腮腺分泌性癌临床病理分析（附2例）

目的:探讨分泌性癌（secretory carcinoma，SC）的分子遗传学特点、病理诊断与鉴别诊断特征、治疗及预后。方法:对2例罕见的腮腺SC进行组织形态分析及免疫组化研究,并复习相关文献。结果:男性患者2例,年龄分别为37岁和45岁,均因发现左面部无痛渐大肿物数年入院,CT均提示左侧腮腺占位。镜下见肿瘤细胞小到中等大,胞核呈圆形及卵圆形,可见小核仁,胞浆丰富,呈嗜酸性颗粒状。这些瘤细胞排列成实性、腺管状、微囊/筛状、乳头状-囊性等结构,周围包绕纤维间隔,部分腔隙内含有胶状或黏液样分泌物,偶见病理性核分裂象,未见坏死。免疫组化显示肿瘤细胞弥漫且强烈地表达Mammaglobin、S-100和SOX10,弥漫表达CK7、CK18、CD117和Vimentin,不同程度地表达GATA3,DOG1大部分区域表达缺失,仅在少数瘤巢周或腔缘呈弱阳性,而CgA、Syn、p63、GCDFP-15、AR和HER-2均阴性,Ki-67增殖指数约10%。结论:通常SC是一种罕见的低度恶性肿瘤,凭借对组织形态特征与免疫组化检测结果的仔细分析,大多数情况下足以做出SC的病理学诊断而勿须分子检测。

Clinicopathologic analysis of secretory carcinoma of the parotid gland(2 cases)

Objective:To investigate the molecular genetic characteristics,pathologic diagnosis,differential diagnosis,treatment and prognosis of secretory carcinoma(SC).Methods:Histomorphological analyse and immunohistochemical study were performed on 2 rare cases of SC of the parotid gland,and the relevant literatures were reviewed.Results:Two male patients with 37 and 45 years old respectively,were admitted to the hospital due to the painless and growing mass on the left face for several years and CT indicated the left parotid gland occupation.Microscopically,the tumor cell was small to medium in size,which possessed relatively uniform round to oval nuclei with small nucleoli and abundant eosinophilic granular cytoplasm.These tumor cells were arranged into solid,glandular tubular,microcystic/cribriform,and papilla-cystic structures,surrounded by fibrous septa,and contained colloid-like or mucinous secretions in some lacunas.Mitotic figures were occasionally seen.There was no necrosis.Immunohistochemistry showed that Mammaglobin,S-100 and SOX10 were diffusely and strongly expressed in tumor cells.CK7,CK18,CD117 and Vimentin were strongly expressed,and GATA3 was expressed to varying degrees.The expression of DOG1 was absent in most of the tumor cells,and was weakly positive only in a few of the surrounding of tumor nests or lumen margin,while CgA,Syn,p63,GCDFP-15,AR and HER-2 were negative.Ki-67 proliferation index was about 10%.Conclusion:In general,SC is a rare low-grade malignant tumor.Careful analysis of histological characteristics and immunohistochemical results is sufficient in most cases to produce a pathological diagnosis of SC without the necessity of molecular testing.