Caveolin-1在腮腺多形性腺瘤及瘤旁组织中的表达及临床意义

  目的   探讨窖蛋白-1（Caveolin-1,Cav-1）在腮腺多形性腺瘤（pleomorphic adenoma,PA）中的表达及临床意义。   方法   采用免疫组织化学法检测了9例正常腮腺、33例原发性PA距离瘤体中心（0 cm）及瘤旁组织中（分别距瘤体中心0.5、1.0、1.5和2.0 cm）Cav-1的表达,并进行统计学分析。   结果   Cav-1在所有正常腮腺样本（100%）均有表达,其主要在导管系统细胞质和细胞膜中表达;除6例距瘤体中心0.5 cm和1例距瘤体中心1.0 cm的样本外,其余瘤旁样本均有Cav-1表达,其表达模式基本上与正常腮腺类似;在PA中,有10例样本（30.30%）表达Cav-1,且在细胞核中显著表达。Cav-1在多形性腺瘤肿瘤组织中的表达最低,并随着与瘤体中心距离的远近,其表达量逐渐升高。Cav-1的表达在瘤体与瘤旁组织间均存在明显差异（P < 0.05）,但瘤旁组织1.0、1.5和2.0 cm间Cav-1表达无显著性差异（P>0.05）。   结论   在腮腺多形性腺瘤发生过程中,Cav-1中表达下调并出现了从细胞质、细胞膜到细胞核的转位现象。上述结果表明Cav-1在多形性腺瘤的发生发展中可能起着重要作用,其表达水平的变化可作为判定手术安全边缘的科学依据之一。      

高频超声诊断在腮腺肿瘤诊断中的价值及误诊原因分析

目的:探讨高频超声诊断在腮腺肿瘤诊断中的价值及分析其误诊的原因,以期提高高频超声诊断腮腺肿瘤的符合率。方法:回顾性分析经手术及病理证实的12例腮腺多形性腺瘤病例、10例Warthin瘤病例的高频超声特点,分析并观察肿块的大小、形态、性质、解剖部位、内部回声,应用彩色多普勒检测肿块内部血流的丰富程度。结果:高频超声诊断12例腮腺多形性腺瘤患者中,诊断为多形性腺瘤6例,正确诊断率为50%,误诊为淋巴结炎2例,误诊为血肿1例,诊断为混合性占位、性质待定3例,误诊率50%。应用高频超声诊断10例Warthin瘤患者时,诊断为Warthin瘤4例,正确诊断率为40%,误诊为多形性腺瘤3例,误诊为淋巴结炎1例,诊断为混合性占位、性质待定2例,误诊率60%。多形性腺瘤与Warthin瘤的回声强度无差异,P>0.05;后壁回声增强、血流信号强度分级有差异,P<0.05,差异有统计学意义。结论:典型的多形性腺瘤、Warthin瘤有各自的声像图特点,非典型的多形性腺瘤类似于Warthin瘤。高频超声检查在腮腺多形性腺瘤与Warthin瘤的鉴别诊断过程中,有较高应用价值。通过观察肿块的形态、边界、包膜、内部回声、后壁回声增强情况,并运用彩色多普勒检查检测内部血流情况,结合患者一般临床资料,可以提高腮腺多形性腺瘤与Warthin瘤的诊断准确率。     

A transpalatal approach (Palate Split) to the Parapharyngeal space

This is a case of a 20 years young boy with a large parapharyngeal pleomorphic adenoma excised via transpalatal approach. The incision was taken about 0.5cm away from the edges of the tumor it provided good, surgical access to the whole length of upper parapharyngeal space and allowed complete tumor excision.     

PCNA和Ki-67在涎腺良、恶性多形性腺瘤中的表达及意义

目的：研究涎腺良、恶性多形性腺瘤的临床病理特点,生物学行为及细胞增殖活性,为其临床诊断及预后评估提供依据。方法：对114例涎腺良、恶性多形性腺瘤进行回顾性分析,对其中20例多形性腺瘤、9例多形性腺瘤生长活跃型及9例恶性多形性腺瘤采用SABC和LSAB免疫组化法观察增殖细胞核抗原（PCNA）和增殖细胞核相关抗原（Ki-67）的表达和分布。结果：恶性多形性腺瘤的PCNA及Ki-67表达水平显著高于多形性腺瘤及多形性腺瘤生长活跃型,其PI值较后二者差异有显著性（P〈0．01）;良性多形性腺瘤的复发组PCNA和Ki-67的表达明显高于原发组,二者之间有显著性差异（P〈0．01）。结论：PCNA和Ki-67检测在判断多形性腺瘤恶性增殖方面有重要意义,对良性多形性腺瘤复发预测有重要的参考价值。     

涎腺肌上皮瘤与多形性腺瘤鉴别诊断的研究

为了探讨涎腺肌上皮瘤与多形性腺瘤的病理鉴别，复查了９３０例多形性腺瘤，对从中确诊的３８例肌上皮瘤进行了病理学和抗ＣＫ－１８、Ａｃｔｉｎ、Ｓ－１００蛋白抗体的免疫组化研究。结果显示：肌上皮瘤的误诊率占多形性腺瘤的４％；病理上分为上皮细胞型、梭形细胞型、浆细胞样细胞型、透明细胞型和混合细胞型，各种形态的瘤细胞可以互相转化；免疫组化显示上述三种抗体各型均呈阳性反应，每例中瘤细胞的阳性程度一致；多形性腺瘤的反应结果则不同。结果表明，明确肌上皮瘤各亚型病理特征是与多形性腺瘤鉴别的关键；免疫组化结果分析有助于两者的鉴别；对组织起源的探讨可从肿瘤分化上认识两者的不同     

原发性肺多形性腺瘤一例

多形性腺瘤是一种好发于涎腺组织的具有恶性潜能的肿瘤，但原发性肺多形性腺瘤在临床上较为少见，国内外也仅有少数病例报道。2017年4月中国医科大学附属第四医院胸外科收治了1例原发性肺多形性腺瘤患者，经单孔胸腔镜手术治疗后，痊愈出院。为提高对肺多形性腺瘤的认识，该研究结合患者的临床资料及相关文献，分析肺多形性腺瘤的诊断与治疗。     

Immunohistochemical study on sebaceous adenoma and sebaceous carcinoma arising in parotid gland

The present study presents two cases of parotid mass diagnosed as sebaceous adenoma and sebaceous carcinoma in which immunohistochemical staining was performed for cytokeratins, vimentin, S-100 proteins, lactoferrin, lysozyme, alpha 1-antichymotrypsin, alpha 1-antitrypsin, and proliferating cell nuclear antigen to evaluate the characteristics of tumor cells and to distinguish these lesions from their counterparts in the skin. Sebaceous adenoma had circumscribed lobules containing sebaceous cell nests with well differentiated sebaceous cells surrounded by basaloid cells and a population of transitional cells. Sebaceous carcinoma had cellular pleomorphism and nuclear atypia and a population of cells resembling neoplastic myoepithelial cells of pleomorphic adenoma. The profile of markers used in the present study when compared with studies on sebaceous tumors of skin and the characteristics of other salivary neoplasms reasonably allowed us to conclude that the sebaceous differentiation and sebaceous tumors in salivary glands may differ from that of their counterparts in skin. The histogenesis of salivary sebaceous neoplasms may be attributable to the process of sebaceous metaplasia in the salivary tissues and based on our finding of similar immunohistochemical profile of sebaceous cells in sebaceous carcinoma with that of neoplastic myoepithelial cells in pleomorphic adenoma as reported earlier, sebaceous neoplasms may have a common histogenetic origin with other salivary neoplasms. However, their origin from the sebaceous glands normally present in the salivary tissues could not be excluded.     

Histopathologic studies of basal cell adenoma of the parotid gland

Five-hundred-thirty-one cases of primary epithelial tumors of the parotid gland were examined. The incidence of basal cell adenomas was 7.5% (40 cases). The tumors could be classified histologically into these subtypes: basal cell (21/40; 42.5%); tubular, (13/40; 32.5%); trabecular (4/40; 10.0%); and papillary (2/40; 5.0%). The pattern of classic basal cell adenoma predominated in the basal-cell type but was also seen in varying degrees in the latter three types with a reciprocal transition. Accordingly, it could be suggested that tubular, trabecular, and papillary types are variants of basal cell adenoma. The higher incidence of basal cell adenomas in our survey could be accounted for by this categorization. Histologically, basal cell adenomas presented various features; (1) cystic formation (26/40; 65.0%), being most frequently seen in tubular and trabecular types; (2) adenoid cystic pattern (4/40; 10.0%); (3) elastosis in the stromal tissues (2/40; 5.0%). Basal cell adenomas were clinicopathologically compared with 291 cases of pleomorphic adenomas. Basal cell adenomas were seen more often in female patients, (60.0%), as were pleomorphic adenomas (68.4%). They were observed more frequently in patients over 50 years of age and the average was ten years higher than for pleomorphic adenoma. The tumor size tended to be smaller (below 2 cm at the greatest diameter) than pleomorphic adenomas.     

24例涎腺恶性多形性腺瘤的临床分析

目的 了解涎腺恶性多形性腺瘤的临床特征、治疗和预后。方法 24例经病理证实的涎腺恶性多形性腺瘤,对其诊断、治疗以及生存率进行分析。结果 恶性多形性腺瘤患者总的5年生存率为66．7％,其中发生于大涎腺者5年生存率为63．6％,发生于小涎腺2例均存活5年以上。结论 治疗首选手术,提倡首治行规范切除,位于领下腺者建议行预防性颈清扫;术后补充放疗不提高局部控制率。     

腮腺良性肿瘤的CT及彩超检查诊断与病理学对照分析

目的研究多层螺旋CT（MSCT）及彩色多普勒血流显像（CDFI）对腮腺多形性腺瘤和腺淋巴瘤的诊断价值及其病理基础。方法对手术病理证实的12例多形性腺瘤和10例腺淋巴瘤的术前MSCT双期增强扫描及CDFI影像学资料进行病理学对照研究,并评价两种检查手段的诊断价值。结果①MSCT双期增强扫描显示多形性腺瘤呈延迟强化表现、腺淋巴瘤呈延迟排空表现,且二者双期强化程度之间的差异有统计学意义（P〈0.05）。②CDFI显示腺淋巴瘤的血供较多形性腺瘤丰富,二者的血流信号差异有统计学意义（P〈0.05）。③病理上多形性腺瘤组织内黏液样和软骨样组织间质丰富,血管结构稀少;腺淋巴瘤组织内淋巴样间质成分丰富,淋巴间质中和被膜内外均有大量血管分布。④CT延迟强化征象对多形性腺瘤诊断的敏感度、特异度分别为91.67%、90.00%,延迟排空征象对腺淋巴瘤诊断的敏感度、特异度为90.00%、100%;CDFI对二者诊断的敏感度和特异度分别为75.00%、80.00%和80.00%、83.33%。结论腮腺多形性腺瘤和腺淋巴瘤的MSCT及CDFI影像学表现特征均与其肿瘤病理学基础相符;MSCT双期增强扫描较CDFI对二者具有更高的诊断价值。     

涎腺多形性腺瘤106例诊治体会

目的 探讨涎腺多形性腺瘤的临床特点、诊断方法及治疗原则。方法 对我科近14年来收治的106例涎腺多形性腺瘤的临床资料进行回顾性分析。结果 106例涎腺多形性腺瘤中，以腮腺最为常见，占52％，颌下腺、腭部、上唇次之，分别为36．8％、8．5％、2．7％。本组共复发4例。结论 细针抽吸细胞学活检可作为涎腺多形性腺瘤的常规术前检查，治疗的成功与否关键在于第一次的手术方式。     

腮腺多形性腺瘤外科术式的演变及发展

腮腺肿瘤以多形性腺瘤居多,目前外科治疗仍是主要的治疗方式。20世纪时学者们由于对面神经解剖和多形性腺瘤包膜病理特性缺乏了解,该病的主要术式为单纯肿瘤剜除术,但术后容易导致复发;试图通过扩大切除的范围控制复发率,于是包膜外切除术开始运用于临床,虽然切除了肿瘤的包膜,但是复发率仍未能很好地控制。腮腺浅叶切除术和腮腺全切术明显降低了复发率,但是伴随着面神经损伤的加重,似乎又矫枉过正。腮腺部分切除术作为新的腮腺手术形式,不但降低了复发率、面神经损伤率,还得到病理学基础研究证据的支持,是目前较为先进的手术方式。但是在经典的腮腺浅叶切除术与先进的腮腺部分切除术之间仍存在争议。经过整形学、病理学、基因检测法等方面探究这两种手术的优劣均各有差异。本文从腮腺术式的演变历程探讨腮腺术式发展的方向。      

A rapid technique for the fluorescent location of pleomorphic adenoma cells in frozen sections of human salivary glands

Both acinar cells and pleomorphic adenoma cells possess a cell surface protease, guanidinobenzoatase (GB) which can be located with a fluorescent probe for the active centre of this enzyme. We have developed a rapid, cheap, fluorescent technique for the differential location of pleomorphic adenoma cells and acinar cells in frozen sections of salivary glands. The fluorescence of other cells (which also possess GB) is selectively quenched, such that only the acinar and pleomorphic adenoma cells are visualised by fluorescent microscopy.     

涎腺多形性腺瘤的倍体分布及与基因治疗的关系

目的:探讨涎腺多形性腺瘤的DNA含量及倍体分布与HSV-tk基因治疗的关系.方法:采用流式细胞仪测定50例涎腺良性多形性腺瘤DNA含量和倍体分布并结合临床资料进行分析;应用腺病毒介导的HSV-tk基因分别转染培养中良性及交界性多形性腺瘤细胞;RT-PCR方法检测基因表达;四唑蓝比色(MTI)法测定HSV-tk系统对二倍体及异倍体肿瘤细胞的杀伤作用.结果:10例正常涎腺组织皆为二倍体;涎腺良性多形性腺瘤异倍体率20.0%;30岁以下年龄,病程在2年以内及瘤体直径＞5cm者异倍体率明显增高(P＜0.05).二倍体肿瘤细胞转染HSV-tk/GCV基因后3、5天,细胞存活率分别为78.3%和37.7%.异倍体肿瘤细胞转染HSV-tk/GCV基因后3、5天,细胞存活率分别为27.6%和27.2%,二者细胞存活率有显著性差异(P＜0.05).结论:1)涎腺多形性腺瘤异倍体检出率与患者的年龄,病程及瘤体直径有密切关系;2)HSV-tk/GCV在治疗后的3、5天对异倍体肿瘤细胞杀伤作用明显高于二倍体肿瘤.     

Oncocytic pleomorphic adenoma of the parotid gland

A rare case of salivary gland pleomorphic adenoma, in which the majority of cells were oncocytic, is reported. The patient, a 53-year-old man, presented with a parotid gland mass that was otherwise asymptomatic. Surgical treatment consisted of a superficial parotid lobectomy. The specimen was prepared in standard fashion and studied by light and electron microscopy. The microscopic features were characteristic of salivary gland pleomorphic adenomas, however, both epithelial and "mesenchymal" elements were oncocytic. Such changes may occur focally in pleomorphic adenomas, but we were unable to find documentation of a wholly oncocytic variant in a review of the medical literature. From our clinical data and previous reports of pleomorphic adenomas with focal oncocytosis, it is concluded that such changes likely do not alter prognosis in affected patients. The possible significance of this lesion in regard to the histogenesis of salivary gland pleomorphic adenomas is discussed.     

Establishment and characterization of pleomorphic adenoma cell systems: an in-vitro demonstration of carcinomas arising secondarily from adenomas in the salivary gland

Background  

Among the salivary gland carcinomas, carcinoma in pleomorphic adenoma has been regarded as a representative carcinoma type which arises secondarily in the background of a pre-existent benign pleomorphic adenoma. It is still poorly understood how and which benign pleomorphic adenoma cells transform into its malignant form, carcinoma ex pleomorphic adenoma.     

Pleomorphic adenoma of the nasal septum

Despite the common occurrence of pleomorphic adenoma of major salivary glands, intranasal pleomorphic adenoma are rare. We present a ease of pleomorphic adenoma of the nasal septum along with a brief review of literature. The histological nature of this lesion in comparison to other salivary gland tumours and the importance of an accurate diagnosis has been stressed.     

Malignant mixed tumor

The term "malignant mixed tumor" is usually synonymous with "carcinoma in pleomorphic adenoma," a secondary carcinoma developing in pre-existing pleomorphic adenoma. However, it sometimes indicates a group of tumors consisting of carcinoma in pleomorphic adenoma, carcinosarcoma (true malignant mixed tumor) and metastasizing benign mixed tumor, the latter 2 being the most infrequent. According to the data of the Japanese committee on TNM classification for salivary gland carcinomas, carcinoma in pleomorphic adenoma accounted for about 10% of all salivary gland carcinomas, both in the parotid and submandibular glands. The main type of carcinomas arising in pleomorphic adenoma were undifferentiated carcinoma, adenocarcinoma and squamous cell carcinoma. Crude 5- and 10-year survival rates were 54.7% and 42.7%, respectively. Invasive carcinomas and carcinomas of high grade malignancy carried worse prognoses. The treatment of choice for carcinoma in pleomorphic adenoma has consisted of en-bloc excision with wide margin. Invasive growth, facial nerve involvement, lymph node metastasis or high-grade malignant tumor are grounds for postoperative radiation therapy. The role of chemotherapy has not yet been well established.     

Radiotherapy in epithelial tumors of the parotid gland: case presentation and literature review

A group of 113 patients irradiated for parotid tumor was studied retrospectively. Sixty-two patients were irradiated after superficial parotidectomy or enucleation of a pleomorphic adenoma. None of them had a recurrence after 5-15 years. Sixteen patients were irradiated postoperatively after surgery for a recurrence of pleomorphic adenoma. Only one of them had developed a recurrent tumor. Thirty-five patients with a malignant parotid tumor were treated by irradiation, 22 after surgery and 13 after biopsy only. Patients with a low malignancy tumor (10/11) and adenoid cystic carcinoma (6/12) responded better than patients with a high malignancy carcinoma (2/12). A tumor larger than 4 cm, facial nerve palsy, lymph node metastasis, and inoperability indicate a poor prognosis. With high dose radiotherapy it is possible to treat inoperable tumors successfully. Adenoid cystic carcinomas can respond well to irradiation alone.     

Functional gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland

IntroductionGland-preserving surgery is often used for benign tumours in the parotid gland. Partial superficial parotidectomy via a periauricular incision may bring satisfactory cosmetic outcomes but the disease control outcome remains unrevealed. This study evaluated functional and disease control outcomes after gland-preserving surgery via periauricular incision for pleomorphic adenoma of the parotid gland.MethodsThis longitudinal study included 248 consecutive patients with parotid pleomorphic adenoma who underwent the preservation of most normal parotid tissues and the facial nerve combined with the en-bloc resection of tumours via periauricular incision. Postoperative complications, subjective satisfaction, salivary function, and tumour recurrence were assessed in each patient. The secretory function of the salivary gland was measured using salivary scintigraphy at 6 months after surgery, and ultrasonography was regularly followed.ResultsMedian tumour size was 2.5 cm (range, 0.8–5.2 cm) and median operation time was 55 min (range, 39–88 min). All tumours were safely removed by gland-preserving surgery via periauricular incision without extension to Blair or hairline incision and tumour spillage. Temporary and permanent paralysis of the facial nerve was 14 (5.6%) and none of the study patients, respectively. Postoperative complications were minor and Frey's syndrome was found in 6 (2.4%) patients. The Secretary function of the affected gland was equal to that of the unaffected gland. No patients had a recurrence for a median follow-up of 78 months (range, 24–126 months).ConclusionsFunctional gland-preserving surgery via periauricular incision can treat pleomorphic adenoma in the parotid gland with satisfactory functional, cosmetic, and disease control outcomes.