鼻腔和鼻窦涎腺型肿瘤94例临床病理分析

Salivary gland-type tumors of the nasal cavity and paranasal sinuses:a clinicopathologic analysis of 94 cases

目的分析鼻腔和鼻窦涎腺型肿瘤的临床病理特征、病理诊断及多形性腺瘤(PA)与腺样囊性癌(ACC)的鉴别诊断要点。方法收集和复习94例鼻腔和鼻窦涎腺型肿瘤的临床病理资料,通过HE及免疫组化染色观察其特征并进行回顾性分析。结果94例鼻腔和鼻窦涎腺型肿瘤患者中,涎腺型腺瘤21例,涎腺型癌73例。涎腺型腺瘤中PA 20例(95.2%);涎腺型癌中ACC 49例(67.1%)。免疫组化:GFAP在PA和ACC中的阳性率分别为100%(10/10)和10%(1/10),而Ki-67的阳性率分别为50%(5/10)和100%(10/10)。PA的GFAP阳性率明显高于ACC,差异极显著(P<0.01)。ACC的Ki-67阳性率高于PA,差异显著(P<0.05)。结论对于PA与ACC鉴别诊断困难的病例,可根据两者瘤细胞巢的结构,细胞成分、形态,腔隙结构、内容物等方面的区别,并结合免疫组化GFAP和Ki-67抗体染色结果对两者进行鉴别诊断。

Objective To analyze the chnicopathologic features and pathological diagnosis of the nasal cavity and paranasal sinuses salivary gland-type tumors, and the differential diagnosis between the pleomorphic adenoma （PA） and adenoid cystic carcinoma （ACC）. Methods The chnical and pathological characteristics were analyzed in 94 cases of salivary gland-type tumors of the nasal cavity and paranasal sinuses. HE and immunohistochemical staining was performed. Results A total of the 94 causes consisted of 21 salivary gland-type adenomas and 73 salivary gland-type carcinomas. The PA accounted for 95.2% of all salivary, gland-type adenomas; the ACC accounted for 67.1% of all salivary gland-type carcinomas. Immunohistochemical staining showed the expression of GFAP and ki-67 in PA was 100% （10/10） and 50% （5/10）, that in ACC was 10% （1/10） and 100% （10/10）, respectively. The expression of GFAP in PA was higher than that in ACC （ P = 0.000）, and that of ki-67 in ACC was higher than that in PA （ P = 0.033）. Conclusion The discrimination between PA and ACC can be made, based on their structure in cell nests, cell component and appearance, and content of the lacuna in tumor tissues combined with the expression of GFAP and ki-67 staining.