唾液腺肌上皮癌13例临床分析

Myoepithelial carcinoma of salivary glands:a clinical analysis of 13 cases

目的:回顾性分析13例唾液腺肌上皮癌的临床资料,为进一步提高诊断及治疗水平提供参考。方法:对1992年2月—2010年9月诊治的13例唾液腺肌上皮癌病例,从生物学行为、诊断、治疗和预后方面进行回顾分析。结果:13例病例中,男6例,女7例,中位年龄40岁,发病部位以腮腺(53.8%)最多见;临床误诊7例,病理误诊2例;全部行手术治疗,术后化疗2例、放疗5例;发生颈淋巴转移4例(30.8%),远处转移2例(15.4%);随访3个月～6a,复发或转移致死亡6例。结论:唾液腺肌上皮癌较罕见,易误诊,确诊依赖病理学及免疫组化检查,易远处转移,T3～T4期颈淋巴转移率较高;治疗方法为以根治性手术为主的综合治疗,T3～T4 cN0期唾液腺肌上皮癌应考虑选择性颈淋巴清扫术,术后放、化疗的效果有待进一步研究。

PURPOSE：This study retrospectively analyzed the clinical data of 13 patients with myoepithelial carcinoma of salivary glands for improving the accuracy of diagnosis and treatment outcome.METHODS： Thirteen cases with myoepithelial carcinoma of the salivary glands in Xiangya Hospital from January 1992 to September 2010 were reviewed,including the clinical biological behavior,diagnosis,treatment and prognosis.RESULTS： Thirteen patients included 6 men and 7 women,aged from 14 to 71 years（median 40 years）.The tumor occurred predominantly in the parotid gland（53.8%）.Among the 13 cases,7 were clinically misdiagnosed as benign tumors and 2 were misdiagnosed pathologically.All cases underwent operation.Two cases received surgery plus adjuvant chemotherapy;five cases underwent surgery plus adjuvant radiotherapy.4（30.8%） had cervical lymph node metastasis and 2 cases（15.4%） developed distant metastasis.Follow-up time ranged from 3 months to 6 years.Six cases died of local recurrence or distal metastasis.CONCLUSIONS： Myoepithelial carcinoma of the salivary glands is a rare tumor.The diagnosis is depended on histology and immunohistochemistry.The tumor has a high rate of distant metastasis and high rate of lymph node metastasis in T3 to T4 cases.Radical surgery is the treatment of choice.Elective neck dissection should be considered in T3 to T4 cN0 cases.The effect of chemotherapy and radiotherapy needs to be investigated.Supported by National Natural Science Foundation of China（30872895） and Key Project of Hunan Provincial Commission of Science and Technology（2008FJ2011）.