涎腺粘膜相关淋巴瘤临床与病理研究

Clinicopathological study of mucosa associated lymphoid tissue lymphoma of salivary glands

目的探讨涎腺粘膜相关淋巴瘤的病理诊断特征及发病机理。方法分析临床资料，利用ＨＥ染色、白细胞共同抗原、ＣＤ２０、ＣＤ４５ＲＯ、上皮膜抗原的ＳＰ法免疫组化及电镜观察２７例涎腺粘膜相关淋巴瘤。结果男性２４例，女性３例，平均年龄５３．４５岁，其中腮腺１２例，颌下腺１５例。涎腺粘膜相关淋巴瘤是由弥漫性中心细胞样（ＣＣＬ）细胞组成，并有“淋巴上皮病变”。ＣＣＬ细胞呈ＣＤ２０阳性、ＣＤ４５ＲＯ阴性。电镜下瘤细胞圆形，核质比高，胞质内少量溶酶体和免疫球蛋白的颗粒，无胞质丝，无细胞外基膜，无细胞间连接。随访：存活５年以上者９例，３～４年者５例，不足１年６例，３例死亡。结论大多数涎腺粘膜相关淋巴瘤为低度恶性，瘤细胞有”回归”现象，少数可转变为高度恶性，预后差。自身免疫性疾病和（或）感染可导致机体产生获得性涎腺粘膜相关淋巴瘤。涎腺组织在持续性刺激下发展为涎腺肌上皮炎，进而转变为涎腺粘膜相关淋巴瘤。

Objective To study the histopathological features and pathogenesis of mucosa associated lymphoid tissue lymphoma (MALT oma) of salivary glands. Methods Surgical specimens from 27 cases of MALT oma of salivary glands were studied using paraffin embedded section, immunohistochemical method (SP method) and electron microscope.Results 12 tumors were located in the pariotid glands, the other 15 in the submandibular glands. Much of the MALT oma of the salivary glands were composed of diffuse centrocyte like (CCL) cells with “lymphoepithelial lesions”. Immunohistochemically, CD20 expression was found to be positive and CD45RO expression was negative in all MALT omas of sailvary glands. Conclusions Most of the MALT omas are low grade malignant tumors and the tumor cells have a 'homing back' phenomenon. A small number of MALT omas can become highly malignant tumors with poor prognosis. Aquired MALT may develop as a reaction to autoimmune disease and/or infection. Hyperimmune reaction and MALT hyperplasia under continuous stimulation may result in myoepithelial sialadenitis and develop into MALT oma of salivary glands.