成涎细胞瘤临床病理特征分析并文献复习_尚轶钒.pdf

10 王秋桐，曹婷婷，周玮玮，等 术后辅助化疗对早期非小细胞肺癌患者预后的影响研究 J 实用心脑肺血管病杂志，2022，30(4):29 36 11 MALHOTA J，MHANGO G，GOMEZ JE，et al Adjuvant chem-otherapy for elderly patients with stage I non-small-cell lung cancer4 cm in size:an SEE-Medicare analysisJ Ann Oncol，2015，26(4):768 773 12 XU J，WANG S，ZHONG H，et al Adjuvant chemotherapy im-proves survival in surgically resected stage IB squamous lung canc-er J Ann Thorac Surg，2019，107(6):1683 1689 13 TANOUE LT Lung cancer staging J Clin Chest Med，2020，41(2):161 174 14 吴家园，万崇华，胡利人，等 可手术非小细胞肺癌的预后相关因素分析 J 广东医学 2015，36(13):2049 2052 15 CHEN W，ZHANG C，WANG G，et al Feasibility of nodal clas-sification for non-small cell lung cancer by merging current N cate-gories with the number of involved lymph node stations J ThoracCancer，2019，10(7):1533 1543(收稿日期:2022 09 12)成涎细胞瘤临床病理特征分析并文献复习尚轶钒，吕新全(郑州大学第一附属医院病理科，河南 郑州 450052)摘要 目的探讨成涎细胞瘤的临床病理特征。方法收集 2017 年 5 月至 2021 年 6 月郑州大学第一附属医院诊治的 2 例成涎细胞瘤患者，回顾性分析其临床特点、组织学表现、免疫组化特征等，并随访预后。结果2 例均为儿童，确诊年龄分别为 3 岁和 2 月。患儿因发现颌面部肿物进行性增大入院，彩超示腮腺内低回声。术后随访 15 63 个月，生存状态良好，尚无复发或转移。组织学表现:肿瘤组织被纤维结缔组织分隔呈结节状，肿瘤细胞排列成片巢状、腺管样，周围基底样细胞呈栅栏状排列，上皮岛中央可见坏死。例 1 部分区域可见乳头状结构，局部伴出血;例 2 可见较多大小不一的血管结构。肿瘤细胞排列紧密，细胞质少，核圆形卵圆形或多角形，异型性明显。例 1 可见 1 2 个明显核仁，核分裂相易见;例 2 核仁不明显，核分裂相可见。2 例均未见明显血管及神经侵犯。免疫表型:导管上皮表达 CK 和 CK7;Calponin 部分肌上皮呈阳性;SOX-10 和 S-100 肌上皮表达;神经内分泌标志物 CD56、SYN 为阴性;Ki-67 指数分别约 60%、20%。此外，例 1 加做 P63 可见外围肌上皮阳性、AFP 阴性;例 2加做平滑肌肌动蛋白呈阳性。结论成涎细胞瘤罕见，好发于婴幼儿，具有一定侵袭性和复发潜能。该病缺乏典型临床及影像学特点，掌握其病理学特征有助于准确做出诊断。关键词 成涎细胞瘤;唾液腺肿瘤;病理诊断;免疫组织化学DOI:10 3969/j issn 1673-5412 2022 06 010 中图分类号 739 87 文献标识码 A 文章编号 1673 5412(2022)06 0507 05Clinicopathological features of sialoblastoma and literature reviewSHANG Yifan，LV Xinquan(Department of Pathology，the First Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China)Abstract ObjectiveTo investigate the clinicopathological features of sialoblastoma MethodsTwo cases of sialo-blastoma diagnosed and treated in the First Affiliated Hospital of Zhengzhou University from May 2017 to June 2021 werecollected The clinical features，histological features and immunohistochemical features were analyzed retrospectively，andthe prognosis was followed up esultsBoth the patients were children，diagnosed at 3 years old and 2 months，respec-tively Both of them were admitted due to progressive enlargement of maxillofacial mass，and color ultrasound showed hypo-echo in parotid gland Both the patients underwent surgical resection and were followed up for 15-63 months They were liv-ing well，without recurrence or metastasis Histological features:The tumor tissue was separated by fibrous connective tissue基金项目:河南省高等学校重点科研计划项目(22A310023)作者简介:尚轶钒(1997 )，女，硕士在读，主要从事肿瘤病理基础与临床研究。E-mail:ssyf1313163 com通信作者:吕新全(1971 )，男，博士，教授，主任医师，主要从事肿瘤病理基础与临床研究。E-mail:lxquan zzu edu cn705肿瘤基础与临床 2022 年 12 月第 35 卷第 6 期and presented nodular shape The tumor cells were arranged into sheets of nests and glandular tubes，and the surroundingbasal-like cells were arranged in palisade shape Necrosis was visible in the center of the upper skin island In case 1，pa-pillary structures could be seen in some areas More vascular structures of varying sizes were seen in case 2 The tumorcells arranged closely，with less cytoplasm，oval or polygonal nuclei，and the atypia was obvious In case 1，there were 1-2 distinct nucleoli，and the mitotic image was easily seen In case 2，the nucleolus was not obvious and the mitotic imagewas visible Obvious vascular and nerve invasion could not be observed in both cases Immunophenotype:CK and CK7were expressed in ductal epithelium Calponin showed that some of the myoepithelium were positive SOX-10 and S-100were diffusely positive in 2 cases Neuroendocrine markers CD56 and SYN were negative Ki-67 index is about 60%and20%respectively In addition，the addition of P63 in case 1 showed positive peripheral myoepithelium，and the addition ofalpha-fetoprotein was negative Case 2 was positive for smooth muscle actin ConclusionSialoblastoma is a rare disease，usually occurs in infants and young children It shows invasiveness and recurrent potential in a certain extent Because oflacking of typical clinical and imaging features，understanding its pathological features is helpful for accurate diagnosis Key words sialoblastoma;salivary gland tumor;pathological diagnosis;immunohistochemistry成涎细胞瘤是一种罕见的具有侵袭潜能的唾液腺肿瘤，好发于先天性或围产期婴儿，又被称为涎腺母细胞瘤、胚组织瘤、先天性基底细胞腺瘤、先天性杂交性基底细胞腺瘤 腺样囊性癌。该肿瘤多发生于腮腺和颌下腺，因缺乏特异性临床特点及影像学特点，常难以准确诊断。目前，国内外报道不足 100 例，我国仅报道14 例(表 1)。本文收集 2 例成涎细胞瘤病例，回顾性分析其临床病理特征，并进行相关文献复习，以提高对该病的认识水平。表 1本组及国内 16 例涎腺成涎细胞瘤病例汇总病例文献/发病时间性别 年龄肿瘤大小病变部位治疗方式随访1何丽丽等/2021 年女2 岁3 0 cm 18 cm 1 2 cm左颌下腺颌下腺病损切除术随访 3 个月，无复发、转移2张银萍等/2017 年男 31 个月多发，大小分别为 4 0 cm 35 cm 15 cm、3 4 cm 25 cm 20 cm、1 7 cm 1 5 cm 10 cm左颌下腺手术切除随访 38 个月，无复发、转移3 5王友元等/1997 2010 年男0 岁50 cm 4 0 cm 8 0 cm 50 cm腮腺保留面神经的肿物整块切除术随访 24 44 个月，无复发、转移6葛畅等/2013 年男 3 个月3 0 cm 30 cm 2 0 cm涎腺浅叶左涎腺及肿物切除术随访 15 个月，无复发、转移7谢宏亮等/2010 年男 3 个月7 5 cm 60 cm 4 0 cm腮腺左侧腮腺区肿物扩大切除术随访 12 个月，无复发、转移8吴一凡等/2012 2020 年男5 岁3 0 cm 60 cm颌下腺右颌下肿物切除术+右颌下腺摘除术随访 102 个月，无复发、转移9男2 岁颊右颊肿物扩大切除术+右颧弓部分切除术+右喙突切除术复发 2