65例恶性成分为非特异性腺癌的涎腺恶性多形性腺瘤临床病理特点

Malignant pleomorphic adenoma of salivary gland with subtype of the malignant component wasclassified as non-specific adenocarcinoma： a clinicopathologic study of 65 cases

目的研究分析恶性成分为非特异性腺癌的涎腺恶性多形性腺瘤（malignant pleOmorphic adenoma，MPA）的临床病理特点，以期为临床诊断和治疗提供参考。方法回顾性分析115例原发MPA的临床病理资料，应用统计学软件分析恶性成分为非特异性腺癌和其他组织学类型病例在临床病理特点方面的差异，分析恶性成分为非特异性腺癌病例的临床病理指标与颈淋巴结转移的相关性。结果恶性成分为非特异性腺癌的65例原发MPA中，男性58例，女性7例；发病年龄23～83岁，平均57岁，50～59岁最好发；发生于大涎腺61例，小涎腺4例；组织学分级为低、中、高度恶性者分别为12、14、39例；非侵袭性、微侵袭性、侵袭性MPA分别为15、13、37例；13例发生颈部淋巴结转移。恶性成分为非特异性腺癌的原发MPA组织学分级与侵袭性呈显著正相关（P〈0．05）；侵袭性与TNM分期呈显著正相关（P〈0．05）；侵袭性和组织学分级与颈部淋巴结转移之间有显著相关性（P〈0．05）。结论MPA恶性成分组织学类型最常见为非特异性腺癌，组织学分级越高，肿瘤的侵袭性越强；侵袭性癌、组织学分级高度恶性者易发生淋巴结转移。

Objective To analyze the clinicopathologic features of salivary malignant pleomorphic adenoma（MPA） （the subtype of the malignant component was classified as non-specific adenocarcinoma）. Methods The clinical and pathological characteristics of 115 salivary gland tumors histologically diagnosed as MPA were analyzed. Results In all the 65 MPA cases, there were 58 male and 7 female patients, and the mean age was 57 years（from 23 to 83 ）. Sixty-one tumors were located in major salivary glands, and 4 in minor. Histologically the malignant components of 39 tumors were high-grade, 14 intermediate-grade, and 12 low-grade. Thirty-seven tumors were invasive carcinoma, 13 minimally invasive, and 15 non-invasive. The high-grade tumors had positive correlation with the invasive carcinomas （ P 〈 0. 05 ） . The invasive carcinomas had positive correlation with TNM clinical stage （ P 〈 0. 05 ）. The invasive carcinoma and the high-grade tumor had correlation with cervical lymph node metastasis （ P 〈 0. 05 ）. Conclusions Nonspecific adenocareinoma are the most common malignant subtype in MPA. The invasive and the high-grade types are more likely to metastasize to cervical lymph node.