涎腺淋巴上皮癌12例临床分析

发布时间：2018-05-10 08:45

本文选题：涎腺 + 淋巴上皮癌　；参考：《临床耳鼻咽喉头颈外科杂志》2017年14期

【摘要】：目的:提高对涎腺淋巴上皮癌(LEC)临床、影像学及病理特点的认识。方法:收集、分析12例涎腺LEC的临床表现、影像学资料、病理组织学及免疫组化检测结果、手术治疗效果资料。结果:12例LEC患者中,病变位于腮腺10例,颌下腺2例;2例为单侧多发肿块,其余10例为单侧单发肿块;4例合并颈部淋巴结转移,1例合并周围性面神经麻痹。10例EB-VCA-IgA阳性。所有病例CT平扫均为等密度,增强扫描均有明显强化。8例肿块形态不规则,境界不清或部分不清,强化不均匀。4例包膜不完整;6例无明显包膜;组织学检查肿瘤由片巢状分布的、呈浸润性生长的肿瘤上皮细胞和丰富的间质淋巴样组织构成,免疫组织化学检测示pan-CK、CD20和CD3阳性表达。12例均行原发灶及累及涎腺根治性切除加同侧选择性或治疗性颈清扫术加术后放疗,2例同时辅助化疗。所有病例均得到随访,9例无瘤生存3~11年,其余3例于明确诊断后1~2年局部复发或(和)远处转移而死亡。结论:涎腺LEC与EB病毒感染有关,多为单侧单发肿块,颈部淋巴结转移率高;CT显示涎腺LEC的肿块多呈恶性肿瘤征;确诊依赖于病理检查;手术联合放疗有可能取得较好的效果,局部复发和远处转移是致死的主要原因。
[Abstract]:Objective: to improve the clinical, imaging and pathological features of salivary gland lymphoepithelial carcinoma (LEC). Methods: the clinical manifestations, imaging data, histopathological and immunohistochemical findings of 12 cases of salivary gland LEC were collected and analyzed. Results among 12 LEC patients, 10 cases were located in parotid gland, 2 cases were unilateral multiple masses in submandibular gland, and 4 cases were unilateral mass with cervical lymph node metastasis in 1 case and peripheral facial paralysis in 1 case. EB-VCA-IgA was positive in 10 cases. In all cases, CT plain scan showed isodensity, enhanced CT scan showed obvious enhancement in 8 cases with irregular shape, unclear boundary or partial unclear boundary, and heterogeneous enhancement in 4 cases with incomplete capsule in 6 cases. Histologically, the tumor was composed of nesting tumor epithelial cells and abundant mesenchymal lymphoid tissue. Immunohistochemical examination showed that the positive expression of pan-CKT CD20 and CD3 in all the 12 cases were treated with primary tumor, radical resection of salivary gland and ipsilateral selective or therapeutic neck dissection plus postoperative radiotherapy and chemotherapy in 2 cases. All cases were followed up for 3 ~ 11 years without tumor. The other 3 cases died of local recurrence or / or distant metastasis 1 ~ 2 years after diagnosis. Conclusion: salivary gland LEC is associated with EBV infection, most of which are unilateral and unilateral masses. Ct with high cervical lymph node metastasis rate shows that salivary gland LEC masses are mostly malignant tumors, the diagnosis depends on pathological examination, surgery combined with radiotherapy may achieve better results. Local recurrence and distant metastasis are the main causes of death.
【作者单位】：南京医科大学附属无锡市第二人民医院耳鼻咽喉头颈外科;南京医科大学附属无锡市第二人民医院口腔科;
【分类号】：R739.87

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