鼻咽原发性腺癌的临床病理分析

背景与目的:鼻咽原发性腺癌非常少见,少有大宗病例的报道。本研究旨在探讨鼻咽原发性腺癌的临床病理特征。方法:复习中山大学肿瘤医院病理科24年鼻咽部癌活检资料;收集有较详细临床资料及蜡块保存较好的鼻咽部原发性腺癌标本39例,进行HE、PAS及Alcian蓝染色,光镜下进行形态学观察;收集177例鼻咽癌(WHO所定义的鼻咽癌,包括角化性鳞状细胞癌和非角化性癌)的临床资料作为对照。结果:(1)24年间鼻咽部癌活检病例共31791例,其中鼻咽腺癌153例,占0.48%。(2)39例鼻咽原发性腺癌患者中位年龄为46岁,发病高峰年龄段为40～49岁。(343.5%(17/39)的鼻咽原发性腺癌为女性。(4)39例鼻咽原发性腺癌中,就诊时局部病变超出鼻咽腔(T3)或/和侵犯破坏颅骨或/和颅神经(T4)者占60.53%,但颈淋巴结肿大者仅7例(占17.95%,7/39),与鼻咽癌的淋巴结转移率(76.84%,136/177)相比差异有显著性(P<0.01)。(5)39例鼻咽原发性腺癌中有普通型腺癌16例和涎腺型腺癌23例,前者包括低度恶性者9例和高度恶性者7例,后者包括腺样囊性癌17例,粘液表皮样癌6例。(6)其中7例普通型腺癌(包括所有5例乳头状腺癌)见到癌组织与鼻咽粘膜表面上皮直接过渡;4例粘液表皮样癌见到癌组织与鼻咽粘膜表面鳞化上皮直接过渡;2例腺样囊性癌见癌旁的小涎腺导管上皮增生、

Clinicopathological characteristics of primary nasopharyngeal adenocarcinoma

BACKGROUND & OBJECTIVE: The primary nasopharyngeal adenocarcinoma (NPAC) is rare. This study was designed to investigate the clinicopathological characteristics of primary NPAC. METHODS: A series of carcinoma biopsies taken from the nasopharynx of the patients followed at Cancer Center, Sun Yat-sen University were reviewed during 24 years. The clinical data and paraffin blocks of 39 NPAC patients were used for this study. In addition, the clinical manifestations of 177 nasopharyngeal carcinoma (NPC) patients were adopted as control. HE, Alcian blue, and PAS histochemical staining were performed and then the morphology was observed under microscope. RESULTS: (1) There were 153 NPACs found in 31791 carcinomas of the nasopharynx; thus the hospital-based frequency of NPAC was 0.48% (153/31791). (2) The median age of 39 NPAC patients was 46.0 years old and the age peak was 40-49 age group. (3) Seventeen out of 39 NPAC patients (43.5%) were female. (4) Most of NPAC tumors (23/38) took growth beyond the nasopharyngeal cavity (T3) and/or invasion to the cranial bone and/or cranial nerves (T4). Furthermore, only 7 NPAC patients (7/39, 17.95%) had lymph node metastasis; and on the contrary, there were 136 out of the 177 patients (136/177, 76.84%) with NPC had lymph node(s) metastasis. There was significant difference between these two percentages (17.95% vs. 76.84%, P< 0.01). (5) The 39 NPACs could be classified into 2 categories, namely conventional type (16 cases) and salivary gland type (23 cases). The conventional type could further be graded as low-grade (9 cases) and high-grade (7 cases). The 23 salivary-gland type NPACs consisted of 17 adenoid cystic carcinomas and 6 mucoepidermoid carcinomas. (6)The continuation of neoplastic cells to surface lining epithelium was presented in 7 conventional type adenocarcinomas (including all 5 papillary adenocarcinomas) and 4 mucoepidermoid carcinomas. The transition from the adenoid cystic carcinoma cells to the atypical hyperplastic lesion of the ductal epithelium of minor salivary gland was observed in 2 cases. CONCLUSION: The primary NPAC is uncommon. The age distribution of NPACs is not different from that of NPCs. Most patients show significant local invasion, but scarce cervical lymph node metastasis, especially adenoid cystic carcinomas.