唾液腺伴胸腺样分化的癌7例临床病理分析  

Salivary carcinoma showing thymus-like differentiation:clinicopathological analysis of 7 cases

作　　者：张春叶[1] 顾挺[1] 夏舒 王瑜 李江[1] Zhang Chunye;Gu Ting;Xia Shu;Wang Yu;Li Jiang(Department of Oral Pathology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine&College of Stomatology,Shanghai Jiao Tong University&National Center for Stomatology&National Clinical Research Center for Oral Diseases&Shanghai Key Laboratory of Stomatology&Shanghai Research Institute of Stomatology,Shanghai 200011,China;Department of Oral Pathology,Nanjing Stomatological Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210018,China)

机构地区：[1]上海交通大学医学院附属第九人民医院口腔病理科、上海交通大学口腔医学院、国家口腔医学中心、国家口腔疾病临床医学研究中心、上海市口腔医学重点实验室、上海市口腔医学研究所,上海200011 [2]南京大学医学院附属口腔医院·南京市口腔医院口腔病理科,南京210018

出　　处：《中华口腔医学杂志》2024年第5期479-485,共7页Chinese Journal of Stomatology

基　　金：国家自然科学基金(82141108,82103405);上海交通大学医学院附属第九人民医院临床研究助推计划(JYLJ202119)。

摘　　要：目的分析唾液腺伴胸腺样分化的癌(CASTLE)临床病理特点。方法收集并筛选上海交通大学医学院附属第九人民医院口腔病理科2020年1月至2023年12月期间满足唾液腺CASTLE诊断的病例。共收集7例患者,其中男性3例,女性4例,年龄范围11~70岁。分析患者的临床表现、镜下表现、免疫组化、预后等特点。结果7例唾液腺CASTLE均位于腮腺;病史1个月~1年,1例患者伴有面部麻木,1例偶有肿胀感;影像学上,4例考虑恶性肿瘤或恶性肿瘤待排。显微镜下,4例肿瘤累及周围腺体组织,所有肿瘤具有多少不一的淋巴组织背景,肿瘤细胞排列呈巢状,其中5例呈淋巴上皮癌样,2例呈鳞状细胞癌图像;淋巴上皮癌样肿瘤细胞除表达CD5外,尚表达CD117,呈鳞状细胞癌图像的病例局灶或部分表达CD117;所有病例均无EB病毒感染。6例有随访信息的患者均行术后放疗,未见肿瘤复发及转移。结论唾液腺CASTLE是一种少见的肿瘤,需与淋巴上皮癌和鳞状细胞癌鉴别,患者预后尚好,CD5在鉴别诊断中具有较大价值。Objective To analyze the clinicopathological features of salivary carcinoma showing thymus-like differentiation(CASTLE).Methods Cases diagnosed with salivary CASTLE from January 2020 to December 2023 were collected and selected from the Department of Oral Pathology,Shanghai Ninth People′s Hospital,Shanghai Jiao Tong University School of Medicine.A total of 7 cases of salivary CASTLE were identified.All the cases originated from parotid.There were 3 males and 4 females.The patients′age range was 11-70 years.The clinical,microscopic,immunohistochemical and prognostic features of these cases were analyzed.Results The duration of disease ranged from 1 month to 1 year,and 1 patient had facial numbness and 1 with swelling sensation occasionally.Radiographically,4 cases showed malignant signs.Microscopically,4 cases involved in parotid gland,and all the tumors had different degrees of lymphoid tissue background.The tumor cells arranged in nests,5 cases with lymphoepithelial carcinoma-like and 2 cases with squamous cell carcinoma morphology.The tumor cells expressed CD5 and CD117 proteins diffusely in lymphoepithelial carcinoma-like cases.However,the tumor cells expressed CD5 diffusely and CD117 focally in cases with squamous cell carcinoma morphology.All the cases had no Epstein-Barr virus infection.Among the 6 patients with follow-up information,all of them underwent postoperative radiotherapy,and none of them had local recurrence and lymph node metastasis.Conclusions Salivary CASTLE is a rare tumor,it should be distinguished from lymphoepithelial carcinoma and squamous cell carcinoma.The patients often have better prognosis and CD5 protein expression has a valuable role in the differential diagnosis.

关 键 词：病理学 临床 唾液腺 伴胸腺样分化的癌 抗原 CD5 

分 类 号：R739.87[医药卫生—肿瘤]