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。     

涎腺基底细胞腺瘤的临床病理观察

本文对１７例涎腺基底细胞腺瘤进行了临床病理及Ｓ一１００蛋白和ＣＥＡ免疫组织化学观察。结果显示：男性７例，女性１０例，平均年龄５０岁。该瘤大多数发生在腮腺（８８％），组织学上分为实性、梁状和管状三个亚型。Ｓ一１００蛋白染色肿瘤细胞呈阴性；ＣＥＡ染色肿瘤的腺管样结构呈阳性着色，而实性上皮团块或条索中则不表达ＣＥＡ，提示该瘤的实性或条索的细胞分化低。     

涎腺正常与肿瘤组织中p63、CK5、CK19、CEA及SmA的表达

目的:探索涎腺正常导管、腺泡及其上皮性肿瘤的组织起源.方法:采用免疫组化(二步法)检测正常涎腺组织14 例、多形性腺瘤14 例、基底细胞腺瘤8 例、腺样囊性癌18 例、黏液表皮样癌9 例、低分化腺癌2 例及腺泡细胞癌、乳头状腺癌、恶性多形性腺瘤、肌上皮癌各1 例中p63、CK5、CK19、CEA及SmA的表达.结果:正常涎腺基底细胞与肌上皮细胞层表达CK5,其中部分细胞表达p63,导管部分基底细胞也呈CK19阳性.多形性腺瘤、基底细胞腺瘤、腺样囊性癌与黏液表皮样癌具p63、CK5及CK19高阳性率, SmA阳性率分别为85.71%、1.25%、61.11%、0.00%.CEA阳性细胞见于11.11%腺样囊性癌与55.56%黏液表皮样癌.结论:正常涎腺导管和腺泡的腺上皮及涎腺上皮性肿瘤可能来源于导管、腺泡基底层内呈p63和CK5阳性细胞中的干细胞.     

定量分析在腺样囊性癌分型上的应用

应用计量病理学方法探讨腺样囊性癌分化与分配的关系。腺样囊性癌在病理上一般分为筛孔状结构,导管为主型,小团块为主型及小条索为主型。按上述四型应用图象分析,经多元判别逐步分析法验证发现,导管为主型与筛孔结构之间差异并不明显,而团块与条索为主型呈上升趋势,从DNA含量观察,发现导管型恶性度最低,筛孔结构次之,团块与小条索型最高。因此定量与定性分析同步进行,对腺样囊性癌准确分型,预测预后及临床制定治疗方案,有较大的实用意义。     

肝素酶在唾液腺腺样囊性癌中的表达及其意义

目的探讨肝素酶在唾液腺腺样囊性癌中的表达及与肿瘤的临床病理及生物学行为的关系。方法采用免疫组化S-P法检测35例唾液腺腺样囊性癌和正常腺体中肝素酶的表达。结果35例腺样囊性癌标本中肝素酶表达阳性为32例,阳性率为91.4%。肝素酶的表达主要位于胞膜及胞质。在实性型以及神经侵袭的标本中表达增强(P<0.05),但其表达强度与性别、年龄无关。肝素酶在正常腺体内没有表达。结论肝素酶的表达与腺样囊性癌的侵袭以及预后关系密切。     

涎腺肿瘤中Pax9基因的表达及其意义

目的:检测正常涎腺组织及涎腺肿瘤中转录因子Pax9的表达。方法:采用免疫组化SABC法,研究Pax9在正常涎腺组织、多形性腺瘤、腺淋巴瘤、基底细胞腺瘤、粘液表皮样癌和腺样囊性癌共48例中的表达情况。结果:除1例多形性腺瘤外,其余组织均表达Pax9。正常涎腺的腺泡细胞和导管内衬细胞、多形性腺瘤的上皮细胞、腺淋巴瘤的肿瘤上皮细胞和基底细胞腺瘤中Pax9弱阳性表达,差异没有显著性;而在增殖活跃的细胞如正常涎腺导管的基底细胞和恶性肿瘤细胞(粘液表皮样癌、腺样囊性癌)中表达增强,恶性肿瘤中Pax9的强阳性表达率明显增高,与正常和良性肿瘤相比具有显著差异(P<0.05)。结论:Pax9在涎腺肿瘤尤其是恶性肿瘤的发生过程中发挥重要的作用。     

涎腺Warthin瘤超声特征与病理对照分析

目的 总结涎腺Warthin瘤的超声图像表现,旨在提高超声诊断的准确性。方法 回顾性分析58例（69个病灶）涎腺Warthin瘤的超声图像表现,并与病理检查结果进行对照分析。结果 涎腺Warthin瘤的超声表现分为3种类型。Ⅰ型：实性肿块型（34个,49.3%）,超声表现为实性弱回声团块,内部见部分网格状回声;病理显示为多种组织成分（如腺上皮细胞、淋巴组织、纤维组织）排列致密而均匀,上皮形成乳头状结构突入少量黏液构成的小囊腔。Ⅱ型：囊实性肿块型（30个,43.5%）,团块内可见片状无回声,囊实性分界清楚;病理显示腺上皮细胞构成不规则的腺管和囊腔样结构,囊腔内含有较多淡黄色黏液或棕色胶冻样物。Ⅲ型：囊性肿块型（5个,7.2%）,超声显示肿块呈分隔状囊性团块;病理显示Warthin伴梗死及感染。超声与病理诊断的符合率为79.7%。结论 Warthin瘤的超声图像表现基于病理组织结构,掌握Warthin瘤的不同超声图像特征以及病理改变有助于作出较为准确的超声诊断。     

影响头颈部腺样囊性癌预后因素的分析

目的 研究影响腺样囊性癌预后的因素。方法 对21例经手术治疗的腺样囊性癌的生长部位、临床分期、病理分型与肿瘤复发、转移及死亡的关系进行随访。结果 临床分期与转移关系密切,其它指标之间无显著性联系。结论 临床分期可以作为影响头颈部腺样囊性癌预后因素,病理分型与肿瘤的预后无关。     

Id1在腺样囊性癌的表达及与肿瘤血管生成相关性研究

目的：研究即分化抑制因子-1（Id1）在腺样囊性癌的表达及其与腺样囊性癌临床病理特征、肿瘤血管生成的关系。方法：免疫组化EnvisionTM法检测46例腺样囊性癌组织和10例正常唾液腺组织Id1的表达,检测CD34的表达,对肿瘤组织微血管密度进行计数。应用SPSS16.0软件对实验数据进行统计学分析。结果：Id1在腺样囊性癌中表达阳性率为65.2%,显著高于正常唾液腺组（P〈0.01）。Id1表达与腺样囊性癌病理分型、临床分期、及肿瘤转移显著相关（P〈0.05）,与患者的性别和年龄无显著性相关（P〉0.05）。Id1在腺样囊性癌中的表达与CD34标记的肿瘤微血管密度密切相关。结论：Id1的表达与腺样囊性癌临床病理特征密切相关,Id1可能通过促进腺样囊性癌的血管生成而与肿瘤的发展和转移密切相关。     

涎腺乳头状腺癌临床病理分析

本文对37例涎腺乳头状腺癌作了临床病理分析;提出了该肿瘤的诊断依据及鉴别诊断意见。并指出该肿瘤的预后明显差于腺泡细胞癌及粘液表皮样癌,但与腺样囊性癌无明显差别。作者还将涎腺乳头状囊腺癌作为乳头状腺癌的一种特殊类型提出,它具有较好的预后。     

涎腺膜性基底细胞腺瘤的组织发生学研究

目的 探讨涎腺膜性基底细胞瘤的组织发生和发展过程。方法 对１２例涎腺膜性基底细胞腺瘤患者进行组织病理学和免疫组织化学研究。结果 ４例患者均可见肿瘤周围的腺体和组织中有多灶性纹和纹管增殖，其最早期的改变为纹管基底细胞增殖，持续不断的导管增殖导致了微小腺瘤的形成。结论 纹管基底细胞的殖明显参与涎 腺膜性基底细胞腺瘤的形成，并在其中起主要作用。这一观点丰富了涎腺肿瘤组织发生的多细胞学说。     

Basal cell adenocarcinomas of the major salivary glands

Basal cell adenoma of salivary gland has become an established variant of monomorphic adenoma since its segregation from pleomorphic adenoma in 1967. Although there have been many comprehensive reports about benign basal cell adenomas, only rare case reports of malignant basal cell type neoplasms have appeared in the literature. Described in this report are the clinicopathologic features of 29 cases labeled basal cell adenocarcinomas that had morphologic characteristics of basal cell adenomas but infiltrative, perineural, and intravascular growth features that indicated a malignant potential. With limited follow-up, seven tumors are known to have recurred, and three of these metastasized to lymph nodes and lung. One patient died with extensive local spread of the tumor. All patients were adults. The peak incidence was in the sixth decade of life, and there was no gender predilection. The parotid gland was the predominant site. A solid type growth configuration was most frequent; membranous, trabecular, and tubular types were less frequent, in that order. Three patients also had dermal cylindromas, perhaps indicative of a salivary gland-skin adnexal diathesis that has been previously reported.     

Wide excision of accessory parotid gland with anterior approach

Accessory parotid gland tissue has been described as salivary tissue adjacent to the Stensen duct that is distinctly separate from the main body of the parotid gland. Of all parotid gland tumors, 1% to 8% arise from the accessory parotid gland. Little is known about the accessory parotid gland, and it is seldom mentioned in the literature. Between 1999 and 2010, we have treated and followed 8 patients with tumors of the accessory parotid gland. There were 5 males and 3 females with a mean age of 35 years. They all presented with an asymptomatic cheek mass, and 4 of them underwent fine-needle aspiration. Ultrasound or computed tomographic scan was used in all patients. All the patients underwent surgical intervention with standard parotidectomy incision and anterior extension. The mean follow-up time was 44 months (range, 6-120 months). Seven patients had benign disease. Four cases were pleomorphic adenoma, and the remaining 3 benign cases were parotid cyst, basal cell adenoma, and hemangioma. Only 1 patient had a malignant tumor that was a lymphoepithelioma-like carcinoma. In 7 cases, wide excision (excision of mass and accessory lobe of the parotid gland) was done because of the intra-accessory parotid gland lesion. One patient had concomitant superficial parotidectomy because the tumor was located very close to and has involved the parotid gland proper. There was no serious postoperative complication and recurrence. Prudent preoperative diagnostic evaluation and meticulous surgical approach are the keys to successful management of midcheek lesions. A wide excision of the accessory lobe of the parotid gland can be a definitive surgery in case of solitary tumor with an intact parotid fascia, and wide excision with anterior approach through a standard parotidectomy incision is preferred to a direct incision over the mass.     

副腮腺肿瘤14例临床分析及治疗体会

目的 初步评估分析副腮腺肿瘤的诊断、治疗与预后情况。方法 回顾性分析14例副腮腺肿瘤患者的诊断与治疗,考虑到副腮腺肿瘤的特殊解剖部位,14例患者均采取常规的腮腺肿瘤手术切口,并进行细致的面神经解剖。对于恶性副腮腺肿瘤给予术后辅助放射治疗。结果 14例副腮腺肿瘤中多形性腺瘤6例,肌上皮瘤2例,腺泡细胞癌2例,基底细胞腺瘤1例,中分化黏液表皮样癌1例,肌上皮癌1例,侵袭性纤维瘤1例。所有患者术后的面型满意,肿瘤无复发。结论 常规的腮腺手术切口进路治疗副腮腺肿瘤是一种安全、有效、美观的方法。     

Trabecular and solid-cribriform types of basal cell adenoma. A morphologic study of two cases of an unusual variant of monomorphic adenoma.

Monomorphic adenomas are a morphologically complex group of salivary gland tumors. Two unusual examples, one a trabecular and the other a solid form of basal cell adenoma, reveal the development of a cribriform growth pattern focally in the former example and diffusely in the latter. They illustrate the potential for cellular differentiation within this subgroup, organization of synthetic products by the tumor cells, and the histologic criteria useful for the distinction of basal cell adenoma from adenoid cystic carcinoma.     

A modified centripetal approach to parotidectomy

A modified centripetal approach to parotidectomy is reported. A total of 422 benign parotid tumors, 383 of which were primary and 39 of which were recurrent, were treated by this technique. The pleomorphic adenoma was the most common type (94.79%) in the series. Superficial parotidectomy was done in 178 cases, and total parotidectomy, in 244 cases. No permanent facial paralysis occurred after parotidectomy in the primary tumor group. Seven recurrences were observed after surgery in the recurrent tumor group.     

Immunohistochemical demonstration of bone morphogenetic protein-2 and type II collagen in pleomorphic adenoma of salivary glands

Immunohistochemical investigation of bone morphogenetic protein-2 (BMP-2) and type II collagen, two cartilage-associated proteins, was undertaken using monoclonal antibodies in 20 cases of salivary pleomorphic adenoma (PA) in order to explore their possible roles in chondroid differentiation of this tumor. Other salivary gland tumors, including adenoid cystic carcinoma (17 cases), polymorphous low-grade adenocarcinoma (10 cases), basal cell adenoma (3 cases), basal cell adenocarcinoma (1 case), and epithelial-myoepithelial carcinoma (2 cases), were also examined for comparison. In PA, BMP-2 immunoreactivity was detected in the luminal and non-luminal cells of the tubulo-ductal structures, plasmacytoid cells, and other scattered tumor cells in solid areas. In addition, tumor cells in chondroid areas in most cases (14/15), and stellate cells in myxoid areas in many cases (7/19), were also intensely labeled for BMP-2. Furthermore, BMP-2 was also detected in the non-neoplastic ductal cells in salivary glands, whereas no other salivary gland tumors were positively stained for this protein. Type II collagen was localized in the intercellular matrix of chondroid areas and in a few chondroid differentiating cells in myxoid areas, confirming its cartilage-specificity. A proportional relationship was observed between BMP-2 expression and chondroid formation, although BMP-2 was also stained in occasional PAs without chondroid formation. It is speculated that BMP-2 might be secreted by tumor cells and play a role in chondroid formation in PA by inducing some tumor cells to produce type II collagen and other chondroid matrical substances, like glycosaminoglycans. The expression of BMP-2 is specific to PA and may possibly be used as a useful marker in differentiating PA from other salivary gland tumors.     

Basal cell adenocarcinoma of the salivary gland: an ultrastructural and immunohistochemical study

OBJECTIVE: The purpose of this study was to examine the ultrastructural and immunohistochemical characteristics of basal cell adenocarcinoma. STUDY DESIGN: Three cases of basal cell adenocarcinoma of the salivary glands were studied by means of light microscopy, electron microscopy, and immunohistochemistry. RESULTS: Some of the architectural tumor patterns encountered were solid, some were trabecular, and some were mixed. Ultrastructurally, solid areas were composed of nonluminal cells, some of which contained tonofilaments and well-formed desmosomes; tubulo-trabecular areas differentiated into both luminal and nonluminal cells. Both growth patterns were associated with the formation of excess basal lamina, marginally and between nonluminal cells. Myofilaments were infrequent in nonluminal cells of solid or trabecular areas. Cytokeratin (AE1/AE3) stained all 3 tumors, more peripherally in the solid pattern and usually centrally in the trabecular areas; vimentin stained all 3 tumors diffusely; smooth muscle actin (IA4) stained all 3 tumors but was mainly confined to peripheral tumor cells in both the solid and the trabecular growth patterns; epithelial membrane antigen and carcinoembryonic antigen stained 1 of the 3 tumors, predominantly in the luminal cells; p53 oncoprotein was focally positive in 2 of the 3 tumors; Ki-67 stained less than 5% of the tumor cells in all cases; and c-erb-B2 was uniformly negative in all cases. Staining patterns of cytokeratin and actin varied with the architecture of the tumor. CONCLUSIONS: Neither ultrastructural characteristics nor immunohistochemistry findings appear to distinguish basal cell adenocarcinoma from basal cell adenoma.     

A study of the extracellular matrix in salivary gland tumors

BACKGROUND: Epithelial-mesenchymal interactions constitute fundamental phenomena in the development and maintenance of the characteristic branching pattern seen in salivary glands. This study was undertaken to discuss the extracellular matrix (ECM) role in morphogenesis and cellular differentiation of salivary gland tumors originating from the intercalated duct. METHODS: The ECM components, laminin (LN), type IV collagen, fibronectin (FN), and tenascin (TN) were revealed using a streptoavidin-biotin immunohistochemical technique and analyzed in 34 cases of salivary gland tumors: pleomorphic adenoma (PA); myoepithelioma; basal cell adenoma (BCA); polymorphous low grade adenocarcinoma (PLGA); and adenoid cystic carcinoma (ACC). RESULTS: LN and type IV collagen were present in all tumors, confining well-organized duct-like structures, separating them from the stroma, or surrounding cell clusters. In PA and myoepithelioma, the basement membrane (BM) fragmentation was observed through LN and type IV collagen staining around each individual spindle-shaped cell, which was strictly related to the cell modification. Interestingly, BM interruption could not be seen in the malign tumors, however, was frequently augmented in some cases. LN, type IV collagen, and FN were also found in the stroma of all tumors studied, except for the pseudocystic spaces of ACC, which were only delimited by replicated LN and type IV collagen. TN exhibited a variable expression, being more intense in solid ACC. CONCLUSIONS: LN and type IV collagen were always present around morphologically well-differentiated duct-like structures in all tumors studied. BM interruption could not be seen in the malign tumors, on the contrary BM production was evident, which is probably related to invasion. FN was present in the stroma of all tumors, but TN was mostly observed in less differentiated and higher degree of malignancy tumors, such as solid ACC.     

Relative frequency of intra-oral minor salivary gland tumors: a study of 380 cases from northern California and comparison to reports from other parts of the world

BACKGROUND: The relative frequency of individual intra-oral minor salivary gland tumors (IMSGT) is not well documented in the literature. The aim of this study was to determine the relative frequency and distribution of IMSGT in an oral pathology biopsy service and to compare the data with similar studies from different parts of the world. METHODS: Files from the Pacific Oral and Maxillofacial Pathology Laboratory of the University of the Pacific, San Francisco, California served as a source of material for this study. Files were systematically searched for all cases of IMSGT during a 20-year period. Tumors were classified according to the 2005 WHO classification of salivary gland tumors. RESULTS: IMSGT were identified in 380 (0.4%) cases of 92 860 accessed. This is the largest series of IMSGT from one source reported in recent years. Of the 380 tumors, 224 (59%) were benign and 156 (41%) were malignant. Of the benign tumors, pleomorphic adenoma (PA) was the most common (39.2%), followed by cystadenoma (6.3%), canalicular adenoma (6.1%), ductal papillomas (4.4%), basal cell adenoma (1.6%), and myoepithelioma (1.3%). Of the malignant tumors, mucoepidermoid carcinoma was the most common (21.8%), followed by polymorphous low-grade adenocarcinoma (7.1%), adenoid cystic carcinoma (6.3%), adenocarcinoma, not otherwise specified (NOS; 2.1%), acinic cell carcinoma (1.6%), clear cell carcinoma, NOS (1.0%), and carcinoma ex PA (0.5%). CONCLUSIONS: Studies related to the relative frequency of individual IMSGTs from different parts of the world are difficult to compare because many studies are outdated, the number of cases is small, the list of tumors is limited, and new entities are not included. To determine the true relative frequency, more studies should be conducted, on a large number of cases from one source, by experienced pathologists in the field of salivary gland tumors.