细针吸取细胞块技术在涎腺腺泡细胞癌诊断中的应用

Application of fine needle aspiration cell blocks in the diagnosis of acinic cell carcinoma

目的涎腺腺泡细胞癌(Ac CC)是一种少见的低度涎腺上皮性恶性肿瘤,易误诊或漏诊。通过细针吸取细胞学(FNAC)检查中的标本采集并制作细胞块的方法,可以提高涎腺腺泡细胞癌的术前确诊率。方法首先,采用持笔式细针穿刺技术获取足够的标本;其次,部分标本制作细胞涂片进行细胞学诊断,剩余标本采用蛋白乙醇凝固-甲醛固定法制作细胞块(CB)及石蜡切片,进行HE、PAS及免疫组化染色;最后,综合分析常规FNAC涂片、细胞块切片的形态学、PAS染色和免疫组化染色,完成病理诊断。结果 11例通过FNAC确诊为腺泡细胞癌的病例中,9例(3例FNAC怀疑腺泡细胞癌)进行了CB制作,通过细胞块切片HE、PAS及免疫组化染色,患者均确诊为涎腺腺泡细胞癌。患者术后病理切片,其组织学类型、免疫组织化学染色结果与细胞块相同。结论细针穿刺取样并采用CB制作技术,能有效提高腺泡细胞癌的诊断准确率,并且,细胞块对组织分型及分类诊断接近术后病理诊断,有很高的应用价值。

Objective Acinic cell carcinoma ( ACC) is a rare low grade epithelial malignant tumor of salivary gland, which is liable to be missed or misdiagnosed. In order to increase the definite diagnosis rate of AcCC,the sampling technique of fine needle aspiration and cell block preparation methods were applied. Methods By pen-holding aspiration sampling technique,sufficient material for cell block preparation was got. Some specimens were used to make cell smears for cytological diagnosis;the remaining specimens were used to make cell blocks ( CB) according to protein-alcohol-coagulation method and then HE,PAS and immunohistochemical staining were performed to help making the pathologic diagnosis. Results The fine needle aspiration cell blocks were performed for 9 cases ( 3 cases suspicious for AcCC),which were all confirmed by PAS and immunohistochemical staining through cell blocks. Postoperative pathological section were obtained in 8 cases. The histological type and immunohistochemical staining results were the same as those of cell blocks. Conclusion Fine needle aspiration sampling technique and application of cell block preparation method can efficiently improve the diagnostic accuracy of AcCC. Moreover, cell blocks have high application value in AcCC histological type and classification,which is close to the pathological diagnosis after operation.