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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 investigate the clinical and pathological features of the malignant transformation of Warthin tumorous epithelium into mucoepidermoid carcinoma. Methods Five cases of malignant transformation of Warthin tumorous epithelium into mucoepidermoid carcinoma were collected and analyzed. The clinical features, pathomorphological features, immunophenotypes and histochemical staining were reviewed. Relevant literatures were reviewed. Results Among 5 patients, there were 3 males and 2 females, aged from 26 to 63 years, with an average age of 45.6 years. Clinical manifestations of parotid gland painless mass. Tumor was nodular in 2 cases, there is a complete capsule, 3 cases of incomplete capsule, incomplete envelope and the surrounding tissue area less clear; mostly solid, brown. Microscopically mucoepidermoid carcinoma is located in the Warthin tumor or on the tumor side, showing the transition between the two. Four of them were low grade mucoepidermoid carcinoma and one was high grade mucoepidermoid carcinoma. Warthin tumor eosinophils CK34βE12, CK5 / 6 and CK7 (+), p63, CK20 and CEA (-); mucoepidermoid carcinoma mucoid CK7 and CEA (+), CK5 / 6, p63, CK34βE12 and CK20 -). CK5 / 6, p63 and CK34βE12 in basal cells and mucoepidermoid carcinoma of Warthin’s tumor were both positive (+), but CK7, CK20 and CEA (-); Ki-67 positive index was higher in mucoepidermoid carcinoma Higher than the Warthin tumor area. Mucous cell PAS staining (+). Conclusion The malignant transformation of Warthin neoplasm into mucoepidermoid carcinoma is very rare. The pathological diagnosis is mainly based on histological morphology: clear mucoepidermoid carcinoma morphology and the migration of both epithelial components.