Metastasis of carcinoma ex pleomorphic adenoma to the brain without previous metastasis to the lungs or bones: a case report

Carcinoma ex pleomorphic adenoma is a rare type of cancer of the salivary gland that involves the malignant transformation of a primary or recurrent pleomorphic adenoma, which often metastasises to the lungs or bones, or both. To the best of our knowledge, however, nobody has reported a distant metastasis of this lesion to the brain without such previous metastasis. We report a case in a 64-year-old man.     

下颌下腺非侵袭性恶性多形性腺瘤1例报告

唾液腺非侵袭性恶性多形性腺瘤(Ca-ex-PA)又称发生在多形性腺瘤中的原位癌,是较少见的病理类型,临床表现与良性多形性腺瘤相似,有条件完整切除肿瘤,复发或转移少见,预后良好.本文报告1例下颌下腺非侵袭性多形性腺瘤的临床病理学特征,认为鉴别非侵袭性Ca-ex-PA和侵袭性Ca-ex-PA对判断预后十分重要,并影响治疗方案的选择,WHO对唾液腺多形性腺瘤恶变的分型在肿瘤的生物学行为和预后方面具有实际意义.     

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.     

涎腺多形性腺瘤恶变机制的研究进展

涎腺多形性腺瘤是最常见的涎腺上皮性肿瘤,多次复发或病程长者可恶变为恶性多形性腺瘤.涎腺多形性腺瘤的恶变是多因素、多基因变异的综合病变过程.研究发现,细胞遗传学改变、癌基因、抑癌基因、黏附分子及细胞外基质蛋白在涎腺多形性腺瘤的恶变过程中均有一定的作用.本文就多形性腺瘤恶变机制的研究进展作一综述.     

Pleomorphic Adenoma of Minor Salivary Gland in a 14 year Old Child

Salivary gland tumours are rare in childhood, and almost all of them occur in parotid gland. Minor salivary gland tumours are even rarer, pleomorphic adenoma being the most frequently found tumour. Only seventeen cases of pleomorphic adenoma arising in the minor salivary gland tumour have been reported in children and adolescents. Pleomorphic adenoma of minor salivary gland represents about 45% of all the tumours of the minor salivary glands. Pleomorphic adenoma is slowly enlarging tumour indistinguishable from adenoid cystic carcinoma clinically, except for pain and ulceration, which is more common in the latter. Carcinoma arising from pleomorphic adenoma has been reported in 3% cases amongst the minor salivary gland tumours. This report presents a case of pleomorphic adenoma of minor salivary gland in a 14 year old female patient with a brief review of literature.     

Juvenile pleomorphic adenoma of the cheek: Report of a rare case and literature analysis

PurposeThe aim of this paper is to describe a rare case of children with pleomorphic adenoma in buccal minor salivary gland and present a brief review of the previous cases in the literature.MethodsResearch was conducted in the PubMed/MEDLINE/Google Scholar databases. The research was supplemented with a manual search to identify related published articles in dental journals.ResultsArticles published from 1986 onwards, in English language with full texts, were selected. Our search revealed that only 6 cases of children with pleomorphic adenoma in cheek (including pleomorphic adenoma arising from accessory parotid gland) were reported in the last 34 years. This paper also reports a case of pleomorphic adenoma on the cheek in a 10-year-old girl. The mass diagnosed with Ultrasonography was removed by wide local excision and no recurrence has been noted with a follow-up period of 14 months.ConclusionSalivary glands tumors are very rare in the pediatric age group, and rarely in minor salivary glands. Proper examination and assessment with preoperative imaging are necessary for its diagnosis. Pleomorphic adenoma should be included in the differential diagnosis of cheek lesions in young and adult patients. The possibility of late recurrences and malignant transformation should be regarded, thus prolonged follow-up is essential.     

细胞表面糖蛋白表达异常与涎腺多形性腺瘤复发的关系

目的　研究多形上皮粘蛋白1(mucin 1)和E-钙粘蛋白(E-cd)与涎腺多形性腺瘤复发的关系,探讨可预测 涎腺多形性腺瘤复发的指标。方法　以52例涎腺多形性腺瘤石蜡标本为研究对象,其中初发33例,复发12例,恶 性7例。采用显微镜观察肿瘤周围包膜的状况,免疫组织化学检测初发、复发、恶性多形性腺瘤细胞的mucin 1和 E-cd蛋白表达情况。结果　初发和复发多形性腺瘤的包膜状况差异无显著性(P>0·05)。初发多形性腺瘤细胞的 mucin 1蛋白表达阳性率(64%)与复发者(67%)的差异无显著性(P>0·05)。两者的差别表现为mucin 1阳性表达 部位分布不同,初发者主要为细胞顶膜染色(19/21),复发者主要为整个细胞膜染色(6/8),两者差异有显著性(P< 0·05);恶性多形性腺瘤染色部位与复发者相同,且阳性表达率显著升高。3种肿瘤的E-cd表达阳性率差异无显著 性(P>0·05)。结论　多形性腺瘤的包膜状况在预测其复发潜能上实际应用性不强,多形性腺瘤细胞E-cd的表达 改变与其复发潜能无显著关系。Mucin 1在多形性腺瘤细胞膜上的异常分布,使其倾向于向周围分散生长,这种异 常分布可作为预测多形性腺瘤复发的指标之一。     

15例下颌下腺复发性多形性腺瘤临床病理分析

目的：观察下颌下腺复发性多形性腺瘤的临床和组织病理学特征,探讨其病因与治疗。方法：回顾分析2005 年6 月—2017 年6月我院诊治的15 例下颌下腺复发性多形性腺瘤患者的临床和病理资料。结果：15例患者中,男4例（26.67%）,女11例（73.33%）;年龄25~73岁,平均年龄39.33岁;3例（20%）复发2次,其余12例（80%）复发1次,平均复发间期是16.3 a。所有患者均采用肿物及下颌下腺切除术（除2例前次手术已切除下颌下腺者外）,术后病理均证实为复发性多形性腺瘤,多结节生长且大多包膜不完整。随访1~13 a,中位随访时间6 a,仅1例（6.67%）患者可疑复发,因其年龄较大,无手术意愿而未行再次手术治疗。结论：下颌下腺复发性多形性腺瘤尚不多见,其临床病理特征与原发性多形性腺瘤类似,手术是有效的治疗方式。     

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。     

腮腺区复发性多形性腺瘤恶变侵犯颧骨1例报告

腮腺区复发性多形性腺瘤（recurrent pleomorphic adenoma,RPA）存在一定的恶变几率,但检索国内外文献未见侵犯颧骨的报道。本文报告1例腮腺区复发性多形性腺瘤恶变侵犯颧骨病例,并结合相关文献分析其临床、影像及病理特点,以进一步提高对该病的认识,减少误诊误治。     

舌下腺癌在多形性腺瘤中1例

发生于舌下腺的癌在多形性腺瘤中极为罕见。本文报道 1例发生于舌下腺的腺样囊性癌在多形性腺瘤的病例。     

伴有脂肪化生的多形性腺瘤1例

伴有脂肪化生的多形性腺瘤是一种罕见的多形性腺瘤.本文报道1例伴有脂肪化生的多形性腺瘤,该患者为28岁女性,发现左耳前肿物2年余,伴有疼痛.CT及B超检查提示为多形性腺瘤可能.手术治疗后病理结果为伴有脂肪化生的多形性腺瘤,脂肪成分占肿瘤的60％.结合文献,本文讨论了该类疾病的命名,总结了其影像学表现、临床病理特征、鉴别诊...     

Myxolipomatous pleomorphic adenoma: an unusual oral presentation

The first case of a myxoid variant of lipomatous pleomorphic adenoma arising in the intraoral minor salivary gland is presented. A well-encapsulated tumor was composed almost entirely of myxolipomatous tissue with honeycomb-like spindled cellular areas, which contained only a scant glandular element. Immunohistochemistry confirmed the myoepithelial nature of spindle cells intimately admixed with mucoadipose component. We propose the term myxolipomatous pleomorphic adenoma for this peculiar lesion.     

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。     

基质金属蛋白酶在涎腺良、恶性多形性腺瘤中的表达

目的:检测基质金属蛋白酶2(MMP-2)、膜型基质金属蛋白酶1(MT1-MMP)、基质金属蛋白酶组织抑制剂2(TIMP-2)及细胞外基质金属蛋白酶诱导因子(EMMPRIN),在人正常涎腺组织和涎腺良、恶性多形性腺瘤中的表达,探讨其表达的生物学意义。方法:通过免疫组织化学技术SP法检测人66例正常涎腺组织、45例涎腺多形性腺瘤及42例涎腺恶性多形性腺瘤中,MMP-2、MT1-MMP、TIMP-2及EMMPRIN的表达,采用χ2检验比较3种组织中MMP-2、MT1-MMP、TIMP-2及EMMPRIN表达的差异。结果:MMP-2在人正常涎腺组织,涎腺良、恶性多形性腺瘤中的阳性表达率分别为9.09%、46.67%、85.71%;MT1-MMP在以上3种组织中的阳性表达率分别9.09%、53.33%、78.57%;TIMP-2在以上3种组织中的阳性表达率分别为10.61%、44.44%、59.52%;EMMPRIN在以上3种组织中的阳性表达率分别为13.64%、48.89%、83.33%。MMP-2、MT1-MMP、TIMP-2及EMMPRIN在涎腺多形性腺瘤中的表达显著高于人正常涎腺组织,且MMP-2、MT1-MMP及EMMPRIN在涎腺良、恶性多形性腺瘤中表达的差异有统计学意义。结论:在涎腺多形性腺瘤中,MT1-MMP、TIMP-2及EMMPRIN的表达与MMP-2的活化有关,且MMP-2、MT1-MMP、TIMP-2及EMMPRIN有可能作为判断多形性腺瘤侵袭性的有效指标。     

A ciliated cyst as a component of pleomorphic adenoma of the parotid gland

A large cyst, lined with ciliated cells (ciliated cyst), was found as a component of a pleomorphic adenoma of the left parotid gland in a 34-year-old Japanese man. The dimensions of the tumor were 25 × 33 mm and it consisted of a solid mass with a centrally located cyst 20 × 23 mm. which contained yellowish-brown material of muddy consistency. The tumor was encapsulated and the solid mass had features typical of a pleomorphic adenoma. The inner surface of the cyst was lined with ciliated cells and scattered mucus-secreting cells in addition to cuboidal-to-flattened cells. In some regions, the neoplastic cells of the pleomorphic adenoma were exposed to the cavity of the cyst. A histological transformation from ciliated cells to pleomorphic adenomatous cells was also observed. These findings indicated that the ciliated epithelium was an element of the tumor. This is the first report, to our knowledge, of a ciliated cyst derived from some elements of a pleomorphic adenoma of the salivary gland.     

颌下腺转移性多形性腺瘤1例

本文报道1例罕见的转移性多形性腺瘤,患者女性,30岁,左颌下腺及右锁骨上包块术后病检结果与患者8年前左颌下腺肿块切除后病检结果一致,病理形态均表现为良性多形性腺瘤。并结合文献报道,对转移性多形性腺瘤的临床病理特征、发病机制及防治方法等进行讨论。     

基质金属蛋白酶及其组织抑制剂在涎腺多形性腺瘤生物学行为中的意义

目的 研究涎腺多形性腺瘤中基质金属蛋白酶(MMP)-2、9及其组织抑制剂(TIMP)-1、2的表达变化与其生物学行为的关系。方法 用免疫组化SP法和明胶酶谱法分别检测9例普通型和14例生长活跃型多形性腺瘤中MMP-2、9及TIMP-1、2的阳性表达及细胞定位，分析其中酶原与活性酶的含量比例。结果 MMP-2及MMP-2／TIMP-1、MMP-2／TIMP-2的比值在生长活跃型多形性腺瘤中的表达高于普通型，活性MMP-2、MMP-9酶原和活性酶在生长活跃型多形性腺瘤中的表达明显高于普通型，涎腺良性肿瘤与普通型多形性腺瘤间、涎腺恶性肿瘤与生长活跃型多形性腺瘤间差异无统计学意义。结论 涎腺生长活跃型多形性腺瘤与涎腺恶性肿瘤有相似的MMP-2、9和TIMP-1、2表达特征，而普通型多形性腺瘤中MMP-2、9和TIMP-1、2的表达与涎腺良性肿瘤相近。检测MMPs、TIMPs有助于判断涎腺多形性腺瘤的生物学行为。     

Immunolocalisation of cartilage-derived retinoic acid-sensitive protein in pleomorphic adenoma of the parotid salivary gland

Pleomorphic adenoma of the parotid salivary glands often contains chondroid elements and may exhibit cartilaginous and osseous differentiation, although the latter is extremely rare. Twenty-nine pleomorphic adenomas (PAs) of the parotid gland were examined immunohistochemically for the distribution of cartilage-derived retinoic acid-sensitive protein (CD-RAP), a recently described marker of chondrocytes, which may be important in the morphogenesis and development of the salivary gland. In the normal parotid gland, the ductal cells expressed CD-RAP, but not the myoepithelial cells. In the pleomorphic salivary adenomas, the duct-like cells, but not the myoepithelial cells, expressed CD-RAP. Since many authorities consider myoepithelial cells to be the source of the chondroid matrix, it is surprising that these cells do not express the chondrocytic marker, CD-RAP. Putative neoplastic myoepithelium in the pleomorphic adenoma and some cells in the myxochondroid areas expressed S-100 and calponin.     

Neural adhesion molecule (N-CAM) in pleomorphic adenoma and carcinoma ex-pleomorphic adenoma

BACKGROUND: The neural cell adhesion molecule (N-CAM) has been implicated in the behaviour of the adenoid cystic carcinoma. In vitro, it was demonstrated that N-CAM inhibits cell invasion. The aim of this study was to search for N-CAM in the most common salivary gland tumour that has a malignant counterpart. METHODS: We investigated the presence of N-CAM in pleomorphic adenoma and its malignant counterpart, the carcinoma ex-pleomorphic adenoma, using the immunohistochemistry technique. RESULTS: Neural cell adhesion molecule was expressed in all cases of pleomorphic adenoma, strongly labelling the luminal cells of the double-layered ductform structures. This expression was weaker in neoplastic myoepithelial cells and progressively diminished at a distance from the luminal cells. In carcinoma, ex-pleomorphic adenoma N-CAM was either totally absent or faintly present at the apical pole of the few luminal cells. CONCLUSIONS: As a result of the peculiar distribution of N-CAM in pleomorphic adenoma, we speculated that N-CAM behaves as a tumour-suppressor molecule, which is expressed in the benign neoplasm and which is down-regulated after malignancy, when the tumour assumes an invasive behaviour.