涎腺粘液表皮样癌术后转移的临床与病理研究

目的:分析涎腺粘液表皮样癌患者术后发生转移的相关临床病理因素。方法:对第四军医大学口腔医学 院首次手术治疗5年以上以及不足5年而发生转移的59例涎腺粘液表皮样癌患者进行回顾性研究,对各项临床、 病理指标通过SPSS软件进行单因素及多因素回归分析。结果:本组涎腺粘液表皮样癌术后转移率为23.73％。 单因素分析发现术前是否出现症状、肿瘤大小、临床分期、骨有无侵犯及分化程度均与术后是否发生转移相关。多 因素分析表明,分化程度以及骨有无侵犯是影响涎腺粘液表皮样癌患者术后转移的主要因素。结论:涎腺粘液表 皮样癌分化程度、骨有无侵犯是影响患者术后转移的主要危险因素。     

涎腺粘液表皮样癌的治疗及预后

粘液表皮样癌来源于涎腺导管上皮 ,在涎腺恶性肿瘤中比较多见 ,约占所有涎腺肿瘤的 10 % ,涎腺恶性肿瘤的30 %。病理上可分为高度恶性及低度恶性二类。组织学上以含有粘液细胞、表皮样细胞和中间型细胞为特征 ,有时还可见到透明细胞及嗜酸细胞。高分化者粘液细胞及表皮样细胞较多 ,中间细胞少 ;低分化者主要为表皮样细胞和中间细胞 ,而粘液细胞少。许多文献报道 ,粘液表皮样癌的预后与肿瘤的病理学分型密切相关 ,低分化型粘液表皮样癌侵袭性强 ,转移率高 ,并可发生远处转移[1] 。粘液表皮样癌的治疗目前仍主要以传统的手术、放疗和化疗为主 …     

涎腺粘液表皮样癌中P53基因表达的研究

目的 探讨Ｐ５３基因在涎腺粘液表皮样癌发生中的作用和意义。方法 采用免疫组织化学方法对４０例涎腺粘液表皮样癌中的表达进行观察。结果 低分化粘液表皮样癌过度表达Ｐ５３基因,阳性表达率为４２．１％,高分化粘液表皮样癌不表达Ｐ５３。经统计学分析表明,高、低分化肿瘤之间差异有显著性。结论 高、低分化的粘液表皮样癌发生时在癌基因激活方面存在差异。Ｐ５３基因突变可能在低分化粘液表皮样癌的发生中具有重要意义。Ｐ     

癌细胞形态测量和DNA定量分析对涎腺癌分类诊断的价值

用图象分析技术测量29例涎腺癌细胞核形态参数和DNA含量。综合核形态和DNA测量结果进行多元判别分析，对涎腺癌作出分类、诊断，总符合率为82.8%，其中高分化粘液表皮样癌100%、腺样囊性癌85.7%、腺癌83.3%、中低分化粘液表皮样癌75%、恶性混合瘤和乳头状囊腺癌均为66.7%。认为核形态测量和DNA定量分析可人微言轻涎腺癌病理诊断的重要辅助手术。     

六亚甲基双乙酰胺联合5-FU对涎腺粘液表皮样癌的分化诱导作用

目的研究平面极性分化诱导剂六亚甲基双乙酰胺（ＨＭＢＡ）联合５ＦＵ对涎腺粘液表皮样癌的分化诱导作用。方法采用“５ＦＵ→ＨＭＢＡ”用药方案联合用药。结果ＨＭＢＡ对涎腺粘液表皮样癌有较强的分化诱导作用，当联合用药时ＨＭＢＡ的分化诱导作用被增强，另一方面，ＨＭＢＡ也明显增强了５ＦＵ的抗癌作用，两者显示出协同抗癌作用。结论将５ＦＵ与ＨＭＢＡ合用，对涎腺粘液表皮样癌的治疗可能具有一定应用价值     

涎腺腺样囊性癌的局部复发及远处转移因素分析

目的:探讨影响涎腺腺样囊性癌患者术后局部复发及远处转移相关因素。方法:回顾性分析49例涎腺腺样囊性癌患者的年龄、性别、民族、病变部位、治疗方法、临床分期、病理分型、病理分级、神经及周围组织侵犯、手术切缘等临床资料,通过随访后采用单因素分析,其中有统计学意义的因素再进入分析模型进行多因素的logistics回归分析;探讨各临床病理因素与患者术后复发及远处转移的关系。结果:总复发率为46.9%,远处转移率为30.6%;单因素分析结果显示:病理分型、病理分级、周围组织侵犯、手术切缘是否干净是影响患者术后复发或转移的因素。多因素分析结果显示:年龄、病变部位、病理分型、周围组织侵犯是影响术后复发,手术切缘是影响术后转移的独立因素。结论:病理分型、手术切缘是术后局部复发或转移的独立相关因素,因此对有高危险复发或转移因素的患者尽量做到手术切缘干净并定期追踪随访。     

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％。     

六亚甲基双乙酰胺联合5—FU对涎腺粘液表皮样癌的分化诱导分析

目的 研究平面极性分化诱导剂六亚甲基双乙酰胺（ＨＭＢＡ）联合５－ＦＵ对涎腺粘液表皮样癌的分化诱导作用。方法采用“５－ＦＵ－ＨＭＢＡ”用药方案联合用药。结果 ＨＭＢＡ对涎腺粘液表皮样癌有较强的分化诱导作用，当联合用药时ＨＭＢＡ的分化诱导作用被增强，另一方面，ＨＭＢＡ也明显增强了５－ＦＵ的抗癌作用，两者显示出协同抗癌作用。结论 将５＝ＦＵ与ＨＭＢＡ合用，对涎腺粘液表皮样癌的治疗可能具有一定应用价值。     

影响涎腺粘液表皮样癌术后复发因素的探讨

粘液表皮样癌 (mucoepidermoidcarcinoma ,MEC)是涎腺恶性肿瘤中最常见的一种 ,约占涎腺上皮性肿瘤的 12 % ,恶性肿瘤的 3 0 % [1] 。MEC的治疗以手术切除为主 ,术后生存率较高 ,一些术后复发的患者仍能够带瘤生存多年。本文就影响涎腺粘液表皮样癌患者术后复发的因素做一探讨。1　材料和方法选择作者的二所医院口腔科 1983～ 1998年经手术治疗的MEC初治患者 71例 ,随访其 5年内的复发情况 ,其中男性 3 2例 ,女性 3 9例 ,男女比例 1∶1 2 2 ,年龄 10～ 74岁 ,中位年龄 3 9岁。大涎腺 41例 ,小涎腺 3 0例 ,病程 1月～ 162月 ,平均5 2 75…     

谷胱苷肽S转移酶在涎腺肿瘤中的表达

用免疫组织化学方法对106例涎腺肿瘤中谷胱苷肽S转移酶π(GST-π)的表达进行了研究.GST-π主要表达在高分化粘液表皮样癌中的表皮样细胞,在其它涎腺肿瘤中表达较弱.该结果提示:GST-π可作为高分化粘液表皮样癌的标志,有助于肿瘤分级.本文还对涎腺肿瘤 GST-π表达情况与肿瘤的抗化疗作用的关系进行了讨论.     

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.     

Brandwein病理评分系统与唾液腺黏液表皮样癌预后的关系

目的:探讨Brandwein病理评分系统中各指标与唾液腺黏液表皮样癌(MEC)术后复发和转移的关系,比较不同病理评分系统分级的病理分级与唾液腺MEC患者术后复发和转移的关系。方法:对33例唾液腺MEC患者的临床病理资料进行回顾性研究,应用寿命表法计算术后的复发率和转移率,用Kaplan-Meier方法对影响术后复发和转移的各因素进行分析,采用Cox比例风险回归模型筛选影响术后复发和转移的危险因素。采用Kaplan-Meier方法,对不同病理评分系统分级的患者3、5、10年复发率和转移率进行比较。结果:33例唾液腺MEC患者术后3、5、10年复发率和转移率分别为8.05%、13.07%、56.17%和7.05%、12.07%、34.20%。单因素分析表明,神经侵犯、病理分级B(按Brandwein病理评分系统分级)等10个因素是MEC患者术后复发的重要因素;组织坏死、临床分期等11个因素是MEC患者术后转移的重要因素。多因素分析表明,病理分级B(P=0.027,OR>1)是MEC患者术后复发的主要影响因素,组织坏死(P=0.004,OR>1)是唾液腺MEC患者术后转移的主要影响因素。病理分级A(按AFIP病理评分系统分级)中,高分化MEC患者10年复发率为25.15%;病理分级B中,高分化MEC患者术后10年内无复发患者。病理分级A中,中分化MEC患者中5年转移率为50.35%,10年转移率为100%;病理分级B中,中分化MEC患者5年、10年内无复发患者。结论:唾液腺MEC患者随着时间的延长,其术后复发率和转移率逐渐增加,术后患者应进行长期随访。病理分级B是患者术后复发的独立危险因素,组织坏死是术后转移的独立危险因素。病理分级B可能是比病理分级A客观性更强的分级方法。     

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。     

Paediatric mucoepidermoid carcinoma of the palate

The purpose of this paper is to review our experience with mucoepidermoid carcinoma (MEC), a rare tumour in minor salivary glands, in a small series of paediatric patients. A retrospective analysis of minor salivary gland tumours seen by one surgeon from March 1991 to December 1999 was undertaken. A total of 58 cases were identified and of these, five (9%) occurred in children. There were 23 cases of MEC, four (17%) of which occurred in patients under the age of 18 who presented with T1 or T2N0M0 low- to intermediate-grade MEC of the palate and adjacent structures. These patients form the basis of this study. All patients were treated with wide local excision, obtaining tumour-free margins, and followed for a mean number of 58 months. None of these tumours invaded bone and resection of bone was not performed in any case as the periosteum was intact and the tumours were low to intermediate grade. To date, all patients remain free of disease. One patient who went elsewhere for treatment, was treated with local resection only, and has also experienced no recurrence. Wide local excision is the treatment of choice for low to intermediate grade MEC of the minor salivary glands in paediatric patients.     

Acinic cell carcinoma of the salivary glands. A review of 20 new cases

Twenty patients with acinic cell carcinoma of the salivary glands are presented. Seventeen tumours were located in the parotid and three in minor salivary glands, one being considered intraosseous. According to the growth patterns, they were classified as solid-acinar in 8 patients, microcystic in 5 patients, follicular in 3 patients and papillocystic in 4 patients. 9 cases were considered high grade malignant tumours and among the 11 well-differentiated, 2 suffered dedifferentiation in local recurrences. Local recurrence appeared in 9 cases. Three cases had nodal disease on admission while 5 developed this during the course of the disease. Distant metastasis appeared in 2 cases. Local recurrence and nodal disease correlated with the degree of differentiation and state of the margins in the surgical specimen. We recommend an aggressive surgical approach followed by postoperative radiotherapy for the undifferentiated tumours and extensive ones. For the limited and better differentiated, a more limited excision, such as total parotidectomy preserving the facial nerve is suggested.     

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.     

Combined treatment of adenoid cystic carcinoma of the salivary glands

A retrospective review of the experience of a single surgeon over a 20-year period is presented. Fifteen patients with primary adenoid cystic carcinoma of the major (6) or minor (9) salivary glands underwent combined treatment with wide local excision and radical postoperative radiotherapy. The actuarial survival is 100% at 5 years and 62% at 10 and 15 years. The disease-specific survival is 100% at 5 years and 86% at 10 and 15 years. There were no loco-regional recurrences. Wide local excision and radical postoperative radiotherapy seems to be an effective treatment for adenoid cystic carcinoma of the salivary glands.     

Oncocytic mucoepidermoid carcinoma of parotid gland origin

This article reports 3 cases of oncocytic mucoepidermoid carcinoma of the parotid gland and compares them with 9 cases from the literature with emphasis on clinical behavior, treatment, and recurrence rate. The tumor occurs most often in the middle-aged to elderly, with a decided predilection for the parotid gland. All three oncocytic mucoepidermoid carcinomas from the Armed Forces Institute of Pathology series were low grade with extensive oncocytic change. Treatment modalities consisted of superficial parotidectomy, total parotidectomy, or total parotidectomy. The mean follow-up interval was 5.5 years. Only one case from the literature, a high-grade mucoepidermoid carcinoma, recurred. Results of this study indicate that the parotid gland oncocytic mucoepidermoid carcinoma behaves in a fashion similar to typical mucoepidermoid carcinoma, with prognosis dependent on clinical stage, histopathologic grade, and adequacy of treatment. Recognizing the spectrum of oncocytic differentiation in salivary gland tumors will serve to establish appropriate diagnoses and treatment.     

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。