涎腺导管癌临床病理和免疫组化研究

SALIVARY DUCT CARCINOMA CLINICOPATHOLOGIC AND IMMUNOHISTOCHEMICAL STUDY

目的 探讨涎腺导管癌 ( SDC)的临床病理特点。方法 对 5例 SDC患者的临床和病理资料进行回顾性分析 ;用免疫组化方法检测细胞角蛋白 ( CK) ,平滑肌肌动蛋白 ( SMA)在 SDC中的表达 ,并与腺样囊性癌对照。结果 1例术后 2年死于全身广泛转移 ,2例带瘤生存 2～ 5年 ,2例失访。5例 SDC镜下呈典型导管癌表现 ,侵犯神经、血管壁和周围的软组织。 2例曾误诊为腺样囊性癌。免疫组化 CK阳性 ,SMA阴性 ,示肿瘤细胞为导管上皮。结论 涎腺导管癌是一种高侵袭性的涎腺癌 ,易发生转移 ,预后差。彻底手术联合放疗和 (或 )化疗的综合治疗有助于延长生存期。

Objective To explore the clinicopathological characteristics and behavior of salivary duct caricinoma (SDC). Methods Clinical and pathologic data of 5 cases of SDC were studied retrospectively. Immunohistochemical stains were performed by the expression of cytokeretin (CK) and smooth-muscle actin (SMA), and in contrast with adenoid cystic carcinoma (ACC). Results Three SDC occurred in the submandibular gland and two in the palate; three patients were men and two were women. Patients ranged in age from 36 to 48 years, Tumour size varied from 2 to 6cm. All patients were treated surgically with radical excision, and three of them received postoperative radiotherapy and chemotherapy. One patient was died of widly systemic metastasis 2 years later, two patients were alive with residual disease for 2～3 years, two were lost to follow up. All tumours were typical infiltrating duct carcinoma microscopically with obvious invasion to neural, vascular and soft tissues. Two patients has been misdiagnosed as ACC. The results of immunohistochemical stain were CK postive and SMA negative, the cells of tumour was ductal epithelia. Conclusion SDC is a highly aggressive malignant neoplasm with distinctie clinical and pathologic infiltrative feature, its prognosis is bad. Adjunctie therapy in treatment for SDC was useful to prolong the patient's life. In histology, Sometime it is difficult to distinguish with ACC in histology. Immunohistochemical stain was helpful to differential diagnosis.