腮腺硬化性多囊性腺病临床病理分析

目的探讨腮腺硬化性多囊性腺病（SPCA）的临床病理特征和预后。方法报道1例腮腺SPCA，做HE和免疫组化染色，结合文献对该病的临床表现、病理形态特点及预后进行探讨。结果患者女性，29岁，发现左腮腺无痛性结节状瘤样肿块1年。组织学上类似于纤维性囊性乳腺病。镜下见病变以大片玻璃样变性的硬化的胶原组织为背景，包埋入囊性扩张的导管，形成不规则、模糊的小叶结构。导管上皮有的呈大汗腺样化生，有的胞质内含丰富、粗大的强嗜伊红酶原颗粒，有的呈泡沫细胞样外观。导管可见上皮增生及结构不良。结论SPCA应纳入大涎腺肿瘤的鉴别诊断之中。目前对该病的自然病程和确切的复发率尚不清楚，同时鉴于已有SPCA伴发导管原位癌的报道，因此患者术后应密切随访。

Sclerosing polycystic sialadenopathy of parotid: a case report and review of literature

Purpose To investigate the clinicopathological characteristics and prognosis of sclerosing polycystic sialadenopathy.Methods The clinical data,pathological features and prognosis were analyzed in one case of sclerosing polycystic sialadenopathy with review of the literature.Results The patient was a 29-year-old woman,presenting with a painless left parotid swelling.Histologically,it was comparable to fibrocystic mastopathy and characterized by distinct hyalinized,centrally accentuated sclerosing collageneous tissue with inclusion of cystically ectatic ducts, forming a vaguely lobular pattern.The dilated ducts frequently showed apocrine-like metaplasia and epithelial hyperplasia.Focally,acinar elements contained abundant large,intensely eosinophilic intracytoplasmic granules believed to represent altered zymogen granules.Some of other ductal epithelial cells showed foamy cell-looking.Immunohistochemical staining(calponin and smooth muscle actin) demonstrated a peripheral myoepithelial layer,which confirmed the intraductal nature of the hyperplastic ducts.The limited available follow-up suggests that this process has a favorable prognosis despite recurrence in some cases.Occasional cases with carcinoma in situ were reported.To date,no patients had developed metastases or died from disease.Differential diagnoses included mucoepidermoid carcinoma,adenoid cystic carcinoma,acinic cell carcinoma,cystadenoma,cystadenocarcinoma,polymorphous low-grade adenocarcinoma and dysgenetic cystic parotid.Conclusions Sclerosing polycystic sialadenopathy should be included among the differential diagnoses of major salivary gland tumors.To date,the natural disease progression of these lesions and recurrence rates cannot yet be accurately reported.In view that some cases can be associated with dysplasia and carcinoma in situ,a long-term postoperative follow-up may be a must for each patient.