678例口腔唾液腺肿瘤临床病理分析

目的探讨近28年唾液腺肿瘤的发病趋势及临床病理特点, 为临床和病理医生提供有价值的诊断思路。方法 材料来自天津医科大学总医院及第二附属医院病理科1980年-2007年临床外科病理档案中口腔唾液腺肿瘤病例, 以Microsoft excel表格形式存储, 应用SPSS11.5对该资料进行统计分析。结果 28年来唾液腺肿瘤总检出数逐年增高, 男女之比为1.030∶1;良恶性肿瘤之比为4.795∶1。良性肿瘤年龄高发区段为40岁-60岁, 恶性肿瘤为50岁-70岁高发。发病部位以腮腺最常见(70.94%)。良性肿瘤以多形性腺瘤最常见(69.34%);恶性以腺样囊性癌最常见(35.90%)。结论 28年来唾液腺良性和恶性肿瘤均呈上升趋势;良恶性肿瘤均以腮腺最常见;发生在各部位的肿瘤均以多形性腺瘤最常见。     

Salivary Gland Tumors in Turkey: Demographic Features and Histopathological Distribution of 510 Patients

The aim of this study was to evaluate the demographic and clinicopathologic data of salivary gland tumors managed at a tertiary referral medical center in Turkey. The data of 510 patients with salivary gland tumors managed during the period of January 1984 to May 2012, were reviewed. Only primary neoplasms derived from salivary glands were included. Out of 510 neoplasms, 352 (69.0 %) were classified as benign and 158 (31.0 %) were classified as malignant. There was a male predominance and male:female ratio was 1.23 (281/229). The most common location was parotid gland (372/510, 72.9 %) followed by minor salivary glands (97/510, 19.0 %) and submandibular gland (40/510, 7.9 %). The malignancy rates were 21.5, 40.0, and 56.7 % in parotid, submandibular, and minor salivary glands locations, respectively. The most common location for minor salivary gland neoplasms was oral cavity (61/97, 62.9 %). Pleomorphic adenoma (PA) was the most common histopathological type (45.3 %) in the whole study group and also among pediatric patients. The most common malignant neoplasms were adenoid cystic carcinoma (39/510, 7.6 %) and mucoepidermoid carcinoma (5.7 %). Salivary gland tumors are more common in men. The malignancy rate is almost three times higher in neoplasms derived from minor glands when compared to parotid gland. PA is the most common histopathological tumor type in all locations and in all age groups.     

Histopathological Diversity in Parotidectomy Materials in Turkish Population: Clinicopathologic Analysis and Demographic Features of 136 Cases in a Tertiary Care Hospital

Background: Salivary gland tumours, which account for approximately 3% of head-neck cancers, are aheterogeneous group and thus it is difficult to identify their epidemiological characteristics. The aim of this studyis to determine demographic features and histopathologic distribution of parotid neoplasms in a large sample fromTurkey. Materials and Methods: This study was conducted retrospectively on 136 parotidectomy materials fromoperations between May 2009-May 2013. Age, gender, tumor diameter, histopathological diagnosis and surgicalmargin status were recorded. Results: The benign cases were 112 (82.4%), while the malignancies were 24 (17.6%).The accuracy rate of FNAC was 91%. There were 46 (33.8%) male and 90 (66.2%) female patients. Female/male ratio (M/F=0.5) was two, the Warthin (WT) tumor being more apparent in males (p<0.05). Pleomorphicadenoma (PA) was detected most frequently among benign pathologies at 61.6% (69/112), while the WarthinTumor (WT) was detected as the second most frequent tumor at 20.5% (23/112). Mucoepidermoid carcinoma(MEC) and carcinoma ex pleomorphic adenoma (Ca ex PA) were detected at equal frequency at 20.8% (5/24)among malign tumors. These were followed by acinic cell carcinoma at 16.7% (4/24). While the surgical marginwas positive in ten patients with malignant tumors (41.7%), all of the benign tumors were negative (p<0.01).No significant difference was detected in the age-gender of patients, tumor size and distribution of sites amongbenign and malignant groups (p>0.05). Conclusions: Pleomorphic adenoma is the most frequently reportedbenign tumor almost in all global literature. Yet, the distribution of malignant tumors displays geographicaldifferences. Based on these data, we believe that our findings will provide a significant contribution to futureepidemiological studies. We think that it will be beneficial to generate awareness on parotid tumors and ensurea fight against smoking as with all head-neck cancers.     

Salivary gland tumors of the tongue. Analysis of 55 new cases and review of the literature

Fifty-five cases of primary salivary gland tumors of the tongue from the files of the Armed Forces Institute of Pathology are reported and analyzed and the results compared with the information in the literature. Five tumors were benign and 50 were malignant. The average age at presentation was 47 years for the benign tumors and 54.3 years for the malignant ones. Although the overall benign/malignant ratio was 1:10, women were more likely to have a malignant tumor than were men. The site of 80% of the benign tumors was the middle to anterior portion of the tongue, whereas over 85% of malignant tumors involved the base. Clinical signs and/or symptoms related to the site aroused suspicion in some cases but often were of short duration and in over 60% of cases did not occur. The most common benign tumor type was the myoepithelial variant of the benign mixed tumor. The most common malignant tumor type was the low-grade mucoepidermoid carcinoma (38%) followed by adenocarcinoma (20%), high-grade mucoepidermoid carcinoma (14%), adenoid cystic carcinoma (10%), and clear cell carcinoma (8%), with occasional basaloid, papillary cystadenocarcinoma, acinic cell and mucus-producing adenocarcinoma. Treatment was similar to that of other accessory salivary gland neoplasms of similar histologic type and clinical stage. Prognosis worsened with high histologic grade, old age, and advanced clinical disease at presentation.     

Benign, malignant salivary gland tumors: comparison of immunohistochemical expression of e-cadherin

The aim of the present study was to assess any variation in the immunohistochemical expression of E-cadherin in benign and malignant salivary gland tumors. A total of 60 cases of benign and malignant salivary gland tumors were evaluated immunohistochemically for E-cadherin expression. These included 10 cases of pleomorphic adenoma (PA), 2 cases of canalicular adenoma (CA), 2 cases of myoepithelioma (MY), 24 cases of adenoid cystic carcinoma (ACC), 12 cases of mucoepidermoid carcinoma (MEC), 9 cases of adenocarcinoma (AC) and 1 case of carcinoma ex pleomorphic adenoma (Ca Ex PA). 48 cases (80%) showed positive expression, in which benign tumors exhibited relatively increased reactivity (85.7%) as compared to the malignant tumors (78.3%). 10 PA, 2 MY, 20 ACC, 9 MEC, 6 AC and 1 Ca Ex PA expressed E-cadherin. Negative expression was evident in CA, ACC, MEC and AC. Statistically significant reduction in reactivity was evident in mucoepidermoid carcinoma and adenocarcinoma, when compared to pleomorphic adenoma.     

MRI征象在腮腺肿瘤定性诊断中的价值及其病理基础

背景与目的：腮腺肿瘤的病理类型非常复杂,MRI在其诊断中具有明显的优越性,但在诸多方面诊断标准仍不统一,需要大样本的病例分析以探讨MRI征象在其诊断中的价值及其病理基础。本文总结常见腮腺良、恶性肿瘤的MRI表现,以探讨各征象在腮腺肿瘤定性诊断中的作用。方法：收集132例腮腺肿瘤及其它病变患者(共140个病灶)的MRI资料,其中良性者89例,恶性者43例。112例经手术病理证实,17例经活检证实,3例经临床观察证实。对其中58例手术切除病灶完整者的标本行病理逐层切片检查,并将结果与MRI影像进行对照分析。MRI平扫采用TlWI、T2WI,其中108例共115个病灶同时行平扫和增强扫描。统计学分析采用X^2检验。结果：(1)常见腮腺良性肿瘤的MRI特征表现：所有行增强扫描的40个腺淋巴瘤均呈轻度增强,其中25例T2WI表现为低、等信号;22例混合瘤T2WI表现为高而不均匀信号;5例血管瘤可见异常增粗的血管结构;3例囊性淋巴管瘤的形状特别不规则并包绕邻近结构;4例脂肪瘤的信号类似于其它部位的脂肪瘤。(2)常见腮腺恶性肿瘤的MRI特征表现：8例混合瘤恶变的T2WI信号高而不均匀,且形状不规则,边界不清楚;7例腺样囊性癌以侵犯范围广泛为特征;8例粘液表皮样癌中,3例低度恶性者边界清楚,与良性肿瘤难区别,5例中、高度恶性者边界不清,易发生坏死及淋巴结转移;9例淋巴瘤均为继发,范围较广,可分辨出由多个结节组成;3例腺泡细胞癌内有TlWI和T2WI均为高信号的囊变区,形状规则或不规则。结论：常见腮腺良、恶性肿瘤在MRI表现上各有特点,对大多数病例用MN进行定性诊断是可能的。     

Intra-oral minor salivary gland tumors: a clinicopathological study of 546 cases

Salivary gland tumors are uncommon and most reported series include tumors affecting both major and minor glands. Very few series have focused solely on intra-oral minor salivary gland tumors. The aim of this study is to report the clinicopathological data of intra-oral minor salivary gland tumors in our oral biopsy files during the last 14 years. A total of 546 minor salivary gland tumors, including 305 benign (55.9%) and 241 malignant (44.1%) lesions, were reviewed. The two most common tumors were pleomorphic adenoma (181 cases, 33.2%) and mucoepidermoid carcinoma (125 cases, 22.9%), and the most commonly affected site was the palate (181 cases, 33.2%). The highest incidence was found in patients in the 5-7th decade of life, and females were more commonly affected than males in the vast majority of various histological types of tumors. Large series of intra-oral minor salivary gland tumors help to understand their clinical and pathological aspects and consequently their proper management and prognosis.     

The range and demographics of salivary gland tumours diagnosed in a UK population

Salivary gland tumours are relatively rare and comprise a diverse range of neoplasms. The aim of this study was to determine the range and demographics of all histologically diagnosed salivary tumours in a European population. All entries for salivary gland tumours from 1974 to 2005 inclusive were retrieved and analysed for each diagnosis including number of specimens, male:female ratio and age range. These data were then analysed for the distribution of benign and malignant salivary tumours in major and minor salivary glands. 58,880 specimens were received; of these, 741 cases (1.3% of all specimens) were diagnosed as salivary gland tumours with a male to female ratio of 0.7:1. There were 481 (64.9%) benign and 260 (35.1%) malignant neoplasms, with the most common tumours being pleomorphic adenoma and mucoepidermoid carcinoma, respectively. Our study provides demographic data on a large series of salivary gland tumours in a European population. Accurate diagnosis is essential as salivary lesions have diverse clinical and prognostic outcomes. This study has confirmed that some tumours have a predilection for certain sites and that the risk of malignant disease is also greater at specific sites within the oral cavity.     

FNAC of salivary gland lesions with histopathological correlation

Hypothesis: Analysis of salivary gland lesions by FNAC and correlation with histopathology. To evaluate utility of FNAC in salivary gland lesions.Back ground: Salivary gland lesions form about 2–6.5% of all head and neck neoplasms in adults. They are easily accessible for FNAC (Fine Needle Aspiration Cytology) and risks of fistula formation or tumour implantation are low compared surgical biopsy. Also, cytology can provide a distinction between asalivary and non salivary lesion, benign and malignant lesions so also specific and non specific inflammation. Methods: Seventy patients were studied prospectively over two years. FNAC was done using 10 cc syringes and 20–22 no. needle. Histomorphology was assessed on routine H & E (haemotxylin and eosin) stained paraffin sections. SPAS (periodic acid Schiff) and mucicarmine satins were also done. Results: 80% of the lesions were neoplastic (61% benign, 31% malignant) and 20% were neoplastic. Pleomorphic adenoma was the most frequent benign neoplasm while mucoepidermoid carcinoma was the most frequent malignant lesion. Among the non neoplastic lesions, the maximum number of cases were of chronic sialadentis. In the present study, FNAC has a sensitivity of 94.54% and specificity of 80.95% for neoplastic lesions. Conclusions: FNAC was found to be a useful diagnostic tool in the evaluation of salivary gland lesions because of its simplicity, excellent patient compliance and rapid diagnosis. This cost effective tool is invaluable in planning the surgical management of the patient.     

The role of immune surveillance in malignant transformation of benign salivary gland tumors

Pleomorphic adenoma (PA), the most common salivary gland tumor, is a benign tumor that carries a risk of malignant transformation to various histologies of carcinoma ex pleomorphic adenoma (CA exPA). Recently, genomic analyses have provided deeper insights into the molecular biology of salivary gland cancers. However, the molecular processes that underlie the progression from PA to CA exPA are largely unknown. In this study, we used RNAseq data from CA ex PA of myoepithelial (n = 24) or salivary duct histology (n = 6), de novo myoepithelial carcinoma (n = 16) and de novo salivary duct carcinoma (n = 10), and compared their constituent immune tumor microenvironments. We found that increasing levels of immune infiltration and activation were associated with a generally lower probability of cancer developing ex-PA, suggesting that immune surveillance may constrain the malignant transformation of benign salivary tumors. More immunologically infiltrated tumors were more likely to have developed de novo. Taken together, these data suggest a role for tumor escape from immune surveillance in the development of CA exPA. The immune-cold microenvironments of CA ex PA tumors may in part explain their more aggressive clinical behavior.     

F. N. A. C. of salivary glands

During a period of 12 years, 874 salivary gland lesions were aspirated of which 740 (86.85%) were from parotid gland. Cystic, inflammatory & neoplastic lesions were 25.25%. 54.45% & 20.30%, respectively. Plcomorphic adenoma was the commonest benign & adenoid cystic carcinoma was the most frequent malignant tumors. On cytohistologic correlation, sensilitvity of cytology for diagnosing cystic, inflammatory, neoplastic lesions proved to be 93.3%. 95.7% & 100% respectively. Overall accuracy for cytodiagnosis of malignant salivary gland lesions in our study was 96.07%.     

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.     

Expression of Ki67 and CD105 as Proliferation and Angiogenesis Markers in Salivary Gland Tumors

Objective: To investigate the association between CD105 and tumor cell proliferation in salivary gland tumors.Methods: In this study, 59 samples of salivary tumors from Khalili Hospital archive, including 20 cases ofpleomorphic adenoma (PA), 20 cases of mucoepidermoid carcinoma (MEC) and 19 cases of adenoid cysticcarcinoma, as well as 10 cases of normal salivary gland tissue, were reviewed by immunohistochemistry (IHC)for CD105 and Ki67 staining. Results: CD105 positive vessels were absent in normal salivary gland tissue inthe vicinity of tumors (51.6% of all tumors were positive). There was a statistically significant difference infrequency of CD105 staining between PA and malignant tumors and between four groups of different lesions(p<0.000) being highest in MEC. Intratumoral microvessel density was also elevated in malignant neoplasms(2.61±3.1) as compared to PA (0.46±0.6). Normal salivary glands did not express Ki67. There was a statisticallysignificant difference in frequency and percentage of Ki67 immunoreactivity in malignant neoplasms (86.5% and10.7±10.8 respectively) compared to PA (50% and 0.78±0.2) and among the four groups values were highest inMEC (p<0.000). Conclusion: n this study, it was observed a higher rate of angiogenesis and cellular proliferationwas noted in malignant tumors compared to benign tumors, but no correlation was observed between these twomarkers.     

Salivary Gland Tumors: A Clinicopathologic Study of 366 Cases in Southern Iran

Background: Salivary gland tumors (SGT) are one of the most complex human neoplasms, demonstratingvariations in their clinicopathological profile related to racial and geographic differences. Few studies with largesamples have been reported in Iran. We here investigated a large group of patients in southern Iran. Materialsand Methods: In this retrospective study, all cases of primary epithelial salivary gland tumors, which had beenrecorded in a 5 years period from 2005-2009, were enrolled. Clinical data such as histopathologic type and site ofthe lesion as well as patients’ age and gender were analyzed. Results: Data of 366 cases of SGTs were recorded.Pleomorphic adenoma (80.2%) and adenoid cystic carcinoma (46.6%) were the most common benign andmalignant neoplasms. Male to female ratio (M/F) and the mean age of patients were 1:1.05 and 37.7 for benigntumors while they were 1.2:1 and 50.6 for malignant tumors, respectively. Parotid and minor salivary glandswere involved more frequently. Conclusions: Although the salivary gland tumours encountered were similar inmost of their characteristics to those reported in other countries, some differences such as relative frequencyand age and gender prevalence were discovered. These findings should help surgeons and pathologists for moreaccurate diagnosis, management and treatment.     

Adenoid cystic carcinoma of the buccal vestibule: A case report and review of the literature

Minor salivary gland tumors of the buccal vestibule are relatively rare. Adenoid cystic carcinoma is the fifth most common salivary gland malignancy following mucoepidermoid carcinoma, adenocarcinoma not otherwise specified (NOS), acinic cell adenocarcinoma and polymorphous low-grade adenocarcinoma (PLGA). Greater than half of adenoid cystic carcinomas occur in the parotid and submandibular glands. The most common intraoral site is the palate. Adenoid cystic carcinoma tends to have a protracted clinical course with wide infiltration and late distant metastases. We present a case of an adenoid cystic carcinoma of the buccal vestibule in a 59-year-old Caucasian female patient that she had been aware of for 15 years.     

116例腮腺粘液表皮样癌患者的预后因素分析

背景与目的:粘液表皮样癌是涎腺中最常见的恶性肿瘤,有关腮腺的粘液表皮样癌的大宗病例报道较少.本研究旨在探讨影响腮腺粘液表皮样癌患者预后的临床病理因素.方法:回顾性分析中山大学肿瘤防治中心1980年5月至2000年12月收治的116例腮腺粘液表皮样癌患者的临床资料,对其预后进行单因素和多因素分析.结果:116例腮腺粘液表皮样癌患者的5、10和15年生存率分别为75.64%、64.55%和60.39%.单因素生存分析显示年龄、饮酒及T分期等12项因素是腮腺粘液表皮样癌预后的影响因素.多因素分析表明T分期(P=0.006,OR＞1)、病理分级(P=0.000,OR＞1)、远处转移(P=0.000,OR＞1)是影响腮腺粘液表皮样癌患者预后的独立因素.结论:T分期、病理分级和远处转移是影响腮腺粘液表皮样癌患者预后的独立危险因素.     

Parotid Gland Tumours in Turkish Population: Analysis of 165 Patients

Background: Retrospective data on 165 patients who presented with a parotid mass and underwent surgeryin our clinics during 2000-2009 were examined. The obtained data (demographic data, surgical procedures,histopathological diagnoses) were compared to similar studies to make contributions to the literature. Materialsand Methods: Patients were classified according to their histopathological diagnosis. Surgical procedures andpatient follow-up were clarified. The results are presented as means and standard deviations. Results: Of the 165masses, 134 (81.3%) were benign and 31 (18.7%) were malignant. Pleomorphic adenoma was the most commonbenign tumour (79 patients, 59%). Lymphoma and adenoid cystic carcinoma were equally common and were themost common malignant parotid gland tumours (both 6 patients, 19.3%). The most frequent surgical procedurewas superficial parotidectomy (92 patients, 55.7%), and the most commonly encountered surgical complicationwas facial paralysis (12 patients, 7.2%). Conclusions: Our data are generally in line with the literature butlymphoma was more common than in most previous reports. Although the number of cases was low, the highincidence of parotid gland lymphoma was remarkable.     

Carcinoma of salivary glands--a clinical analysis of 342 cases

342 cases with carcinoma of salivary glands were analysed. 152 tumors were located in parotid, 42 in submaxillary, 17 in sublingual and 131 in minor salivary glands. Pathological diagnosis were 106 mucoepidermoid carcinoma, 80 adenoid cystic carcinoma, 54 malignant mixed tumor, 40 adenocarcinoma, 38 papillary cystadenocarcinoma, 17 acinic cell carcinoma, 5 squamous cell carcinoma, and 2 undifferentiated carcinoma. The 3, 5, 10 and 15 year survival rates of these 342 cases were 76.6%, 65.9%, 48% and 29%, respectively. The difference between survival rate and relapse-free survival rate was about 8%. The prognosis of acinic cell carcinoma and mucoepidermoid carcinoma was much better than that of squamous cell carcinoma, adenocarcinoma and undifferentiated carcinoma. The survival rates, according to location, were: minor salivary gland tumors the highest, and those of submaxillary gland tumors the lowest. Postoperative radiotherapy improved the survival rate of adenoid cystic carcinoma. The overall recurrence rate was 37.4%, the neck lymph node metastasis rate 14.3% and the distant metastasis rate 9.1%.     

涎腺癌中增殖细胞核抗原的表达及意义

目的探讨增殖细胞核抗原(proliferating cell nuclear antigen PCNA)在涎腺癌中的表达及临床病理学意义.方法采用免疫组化S-P法检测62例涎腺癌(10例恶性混合瘤;20例腺样囊性癌;32例粘液表皮样癌)中PCNA表达情况.结果PCNA在不同类型的涎腺癌中表现出不同的表达水平及分布特征,PCNA阳性程度与肿瘤的组织学分级及临床行为(复发、转移)明显相关.结论涎腺癌中PCNA表达水平与细胞分化有关;PCNA指数可作为粘液表皮样癌病理分级的重要参数;PCNA高表达可能是涎腺癌预后不良的标志.     

Salivary gland carcinoma in Denmark 1990-2005: a national study of incidence, site and histology. Results of the Danish Head and Neck Cancer Group (DAHANCA)

To describe the incidence, site and histology (WHO 2005) of salivary gland carcinomas in Denmark. Nine hundred and eighty-three patients diagnosed from 1990 to 2005 were identified from three nation-wide registries. The associated clinical data were retrospectively retrieved from patient medical records. Histological revision was performed in 886 cases (90%). Based on histological revision, 31 patients (3%) were excluded from the study leaving 952 for epidemiological analysis. The mean crude incidence in Denmark was 1.1/100,000/year. The male vs. female ratio was 0.97 and the median age was 62 years. The parotid gland was the most common site (52.5%) followed by the minor salivary glands of the oral cavity (26.3%). The most frequent histological subtypes were adenoid cystic carcinoma (25.2%), mucoepidermoid carcinoma (16.9%), adenocarcinoma NOS (12.2%) and acinic cell carcinoma (10.2%). The revision process changed the histological diagnosis in 121 out of 886 cases (14%). The incidence of salivary gland carcinoma in Denmark is higher than previously reported. More than half of salivary gland carcinomas are located in the parotid gland with adenoid cystic carcinoma being the most frequent subtype. Histological classification of salivary gland carcinomas is difficult and evaluation by dedicated pathology specialists might be essential for optimal diagnosis and treatment.