腮腺上皮-肌上皮癌伴高级别转化趋势临床病理观察

Epithelial-myoepithelial carcinoma of parotid gland with high grade transformation

目的探讨腮腺上皮-肌上皮癌伴高级别转化临床病理特征及诊断依据。方法报道1例少见的腮腺上皮-肌上皮癌伴高级别转化趋势并文献复习。结果肿块囊实性,包膜完整。肿瘤组织大部分呈实性片状生长,缺乏导管成分。肌上皮样肿瘤细胞增生活跃,细胞核大、空泡状、核仁明显,核分裂相多见20～30/10HP。免疫标志:导管样上皮细胞EMA(+)、CAM5.2(+)、p63(-)、SMA(-)、S-100(-);肌上皮样细胞EMA(-)、CAM5.2(-)、p63(+)、SMA(+)、S-100(+)、PSA(-)、p53(++)、CyclinD1(+20%～30%)、Ki-67增殖指数约60%。结论腮腺上皮-肌上皮癌伴高级别转化是一种罕见的恶性肿瘤,诊断需依靠组织形态及免疫组织化学检测。

Objective To review the clinicopathological features and the diagnosis of epithelial myoepithelial carcinoma（EMC） of the parotid gland with high grade transformation.Methods A rare case of EMC with high grade transformation was reported and relevant literatures were reviewed.Results Macroscopically the mass was encapsulated and contained solid and cystic.Most of tumor appeared solid sheets growth pattern and lack of duct component.The nuclei of myoepithelial-like tumor cells were large and vesicular,contained a prominent nucleolus,mitosis was observed frequently（20~30/10HP）.Duct-like epithelial cells expressed EMA and CAM5.2,but were negative for p63,SMA and S-100.Myoepithelial-like cells expressed S-100,SMA and p63,but were negative for EMA,CAM5.2 and PSA.Most tumor cells was positive for p53,positive CyclinD1 was expressed in 20%~30% tumor cells,positive Ki-67 was in 60% tumor cells.Conclusion EMC with high grade transformation is a rare malignant tumor,and its diagnosis depends on histological morphology and immunohistochemistry.