. We have previously characterized the Ms cells as a highly metastatic mucoepidermoid carcinoma cell line that expresses high levels of transforming growth factor β1 (TGF‐β1). Here, we studied the effect of suppressing TGF‐β1 by RNA silencing on the invasive and metastatic potential of mucoepidermoid carcinoma. Methods: Cell motility, substratum adhesion, and transmembrane invasion were estimated by migration, matrigel adhesion, and matrigel invasion assay. Matrix metalloproteinase (MMP)‐2 and MMP‐9 activity were determined using gelatin gel zymography. Balb/c nu/nu nude mice lung metastatic model was used to test the metastatic ability of the Ms cells. Lung metastatic tumors were experimentally induced by mice tail vein inoculation of cancer cells. Results: TGF‐β1 silencing inhibits cell motility, substratum adhesion, and transmembrane invasion. In vivo, a significant decrease in lung metastasis was observed when mice received tail vein injections of TGF‐β1‐silenced mucoepidermoid carcinoma cells, as compared to controls. Conclusion: These results unveil a critical role for TGF‐β1 in the progression of mucoepidermoid carcinomas and suggest that patients with this malignancy may benefit from therapeutic inhibition of the effectors of the TGF‐β1 pathway.     

Colonic adenocarcinoma with metastasis to the gingiva

Metastatic tumors involve the oral cavity, and the most common primary sites are the breast and lung. Most cases affect the mandible and maxilla in that order, although some of them can be located in the soft perioral tissues. We report the case of a 62-year-old male who had been diagnosed with sigmoid adenocarcinoma with nodal and liver metastasis, who presented 6 months later with a gingival polypoid tumor, at first considered as a primary neoplasm of gingiva, that was diagnosed in a biopsy as metastatic intestinal adenocarcinoma. The histological evaluation is essential to separate adenocarcinoma from the commoner in this site squamous cell carcinoma, and the immunohistochemical techniques are useful to distinguish metastatic tumor versus primary adenocarcinoma from the minor salivary glands of the area. The intraoral spread of a disseminated neoplasm is generally a sign of bad prognosis, although a longer survival can be expected if a radical surgical treatment of a solitary metastasis is carried out.     

Utility of neck dissection for management of carcinoma of the parotid gland

To validate the use of neck dissection as part of the management of patients with parotid carcinomas, we retrospectively reviewed pathological and clinical data from the head and neck pathology archive at Guy’s and St Thomas’ Hospital on all patients who had primary parotid carcinomas resected between 1992 and 2014. The main outcome measure was the incidence of metastatic disease. A total of 54 of the 82 patients identified had neck dissections. Nodal metastases were detected in 10 with high-grade, invasive carcinoma ex-pleomorphic adenomas, two with salivary duct carcinomas, one with a high-grade adenocarcinoma not otherwise specified (NOS), one with an adenoid cystic carcinoma, and one with a high-grade acinic cell carcinoma. No metastases were found in those with a low-grade acinic cell carcinoma, low-grade mucoepidermoid carcinoma, epithelial-myoepithelial carcinoma, or non-invasive carcinoma ex-pleomorphic adenoma. The findings of this study support the use of routine neck dissection for the treatment of high-grade, invasive carcinoma ex-pleomorphic adenoma, salivary duct carcinoma, high-grade adenocarcinoma NOS, adenoid cystic carcinoma, and high-grade acinic cell carcinoma.     

Epithelial salivary gland tumors of children and adolescents in west China population: a clinicopathologic study of 79 cases

Objective:  Determine the clinical and histopathologic features of epithelial salivary gland tumors of children and adolescents.
Methods:  A total of 79 cases of epithelial salivary gland tumors of children and adolescents were retrieved from the files. Information about demographic, clinical, histopathologic characteristics, and follow-up status were analyzed.
Results:  Sixty tumors (75.9%) were benign and 19 (24.1%) malignant. The most common tumor overall was pleomorphic adenoma (PA). The parotid was the most frequently involved site (43.0%). PA was the most common type of benign tumor. The most common malignant tumor was mucoepidermoid carcinoma. Five patients with parotid PA and two cases with palate myoepithelioma showed local recurrences. One patient with mucoepidermoid carcinoma showed local recurrences and died from the tumor 3 years after the initial treatment. One patient with adenocarcinoma presented local and neck recurrences, and died 4 years after initial treatment.
Conclusions:  Our data showed that the salivary gland tumors in children and adolescents may be the higher incidence of benign tumors, especially of PA; the slightly higher tendency for female predominance; the higher incidence of parotid glands. Mucoepidermoid carcinoma was the most common malignant tumor, with majority of low grade. Initial treatment should be planned to excise the tumor completely with satisfactory margins. The neck dissections or postoperative radiotherapy were performed in patients with low differentiation malignancies, or patients who present nodal metastasis or with clinically suspicious regional metastasis.     

An immunohistochemical study of thrombomodulin in oral squamous cell carcinoma and its association with invasive and metastatic potential

Thrombomodulin (TM) is a glycoprotein that was originally identified on vascular endothelium and characterized as a natural endothelial anticoagulant. We reported previously that TM was also expressed at cell-cell boundaries of squamous epithelium, except in the basal layer cells and upper granular layer cells. The expression pattern of TM in the squamous cells implies that this molecule might be associated with keratinocyte differentiation, as well as being a potent anticoagulant. In the present study we examined TM expression immunohistochemically in biopsy specimens from 65 patients with primary oral squamous cell carcinoma (OSCC). and compared the results with the biological behavior of the carcinomas. The patients with intense TM expression in the carcinoma showed a significantly lower frequency of lymph node metastasis and significantly more favorable survival than those with negative TM expression. The TM expression was a better marker than the other prognostic factors, such as differentiation degree, tumor size and invasion mode. When TM expression was compared between the primary and metastatic lesions in the 36 patients who had lymph node metastasis, 14 (39%) showed decreased TM expression. 19 (53%) showed no change, and 3 (8%) showed an increase in the metastatic lesions. Wilcoxon's signed-rank test indicated that tumor cells positive for TM expression were significantly rarer in the metastatic lesions than in the primary tumors (P<0.05). These results indicate that reduced expression of TM is associated with metastasis of carcinoma cells. The reduction of TM expression seems to play an important role in the metastatic process of OSCC, and to be related with a poor outcome for the patients.     

增殖细胞核抗原和Ki-67抗原在涎腺癌中的表达

目的:探讨细胞增殖核抗原和Ki-67抗原在不同类型涎腺癌中的表达及意义。方法:采用SABC和LSAB免疫组化法分别检测PCNA和Ki-67在17例粘液表皮样癌、12例腺样囊性癌、9例恶性多形性腺瘤中的表达和分布。结果:1)PCNA及Ki-67的增殖指数即PI值在粘液表皮样癌和腺样囊性癌的不同分级中表达不同,且有统计学意义(P<0.005)。2)恶性多形性腺瘤PCNA及Ki-67的PI值较高,与腺样囊性癌及粘液表皮样癌相比差异有统计学意义(P<0.001)。3)PCNA及Ki-67的表达水平与涎腺癌的生物学行为(复发和转移)明显相关。结论:涎腺癌中PCNA和Ki-67的表达水平与细胞分化有关,其PI值可作为粘液表皮样癌和腺样囊性癌的组织学分级的重要参数,也是诊断恶性多形性腺瘤的重要指标。PCNA和Ki-67的高表达预示着涎腺癌预后的不良。     

Angiogenesis and lymphangiogenesis in mucoepidermoid carcinoma of minor salivary glands

J Oral Pathol Med (2012) 41: 603-609 Background: Mucoepidermoid carcinoma is the most common malignant tumor of salivary glands. This tumor is characterized by a great variability in clinical behavior, and little is known about the pathological mechanisms involved in its variance. Angiogenesis is an important step in tumor progression and is believed to be an essential event for metastatic dissemination. Methods: We aimed to investigate angiogenesis and lymphangiogenesis in mucoepidermoid carcinoma measuring the density of neoformed and lymphatic vessels using CD105 and D2-40 antibodies, respectively, and by immunohistochemical evaluation of VEGF-A and VEGF-C proteins. It was also investigated the expression of D2-40 in neoplastic cells. Results: We studied 26 cases of mucoepidermoid carcinoma, which showed great angiogenic activity measured by neoformed vessel density. However, a low density of lymphatics was observed. VEGF-A, VEGF-C, and D2-40 were commonly detected in mucoepidermoid carcinoma, but only VEGF-A expression correlated with neoformed vessel density. Recurrence and nodal metastasis were associated with low VEGF-A expression and low neoformed vessel density, indicating that impaired angiogenesis could lead to an aggressive phenotype. Conclusions: Angiogenesis seems important in the modulation of mucoepidermoid carcinoma pathogenesis; however, none of the parameters analyzed could predict tumor behavior.