涎腺黏液表皮样癌与多形性腺瘤的细胞学诊断及鉴别  

Cytological diagnosis and differential diagnosis of mucoepidermoid carcinoma of salivary glands and pleomorphic adenoma

作　　者：黄丛改 李孟泽[2] 汪少华 刘云 万宇 王洁琼 唐晓琴 杨志惠 HUANG Cong-gai;LI Meng-ze;WANG Shao-hua;LIU Yun;WAN Yu;WANG Jie-qiong;TANG Xiao-qin;YANG Zhi-hui(Department of Pathology,the Affiliated Hospital of Southwest Medical University,Luzhou 646000,China;Department of Orthopaedics,Luzhou Traditional Chinese Medicine Hospital,Luzhou 646000,China)

机构地区：[1]西南医科大学附属医院病理科,泸州646000 [2]四川省泸州市中医医院骨一科,泸州646000

出　　处：《临床与实验病理学杂志》2021年第4期424-427,共4页Chinese Journal of Clinical and Experimental Pathology

摘　　要：目的分析涎腺黏液表皮样癌(mucoepidermoid carcinoma,MEC)的细胞学形态特点,探讨涎腺MEC与涎腺多形性腺瘤(pleomorphic adenoma,PA)的细胞学鉴别诊断。方法回顾性分析2014年8月~2017年7月西南医科大学附属医院存档的21例头颈部涎腺MEC及190例涎腺PA的细胞学涂片。结果MEC主要由黏液细胞、中间细胞和表皮样细胞构成,背景可有黏液以及巨噬细胞、中性粒细胞和淋巴细胞,黏液常见;细胞核呈圆形或卵圆形、可有异型性,细胞核深染,染色质粗或略粗且分布不均,细胞核大且大小不一、形状不规则、核分裂象少见;小核仁可见,部分病例核仁明显;瘤细胞胞质丰富。PA细胞学涂片黏液背景特点与MEC相似,其与MEC的不同之处主要为:单个散在分布的肿瘤性导管细胞少见;肌上皮细胞多见;细胞核染色略深,形状规则一致、大小均一、无异型性;瘤细胞胞质无MEC丰富。结论涎腺MEC与PA细胞学表现既相似又各有特点,绝大多数病例可通过细胞学诊断及鉴别。黏液物质是细胞学诊断MEC的重要线索,但非该恶性肿瘤的特异性改变。黏液细胞、表皮样细胞和中间细胞是诊断MEC的必要条件,肌上皮细胞和成团的腺上皮细胞是诊断PA的必要条件,也是鉴别MEC与PA可靠的细胞学指标。Purpose To describe the cytologic features of mucoepidermoid carcinoma(MEC)of salivary glands,and to identify the cytologic features of MEC different from pleomorphic adenoma(PA).Methods A retrospective review of cytology smears of 21 cases of MEC and 190 cases of PA of salivary glands were performed.All cases were collected from the affiliated hospital of Southwest Medical University from 2014 August to 2017 July.All cases had histological confirmation.Results MEC was mainly composed of mucous cells,intermediate cells and epidermoid cells,with background of mucinous cells,macrophages,neutrophils and lymphocytes.Mucous was common.The nuclei were round or oval with atypia.The nuclei were hyperchromatic with coarse or slightly coarse chromatin and unevenly distributed.The nuclei were large and of different sizes,irregular in shape and rarely mitosis.Small nucleoli were visible,and nucleoli were obvious in some cases.Tumor cells had abundant cytoplasm.Heteromorphism of MEC nuclei:the nuclei are hyperchromatic,with coarse or slightly coarse chromatin and unevenly distributed.Large and varied nuclei.The nuclei are slightly irregular in shape,and mitoses are rare.The background characteristics of the mucus in PA cytology smear were similar to those of MEC,and the differences between MEC and PA cytology smear were mainly as follows:single scattered tumor ductal cells were rare.Myoepithelial cells were more common.The nuclei were slightly darker,with uniform shape,uniform size and no atypia.The cytoplasm of tumor cells was not as rich as MEC.Conclusion The cytological manifestations of MEC and PA in salivary glands are similar and have their own characteristics,and the majority of cases can be diagnosed and differentiated by cytology.Mucinous substance is an important clue for cytological diagnosis of MEC,but it is not a specific change of this malignant tumor.Mucinous cells,epidermoid cells and intermediate cells are necessary conditions for the diagnosis of MEC,while myoepithelial cells and lumpy glandular epithelial c

关 键 词：涎腺肿瘤 多形性腺瘤 黏液表皮样 细胞学诊断 

分 类 号：R739.87[医药卫生—肿瘤]