腮腺Warthin瘤上皮成分恶变为黏液表皮样癌5例临床病理分析

Clinical and pathologic features of mucoepidermoid carcinoma arising in Warthin's tumour of the parotid gland

目的 探讨Warthin瘤上皮成分恶变为黏液表皮样癌的临床及病理学特点.方法 收集并分析5例Warthin瘤上皮成分恶变为黏液表皮样癌的病例,研究其临床特点、病理形态学特点、免疫表型以及组织化学染色特点,并复习相关文献.结果 5例患者中,男性3例,女性2例,年龄26 ～ 63岁,平均年龄45.6岁.临床均表现为腮腺区无痛性肿物.肿物呈结节状,其中2例有完整包膜,3例包膜不完整,包膜不完整区域与周围组织界限欠清;切面大多为实性、灰褐色.镜下黏液表皮样癌组织位于Warthin瘤瘤体内或肿瘤一侧,两者之间可见移行区.其中4例为低级别黏液表皮样癌,1例为高级别黏液表皮样癌.Warthin瘤嗜酸性上皮CK34βE12 、CK5/6和CK7（＋）,p63、CK20和CEA（-）;黏液表皮样癌黏液细胞CK7和CEA（＋）,CK5/6、p63 、CK34βE12和CK20均为（-）;Warthin瘤的基底细胞及黏液表皮样癌的表皮样细胞CK5/6、p63和CK34βE12均（＋）,而CK7、CK20和CEA（-）;Ki-67阳性指数在黏液表皮样癌区域高于Warthin瘤区域.黏液细胞PAS染色（＋）.结论 Warthin瘤上皮成分恶变为黏液表皮样癌极为罕见,有病理诊断主要依据组织学形态：明确的黏液表皮样癌形态及二者上皮成分移行.

Objective To study the clinical and pathologic features of mucoepidermoid carcinoma arising in Warthin＇ s tumor. Methods Five cases of mucoepidermoid carcinoma arising in Warthin＇ s tumor were investigated by light microscopy, immunohistochemical staining, and histochemical staining. Results The patients included 3 males and 2 females. The age of patients ranged from 26 to 63 years （ median = 45.6 years）. 5 cases were all presented a painless mass. A cut surface of the specimen showed a totally grayish-brown mass with totally encapsulated in two cases, and incomplete encapsulated in 3 cases. Microscopic examination revealed that the tumor was mainly composed of Warthin＇ s tumor, but some area showed the morphological patterns of mucoepidermoid carcinoma （4 cases of low grade mucoepidermoid carcinoma and one case of high grade mucoepidermoid carcinoma）. A transitional zone between Warthin＇ s tumor and mucoepidermoid carcinoma was evident. Oncocytic cells of Warthin＇ s tumor were strongly positive for CK3413E12, CK5/6 and CK7, and negative for p63, CK20 and CEA. The goblet cells of mucoepidermoid carcinoma were all strongly positive for CK7 and CEA, and negative for CK5/6, P63, CK3413E12 and CK20. The basal cell of Warthin tumor and the epidermoid cell of mucoepidermoid carcinoma were both positive for CK5/6, P63 and CK3413E12, and negetive for CK7, CK20 and CEA. Index for Ki67 in the areas of mucoepidermoid carcinoma was higher than the areas of the Warthin＇s tumor. Mucin secreting cells was positive for mucin staining （AB/PAS）. Conclusions Mucoepidermoid carcinoma arising in Warthin＇ s tumor is extremely rare. The diagonosis is based on the histological features： mucoepidermoid carcinoma and the transitional zone between the Warthin＇ s tumor and the mucoepidermoid carcinoma.