涎腺肌上皮为主性肿瘤的细胞形态特征及诊断价值

The Morphological Characteristic of Neoplastic Cells and Its Diagnostic Value on Salivary Gland Tumors with Prominent Myoepithelial Cells

目的进一步明确涎腺肿瘤性肌上皮细胞形态特征及生物学特性，提高涎腺肌上皮为主性肿瘤的正确诊断率。方法筛选４０例涎腺肌上皮瘤组织，应用组织病理学和免疫组织化学方法，研究肿瘤性肌上皮细胞形态特征及其ＣＫ－１８，ａｃｔｉｎ，ｐ５３和Ｃ－ｅｒｂＢ－２的表达。结果根据肿瘤性肌上皮细胞形态特征将其分为上皮细胞型、梭形细胞型、透明细胞型和类浆细胞型。ＣＫ－１８和ａｃｔｉｎ的阳性表达显示上皮细胞型的上皮性和肌性特点都较强，而透明细胞型的这两种特点都较弱；梭形细胞型和类浆细胞型的肌性特点较上皮性特点强。肿瘤性肌上皮细胞相互间具有内在联系。Ｃ－ｅｒｂＢ－２在透明细胞型、上皮细胞型、梭形细胞型中的阳性表达分别为６４．２９％，５０％，１６．６７％，类浆细胞型则不表达，４种类型肌上皮细胞间的阳性表达具有显著性差异，Ｐ＜０．０５。结论进一步认识涎腺肿瘤性肌上皮细胞的形态特征，了解涎腺肿瘤性肌上皮细胞间的演变规律，掌握ＣＫ－１８和ａｃｔｉｎ双重阳性表达，对于肌上皮瘤的病理诊断和分型具有一定的实用价值。

Objective To understands the morphological characteristic and the biological property of neoplastic myoepithelial cells and improve the pathological diagnosis of myoepitheliomas.Methods Histopathological and immunohistochemical methods were used to study the morphological characteristics of neoplastic myoepithelial cells and the expression of CK 18, actin, p53 and C erbB 2 in the specimens of myoepithelioma taken from 40 cases with the tumor in salivary glands.Results Neoplastic myoepithelial cells could be divided into epithelial, spindle, clear and plasmacytoid (hyaline) types according to their morphological characteristics. The epithelial and muscular properties of the epithelial cells were strong but that of the clear cells were weak. The muscular property of the spindle and the plasmacytoid cell was stronger than their epithelial property. Among the neoplastic myoepithelial cells there was internal relationship. C erbB 2 positive rates for clear, epithelial, spindle and plasmacytoid cells were 64.29%, 50%, 16.67% and 0%, respectively, significant differences being among them ( P <0.05). Conclusions The morphological characteristics of neoplastic myoepithelial cells, its transformation and the double expressions of CK 18 and actin are useful in the diagnosis and classification of myoepitheliomas. It is important that the biological property of neoplastic myoepithelial cells can be judged by the expression of C erbB 2.