涎腺恶性多形性腺瘤11例临床病理分析

目的 探讨恶性多形性腺瘤(malignant pleomorphic adenoma, MPA)的临床病理学特征。方法 回顾性分析11例MPA的临床病理学及免疫表型特征,并复习相关文献。结果 11例MPA发病年龄27～76岁,平均50岁,中位年龄53岁;男女比为6∶5。肿瘤部位：腮腺7例,颊部2例,腭部1例,咽旁1例;其中10例为原发性肿瘤,1例为复发性肿瘤。恶性成分的组织学类型包括：唾液腺导管癌4例,肌上皮癌3例,黏液表皮样癌2例,多形性腺癌1例,癌肉瘤1例。其中,侵袭性癌3例,非侵袭性癌8例。侵袭性癌中,2例发生颈部淋巴结转移,2例术后复发,1例死亡。非侵袭性癌中未出现淋巴结转移、复发或死亡。结论 MPA多见于中老年男性,好发于腮腺。组织学通常同时具有良性多形性腺瘤成分和恶性肿瘤成分,恶性成分多为唾液腺导管癌和肌上皮癌,侵袭性癌易发生颈部淋巴结转移、复发和死亡。     

涎腺恶性肌上皮瘤临床病理分析

目的分析涎腺原发性恶性肌上皮瘤临床表现、形态特征和生物学行为。方法对16例涎腺恶性肌上皮瘤组织进行HE染色和免疫组织化学染色,并进行回顾性分析。免疫组织化学采用EnVision法,所用抗体包括肌动蛋白、细胞角蛋白(CK)、上皮膜抗原(EMA)、波形蛋白、S-100、结蛋白、肌特异性肌动蛋白(MSA)、平滑肌肌动蛋白(SMA)、肌红蛋白,增殖细胞核抗原、白细胞共同抗原和胶质纤维酸性蛋白。结果16例中男性6例,女性10例,年龄12～65岁,平均44岁。肿瘤主要发生于腮腺和腭部小涎腺。临床上主要表现为快速生长或生长突然加速的局部包块,可有溃疡形成、骨质破坏和神经侵犯。16例中7例为复发病例,2例有颌下或颈部淋巴结转移。大部分肿物侵犯周围涎腺组织或邻近脂肪、肌肉、骨组织,侵入程度不一。肿瘤细胞形态多样化,有透明、梭形、上皮样、浆细胞样型和混合型,有一定细胞异型性,核分裂象较多。肿瘤以透明细胞型为主,占9例。免疫组织化学示瘤细胞CK、EMA、MSA、结蛋白、S-100阳性。结论涎腺恶性肌上皮瘤为比较少见的低度恶性的肿瘤,不易发生淋巴结和远处转移但容易复发,局部软组织和骨组织易受侵犯,生物学行为不一,在组织学的基础上结合免疫组织化学等其他检查可以确诊。     

涎腺黏液表皮样癌与多形性腺瘤的细胞学诊断及鉴别

目的 分析涎腺黏液表皮样癌(mucoepidermoid carcinoma,MEC)的细胞学形态特点,探讨涎腺MEC与涎腺多形性腺瘤(pleomorphic adenoma,PA)的细胞学鉴别诊断.方法 回顾性分析2014年8月～2017年7月西南医科大学附属医院存档的21例头颈部涎腺MEC及190例涎腺PA的细胞学...     

涎腺癌肉瘤临床及病理分析

目的：探讨涎腺癌肉瘤的临床病理学特点及其鉴别诊断。方法：对3例涎腺癌肉瘤患者的临床资料进行回顾性研究并复习相关文献，对全部病例的组织学标本重新进行镜下观察。结果：涎腺癌肉瘤临床表现常为迅速增大的颜面部肿物并伴疼豢。光匀下组织学观察常可见肉瘤和癌两种成分并存，癌多为鳞状细胞癌和腺癌，肉瘤以骨或软骨肉瘤为主。结论：涎腺癌肉瘤的临床特点与涎腺其他恶性肿瘤较难区别，但涎腺癌肉瘤的恶性程度极高。     

涎腺多形性腺瘤的组织发生学研究

应用5种中间丝单克隆抗体和S—100蛋白多克隆抗体对21例涎腺多形性腺瘤进行了免疫组化研究。结果肿瘤组织内腺管样结构的外层、片块状结构和粘液软骨样区的细胞波形蛋白、胶质纤维酸性蛋白和S—100蛋白阳性,表明由于肿瘤干细胞向腺上皮和肌上皮的分化,致使其细胞成分具有多形性表现的特点。     

涎腺导管癌4例临床病理分析

目的探讨涎腺导管癌(salivary duct carcinoma)的临床病理特征、免疫表型、治疗及预后。方法回顾性分析4例涎腺导管癌的临床病理资料、病理学形态及免疫表型特征,并复习相关文献。结果 4例均为男性,平均发病年龄49岁(范围36～71岁),且均发生于腮腺(4/4)。肿瘤最大径3～4 cm。镜下组织形态类似于高级别乳腺导管癌,肿瘤呈实性、管状排列,可见导管扩张及粉刺样坏死,瘤细胞较大,细胞核大,异型性明显,胞质丰富,嗜酸性。免疫表型:CK(AE1/AE3)、EMA、S-100、GCDFP-15、AR、Ki-67均阳性,SMA、CEA、p63、CD56、CGA、Calponin、PR均阴性,1例ER为1+,按乳腺癌HER-2判读标准,2例HER-2为2+,2例为0～1+。随访2例患者(2/4)于2年内发生转移。结论涎腺导管癌是一种罕见的侵袭性恶性肿瘤,预后较差,与乳腺导管癌形态相似。     

伴肌上皮分化的黏液样肾肿瘤：与涎腺多形性腺瘤相似的病例描述

近年来，随着成人肾上皮性肿瘤形态学和遗传学特点研究的进展，已对此类肿瘤做出了具有临床和预后意义的明确的分级，这些肿瘤的分级依赖于形态学表现，同时也反映了这些肿瘤具有明确的遗传学特征。然而大约6％～7％的肾肿瘤形态学上仍未能分类，需要对这些尚未分类肿瘤的形态学进行详细分析来提高更多具有相同分子学和遗传学特征的同种类别肿瘤的识别。在这组很少描述的肾脏病变中，具有明确的形态学、免疫表型和良性过程的成人肾上皮性肿瘤，被确定为“低级别黏液样肾上皮性肿瘤”。[第一段]     

涎腺多形性低度恶性腺癌3例临床病理分析

目的探讨涎腺多形性低度恶性腺癌的临床及病理特征。方法对3例涎腺多形性低度恶性腺癌进行光镜及免疫组化检查并复习相关文献。结果 3例均为女性,年龄分别为51、54、56岁,发生部位2例在腭部,1例在腮腺下极。术前被误诊为多形性腺癌及腺样囊性癌。组织学检查:细胞较一致,呈小叶状、乳头状、筛状、小管状排列、具有多样性,浸润性生长。免疫组化:GFAP阴性表达,CK、vimentin、S-100、CEA呈阳性表达。结论涎腺多形性低度恶性腺癌发病率低,为低度恶性肿瘤,应注意与其它良恶性肿瘤鉴别诊断。     

婴幼儿鼻腔多形性腺瘤一例

患儿男,1岁。因左侧鼻塞流黄鼻涕3个月,左眼球突出1周于2003年5月9日收入院。患儿家长于3个月前发现患儿左侧鼻塞伴流黄鼻涕,睡眠时出现打鼾张口呼吸,并逐渐加重,1周前出现眼球突出。专科检查：鼻部外形无明显畸形,鼻中隔向右偏曲,左侧鼻腔内可见肿物生长,表面有脓性分泌物。左眼睑肿胀,左眼球向前外侧突出,眼球运动正常,CT示左侧鼻腔、上颌窦和筛窦有密度增强影。     

Cyclin D1 and p16 expression in pleomorphic adenoma and carcinoma ex pleomorphic adenoma of the parotid gland

AIMS: To compare cyclin D1 and p16(ink4) (p16) expression in normal tissue, pleomorphic adenoma (PA) and carcinoma ex pleomorphic adenoma (CXPA) of the parotid gland. METHODS AND RESULTS: Immunohistochemistry was used to examine cyclin D1 and p16 expression in 43 parotid tumours (29 PAs and 14 CXPAs). Cyclin D1 and p16 were both significantly more likely to be expressed in the neoplastic than in the normal epithelial and stromal components of PA and CXPA (P < 0.001 and P < 0.005, respectively). Cyclin D1 was more likely to be expressed in the malignant components of CXPA than in the benign components of PA (50% versus 31% and 31%, respectively), but the trend was not statistically significant. There was no evidence of this association for p16 (corresponding positivity rates 69% versus 81% and 52%). CONCLUSIONS: Our findings provide preliminary evidence of roles for cyclin D1 and p16 in the development of PA and for cyclin D1 in the progression of PA to CXPA.     

DNA copy number changes in carcinoma in pleomorphic adenoma of the salivary gland: a comparative genomic hybridization study

Pleomorphic adenoma is the most common benign tumor of the salivary glands and is rarely associated with concurrent epithelial malignancy, which is designated as carcinoma in pleomorphic adenoma (CPA). Genetic abnormalities potentially related to the development of CPA have not been fully investigated. We analyzed DNA copy number changes in each of the adenomatous and carcinomatous components of seven CPA by comparative genomic hybridization using DNA extracted from microdissected tissues of formalin-fixed, paraffin-embedded tumor samples. Carcinomatous components of CPA showed multiple DNA copy number changes at 1-18 different genomic sites (mean 13 sites). Adenomatous components displayed less frequent DNA copy number changes (0-13 sites; mean, 5). In both components, the majority of the changes were gains. The most common recurrent gains in carcinomatous components were seen at 6q (four cases in each), whereas gains at 13q1-2 and 15q1 were most frequently detected in adenomatous components (three cases in each). In five CPA, the same chromosomal regions were involved in the DNA copy number changes detected in both components. Our data suggest that an accumulated or increased number of chromosomal changes including 6q abnormalities may be associated with the development of carcinomatous components in a subset of CPA.     

Cytological features of carcinoma ex pleomorphic adenoma of the salivary glands: A diagnostic challenge

Carcinoma ex pleomorphic adenoma (CXPA) of the salivary glands is a relatively rare carcinoma. The detection rate of the carcinoma component in the cytological specimens is not high and may be challenging in cytological examination. The purpose of the present study was to analyze the cytological specimens of CXPA with emphasis on the detection of the carcinoma component. We reviewed the cytological characteristics of patients histopathologically diagnosed with CXPA who underwent preoperative cytological examination. Of the 10 patients enrolled in the study, 8 had tumors located in the parotid gland, and 2 in the submandibular gland. A review of the cytological specimens revealed the presence of the carcinoma component in all 10 cases and the pleomorphic adenoma (PA) component in 6 cases, although initial cytodiagnosis detected the carcinoma component in 8 cases. The cytological feature of this component was the presence of variable‐sized clusters of polygonal cells with relatively rich cytoplasm and large round to oval nuclei in a necrotic background. Interestingly, carcinoma cells mixed with the PA component were also present. On histopathological analysis, 7 cases were intracapsular, and the remaining 3 cases were widely invasive CXPA. Further, 9 cases had salivary duct carcinoma as carcinoma component. In conclusion, these findings show that careful detection of the carcinoma cells, particularly within the PA component, is crucial for early detection of CXPA, and the presence of necrosis might help with the detection of the carcinoma component.     

Carcinoma ex pleomorphic adenoma with special reference to the prognostic significance of histological progression: a clinicopathological investigation of 41 cases

Weiler C, Zengel P, van der Wal J E, Guntinas‐Lichius O, Schwarz S, Harrison J D, Kirchner T & Ihrler S
(2011) Histopathology 59 , 741–750 Carcinoma ex pleomorphic adenoma with special reference to the prognostic significance of histological progression: a clinicopathological investigation of 41 cases Aims: To investigate a large series of cases of carcinoma ex pleomorphic adenoma (CEPA) to determine prognostic factors. Methods and results: Thirty cases of CEPA associated with primary pleomorphic adenoma (PA) and 11 cases of CEPA associated with recurrent PA were investigated. The median follow‐up was 57.7 months, and ranged from 4 to 156 months. Purely intraductal carcinoma was found in 15 cases. Intraductal and extraductal intracapsular carcinoma together was found in one case. Extracapsular carcinoma was found in 25 cases. Prognosis was good for CEPA that was purely intraductal, extraductal intracapsular, or up to 5 mm extracapsular, and poor for CEPA that was 8 mm or more extracapsular. There were relatively more cases of CEPA with extracapsular invasion of 8 mm or more from recurrent PA than from primary PA, and the prognosis for CEPA associated with recurrent PA was worse than that for CEPA associated with primary PA. Conclusions: The threshold for distinguishing minor extracapsular invasion with good prognosis from wide extracapsular invasion with poor prognosis is 5 mm. The worse prognosis for CEPA associated with recurrent PA indicates the necessity for close surveillance of patients with recurrent PA.     

Combined salivary duct carcinoma and squamous cell carcinoma suspected of carcinoma ex pleomorphic adenoma

A 76‐year‐old Japanese woman had noticed an asymptomatic and palpable mass in her left parotid gland region for 20 years. The tumor had showed rapid growth during the last two months. Therefore, the tumor was clinically suspected of being a malignant tumor and was surgically resected. A histopathological examination revealed that the tumor consisted of two different histopathological neoplastic components accompanied by hyalinized fibrosis at the center of the tumor. The two‐neoplastic components were squamous cell carcinoma and salivary duct carcinoma. The tumor was suspected to be a carcinoma ex pleomorphic adenoma after considering the clinical course and the histopathological findings, such as hyalinized fibrosis at the center of the tumor. There was no evidence of recurrence at 30 months after the surgical resection.     

Carcinoma ex pleomorphic adenoma

Carcinoma ex pleomorphic adenoma is an epithelial malignant neoplasm arising from a primary or recurrent pleomorphic adenoma and is a diagnostic challenge for cytopathologists. Diagnosis requires that elements from the benign pleomorphic adenoma and the malignant component need to be seen. We report a case of carcinoma ex pleomorphic adenoma in a patient presenting with left facial nerve palsy and a painless left parotid lump. Ultrasound imaging revealed a suspicious parotid mass and FNA cytology showed background benign myoepithelial and ductal cells, chondro-myxoid stroma, and overtly malignant epithelial and myoepithelial cells; features consistent with carcinoma ex pleomorphic adenoma. A radical parotidectomy was performed and histology confirmed the diagnosis of invasive salivary duct carcinoma ex pleomorphic adenoma. Early diagnosis of carcinoma ex pleomorphic adenoma is important and cytology plays a key role; however, findings should be correlated with radiology and clinical history and the potential limitations of cytology should be appreciated.     

Ultrastructural analysis of salivary gland pleomorphic adenoma, with particular reference to myoepithelial cells

Previous ultrastructural studies of pleomorphic adenoma have presented conflicting results with regard to the role of myoepithelial cells in the histogenesis of this tumour. In the present study specimens of ten major salivary gland pleomorphic adenomas were examined ultrastructurally and a number of cell types identified. The material was subjected to quantification using the stereological method of point counting. The results showed a wide spectrum of differentiation within these tumours in which typical myoepithelial cells were rarely encountered even in situations where they are reported to occur in routine histological preparations. Cells with some myoepithelial features were more numerous but duct cells accounted for the majority of tumour cells. The ultrastructural findings correlated well with previously reported immunocytochemical data and further support certain ideas about salivary gland tumour histogenesis.     

Carcinoma ex pleomorphic adenoma: A diagnostic challenge on cytology

Carcinoma ex pleomorphic adenoma (Ca ex PA) is a malignant neoplasm arising from primary or recurrent benign pleomorphic adenoma. It is rare with an annual incidence rate of 0.17 tumors per million. Histopathology remains the gold standard for the diagnosis of Ca ex PA, with only a handful of cases reported on cytology. In our case a 66‐year‐old male presented with the right parotid mass for 5 years rapidly increasing for the last 3 months. Fine needle aspiration cytology (FNAC) smears showed malignant tumor cells in clusters along with benign myoepithelial cells in chondromyxoid background. Histopathologically, highly pleomorphic malignant epithelial cells in sheets along with foci of comedonecrosis and areas corresponding to benign pleomorphic adenoma were observed on careful scrutiny. Immunohistochemistry revealed positivity for cytokeratin (CK 7) and gross cystic disease fluid protein 15 (GCDFP‐15) while CK5/6 and high molecular weight CK (34 βE12) were negative in the malignant tumor cells. So, the final impression was Ca ex PA with salivary duct carcinoma as malignant component. We hereby report this case to highlight the significance of FNAC in the diagnosis of Ca ex PA which can be easily missed on cytopathology. However, it is important to corroborate the cytological findings with clinical suspicion of malignancy as well as radiology. Diagn. Cytopathol. 2017;45:651–654. © 2017 Wiley Periodicals, Inc.