涎腺硬化性多囊性腺病的临床病理及影像学分析  

The clinical pathologic and imaging features of sclerosing polycystic adenosis of salivary gland

作　　者：张全武[1] 和莹莹[1] 娄欣[1] 刘俊玲[1] 赵红梅[1] 肖艳景[1] 邢辰威 

机构地区：[1]郑州大学附属郑州中心医院病理科,河南郑州450007

出　　处：《现代肿瘤医学》2015年第8期1067-1070,共4页Journal of Modern Oncology

摘　　要：目的:探讨涎腺硬化性多囊性腺病(SPA)的影像学、临床病理特征及预后。方法:对1例SPA进行影像学、组织学形态及免疫组化染色观察,随访26个月并结合文献复习,探讨该病的临床病理特征及预后。结果:SPA临床上主要表现为涎腺缓慢生长的无痛性肿块。组织学特征与乳腺纤维囊肿性病变相似,表现为不规则的导管及腺泡分布于丰富的硬化性胶原间质中,形成模糊的小叶状结构。腺上皮细胞形态多样,有的呈大汗腺样化生,有的胞质内含丰富的嗜伊红酶原颗粒,导管上皮可以增生并伴有非典型性。免疫组化染色显示腺上皮EMA弥漫强阳性,导管及腺泡周围肌上皮SMA及Calponin阳性。Ki-67指数<1%。影像学表现:彩超结果表现为边界相对清楚或不清楚的低回声团,可以探及稀疏的血流信号。CT:表现为软组织密度肿块影,边缘较光滑,与正常腮腺分界清楚,也可边界不清。结论:硬化性多囊性腺病是一种罕见的涎腺疾病。主要发生于腮腺,预后较好。影像学缺乏特征表现,界限不清时易误诊为恶性肿瘤。需与黏液表皮样癌、多形性低度恶性腺癌、慢性涎腺炎等鉴别。Objective：To explore the clinicopathologic features, diagnosis and prognosis of sclerosing polycystic adenosis of salivary gland （SPA）. Methods：One case of sclerosing polycystic adenosis was report. The clinicopatholo- gy data and immunohistochemieal features were analyzed with review of the literature. Results ： a 15 - year - old fe- male was referred with a slowly growing painless mass in right parotid gland. Histologically, the tumor comparable to fibrocystic mastopathy and characterized by distinct hyalineized, centrally accentrated sclerosing collageneous tissue with inclusion of cystically ectatic ducts, forming a vaguely lobular pattern. The ducts epithelial frequently showed apo- crine- like metaplasia and epithelial hyperplasia or atypical hyperplasia, some epithelial cells contained abundant eo- sinophilic zymogen granules, some cells showed foamy - cell looking. Immunohistochemical staining （ calponin and smooth muscle aetin and S- 100） showed a peripheralmyopihheal layer which confirmed the intraductal nature of the hyperplastic ducts. Some cells expressed ER and AR protein, there were no significance image features except for low density mass in salivary location ,the borders of mass are defined or ill - defined. The limited follow - up suggests that has a favorable prognosis. Conclusion：SPA is rare disease of salivary gland with a favorable prognosis. Differential di- agnosis include mucoepidermoid carcinoma,polymorphous low grade adenocarcinoma and so on.

关 键 词：硬化性多囊性腺病 涎腺 预后 鉴别诊断 

分 类 号：R739.87[医药卫生—肿瘤]