唾腺上皮肌上皮癌伴高级别转化的临床病理观察及文献复习

Epithelial-myoepithelial carcinoma with high-grade transformation:a clinicopathologic study of a case and literature review

目的:探讨唾腺上皮肌上皮癌伴高级别转化的临床病理特征。方法:对1例上皮肌上皮癌伴高级别转化进行组织病理学观察和免疫组化检测,复习临床资料和相关文献。结果:女性患者,60岁,临床表现为左下颌无痛性包块20年,近来增大明显。CT检查发现左侧颌下腺有3.0 cm×3.4 cm的肿物,形态不规则,其内可见钙化影。镜下见肿物由经典上皮肌上皮癌(80%)和高级别癌(20%)两部分构成。结论:唾腺上皮肌上皮癌伴高级别转化非常罕见,局部侵袭性强,淋巴结转移率和远处转移率明显比经典上皮肌上皮癌高,预后差,治疗上除外科手术扩大切除外,还需行颈部淋巴结清扫和辅助性放疗。

Objective：To investigate the clinicopathologic features of epithelial-myoepithelial carcinoma（EMC） with high-grade transformation （HGT）. Method：The clinical manifestations,histopathological features and immunohistochemical results of a EMC with HGT were analyzed,with review of the related literatures. Result：The patient was a 60-year-old woman who requested examination of the rapid growth of a mass in the left submandibular area,which he had first noticed 20 years previously. CT revealed an irregular-shaped mass measuring 3.0 cm ×3.4 cm with scattered calcifications in the left submandibular gland. Histologically,the tumor had 2 distinct carcinomatous components,including approximately 80%EMC and 20 % high-grade carcinoma of the whole tumor,respectively. Conclusion：EMC with HGT is extremely rare,and it has more aggressive behavior than typical EMC,with a high propensity for lymph node and distant metastases. The worse progno-sis suggests the need for more radical treatment than in typical low-grade EMC,including wider excision,neck dissection, and possible adjuvant radiation therapy.