舌腺样囊性癌1例

腺样囊性癌是一种多来源于大、小涎腺或上呼吸道黏液腺的低度恶性肿瘤,有较强的侵袭性,常沿神经生长并侵犯神经,发生于头颈部的较为少见,发生于舌部者更是少见。本文报道1例发生于舌根部的腺样囊性癌,并结合文献对其病理临床特征以及诊断、治疗进行探讨。     

涎腺腺样囊性癌嗜神经侵袭分子机制的研究进展

涎腺腺样囊性癌是发生于涎腺的一种非常常见的恶性肿瘤,其重要特质是嗜神经侵袭,这一特质是其在临床手术中很难被彻底切除的重要原因之一;部分肿瘤细胞的残留易导致肿瘤术后复发,成为临床治疗的一大难题。因此,深入探讨涎腺腺样囊性癌嗜神经侵袭这一特性的分子机制对克服这一难题具有重要意义,本文就涎腺腺样囊性癌嗜神经侵袭分子机制的研究进展作一综述。     

雪旺细胞标志物S100蛋白在涎腺腺样囊性癌嗜神经侵袭中的意义

目的：对比研究雪旺细胞标志物S100蛋白在腺样囊性癌及粘液表皮样癌中的表达，探讨其与腺样囊性癌嗜神经侵袭间的关系。方法：选取20例腺样囊性癌和18例粘液表皮样癌标本，分别进行S100免疫组化染色。结果：腺样囊性癌嗜神经侵袭的能力明显高于粘液表皮样癌，两者有显著性差异。S100在绝大多数腺样囊性癌中均有表达，而在粘液表皮样癌中则没有表达。两者有显著性差异。结论：腺样囊性癌细胞发生了雪旺细胞分化进而侵袭神经可能是腺样囊性癌嗜神经侵袭的组织学基础。     

髓磷脂碱性蛋白在涎腺腺样囊性癌中的表达

目的:利用免疫组化方法研究雪旺氏细胞标记物髓磷脂碱性蛋白(MBP)在腺样囊性癌中的表达,探讨腺样囊性癌中肌上皮细胞向雪旺氏细胞分化与腺样囊性癌嗜神经侵袭之间的关系。方法:对17例腺样囊性癌标本进行MBP免疫组化染色,利用双重免疫荧光染色及激光共聚焦显微镜技术检测MBP和肌上皮标记物MA在腺样囊性癌中的共表达。结果:17例腺样囊性癌中有6例MBP免疫组化染色呈阳性反应,双重免疫荧光染色发现MBP与MA在同一腺样囊性癌细胞的胞浆中表达。结论:腺样囊性癌中的肌上皮细胞发生了雪旺氏分化,推测这种分化与腺样囊性癌嗜神经侵袭密切相关。     

Dermo-1在涎腺腺样囊性癌中的表达及其临床意义

目的探讨转录因子Dermo-1在涎腺腺样囊性癌中的表达水平及其与各临床病理因素的关系。方法采用免疫组化方法检测40例涎腺腺样囊性癌组织中Dermo-1蛋白的表达情况,分析Dermo-1表达与腺样囊性癌临床病理因素的关系,以20例正常涎腺组织作对照。结果 Dermo-1在涎腺腺样囊性癌组织中的表达水平明显高于正常涎腺组织（P〈0.05）。Dermo-1表达与腺样囊性癌的病理分型、嗜神经侵袭、术后复发及远位转移有关（P〈0.05）。结论 Dermo-1蛋白表达可能与涎腺腺样囊性癌的分化调节、嗜神经侵袭及远位转移有关系,检测Dermo-1的表达水平对判断腺样囊性癌患者的预后有一定的参考价值。     

头颈部腺样囊性癌的研究进展

涎腺腺样囊性癌是头颈部较少见的恶性肿瘤,但却是涎腺最常见的恶性肿瘤之一,具有局部侵袭性生长,早期易沿神经扩散,且容易侵入血管,造成血行性转移的独特的生物学特性。鉴于涎腺腺样囊性癌的独特生物学特性,本文对其流行病学、临床表现、病理学、诊断检查及治疗和预后研究进展作一综述,以期为该病的诊断和治疗有所帮助。     

腺样囊性癌嗜神经侵袭体外模型的建立

目的：期望建立一种腺样囊性癌嗜神经侵袭的体外研究模型。方法：通过将腺样囊性癌细胞系ACC—M与小鼠背根神经节在基质胶中进行共培养,采用倒置相差显微镜和荧光双染动态观察肿瘤细胞与神经轴突的相互作用过程。结果：通过对腺样囊性癌嗜神经侵袭的体外模型的观察,发现嗜神经侵袭过程的发生是肿瘤细胞与神经之间特异性的相互作用。结论：本研究的腺样囊性癌一背根神经节共培养能够模拟癌细胞嗜神经侵袭的发生过程,对于研究腺样囊性癌嗜神经侵袭的分子机制具有重要价值。     

中期因子在涎腺腺样囊性癌组织中的表达及意义

目的探讨中期因子(midkine,MK)在涎腺腺样囊性癌组织中的表达及其与发生嗜神经侵袭的关系。方法采用免疫组织化学SP法检测35例涎腺腺样囊性癌组织和20例正常涎腺组织中MK蛋白的表达情况,并分析其与嗜神经侵袭的关系。结果 MK在涎腺腺样囊性癌组织中高表达,阳性表达率为82.9%(29/35),在正常涎腺组织中低表达,阳性表达率为10.0%(2/20),二者间差异有统计学意义(P<0.01);MK的表达与患者的年龄、性别以及病理分型无关(P>0.05);与肿瘤是否发生嗜神经侵袭有关(P<0.05)。结论 MK蛋白可能参与涎腺腺样囊性癌的发生,其表达水平的升高可能与涎腺腺样囊性癌发生嗜神经侵袭有关。     

腭部腺样囊性癌的放射治疗

腺样囊性癌在腭部肿瘤中最为常见,由于它具有沿神经血管播散以及直接浸润生长的特性,临床上多采用手术切除或手术与放射联合治疗。本文回顾分析16例腭部腺样囊性癌的治疗经验,旨在确定放射治疗在处理此类患者中的价值。     

趋化因子受体5在唾液腺腺样囊性癌中的表达及意义

目的探讨趋化因子受体5(CCR5)在唾液腺腺样囊性癌的表达及其与临床病理分型和嗜神经性的关系。方法运用免疫组织化学的方法(SP法)检测CCR5在人唾液腺腺样囊性癌标本及正常唾液腺标本中的表达。结果 CCR5在唾液腺腺样囊性癌标本中的阳性表达率为93.8%(30/32),与在正常唾液腺组织的表达有显著性差异(P<0.05)。CCR5在唾液腺腺样囊性癌不同的临床病理分型中的表达差异无统计学意义(P>0.05)。在30例阳性表达的腺样囊性癌标本中,可见嗜神经现象组与未见嗜神经现象组中CCR5的表达有统计学差异(P<0.05)。结论 CCR5可能与唾液腺腺样囊性癌的发生相关,其表达水平与腺样囊性癌的临床病理类型无相关性,与侵袭神经有相关性。     

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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。     

2489例涎腺上皮性肿瘤临床病理分析

目的:了解涎腺上皮性肿瘤的临床病理特点。方法:对2489例涎腺上皮性肿瘤临床病理资料进行统计分析。结果:涎腺恶性上皮性肿瘤840例,腺样囊性癌、黏液表皮样癌、癌在多形性腺瘤中居其前3位;涎腺良性上皮性肿瘤1649例,多形性腺瘤、Warthin瘤、基底细胞腺瘤居其前3位。涎腺恶性、良性上皮性肿瘤男女之比为1.13∶1和0.99∶1;平均发病年龄47.86岁和44.86岁;腮腺和腭部为好发部位。结论:腺样囊性癌和多形性腺瘤是最常见的涎腺恶性、良性上皮性肿瘤。     

Unusual localization of an adenoid cystic carcinoma subsequent to superficial parotidectomy for a benign lesion

Adenoid cystic carcinoma of the parotid gland is relatively rare. According to a retrospective study of the medical records and histopathology files of 514 cases of parotid tumors operated at our hospital over a period of 18 years, adenoid cystic carcinoma represented only 2.3% of all parotid gland neoplasms, a total of 12 cases. In our records we retrieved only one documented case of adenoid cystic carcinoma that originated in the parotid gland subsequent to superficial parotidectomy for a benign lesion (pleomorphic adenoma).An even more exceptional presentation of adenoid cystic carcinoma is as a bilobed tumor extending from the post auricular to the temporal and zygomatic region. The management of this case is presented along with a brief review of the literature concerning the evaluation and management of this rare entity.     

Adenoid cystic carcinoma of the parotid gland

Adenoid cystic carcinoma (ACC) of salivary glands is a slow-growing malignant tumor, characterized by wide local infiltration, perineural spread, a propensity to local recurrence and late distant metastasis. Although ACC is the second most common malignant salivary gland neoplasm and constitutes approximately one-third of all salivary gland malignancies, it is relatively rare in parotid gland. Here, we present a case report of a cribriform type of ACC involving parotid salivary gland in a 66-year-old female.     

Survival and prognosis for cancer of the submandibular gland.

PURPOSE: We sought to determine survival and factors affecting survival for patients with cancer of the submandibular gland. METHODS: All cases of surgically treated cancer of the submandibular gland were extracted from the Surveillance, Epidemiology and End Results database for the time period 1988 to 1998. After tabulation of demographic, tumor-specific, and survival data, Kaplan-Meier survival analysis was conducted according to histopathologic results. Cox regression analysis stratified for histopathology was conducted to determine factors that influenced survival. RESULTS: A total of 370 cases of submandibular gland cancer were analyzed. Adenoid cystic carcinoma accounted for 42.2% of cases followed by mucoepidermoid carcinoma (22.2%). Overall mean, median, and 5-year survival times and rate were 82 months, 97 months, and 59.7% for the entire cohort, respectively. Adenoid cystic carcinoma exhibited the best mean survival (99 months), whereas squamous cell carcinoma exhibited the poorest mean survival (52 months). Younger age, decreased tumor grade, and radiation therapy were found to improve survival (P <.001,.005, and.015, respectively). Gender, tumor size, extraglandular extension, and nodal positivity did not statistically influence survival. CONCLUSIONS: Significantly different survival can be expected depending on individual tumor histopathology in submandibular gland cancer. Tumor grade and radiation therapy have important effects on prognosis.     

An unusual case of adenoid cystic carcinoma with hard palate perforation

Adenoid cystic carcinoma is a malignant tumor which occurs frequently in hard palate associated with minor salivary glands. The lesion generally presents as a painful slow growing mass and it is characterized by recurrences and distant metastasis resulting in a poor prognosis for the patient. This paper reports an atypical adenoid cystic carcinoma with palatal perforation which occurred in a young woman. Initial diagnostic hypothesis were necrotizing sialometaplasia and lues. Although adenoid cystic carcinoma is common in hard palate, cases with palatal perforation are uncommon and may lead to delay in diagnosis and therapy.     

The treatment of sublingual gland tumours

This study assessed the clinical and histological features and therapeutic efficacy of 25 cases of sublingual gland tumours from 1998 to 2008. There were 17 female patients and 8 male, the ratio of females to males was 2.1:1. The mean age was 48.6 years. 4 cases were benign tumours (16%). 21 cases were malignant sublingual gland tumours (84%) and of these, 18 were adenoid cystic carcinoma (86%). Adenoid cystic carcinoma was mainly of the histological type, and the other histological classifications included mucoepidermoid carcinoma, pleomorphic adenoma, myoepithelioma, oncocytoma and polymorphous low-grade adenocarcinoma. Sublingual gland tumours are rare and most are malignant. For malignant sublingual gland tumours, early diagnosis and aggressive surgical treatment, especially for tumours with nerve involvement, is the key to improving prognosis. Free radial forearm flap or pectoralis major myocutaneous flap are appropriate methods for mouth floor reconstruction. For benign sublingual gland tumours, the resection of tumour and sublingual gland is the preferred treatment.     

Sublingual gland neoplasms: clinicopathological study of 8 cases

Background Sublingual gland neoplasms are very rare and the majority of them are malignant. The aim of this study was to evaluate the clinical course, treatment, and outcomes of these uncommon neoplasms based on the authors’ experience and the recent literature.Material and Methods The medical charts of 8 patients with primary epithelial sublingual gland tumors treated between 1994 and 2020 were reviewed.Results Malignant tumors comprised 75% (6/8) of cases. Adenoid cystic carcinoma was the most common (50%, 3/6) and characterized by high risk of local recurrence and lung metastasis. Pleomorphic adenoma was the only representative of benign tumors with no evidence of local recurrence in follow up.Conclusions Treatment of choice of sublingual gland tumors is surgery. However, due to the fact that adenoid cystic carcinoma is the most common malignancy with poor prognosis, surgical treatment should be combined with postoperative radiotherapy. Benign sublingual tumors are less common and treatment of choice in these cases is tumor resection together with sublingual gland. Key words:Salivary gland neoplasms, sublingual gland, pleomorphic adenoma, adenoid cystic carcinoma, mucoepidermoid carcinoma.