涎腺透明细胞变异型黏液表皮样癌的临床病理研究

目的：报告10例涎腺透明细胞变异型黏液表皮样癌的临床病理及角蛋白表达特点。方法：回顾复习武汉大学口腔医学院1985～2006年收治、并经病理诊断为黏液表皮样癌的病例，确诊10例透明细胞变异型。全部病例行HE、PAS、AB—PAS、阿辛蓝和角蛋白免疫组织化学染色并随访。结果：本组病例约占同期所有涎腺MEC的4．7％（10／211），其中男女各5例，平均年龄42岁，腭部8例，舌根和腮腺各一例。镜下肿瘤主要由透明细胞组成的团块状或片状癌巢，其内混合少量非透明细胞（表皮样细胞或中间细胞），通常位于透明细胞的周边，呈逐渐的过渡。角蛋白免疫组化结果显示，CK7、CK8／18和CK19在所有病例中都呈强阳性表达，CK5／6、CK14、CK17和CK10／13大部分病例中呈局灶性或散在细胞表达。结论：透明细胞变异型黏液表皮样癌是黏液表皮样癌一种少见的变异，腭部多见。组织化学染色和CK10／13在透明细胞变异型黏液表皮样癌与非特异性透明细胞癌的鉴别诊断中有帮助。     

8例涎腺透明细胞癌临床病理分析

目的:探讨涎腺透明细胞癌(CCCs)生物学特性和组织来源。方法:收集8例涎腺透明细胞癌标本,采用免疫组化方法和文献回顾对涎腺透明细胞癌进行研究分析。结果:透明细胞癌EMA和CK8全阳性表达(8/8、100/100),Ck18和CK-HMW小部分阳性表达(各2/8、25/100),S-100仅1例阳性表达。SMA、Calpon in和P53无表达,bc l-2全阳性表达,PCNA阳性表达率为72.25%。结论:涎腺透明细胞癌是腺上皮性肿瘤,肿瘤细胞增殖活跃,是一种低度恶性肿瘤。     

涎腺肿瘤256例临床病理分析

涎腺肿瘤２５６例临床病理分析湖北医科大学附属口腔医院外科（４３００７０）许丽萍钟林生王秀丽我科１９８５年－１９９０年共收治涎腺肿瘤２５６例，其诊断均经病理证实，本文就其临床及病理资料分析如下。临床资料１、性别和年龄：男性１３５例，女性１２１例，男女之...     

涎腺透明细胞肌上皮癌和透明细胞癌的临床病理比较分析

目的：探讨涎腺透明细胞肌上皮癌和透明细胞癌的临床病理与免疫组化特征。方法：回顾分析武汉大学口腔医学院口腔病理科1985～2008年期间确诊的3例透明细胞肌上皮癌和5例透明细胞癌。常规HE染色和免疫组化（CKAE1/AE3,S100,vimentin,smooth muscle actin,calponin,P63和maspin）做比较观察。结果：两种肿瘤几乎全部由透明细胞构成,在透明细胞肌上皮癌中可见少量梭形细胞,透明细胞癌中可见少量含有嗜酸性胞浆的细胞。免疫组化显示：透明细胞肌上皮癌中,3例均阳性表达CKAE1/AE3,S100,vimentin,P63和maspin,2例阳性表达smooth muscle actin和Calponin;透明细胞癌中,5例均阳性表达CKAE1/AE3,P63和maspin,而S100,vimentin,smooth muscle actin,calponin均呈阴性表达。结论：涎腺透明细胞肌上皮癌和透明细胞癌都很罕见,二者可通过组织病理和免疫组化特点进行鉴别。由于肿瘤性肌上皮细胞可呈现不同的肌源性分化,因此联合运用多种提示肌上皮源性的标志物如CKAE1/AE3,S100,vimentin,smooth muscle actin和calponin对二者鉴别诊断有帮助。P63和maspin缺乏特异性。     

6例口腔乳头状涎腺瘤的临床病理特点分析

目的:探讨口腔乳头状涎腺瘤(Sialadenomapapilliferum,SP)的临床病理特点、病变性质、生物学行为及组织学发生。方法:对6例SP复片,观察其组织病理学特点,分析临床资料并随访,其中4例进行免疫组织化学染色,所用抗体为AE1/AE3、CK8、S-100、SMA、Vim、GFAP。结果:患者平均年龄64岁,男女之比为1∶1。临床无明显症状,肿瘤部位:舌缘3例,腭2例,舌根1例,肿瘤平均直径1cm。镜下见肿瘤无明显包膜,表面为口腔黏膜乳头状增生的复层鳞状上皮,其下肿瘤形成大小不等的管腔、囊腔样结构,部分管腔表面形成乳头状突起,管腔及乳头上皮被覆双层细胞。随访4例,均无复发及转移。免疫组化结果:表层细胞对AE1/AE3、CK8呈阳性表达,基底层细胞对S-100、AE1/AE3、SMA、Vim、GFAP呈阳性表达。结论:SP为良性肿瘤,组织学上以大小不等的管腔样结构内形成乳头为特征,预后良好,肿瘤可能来源于类似于分泌管的导管细胞。     

涎腺正常与肿瘤组织中p63、CK5、CK19、CEA及SmA的表达

目的:探索涎腺正常导管、腺泡及其上皮性肿瘤的组织起源.方法:采用免疫组化(二步法)检测正常涎腺组织14 例、多形性腺瘤14 例、基底细胞腺瘤8 例、腺样囊性癌18 例、黏液表皮样癌9 例、低分化腺癌2 例及腺泡细胞癌、乳头状腺癌、恶性多形性腺瘤、肌上皮癌各1 例中p63、CK5、CK19、CEA及SmA的表达.结果:正常涎腺基底细胞与肌上皮细胞层表达CK5,其中部分细胞表达p63,导管部分基底细胞也呈CK19阳性.多形性腺瘤、基底细胞腺瘤、腺样囊性癌与黏液表皮样癌具p63、CK5及CK19高阳性率, SmA阳性率分别为85.71%、1.25%、61.11%、0.00%.CEA阳性细胞见于11.11%腺样囊性癌与55.56%黏液表皮样癌.结论:正常涎腺导管和腺泡的腺上皮及涎腺上皮性肿瘤可能来源于导管、腺泡基底层内呈p63和CK5阳性细胞中的干细胞.     

GST-π、TopoⅡ在涎腺肿瘤中的表达及意义

目的：探讨谷胱苷肽S转移酶-π（GST-π）和DNA拓扑异构酶Ⅱ（TopoⅡ）在涎腺肿瘤组织中的表达及临床意义。方法：采用免疫组化方法检测10例正常涎腺组织、16例涎腺良性肿瘤、27例涎腺恶性肿瘤组织中GST-π、TopoⅡ的表达，分析GST-π、TopoⅡ的表达与涎腺肿瘤临床病理特征。结果：涎腺恶性肿瘤GST-π的阳性率为77．78％，明显高于涎腺良性肿瘤GST-π的阳性率12．50％（P〈0．001）。涎腺肿瘤中GST-π表达与TopoⅡ表达之间无明显相关性（Ｐ〉0．05）。27例涎腺恶性肿瘤中GST-π、TopoⅡ的表达与肿瘤病理类型有关（P〈0．05），而与患者的年龄、性别、有无淋巴结转移及临床分期无关。结论：GST-π、TopoⅡ可能与涎腺肿瘤的发生发展相关。检测GST-π、TopoⅡ的表达情况不仅可为涎腺恶性肿瘤化疗用药提供参考，而且可作为涎腺恶性肿瘤判断预后的指标。     

涎腺肿瘤中端粒长度及端粒酶活性测定的意义

目的：探讨端粒长度及端粒活性变化在涎腺肿瘤发生中的作用和端粒酶活性水平与涎腺肿瘤生物学行为间的关系。方法：利用TRAP法分别测定35例良性涎腺肿瘤及24例恶性涎腺肿瘤的端粒酶活性，分析其表达情况及与涎腺肿瘤生物学行为间的关系。利用Southern杂交方法测定良，恶性涎腺肿瘤及正常涎腺的端粒长度，并进行统计分析。结果：良性肿瘤端粒酶表达率为17．14％，而恶性肿瘤表达率为90％，5例有触压痛的良性涎腺肿瘤及3例有面神经受累症状的恶性涎腺肿瘤患者均为端粒酶强阳性，35例良性肿瘤中，有32例端粒酶长度是缩短的，有2例长于正常涎腺端粒长度；24例恶性肿瘤中，有15例短于正常涎腺端粒长度，有5例长于正常涎腺端粒长度，有4例处于正常涎腺端粒长度范围内，15例短于正常涎腺端粒长度的恶性涎腺肿瘤均有酶表达，而32例良性肿瘤端粒酶活性表达率为10．34％，结论：端粒缩短并激活端粒酶是涎腺肿瘤形成的重要因素，端粒酶可能会成为涎腺恶性肿瘤的一个新的肿瘤标志物，恶性涎腺肿瘤不良的生物学行为与端粒酶活性水平间有高度相关性。     

涎腺导管癌临床及病理学特点的研究

目的探讨涎腺导管癌（SDC）临床及病理学特点,为临床诊断和治疗提供依据。方法对昆明医学院附属口腔医院2001年3月-2009年2月收治的8例SDC患者进行临床资料回顾分析,并用免疫组织化学方法检测SDC组织中血管内皮生长因子（VEGF）、细胞角蛋白（CK）、巨囊性病液体蛋白（GCDFP）-15、雄激素受体（AR）、癌基因C-erBb-2的表达情况。结果SDC好发于腮腺,术前多有面瘫表现,复发3例。计算机断层扫描示界限不清,可伴有类结晶形成。VEGF、CK、GCDFP-15及C-erBb-2均呈阳性表达,多数病例AR呈阳性表达。结论SDC是一类恶性程度很高的涎腺肿瘤,类似乳腺导管癌。GCDFP-15、AR及C-erBb-2对SDC的病理学诊断有较重要的参考价值。     

腮腺透明细胞型嗜酸细胞腺瘤1例

腮腺嗜酸细胞腺瘤是一种涎腺良性肿瘤,其发病率低,既往文献少有报道,而以透明细胞为主型的嗜酸细胞腺瘤病例报道更为少见。该肿瘤临床表现及影像学检查无特异性,在诊疗中与涎腺其他肿瘤如嗜酸细胞癌以及转移性肾透明细胞癌鉴别困难,易导致误诊误治。为探讨涎腺透明细胞为主型嗜酸细胞腺瘤的诊断和治疗,提高对该肿瘤的临床病理组织学特征的认识,现报告1例腮腺透明细胞为主型嗜酸细胞腺瘤病例,并对以往相关文献进行回顾复习。     

涎腺肌上皮瘤的临床病理分型和免疫组化研究

对从１８７３例涎腺肿瘤复查后确诊的４３例涎腺肌上皮瘤进行了临床病理学和免疫组化研究。结果显示：该瘤的患病率约占涎腺肿瘤的２．３％，好发于腮腺（４８．８４％）和腭腺（４１．８６％）；该瘤在病理上可分为５型：即上皮细胞型、梭形细胞型、浆细胞样细胞型、透明细胞型和混合细胞型，其实质细胞——肿瘤性肌上皮细胞为一个连续变化的瘤细胞谱，各种形态的瘤细胞可以互相转化；免疫组化ＣＫ－１８、ａｃｔｉｎ染色显示上述各型瘤细胞均为程度不等的阳性。作者认为提高该瘤确诊率的关键是对各型瘤细胞的认识；联合应用ＣＫ－１８、ａｃｔｉｎ有助于该瘤的诊断和与多形性腺瘤的鉴别。     

Expression of different keratins in salivary gland tumours

Twenty-four salivary gland tumours (six pleomorphic adenomas, two myoepitheliomas, five basal cell adenomas, six adenoid cystic carcinomas and five polymorphous low grade adenocarcinomas) were investigated by an immunocytochemical technique using monoclonal antibodies against cytokeratins (CKs) 7, 8, 10, 13, 14, 18 and 19. The luminal cells of ductal structures of the tumours reacted with all the CKs studied except for CK 13 and CK 10 and sometimes CK 14, showing an immunoprofile comparable to that of the intercalated segment of a normal salivary gland. The outer cells of the ducts rarely stained with CK 14, confirming that full differentiation of the myoepithelial cells is seldom achieved in tumours. Considerations were made regarding the intriguing expression of CK 14, the heterogeneous expression of CKs in the modified myoepithelial cells and the immunoprofile of the polymorphous low-grade adenocarcinoma.     

涎腺肿瘤中端粒酶活性的检测及意义

目的 :探讨端粒酶活性在肿瘤诊断中的意义。方法 :采用非放射性同位素端粒酶重复扩增酶标法对2 9例涎腺肿瘤及 5例正常涎腺组织端粒酶活性进行检测 ,同时还对其中 5例涎腺肿瘤的细针穿刺细胞学检查标本进行了端粒酶活性检测。结果 :16例恶性涎腺肿瘤中 13例为端粒酶阳性 ,占本组恶性涎腺肿瘤的81% ,2例高分化粘液表皮样癌和 1例腺样囊性癌示端粒酶阴性。在 13例良性涎腺肿瘤中仅 1例端粒酶弱阳性。 5例正常涎腺组织端粒酶活性皆为阴性。 5例细针穿刺细胞学检查标本端粒酶活性检测显示 :3例恶性涎腺肿瘤中 2例端粒酶阳性 ,1例端粒酶阴性 ;2例良性涎腺肿瘤端粒酶阴性。结论 :把端粒酶作为新的肿瘤基因诊断的标志物是很有可能的     

A clinico-pathologic study of 311 intra-oral salivary gland tumors in Thais

Background:  There have been several epidemiologic studies on intra-oral salivary gland tumors in several countries, but little is known of these tumors in Thailand.
Objectives:  To determine the relative frequency and distribution of various types of intra-oral salivary gland tumors in the Thai population.
Methods:  The files of the Department of Oral Pathology, Faculty of Dentistry, Chulalongkorn University, from 1969 to 2007 were searched for intra-oral salivary gland tumors. Histopathologic slides were reviewed and reclassified according to the 2005 WHO Classification of Head and Neck Tumors. The age, gender, race, and anatomical distribution of the tumors were collected from the patients' records.
Results:  Of the 16,358 accessioned cases, 311 cases (1.90%) were diagnosed as intra-oral salivary gland tumors. One hundred and forty-seven cases (47.27%) were benign tumors, while 164 cases (52.73%) were malignant tumors. The mean age of the patient ± SD = 41.57 ± 16.65 years. Females outnumbered male patients by a ratio of M:F = 1:1.38. Almost all except one patient were Thais. Pleomorphic adenoma was the most common intra-oral salivary gland tumor. The majority of cases occurred at the palate.
Conclusions:  Pleomorphic adenoma is the most common intra-oral salivary gland tumor and the most common benign intra-oral salivary gland tumor, while mucoepidermoid carcinoma is the most common malignant intra-oral salivary gland tumor. Intra-oral salivary gland tumors in Thailand elicit similar trend as in previous studies, with only minor differences such as the ranking of some tumors, the higher incidence of intra-bony location, and the lower incidence of polymorphous low-grade adenocarcinoma.     

Ameloblastoma, calcifying epithelial odontogenic tumor, and glandular odontogenic cyst show a distinctive immunophenotype with some myoepithelial antigen expression

Background:  Odontogenic neoplasms have some morphologic overlap with salivary gland neoplasms, many of which show myoepithelial differentiation. In the 1980s, an ultrastructural study identified a population of myoepithelial-like cells in calcifying epithelial odontogenic tumor. Myoepithelial derived tumors have since been shown to have distinct immunohistochemical profiles.
Methods:  We examined a series of odontogenic neoplasms, including 11 ameloblastomas, four calcifying epithelial odontogenic tumors, five glandular odontogenic cysts (GOCs), and five keratocystic odontogenic tumors with a panel of myoepithelial-associated immunohistochemical stains. We also assessed representative control examples of oral mucosa, odontogenic rests, and dentigerous cysts.
Results:  All of the neoplastic and non-neoplastic oral epithelium-derived entities share a p63-positive, high molecular weight cytokeratin (CK5/6)-positive immunophenotype. Calponin reactivity was at least focally present in two of four calcifying epithelial odontogenic tumors, three of five GOCs, and 10 of 11 ameloblastomas; the sole completely non-reactive ameloblastoma represents a lung metastasis. One case of calcifying epithelial odontogenic tumor was focally positive for glial fibrillary acidic protein. However, other more definitive markers of myoepithelial differentiation, including S-100 and smooth muscle actin, were negative. Two of three calcifying epithelial odontogenic tumors and five of five GOCs were also positive for a low molecular weight cytokeratin (CK7).
Conclusions:  Ameloblastomas, GOCs, and calcifying epithelial odontogenic tumors show a distinctive immunophenotype which overlaps with that of myoepithelial-derived salivary gland neoplasms but does not provide definitive support for myoepithelial differentiation.     

Distribution of intermediate filaments in the salivary glands and salivary gland tumors]

13 cases of salivary glands and 30 of salivary gland tumors were studied by ABC method with 6 monoclonal antibodies to intermediate filaments and one to microfilament. The results showed that the distribution of intermediate filaments in salivary glands had their regularity. According to the reaction to the antibodies, these tumors could be divided into 3 groups and 3 subgroups. The findings also suggested that in the salivary gland tissue the epithelial cells which mainly contained the 54 Kd keratin and the epithelial cells which mainly contained 57/66 Kd keratin were the origin of the salivary gland tumors. The actin-positive myoepithelial cells might play a role in some tumor formation.     

Relative frequency of intra-oral minor salivary gland tumors: a study of 380 cases from northern California and comparison to reports from other parts of the world

BACKGROUND: The relative frequency of individual intra-oral minor salivary gland tumors (IMSGT) is not well documented in the literature. The aim of this study was to determine the relative frequency and distribution of IMSGT in an oral pathology biopsy service and to compare the data with similar studies from different parts of the world. METHODS: Files from the Pacific Oral and Maxillofacial Pathology Laboratory of the University of the Pacific, San Francisco, California served as a source of material for this study. Files were systematically searched for all cases of IMSGT during a 20-year period. Tumors were classified according to the 2005 WHO classification of salivary gland tumors. RESULTS: IMSGT were identified in 380 (0.4%) cases of 92 860 accessed. This is the largest series of IMSGT from one source reported in recent years. Of the 380 tumors, 224 (59%) were benign and 156 (41%) were malignant. Of the benign tumors, pleomorphic adenoma (PA) was the most common (39.2%), followed by cystadenoma (6.3%), canalicular adenoma (6.1%), ductal papillomas (4.4%), basal cell adenoma (1.6%), and myoepithelioma (1.3%). Of the malignant tumors, mucoepidermoid carcinoma was the most common (21.8%), followed by polymorphous low-grade adenocarcinoma (7.1%), adenoid cystic carcinoma (6.3%), adenocarcinoma, not otherwise specified (NOS; 2.1%), acinic cell carcinoma (1.6%), clear cell carcinoma, NOS (1.0%), and carcinoma ex PA (0.5%). CONCLUSIONS: Studies related to the relative frequency of individual IMSGTs from different parts of the world are difficult to compare because many studies are outdated, the number of cases is small, the list of tumors is limited, and new entities are not included. To determine the true relative frequency, more studies should be conducted, on a large number of cases from one source, by experienced pathologists in the field of salivary gland tumors.     

Clear cell myoepithelial carcinoma of minor salivary gland: a case report

Myoepithelial carcinoma with predominantly clear cell morphology is rare. A review of the literature identified 15 unequivocal cases, only two of which were of minor salivary gland origin. A case of minor salivary gland clear cell myoepithelial carcinoma of the retromolar region in a 70-year-old man is presented. It is important to recognize the clinicopathologic features of this unusual tumor, because of its histological similarity to several other primary and metastatic clear cell tumors and its aggressive behavior.