涎腺多形性腺瘤的交界性生物学行为的探讨

Study on borderline biological behaviors of salivary gland pleomorphic adenoma

目的 探讨涎腺多形性腺瘤的交界性生物学行为与组织结构的关系。方法 运用组织病理学、免疫组织化学和临床资料 ,研究本瘤与恶性多形性腺瘤和低度恶性腺泡细胞癌的区别。结果 多形性腺瘤见于各年龄组 ,女性多于男性 ;病史长 ,生长缓慢 ;组织结构由肌上皮、腺上皮、鳞化上皮、基底样细胞、软骨及粘液等构成 ;细胞异型性不明显 ,罕见核分裂像及出血坏死 ,肿瘤细胞PCNA指数及间质血管数低于恶性多形性腺瘤 (P <0 0 1) ,与腺泡细胞癌相近 (P >0 0 5 ) ;此外 67例中包膜不完整 16例 ,18例有包膜浸润 ,包膜浸润组PCNA指数明显高于其余病例 ,部分肿瘤切除后多次复发。结论 多形性腺瘤细胞成分复杂 ,其形态无恶性指征 ,但具有浸润包膜生长、部分病例术后可复发的生物学行为。该瘤交界性行为可能与部分瘤细胞增殖活性较高 ,包膜附近血管丰富 。

Objective To investigate the clinical pathological characteristics of salivary gland pleomorphic adenoma and to explore the relationship of its borderline biological behaviors and histological structure. Methods Histopathological and immunohistochemical methods and clinical data were employed to study the benign malignant characteristic of salivary gland pleomophic adenoma and its difference from malignant pleomorphic adenoma and low grade acinic cell carcinoma. Results Pleomorphic adenoma was distributed in different age groups, and female more than male. The histological structure consisted of myoepithelial, glandular epithelial, squamous epithelial, basal cell like cells, cartilage and mucus. Atypical cell was not evident. Mitotic figures and cell necrosis was rare. PCNA index of the tumor cell and number of blood vessel in salivary gland pleomorphic adenoma were lower than that in the malignant pleomophic adenoma ( P <0.01) and were similar to the acinic cell carcinoma. The envelop of salivary gland pleomorphic adenoma was not intact in 16 of 67 patients. Envelop infiltration was found in 18 patients. PCNA index of envelop infiltration group was higher than other groups. Some patients recurred repeatedly after operation. Conclusion The cells constituting salivary gland pleomorphc adenoma are complex and without malignant features, but with envelop infiltration in some cases, and recurrence are seen after operation. The borderline behavion of adenoma may be related to the high activity of proliferation in some tumor cell and abundant in blood vessels near the envelop.