涎腺透明细胞肌上皮癌和透明细胞癌的临床病理比较分析

Clear Cell Myoepithelial Carcinoma and Clear Cell Carcinoma of The Salivary Gland:A Clinicopathological Comparison

目的:探讨涎腺透明细胞肌上皮癌和透明细胞癌的临床病理与免疫组化特征。方法:回顾分析武汉大学口腔医学院口腔病理科1985～2008年期间确诊的3例透明细胞肌上皮癌和5例透明细胞癌。常规HE染色和免疫组化(CKAE1/AE3,S100,vimentin,smooth muscle actin,calponin,P63和maspin)做比较观察。结果:两种肿瘤几乎全部由透明细胞构成,在透明细胞肌上皮癌中可见少量梭形细胞,透明细胞癌中可见少量含有嗜酸性胞浆的细胞。免疫组化显示:透明细胞肌上皮癌中,3例均阳性表达CKAE1/AE3,S100,vimentin,P63和maspin,2例阳性表达smooth muscle actin和Calponin;透明细胞癌中,5例均阳性表达CKAE1/AE3,P63和maspin,而S100,vimentin,smooth muscle actin,calponin均呈阴性表达。结论:涎腺透明细胞肌上皮癌和透明细胞癌都很罕见,二者可通过组织病理和免疫组化特点进行鉴别。由于肿瘤性肌上皮细胞可呈现不同的肌源性分化,因此联合运用多种提示肌上皮源性的标志物如CKAE1/AE3,S100,vimentin,smooth muscle actin和calponin对二者鉴别诊断有帮助。P63和maspin缺乏特异性。

Objective：To investigate the histopathological and immunohistochemical profiles of clear cell myoepithelial carcinoma,and compare them with those of CCC of salivary glands in an attempt to elucidate the correct diagnosis of these two tumors.Methods：Three CCMCs and five CCCs were reviewed from files of the Department of Oral Pathology,School of Stomatology,Wuhan University.Immunohistochemistry was performed on paraffin-embedded tissue with antibodies to CKAE1/AE3,S100,vimentin,smooth muscle actin,calponin,p63 and maspin.Results：Both types of tumors were composed of exclusively of clear cells,with a few spindle-shaped cells in CCMCs and cells with eosinophilic cytoplasm in CCCs.Immunohistochemically,all three CCMCs were positive for CKAE1/AE3,S100,vimentin,p63 and maspin,and two expressed smooth muscle actin and calponin.All five CCCs were positive for CKAE1/AE3,p63 and maspin,but negative for S100,vimentin,smooth muscle actin and calponin.Conclusion：Both CCMC and CCC of salivary glands are rare,and can be distinguished based on histopathological and immunohistochemical features.Because with neoplastic transformation the modified myoepithelial cells may show variable degrees of smooth muscle differentiation.The combination of CK,S100,vimentin and smooth muscle actin /calponin should be used to confirm the myoepithelial differentiation in CCMC and distinguish CCMC from CCC in conjunction with morphologic features.The results of this study also suggest that the immunostaining of CCMC and CCC with p63 and maspin can not offer an adjunctive aid in differential diagnosis between these two tumors.