右腮腺区脊索瘤临床病理观察

Chordoma in right parotid:a clinicopathological analysis

目的报道腮腺区罕见脊索瘤1例,结合文献探讨脊索瘤生物学行为、临床病理特征以及免疫组化特点。方法分析脊索瘤的临床、组织病理学资料,应用常规HE染色及免疫组化染色行CK、Vim、S-100、EMA和CEA等检测。结果组织学上,脊索瘤被纤维组织分隔成分叶状,以液滴或空泡细胞为显著特征。免疫组化显示Vim、CK、EMA(+),少数细胞S-100呈(+),CEA(-)。结论脊索瘤属于具有上皮性及间叶性抗原分化特性的低度恶性肿瘤,腮腺区脊索瘤极罕见,组织学形态上应与转移的黏液腺癌、黏液样软骨肉瘤及软骨瘤鉴别。此瘤侵袭性强,易复发和误诊,可通过CK、Vim、EMA、CEA和S-100联合标记进行鉴别诊断。

Objective To study the clinicopathological, differential diagnosis, biologic characterstics and features of chordoma. Methods One case of chordoma in right parotid was studied by clinicopathologic analysis and immunohistochemistry, lmmunohistochemical staining for cytokeratin, vimentin, S-100 protein （S-100）, epithelial membrance antigen （EMA） and carcinoembryonic antigen （CEA） were performed and the related literatures reviewed. Results Microscopically, there were characteristics of lobules of physaliphorous cells, seperated by fibrous tissues staining showed that the tumor cells were positive for cytokeratin, vimentin, EMA and a few of them positive for S-100. CEA was negative. Conclusion Chordoma is a rare and low-grade malignant tumor with epithelial and mesenchymal differentiation. Histologically, the tumor must be differentiated from myxoid chondrosarcoma, chondroma and metastatic mucinous adenocarcinoma. This tumor is high-invasive, easy to recur and to be misdiagnosed. It is helpful for the differential diagnosis to use combined immunostaining of CK, Vim, EMA, S-100 and CEA.