鼻腔坏死性涎腺化生临床病理观察

Necrotizing sialometaplasia of nasal cavity: a case report and review of literature

目的探讨坏死性涎腺化生(NS)的临床症状、病理特点及鉴别诊断。方法复习1例发生于鼻甲黏膜的坏死性涎腺化生的临床资料、镜下形态和免疫组化标记,并复习相关文献。结果坏死性涎腺化生组织形态特点:①组织基本结构保存;②形态改变具有分层变化,黏膜表面继发鳞状上皮假上皮瘤样增生,涎腺腺泡、导管鳞状细胞化生;化生的鳞状上皮团保留了原导管或腺泡的组织结构,细胞无明显异型;③鳞化的导管上皮p63和34βE12(+),p53(-),Ki-67阳性细胞数≤5%。结论坏死性涎腺化生是可识别的继发性良性病变,具有慢性缺血坏死后继发的鳞状上皮巢状增生现象;免疫组化结果提示鳞状细胞巢周围有肌上皮样细胞的存在。掌握坏死性涎腺化生的诊断与鉴别诊断标准对临床治疗具有重要意义。

Objective To investigate the clinicopathological features,diagnosis and differential diagnosis of necrotizing sialometaplasia（NS）.Methods A case of necrotizing sialometaplasia involving in nasal mucosa was studied by clinical analysis,light microscopy,immunophenotyping and recview of relative literatures.Results The pathological features of NS included the lobular architecture remained of the involved glands,a ＂stratafication＂ phenomenon,pseudoepitheliomatous hyperplasia of the surface epithelium,and squmaous metaplasia of underlying ducts and acini.Immunophenotyping showed that P63 and 34βE12 were positive in squamous metaplasia of the ducts and acini;Ki67 index was low（10%）,and P53 was negative.Conclusion Necrotizing sialometaplasia is a benign inflammatory lesion with squamous metaplasia secondary to chonic ischemic necrosis of the gland.Immunohistochemistry suggests that myoepithelia exist around squamous cell nests.It is important for the clinical treatment of the lesion to establish a correct diagnosis.