12例涎腺肌上皮癌诊断与治疗分析

发布时间：2018-03-14 19:26

本文选题：肌上皮癌　切入点：涎腺　出处：《中国癌症杂志》2017年07期 　论文类型：期刊论文

【摘要】：背景与目的:涎腺肌上皮癌(myoepithelial carcinoma,MC)是一种罕见的涎腺恶性肿瘤,其诊断及治疗存在争议。该研究旨在探讨涎腺MC的临床表现、病理、免疫组织化学表型及治疗,以期提高该病的诊断和治疗水平。方法:对2010年1月—2016年6月就诊于西安交通大学第一附属医院的12例涎腺MC患者进行分析。平均年龄为(48.9±12.2)岁。采用H-E及免疫组织化学法染色,对组织形态学及免疫组织化学表型进行分析。11例行肿瘤扩大切除术,2例术后辅以放疗;1例未完整切除者,术后给予多西他赛120 mg(第1天)+顺铂40 mg(第1~3天)化疗4个周期。结果:7例发生于腮腺,5例发生于小涎腺。肿瘤直径为2.0~5.0 cm,肿瘤在切面上呈灰白色或灰红色,多无完整包膜,与周围组织分界不清,肿瘤内可有坏死及液化区。涎腺MC组织中透明细胞多见,亦可见上皮细胞、浆细胞样细胞及梭形细胞,细胞异型性明显;4例伴有出血坏死。12例表达CK,7例表达S-100,7例表达EMA,4例表达SMA,8例表达calponin,11例表达p63,5例表达vimentin,9例表达Ki-67。Ki-67增殖指数为2%~40%,平均为15%。随访2~78个月,10例术后患者未见局部复发及远处转移,1例于术后5个月因肾脏透明细胞癌死亡。1例经化疗后3个月死亡。结论:涎腺MC细胞形态多样,病理检查结合CK、p63、Ki-67、S-100、Vim、Calponin、EMA及SMA等免疫指标可提高MC的确诊率。以手术治疗为主,手术应有足够的边界,临床无淋巴结转移者,颈淋巴结清扫术不作为手术必须部分。
[Abstract]:Background & AIM: myoepithelial carcinoma of salivary gland (MCMC) is a rare malignant tumor of salivary gland and its diagnosis and treatment are controversial. Methods: from January 2010 to June 2016, 12 patients with salivary gland MC in the first affiliated Hospital of Xi'an Jiaotong University were analyzed. The average age was 48.9 卤12.2 years. H-E and immunohistochemical staining were used. Histomorphology and immunohistochemical phenotype were analyzed. 11 cases were treated with extended resection of tumor, 2 cases were treated with radiotherapy and 1 case was not completely resected. After operation, doxetaxel 120 mg (day 1) and cisplatin 40 mg (day 1) were given for 4 cycles. Results 7 cases occurred in parotid gland and 5 cases occurred in small salivary gland. The diameter of tumor was 2.0 ~ 5.0 cm. The tumor was grayish white or grayish red on the cut plane and had no complete capsule. There are necrotic and liquefaction areas in the tumor. Clear cells, epithelial cells, plasma cell-like cells and fusiform cells can also be seen in MC tissue of salivary gland. The proliferative index of Ki-67.Ki-67 was observed in 4 cases (mean 15 points) and in 9 cases (P < 0.05). The proliferative index of Ki-67.Ki-67 was 20.40% in 9 cases, and the expression of Ki-67.Ki-67 in 9 cases (mean 15). The follow-up period was 2 ~ 78 months after operation in 10 patients without Ki-67.Ki-67 proliferation index (P < 0.05). The expression of S-100T was found in 7 cases, and the expression of SMA in 8 cases, and the expression of calponin in 11 cases, p63N in 5 cases, and the proliferative index of Ki-67.Ki-67 in 9 cases was 20.40% (mean 15). Local recurrence and distant metastasis were found in 1 case died of clear cell carcinoma of kidney 5 months after operation. Conclusion: the morphology of MC cells in salivary gland is diverse. The diagnosis rate of MC could be improved by pathological examination combined with the immunological index of CKP p63Ki-67S-100 and SMA. The surgical treatment should be based on sufficient boundary. The neck lymph node dissection should not be a part of the operation if there is no lymph node metastasis in clinic.
【作者单位】：西安交通大学第一附属医院病理科;西安交通大学第一附属医院耳鼻咽喉头颈外科;
【分类号】：R739.87

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