12例涎腺肌上皮癌诊断与治疗分析

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。

Diagnosis and treatment analysis of 12 cases of salivary myoepithelial carcinoma

Background and purpose: Salivary gland myoepithelial carcinoma (MC) is a rare malignant salivary gland neoplasm, and its diagnosis and treatment remain controversial. This study aimed to discuss the clinical features, pathological manifestation, immunohistochemical phenotype and therapy in order to make progress in diagnosis and treatment of salivary gland MC. Methods: The clinical data of 12 cases of salivary gland MC from Jan. 2010 to Jun. 2016 were analyzed. The average age of the 12 cases was (48.9±12.2) years. Microscopic changes were analyzed after the sections were stained with routine H-E and immunohistochemical methods. 11 cases received radical surgery only, and 2 cases received postoperative radiotherapy. One case with incomplete resection was administered with 4 cycles of docetaxel+cisplatin chemotherapy regimen (120 mg docetaxel on day 1 and 40 mg cisplatin on days 1‑3, every 28 days). Results: Seven cases occurred in parotid glands and 5 occurred in minor salivary glands. The common size of MC was between 2 and 5 centimeters. Tumors in section appeared off white or grey pink, the capsules were intact, the boundaries were unclear, and necrosis and liquescence existed. Clear cells were predominant in MC, while epithelioid, plasmacytoid, and spindle cells also existed. Cell atypia was obvious and necrosis and liquescence were shown in 4 cases. CK, S-100, EMA, SMA, calponin, p63, Vim and Ki-67 were expressed in 12, 7, 7, 4, 8, 11, 5 and 9 cases, respectively. Ki-67 labelling index was 2%～40%, and 15% was the average. The follow-up time was 2-78 months. Local recurrence and metastasis were not detected in 10 cases whounderwent extended resection, and 1 case died of renal myoepithelial carcinoma 5 months after operation. One case died 3 months after chemotherapy. Conclusion: The histological changes of myoepithelial carcinoma cells are diverse. Pathological methods and the immunohistochemical examination of CK, p63, Ki-67, S-100, Vim, calponin, EMA and SMA are helpful for improving the diagnosis rate. Surgery with tumour-free margins is the main treatment for myoepithelial carcinoma. Neck dissection is not necessary for the cases without local lymphatic metastasis.