涎腺恶性多形性腺瘤161例临床病理分析

Malignant pleomorphic adenoma of salivary gland:a clinicopathologic study of 161 cases

目的分析涎腺恶性多形性腺瘤(malignant pleomorphic adenoma,MPA)的临床病理特征。方法对经病理复片诊断为MPA的161例临床病理材料进行回顾性分析。结果161例MPA中,152例为原发性肿瘤、7例为局部复发性肿瘤、2例为肿瘤颈淋巴结转移灶。152例原发MPA中发生于腮腺85例、腭部39例、颌下腺21例、颊部3例、唇部2例、磨牙后区1例、上颌骨1例;男性95例,女性57例,男女比为1.7∶1;发病年龄为27～92岁,平均59岁。恶性成分的组织学类型包括肌上皮癌62例、非特异性腺癌59例、腺样囊性癌8例、黏液表皮样癌7例、导管癌3例、腺鳞癌3例、上皮-肌上皮癌3例、癌肉瘤3例、未分化癌2例、腺泡细胞癌1例、黏液腺癌1例。组织学高、中、低度恶性的分别为45、69、38例。同一肿瘤中恶性成分≤50%的为21例,>50%的为131例。侵袭性、微侵袭性、非侵袭性癌分别为106、10、33例。侵袭性癌、组织学分级与肿瘤发生颈淋巴结转移之间有显著相关性(P值均<0.01)。结论MPA多见于中老年男性,好发于腮腺;临床表现多为无痛渐大性肿块,以近期生长迅速为特征;组织学表现为常同时具有良性多形性腺瘤成分和恶性肿瘤成分,侵袭性癌多见,恶性成分常多于良性成分,恶性成分以肌上皮癌和非特异性腺癌为多见;侵袭性癌、组织学分级高度恶性者易发生颈淋巴结转移。

Purpose To analyze the clinicopathologic features of salivary malignant pleomorphic adenoma. Methods The clinical and pathological characteristics of 161 salivary gland tumors histologically diagnosed as MPA were analyzed. Results Of the 161 MPA cases, 152 were primary tumors, 7 were recurrent tumors, and 2 were cervical lymph node metastatic tumors. The ratio of male to female of 152 patients with primary MPA was 1.7 ： 1 （95 to 57）, and the mean age was 59 years（from 27 to 92）. 85 tumors were located in parotid gland, 39 in palate, 21 in submandibular gland, 3 in buccal, 2 in lip, and one in retromolar region and maxillary respectively. The subtype of the malignant component was classified as myoepithelial carcinoma in 62 tumors, adenocarcinoma not other specified in 59, adenoid cystic carcinoma in 8, mucoepidermoid carcinoma in 7, salivary duct carcinoma in 3, adenosquamous carcinoma in 3, epithelial-myoepithelial carcinoma in 3, carcinosarcoma in 3, undifferentiated carcinoma in 2, acinic cell carcinoma in 1, and mucinous adenocarcinoma in 1. Histologically the malignant components of 45 tumors were high-grade, 69 intermediate-grade, and 38 low-grade. The malignant components made up less than 50% of the mass in 21 patients, and greater than 50% in 131. 106 tumors were invasive carcinoma, 10 minimally invasive, and 33 non-invasive. The invasive carcinoma and the high-grade tumor had correlation with cervical lymph node metastasis（ P 〈 0. 01 ）. Conclusions MPA is more common in elder male, frequently involves the parotid gland and usually presentes as a painless mass, which grew slowly and recently occurs rapid enlargement. Histologically, benign pleomorphic adenoma components as well as various types of malignant components can be found in most of MPA. The majority of tumors are invasive carcinoma. The malignant components are usually much more than the benign components, and myoepithelial carcinoma and adenocarcinoma not other specified are the most common malignant subtypes. It is more possible for the invasive carcinoma and the high-grade tumor to occur cervical lymph node metastasis.