唾液腺多形性腺瘤恶变108例临床病理分析

目的:研究唾液腺多形性腺瘤恶变的临床病理特点。方法:回顾分析上海交通大学医学院附属第九人民医院口腔颌面外科1993年1月至2005年5月间唾液腺多形性腺瘤恶变病例的病理与临床资料。结果:108例唾液腺多形性腺瘤恶变病例,男68例,女40例,男女比为1.7∶1;年龄28～92岁,60～70岁最好发(29例),其次为50～60岁(22例)、70～80岁(20例)和40～50岁(19例)。发生于腮腺者68例,腭部20例,下颌下腺15例,其他部位包括唇、咽旁小唾液腺等。恶变成分主要为腺癌(26例),其次为肌上皮癌(19例),黏液表皮样癌(6例,包括低、中、高度恶性),腺样囊性癌(4例),其他有腺鳞癌、上皮-肌上皮癌、腺泡细胞癌、唾液腺导管癌、鳞癌等。5例发生颈部淋巴结转移,约占4.6%,其原发灶的恶变成分主要为腺癌。结论:唾液腺多形性腺瘤恶变多见于中老年男性,好发于腮腺,其次为下颌下腺和腭部,恶变成分多为腺癌和肌上皮癌;发生颈淋巴结转移者,恶变成分多为腺癌。     

唾液腺腺样囊性癌474例临床病理分析

目的：分析474例唾液腺腺样囊性癌(adenoid cystic carcinoma, ACC)的临床病理特征。方法：回顾分析上海交通大学医学院附属第九人民医院口腔病理科诊断为原发性ACC的474例临床病理资料。采用SPSS18.0软件包对数据进行统计学处理。结果：474例ACC中,男女之比为1.03∶1(240∶234);发病年龄11~83岁,平均年龄52岁;腮腺和腭部分别是大小唾液腺中最常见的部位;病程1个月~37 a不等,平均21个月;64%的患者出现不同程度的症状;72%的患者就诊时TNM分期为Ⅱ期和Ⅲ期;组织学上,76%的患者表现为筛状/管状型。组织学类型为实体型者较筛状/管状型者更易发生颈淋巴结转移(P=0.016)。结论：ACC多见于中老年人,腮腺和腭部最常见。临床上多伴有不同程度的症状,组织学表现以筛状/管状型多见,实体型者更易发生颈淋巴结转移。     

EphA2在涎腺肿瘤中的表达及其临床意义

目的检测EphA2在涎腺肿瘤中的表达，并分析其临床病理意义。方法免疫组化S-P法检测10例正常涎腺组织、30例多形性腺瘤、30例黏液表皮样癌（MEC）、30例腺样囊性癌（ACC）中EphA2的表达。分析EphA2表达与患者的年龄、性别、肿瘤部位、大小、TNM分期以及复发、淋巴结转移等临床病理因素的关系。比较EphA2在正常涎腺组织及几种常见的涎腺良、恶性肿瘤中的表达差异。结果EphA2在正常涎腺组织中主要表达于腺管上皮，而腺泡细胞几乎不表达。EphA2在正常涎腺组织、多形性腺瘤、涎腺癌（包括黏液表皮样癌和腺样囊性癌2组）中的表达依次增高，存在显著性差异（P〈0．05）。EphA2的表达与涎腺癌瘤体大小、TNM分期、复发和淋巴结转移有关（P〈0．05）。结论EphA2可能影响涎腺肿瘤发生、发展及其预后。     

单侧腮腺及颌下腺不同病理类型肿瘤1例

本文报道1例单侧涎腺不同病理类型肿瘤。患者女性,术后病检结果示左侧腮腺腺样囊性癌和左侧颌下腺多形性腺瘤。并结合文献报道,对涎腺多发性原发性肿瘤的分类、临床组织病理学特征、诊断及机制等进行讨论。     

多形性腺瘤基因1与唾液腺肿瘤

近年来学者发现,多形性腺瘤基因1的激活和表达与多形性腺瘤及其他唾液液肿瘤的发生密切相关。多形性腺瘤基因1具有转录因子活性,通过对下游靶基因的表达调控而发挥生物学功能。对多形性腺瘤基因1及其相关基因的功能以及其在多形性腺瘤发病机制中的作用研究,在口腔颌面肿瘤领域具普遍指导意义。     

口腔小唾液腺肿瘤213例回顾分析

口腔小唾液腺肿瘤（MSGTs）根据其组织形态学差异可分为多种类型，该文旨在研究MSGTs的发病率及其临床特征与组织病理学特点之间的关系。作者回顾性研究了213例MSGTs患者，所有病例均行复片证实，部分行特殊染色和免疫组化染色，并对肿瘤的临床特征进行描述。结果：119例（56％）为良性肿瘤，94例（44％）为恶性；良性肿瘤中多形性腺瘤最为常见（93／119），其次为管状腺瘤（25／119）；94例恶性肿瘤中，黏液表皮样癌45例（均为低度恶性），     

唾液腺黏液表皮样癌术后生存资料分析

目的观察唾液腺黏液表皮样癌（MEC）术后生存率及不同临床分期患者的生存率，并确定影响术后生存的主要临床病理因素。方法对119例MEC按照临床流行病学关于预后研究的方法进行数据收集，乘积．极限法计算术后各时点的观察生存率，时序检验各临床病理因素对术后观察生存率的影响。结果119例唾液MEC患者术后总体的5、10、15年生存率分别为192．53％、87．52％、85．39％。年龄≥40岁、TNMm、Ⅳ期、低分化患者术后生存率分别显著低于年龄〈40岁、TNMI、Ⅱ期、高分化患者（P〈0．05），大唾液腺MEC男性患者术后生存率明显低于女性（P=0．008）。分化程度、TNM分期及术前症状是进入Cox比例风险回归模型的3个对术后生存率有显著影响的主要因素。结论高分化型唾液腺MEC属于预后相对较好的恶性肿瘤，分化程度、TNM分期是影响患者预后的重要临床病理因素。     

唾液腺腺样囊性癌p53基因突变及其与临床病理的关系

目的:研究唾液腺腺样囊性癌(ACC)p53基因突变及其与临床病理因素的关系。方法:选择38例唾液腺ACC病理标本,采用聚合酶链式反应单链构象多态性分析(PCR-SSCP)进行p53基因突变(5-8外显子)的检测;应用SPSS10.0统计学分析软件,采用Kaplan-Meier法进行生存分析,并绘制生存曲线。p53基因突变与ACC各病理类型、局部复发率、远处转移率及临床分期的关系采用Fisher精确检验。结果:p53基因5-8外显子突变检出率为65.8%,p53基因突变与唾液腺ACC的肿瘤复发、远处转移及术后生存有关(P<0.05),与肿瘤病理类型、临床分期无关(P>0.05)。结论:p53基因突变在唾液腺ACC中有较高的检出率,并可能与患者的预后有关。     

38例多形性腺瘤临床病理分析

<正>多形性腺瘤（Plemorphic　adenoma）又称混合瘤 Mixed　tu-mor,是最常见的涎腺肿瘤,我们对38例多形性腺瘤进行病理形态学观察,对其进行分类研究,提高肿瘤的诊断正确率。结果报告如下。1 材料和方法 本文收集了本院1987-1999年间手术标本,病理诊断多形性腺瘤的38例。标本均用10％甲醛固定,石蜡包埋、切片、苏木精-伊红（HE）染色,用光学显微镜观察。     

多形性腺瘤基因1与唾液腺肿瘤

近年来学者发现，多形性腺瘤基因1的激活和表达与多形性腺瘤及其他唾液腺肿瘤的发生密切相关。多形性腺瘤基因1具有转录因子活性，通过对下游靶基因的表达调控而发挥生物学功能。对多形性腺瘤基因1及其相关基因的功能以及其在多形性腺瘤发病机制中的作用研究，在口腔颌面肿瘤领域具普遍指导意义。     

Primary epithelial salivary gland tumours in children and adolescents

Primary epithelial tumours of the salivary glands are very rare in paediatric patients. 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. The medical charts of 12 female patients and seven male patients with primary epithelial salivary gland tumours were reviewed. All were under 19 years of age and underwent surgical treatment between 1994 and 2016. The results of this group of paediatric patients were compared with those of 621 adult patients. The two most common tumours in the paediatric patients were pleomorphic adenoma and mucoepidermoid carcinoma (89.4%; P = 0.004). The incidence of facial nerve palsy following surgery of the parotid tumours was similar in the two groups (P = 1.000). The most common primary cancer in the paediatric group was mucoepidermoid carcinoma (77.8%), while in the adult group, adenoid cystic carcinoma was most common (P < 0.001). The paediatric group had only low-grade cancers in early stages (P < 0.001), with an overall 5-year survival rate of 100%. These results show that the incidence of malignant salivary gland tumours is higher in paediatric patients than in adult patients. This should be taken into account during diagnosis and therapy.     

涎腺粘液表皮样癌诊断与治疗

目的：探讨涎腺黏液表皮样癌的诊断、治疗及疗效。方法：收集2001～2008年收治的20例涎腺黏液表皮样癌病例资料进行回顾分析。结果：20例黏液表皮样癌中腮腺13例（65%）,副腮腺1例（5%）,腭部2例（10%）,颌骨2例（10%）,颌下腺1例（5%）,颊黏膜1例（5%）。其中11例为高分化,4例为中分化,1例为低分化,其余未分级。20例患者均行手术切除（切除范围视肿瘤部位及分级而定）,其中4例行同侧颈部选择性淋巴清扫术,17例行术后放疗。3例因面神经受累同时切除面神经,其中1例行面神经吻合术,1例行耳大神经移植术,手术半年后患者面神经功能恢复良好。随访1～5年,失访2例,平均随访时间2.44年。获随访的18例均无复发。结论：手术切除时应重视原发灶切除的彻底性,在疑有颈部淋巴结转移时应同期进行选择性颈部淋巴清扫术;对于术中切除不彻底,有颈部淋巴结转移,病理结果显示为中低分化病例应进行术后放疗。     

Precancerous foci in pleomorphic adenoma of the salivary gland: recognition of focal carcinoma and atypical tumor cells by P53 immunohistochemistry

BACKGROUND: It is still controversial if atypical tumor cells scattered in salivary pleomorphic adenomas are precancerous and how carcinoma arises in pleomorphic adenomas. METHODS: We studied clinicopathologically the frequency and variation of cellular atypia among tumor cells and examined the expression status of p53 gene products as well as proliferating cell nuclear antigen (PCNA) in 101 surgical materials of pleomorphic adenomas. RESULTS: Histopathologically, atypical tumor cells were found in 51% of the cases examined. Their mode of distribution was classified into three groups: focal (six cases, 6%) which could be identified as focal carcinoma, measuring less than 1 mm in diameter; sporadic (15 cases, 15%) and singular (30 cases, 30%). These atypical cells were located mainly within sheet-like nests of tumor cells but not in chondroid or fibro-hyaline foci. Immunohistochemically, most of the atypical cells were positive for p53 gene products and PCNA. CONCLUSION: The results indicated that atypical cells with p53 protein accumulation in their nuclei could be regarded as cells in a precancerous state not yet forming an apparent carcinomatous nest. Some cell population with these atypical cells are likely to form focal carcinomas and then to an apparent form of carcinoma in pleomorphic adenoma.     

Warthin样黏液表皮样癌、Warthin瘤合并黏液表皮样癌及伴黏液化生3例

Warthin样黏液表皮样癌是一种新近发现的涎腺黏液表皮样癌亚型,形态类似于Warthin瘤,但具有与黏液表皮样癌相似的t(11;19)(q21;p13)染色体易位.因此鉴别诊断非常重要.Warthin瘤合并黏液表皮样癌极为罕见.本文报告了1例Warthin样黏液表皮样癌、1例Warthin瘤合并黏液表皮样癌、1例Wa...     

DNA ploidy analysis in salivary gland tumours by image cytometry

AIM: To determine whether DNA ploidy by image cytometry is a good diagnostic tool to distinguish benign and malignant salivary gland tumours. METHODS: A total of 62 salivary gland tumours were studied. Cases were histologically diagnosed [haematoxylin and eosin (H&E)]. According to the World Health Organization (WHO) classification, there were 14 mucoepidermoid carcinomas (MEC), 11 adenoid cystic carcinomas (ACC), 10 pleomorphic adenomas (PA), 10 carcinoma ex PA (CEPA), 9 acinic cell carcinomas (ACCa), 3 polymorphous low-grade adenocarcinomas (PLGA), 2 papillary cystadenocarcinomas (PC), 1 myoepithelial carcinoma (MC), 1 undifferentiated carcinoma (UC) and 1 mucinous adenocarcinoma (MA). Paraffin sections (40 microm) were micro-dissected to isolate tumour areas; cell nuclei were extracted and Feulgen-stained cytospin monolayers were analysed using a DNA image cytometry system. For each case, DNA index (DI) was calculated relative to internal controls (lymphocytes; DI=1.0). Cases were categorized as diploid or aneuploid and the proportion of cells over 5c was also calculated. RESULTS: Fifty-three of 62 salivary gland tumours were uniformly diploid. Only nine cases were aneuploid: five CEPA, one low-grade MEC, one PC, one UC and one MA. CONCLUSIONS: The vast majority of salivary gland tumours were diploid. High-grade malignancies may be aneuploid, and ploidy may be useful to identify malignant change in atypical PA. Further, larger studies are needed to confirm our results and to further evaluate the usefulness of the technique in high-grade lesions.     

Pleomorphic adenoma of the buccal salivary gland: magnetic resonance imaging findings with differential diagnoses

The majority of minor salivary gland tumors are malignant. Of the benign tumors, pleomorphic adenomas are most common. The cheeks, lips, and gingiva are rarely sites of occurrence. A case of pleomorphic adenoma of the buccal salivary gland is presented here with a discussion of the importance of magnetic resonance imaging in demonstrating the extent of the lesion and establishing a differential diagnoses.     

63例涎腺腺样囊性癌患者预后相关因素的Cox模型分析

目的 探讨影响涎腺腺样囊性癌(adenoid cystic carcinoma,ACC)患者术后生存的相关因素。方法 回顾性分析1988年1月—2005年10月在我院手术治疗并经病理确诊的63例涎腺ACC患者临床资料,对可能影响患者术后生存的指标进行Kaplan-Meier检验后,采用Cox比例风险回归模型进行多因素分析。结果 63例涎腺ACC患者术后3、5、10年的总生存率分别为77.64%、68.31%、39.26%,无瘤生存率分别为65.73%、57.17%、38.92%。Cox比例风险回归模型多因素分析结果显示:TNM分期、病理类型、神经侵犯、手术方式、放/化疗、局部复发及远处转移是影响患者术后生存的重要因素。结论 高TNM分期、实性病理类型、神经周围侵犯、有局部复发及远处转移等是涎腺ACC患者术后生存的危险因素,能缩短术后生存时间;手术加放/化疗是保护因素。?