桩蛋白在涎腺黏液表皮样癌中的表达

目的:探讨桩蛋白(paxillin)在涎腺黏液表皮样癌中表达的意义。方法:采用HE染色方法筛选典型病例与免疫组织化学方法分析21例黏液表皮样癌中paxillin的表达。结果:paxillin在正常涎腺组织的基底膜、腺管部位有弱阳性表达,在黏液表皮样癌中有强阳性表达,其强弱程度与病理分级存在相关性(r=0.75,P<0.01),染色强度与染色面积评分之和与病理分级存在相关性(r=0.93,P<0.01),在肿瘤浸润前沿表达显著。结论:在涎腺黏液表皮样癌中paxillin表达强弱程度与病理分级密切联系,癌症浸润前沿表达情况可以为临床治疗提供参考。     

Ultrastructure of mucoepidermoid carcinoma in minor salivary glands.

Three cases of mucoepidermoid carcinoma of minor salivary glands were studied by electron microscopy. Mucus-secreting cells contained numerous mucous globules and bundles of fine cytoplasmic filaments. Another cell type contained a large number of glycogen particles, akin to tumor cells in glycogen-rich adenocarcinoma, and it is postulated that these cells represent the intermediate cells observed by light microscopy. Epidermoid cells contained a moderate amount of tonofilaments and various numbers of organelles. Mucus-secreting and epidermoid cells that surrounded a cystic space exhibited many microvilli. Results of this study support the theory that mucoepidermoid carcinoma develops from salivary gland duct cells with different cellular differentiation potentials and, in general, agree with the conventional grading system of mucoepidermoid carcinoma.     

Prevalence of mucoepidermoid carcinoma among intraoral minor salivary gland tumors: A systematic review and meta-analysis

This study aimed to synthetize and critically appraise available evidence regarding mucoepidermoid carcinoma (MEC) prevalence among intraoral minor salivary gland tumors (MiSGT). Five main electronic databases and three grey literature databases were searched. The risk of bias (RoB) was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Studies Reporting Prevalence Data. Proportion meta-analyses were performed. From 1321 studies identified, 82 were included in qualitative synthesis and 80 in meta-analyses. Sixteen were classified as high, 33 as moderate, and 33 as low RoB. A total of 12 774 MiSGT were found, of which overall MEC prevalence was 16.5% (95% Confidence Interval [95% CI] = 14.8%-18.4%). Most MiSGT were found in the palate (n = 7115), although MEC pooled prevalence in this anatomic location was only 13.6% (95% CI = 11.7%-15.6%). The retromolar area presented the highest pooled prevalence (58.9%; 95% CI = 47.0%-70.3%), followed by gingiva (28.8%; 95% CI = 22.7%-35.4%) and tongue (27.2%; 95% CI = 21.2%-33.6%). Regarding geographic location, Middle East presented the highest pooled prevalence (20.8%; 95% CI = 14.8%-27.6%), followed by America (20.0%, 95% CI = 17.2%-23%) and Europe (15.6%; 95% CI = 9.2%-23.5%). Among MiSGT, the MEC overall prevalence was approximately 16.5%. Although most MiSGT were found in the palate, the retromolar area was proportionally more affected by MEC.     

组织蛋白酶D在涎腺黏液表皮样癌中的表达

目的探讨组织蛋白酶D(Cath-D)在涎腺黏液表皮样癌中表达的意义。方法采用苏木素-伊红染色方法筛选典型病例与免疫组织化学方法分析21例黏液表皮样癌中Cath-D的表达。结果 Cath-D在正常涎腺组织的基底膜、腺管部位有弱阳性表达,在黏液表皮样癌中有强阳性表达,其强弱程度与病理分级存在相关性(r=0.54,P<0.01)。染色强度与染色面积评分之和与病理分级存在相关性(r=0.66,P<0.01)。在肿瘤浸润前沿表达显著。结论在涎腺黏液表皮样癌中Cath-D表达强弱程度与病理分级密切联系,癌症浸润前沿表达情况可以为临床治疗提供参考。     

Ultrastructural study of the histogenesis of salivary gland mucoepidermoid carcinoma

This electronmicroscope study of the histogenesis of mucoepidermoid carcinoma is based on 15 cases from the major and minor salivary glands. Six major cell types were identified: undifferentiated (cuboid) stem cells, intermediate (columnar) cells, serous/mucoid secretory cells, mucus-producing goblet cells, squamous/epidermoid cells and myoepithelium. It is proposed that undifferentiated stem cells serve as pluripotential reserves which give rise to the various cell types seen in mucoepidermoid carcinoma. Reserve cells in the acinar-intercalated duct components of the salivary glands appeared to give rise to the serous/mucoid and myoepithelial cell populations of mucoepidermoid carcinoma. Reserve cells in the proximal ducts system (intra/extralobular striated ducts and excretory ducts) differentiated into myoepithelium, intermediate (columnar) cells, squamous/epidermoid and mucus-producing goblet cell lines. It is proposed that neoplastic reserve cells give rise to different tumor types in the salivary glands. These types result from varying admixtures and arrangements of tumor cells at different stages of their structural and functional cytodifferentiation from reserve cells. It is further proposed that neoplastic reserve cells differentiate along similar cell lines as the embryonic "stem cells" in the development of normal salivary glands.     

Mucoepidermoid carcinoma of minor salivary glands: a clinical study of 16 cases and review of the literature

OBJECTIVE: Mucoepidermoid carcinoma (MEC) is the most common malignant tumor of salivary glands with a widely diverse biologic behavior that is correlated with the histological grade of the tumor. The purpose of this study was to evaluate the clinical outcomes of MEC of minor salivary glands in a group of 16 patients, who were treated in our clinic, and to discuss the management of this carcinoma. MATERIALS AND METHODS: Between 1985 and 2000, 16 patients with MEC of minor salivary glands were treated in the Clinic of Oral and Maxillofacial Surgery of the 'G. Papanikolaou' General Hospital, in Thessaloniki. The age range was 16-65 years. The distribution of the primary sites was: hard plate (one), soft palate (two), hard and soft palate (three), hard and soft palate with spread in paranasal sinus and nasal cavity (one), buccal mucosa (three), hard palate, alveolar process and buccal mucosa (two), and retromolar triangle (our). The tumors were clinically staged according to the tumor nodes metastase (TNM) system (Seifert, 1991). All patients were treated radically with surgery. The surgery was combined with radiotherapy in nine patients. Radiotherapy was delivered using Co-60. Doses ranged from 50 to 60 Gy and the duration of the therapy ranged from 25 to 35 days. Immunohistochemical assay of the expression of the Ki-67 antigen was performed on a subset of 15 cases. RESULTS: The mean follow-up range was 4-14 years. From the 16 patients with MECs 10 (62.5%) were alive and five (35.6%) had died from the disease. Four patients were free of the disease for more than 5 years (range 8-14), five patients were free of the disease for 5 years and one patient was free of the disease for 4 years. One patient lived more than 10 years and died from another cause. Local recurrence developed in one patient 10 years after the initial treatment. Lymph node metastases occurred in one patient within the first year after the initial surgical treatment. Distant metastases (two in bones and one in lungs) occurred in three patients within 2 years after completing the treatment. The Pearson chi-square statistical analysis was used for comparing the Ki-67 values in correlation with histological grade of the tumors. The Ki-67 expression was only 1% in low-grade MECs, while in intermediate-grade tumors it was estimated between 3 and 4%. The high-grade tumors had increased expression (10%) of tumor cells. CONCLUSION: Complete surgical excision is the treatment of choice for MECs. Adequate excision is important in all grades of tumors. Prognosis of MECs is a function of the histological grade, adequacy of excision and clinical staging. The immunohistochemical study of Ki-67 expression may provide additional prognostic information for this tumor.     

唾液腺粘液表皮样癌组织P-gp单克隆抗体JSB-1及GST-π抗体的检测

目的　探讨唾液腺粘液表皮样癌耐药性产生的机制,以便有针对性地采取逆转措施提高综合治疗中化疗的效果。方法　选取四川大学华西口腔医院口腔颌面外科1995~2000年40例术前未经任何治疗的唾液腺粘液表皮样癌标本,采用免疫组化ABC法,进行P-gp单克隆抗体JSB-1的检测,同时对其中10例进行了GST-π的检测。结果　JSB-1表达阳性率为67·5%(27/40),与分化程度相关,高分化组和中分化组均高于低分化组(P<0·05),高分化组和中分化组之间无统计学差异(P>0·05)。GST-π表达阳性率为90%(9/10)。两种抗体的表达在唾液腺粘液表皮样癌组织中的表达无统计学差异,亦无相关性。结论　JSB-1及GST-π与唾液腺粘液表皮样癌产生耐药的机制有关,为开展其耐药性的研究提供了靶标。     

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。     

Relationship between major and minor salivary gland mucoepidermoid carcinoma malignancy grading and presence of stromal myofibroblasts: immunohistochemical study

OBJECTIVE: Mucoepidermoid carcinoma (MEC) is the most common malignant salivary tumour, classified as low, intermediate and high grade. Myofibroblasts are the main stromal component and are included as prognostic factor in some tumours. The aim of this study was to evaluate the myofibroblasts in the stroma of MEC with possible relationship to malignancy grading. METHODS: Twenty-five cases of MEC (six low grade, 11 intermediate grade, four high grade and four metastasis) were stained for vimentin, desmin and smooth muscle actin (SMA) for the identification of myofibroblasts. Transforming growth factors (TGFbeta1 and TGFbetaRII) were also assessed in our study. RESULTS: Myofibroblasts were present in all cases, in amounts varying according to histological grading. TGFbeta1 was positive in squamous cells of intermediate grade tumours, and in the stroma of only four cases. TGFbetaRII was positive in most squamous and intermediate cells, regardless of malignancy grading. CONCLUSIONS: Our study showed that the analysis of neoplastic stroma must be added to the studies of neoplastic cells to draw a better picture leading to tumour diagnosis and prognosis.     

Immunohistochemical and fluorescent microscopic study of histogenesis of salivary mucoepidermoid carcinoma

The purpose of the present investigation was to study the histogenesis of the mucoepidermoid carcinoma of the salivary glands. Eleven cases of mucoepidermoid carcinoma of the minor salivary glands and five of the major glands were extensively studied employing immunohistochemical and fluorescent microscopic techniques. Both the intermediate cells and the duct cells showed a rather similar pattern of reactivity for vimentin, actin and EMA. Also, the intermediate cells and the myoepithelial cells showed a similar reaction pattern for keratin and UGA-1. The intermediate, myoepithelial and duct cells shared a similar reaction pattern for desmin, myosin, CEA, and S-100 protein. However, the rest of the tumor markers studied (AFP, PNA and WGA) were found to be non contributary. We also found that the intermediate and to some extent the epidermoid tumor cells showed a positive reaction with Azophloxine GA, which is a selective stain for myoepithelial cells in the normal glands. Based on these findings, the duct cells, the myoepithelial cell in the normal glands and the intermediate cells of the mucoepidermoid carcinoma share certain similar characteristics. The intermediate cells may actually be a mixed population, some having characteristics of the myopithelial cells and others of duct cells. These findings are relevant to the possible role of the intermediate cell in the histogenesis of the mucoepidermoid carcinoma.     

XIAP在涎腺黏液表皮样癌中的表达及意义

目的检测X染色体连锁凋亡抑制蛋白(x-linked inhibitor of apoptosis protein,XIAP)在涎腺黏液表皮样癌(mucoepidermoid carcinoma,MEC)中的表达,探讨XIAP的表达在涎腺黏液表皮样癌发生发展中的作用。方法采用免疫组织化学法检测25例涎腺黏液表皮样癌中XIAP的表达,分析其与临床病例的关系。结果 XIAP在MEC中呈高表达,在正常涎腺组织中不表达或低表达;MEC和正常涎腺组织XIAP阳性检出率分别为84%(21/25)和0.00%(0/10)(P<0.01);XIAP表达与MEC组织病理分化程度呈正相关关系(P<0.05),而与肿瘤部位、临床分期、远处转移无相关性(P>0.05)。结论 XIAP在MEC中高表达,可能在MEC发生过程中具有重要的作用。     

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...     

TSA诱导人粘液表皮样癌细胞MEC-1凋亡机制的初步研究

目的探讨曲古抑菌素A(TSA)对人粘液表皮样癌细胞(MEC-1)的体外生物学作用及其作用机制。方法应用不同浓度的TSA作用于人粘液表皮样癌细胞MEC-1细胞后,观察TSA对MEC-1细胞生长状态的影响;通过噻唑蓝(MTT)比色法检测TSA对MEC-1细胞增殖变化的作用,应用原位末端标记法(TUNEL)、流式细胞术检测经Annexin V-FITC/PI双染后MEC-1细胞的早期凋亡作用。结果TSA可显著地抑制MEC-1细胞的生长,并且具有时间和剂量依赖性,通过倒置显微镜可明显观察到细胞的形态学改变;通过TUNEL法、流式细胞仪检测显示TSA可以诱导MEC-1细胞凋亡。结论TSA对人粘液表皮样癌细胞MEC-1具有显著的体外生长抑制,其主要作用是诱导细胞凋亡。     

Immunoprofile of mucoepidermoid carcinomas of minor salivary glands.

Because the data on the antigenic phenotype of mucoepidermoid carcinoma (MEC) are incomplete and somewhat disparate, 45 MECs were evaluated immunohistochemically for low- and high-molecular-weight keratins, vimentin, glial fibrillary acidic protein, smooth muscle actin, and S-100 protein. Tumors stained uniformly for keratins and, on occasion, focally for vimentin. Tumors were nonreactive with antibodies to glial fibrillary acidic protein and, with few exceptions, to muscle-specific actins and S-100 protein. Clear cell and papillary histologic variants were seen as potential diagnostic pitfalls. If used with hematoxylin-and-eosin-stained sections, limited potential is seen for this antibody panel in surgical pathology. Myoepithelial cell-associated antigens are expressed to a very limited extent in MECs.     

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。     

影响涎腺粘液表皮样癌术后复发的临床病理因素分析

目的 探讨影响涎腺粘液表皮样癌病人术后复发的临床病理因素。方法 回顾经本院手术并获得五年以上随访或不足五年而出现复发的涎腺粘波表皮样癌77例，对各项临床病理指标进行单因素似然比检验及多因素Logistic回归分析，资料的统计学处理全部通过SPSS软件完成。结果 本组涎腺粘液表皮样癌术后复发有其自身的特点。在单因素分析中，性别、分化程度、原发灶的处理方式、小涎腺粘液表皮样癌侵犯骨的处理等因素均与术后复发相关。性别、分化程度、原发灶的处理方式做为影响术后复发的主要因素进入Logistic回归方程，所得回归方程对术后复发的分类能力可达84．4％。结论 性别、分化程度、原发灶的处理方式是影响涎腺粘液表皮样癌术后复发的主要因素。