唾液腺分泌性癌10例临床病理分析  

Clinicopathological observation of 10 cases of salivary secretory carcinoma

作　　者：刘艳艳 汤晓飞[2] 王凤光[1] 汪育苗[1] 刘娜 胡晔华[1] 赵聪慧 袁晓红[1] Liu Yanyan;Tang Xiaofei;Wang Fengguang;Wang Yumiao;Liu Na;Hu Yehua;Zhao Conghui;Yuan Xiaohong(Department of Pathology,Capital Medical University School of Stomatology,Beijing 100050,China;Institute of Dental Research,Capital Medical University School of Stomatology,Beijing 100050,China)

机构地区：[1]首都医科大学口腔医学院病理科,北京100050 [2]首都医科大学口腔医学院口腔医学研究所,北京100050

出　　处：《中华口腔医学杂志》2022年第11期1128-1133,共6页Chinese Journal of Stomatology

摘　　要：目的探讨唾液腺分泌性癌(salivary secretory carcinoma,SSC)的临床及病理特征。方法回顾性纳入2014年1月至2021年12月于首都医科大学口腔医学院病理科确诊的SSC10例,其中男性5例,女性5例,中位年龄46.5岁。观察SSC镜下形态、免疫表型、特殊染色及其临床随访情况,并用荧光原位杂交法检测ETV6-NTRK3融合基因情况。10例患者检测了S-100、波形蛋白、乳腺球蛋白、Dog-1、p63及Ki-67,9例检测了细胞角蛋白(cytokeratin,CK)8/18,8例检测了CK7,6例检测了钙调理蛋白,5例检测了平滑肌肌动蛋白(smooth muscle actin,SMA),4例检测了CK5/6,1例检测了SOX10。结果10例SSC中7例位于腮腺,3例位于颊部。组织形态学显示有实性型、乳头-囊状型、滤泡型、微囊型及大囊型,7例肿瘤细胞以单一排列方式为主,部分区域合并其他排列方式;肿瘤细胞胞质丰富、嗜酸性,呈细颗粒状或空泡状,2例可见透明胞质,细胞核大都表现为椭圆形泡状核,中央可见核仁。免疫组化染色显示,CK7、CK8/18、S-100均为阳性,波形蛋白5例阳性、4例部分阳性和1例少部分阳性,7例乳腺球蛋白阳性、1例部分阳性及2例仅个别细胞阳性,Dog-1、CK5/6、SMA、钙调理蛋白均为阴性,p637例阴性、3例少部分阳性,Ki-67指数为5%-20%。5例行过碘酸希夫(periodic acid-Schiff,PAS)染色及淀粉酶消化PAS染色均表现为分泌物阳性。10例均检测到ETV6-NTRK3融合基因信号。6例患者随访时间为32-91个月,其中2例分别于术后28和74个月复发,并再次行手术切除,6例随访病例复查至随访期末均无复发。结论SSC为较罕见的低度恶性肿瘤,部分SSC病例可出现形态不典型或免疫组化指标乳腺球蛋白仅个别肿瘤细胞阳性的现象,因此诊断需结合形态学及免疫组化染色,必要时进行分子检测。Objective To investigate the clinical and pathological features of salivary secretory carcinoma(SSC).Methods Ten cases of SSC confirmed in the Department of Pathology,Capital Medical University School of Stomatology from January 2014 to December 2021 were retrospectively included,including 5 males and 5 females,with a median age of 46.5 years.The microscopic morphology,immunophenotype,special staining and clinical follow-up of 10 cases of salivary secretory carcinoma were observed.Ten patients were tested with S-100,vimentin,mammaglobin,Dog-1,p63 and Ki-67,9 cases with cytokeratin(CK)8/18,8 with CK7,6 with calponin,5 with smooth muscle actin(SMA)and GCDFP15,4 with CK5/6 and 1 with SOX10.The ETV6-NTRK3 fusion gene was detected by fluorescence in situ hybridization.Results Seven of the 10 SSC were located in the parotid gland and 3 were located in the cheeks.Histomorphology showed solid,papillary-cystic,follicular,microcystic,and macrocystic types.In 7 cases,tumor cells were dominated by single arrangement type,while certain mixed arrangements existed in some areas.The cytoplasm of the tumor cells was rich in eosinophilic,fine granular or vacuolar shapes,and clear cytoplasm was seen in 2 cases.The nuclei were mostly oval-shaped vesicular nuclei,with nucleoli in the center.Immunohistochemistry showed CK7(8/8)positive,CK8/18(9/9)positive,S-100(10/10)positive,vimentin(5/10)positive,(4/10)partially positive and(1/10)less partially positive,mammaglobin(7/10)positive,(1/10)partially positive and(2/10)some individual cells positive,Dog-1(10/10)negative,CK5/6(4/4)negative,p63(7/10)negative and(3/10)partially positive,SMA(5/5)negative,calponin(6/6)negative,and Ki-67 index was 5%-20%.Secretions of 5 cases showed periodic acid-Schiff(PAS)and PAS with diastase(PAS-D)staining positive.All 10 cases showed ETV6-NTRK3 fusion positive.Six cases were successfully followed up for 32-91 months,of which 2 cases recurred after 28 and 74 months and underwent surgical resection again.All cases followed up are alive and disease-free.Conclu

关 键 词：免疫组织化学 唾液腺分泌性癌 ETV6-NTRK3 诊断 鉴别 

分 类 号：R739.87[医药卫生—肿瘤]