涎腺分泌性癌5例临床病理及预后分析  

Secretory carcinoma of salivary gland:a clinicopathological and prognosis analysis of 5 cases

作　　者：赵利敏[1] 白睿华 王志永[1] 杨元元[1] 刘晓博[1] ZHAO Limin;BAI Ruihua;WANG Zhiyong;YANG Yuanyuan;LIU Xiaobo(Department of Pathology,The First People's Hospital of Zhengzhou,Zhengzhou,He'nan 450004,China;Department of Pathology,Cancer Hospital Affiliated to Zhengzhou University,He'nan Cancer Hospital,Zhengzhou,He'nan 450008,China)

机构地区：[1]郑州市第一人民医院病理科,河南郑州450004 [2]郑州大学附属肿瘤医院、河南省肿瘤医院病理科,河南郑州450008

出　　处：《安徽医药》2025年第3期600-603,I0006,共5页Anhui Medical and Pharmaceutical Journal

摘　　要：目的探讨涎腺分泌性癌(SCSG)的临床病理学特征、免疫表型、分子病理学特征、诊断及预后。方法收集2019年12月至2023年2月郑州市第一人民医院及河南省肿瘤医院病理科诊断SCSG 5例病人的临床病理资料,采用苏木精-伊红(HE)、免疫组织化学染色及荧光原位杂交(FISH)进行病理学观察。结果5例中男2例,女3例,年龄范围6~73岁;4例病变位于腮腺,1例位于上唇,临床多无明显诱因出现面部肿物前来就诊;镜下肿瘤腔内可见嗜酸性均质分泌物,细胞核大小相对一致,胞浆丰富,偶见核分裂象。免疫表型:5例肿瘤细胞广谱细胞角蛋白(CK)、细胞角蛋白7(CK7)、乳腺球蛋白(Mammaglobin)、神经特异性蛋白(S-100)、GATA结合蛋白-3(GATA-3)阳性,波形蛋白(Vimentin)及上皮膜蛋白(EMA)部分阳性,钙调理蛋白(Calponin)、酪氨酸激酶生长因子受体(CD117)、DOG-1、P63阴性、Ki67(5%~20%+)。5例中3例进行了ETV6-NTRK3基因融合检测,均为阳性。5例均进行了手术切除,其中1例进行了放疗;随访5例病人无瘤生存(分别随访10、16、34、38、46个月)。结论SCSG属于较为罕见的低度恶性涎腺肿瘤,易误诊为其他恶性肿瘤,免疫组织化学标志物及ETV6-NTRK3基因检测的联合应用对SCSG的诊断及治疗有较大价值。Objective To investigate the clinicopathological features,immunophenotype,molecular pathological characteristics,diagnoses and prognosis of secretory carcinoma of salivary gland(SCSG).Methods Clinicopathological data of 5 patients with SCSG diagnosed in the Department of Pathology of The First People's Hospital of Zhengzhou and Henan Cancer Hospital from December 2019 to February 2023 were collected.Hematoxylin-eosin(HE)staining,immunohistochemical staining and fluorescence in situ hybridization(FISH)were used for pathological observation.Results Among the 5 patients,2 were male and 3 were female,with an age range of 6-73 years.Four lesions were located in the parotid gland,and one in the upper lip.Clinically,the patients mostly sought medical treatment because of facial masses without obvious inducement.Microscopically,homogeneous eosinophilic secretion was visible in the lumen.The nuclei were relatively uniform in size.The cytoplasm was rich and occasionally showed nuclear division.Immunohistochemically,generalized cytokeratin(CK),CK7,Mammaglobin,neuron-specific protein(S-100),and GATA binding protein-3(GATA-3)were positive,and Vimentin and epithelial membrane antigen(EMA)were partially positive in tumor cells of the 5 cases.Calponin,growth factor receptor tyrosine kinase(CD117),DOG-1,and P63 were negative.Ki67 was positive in 5%-20%of tumor cells.Among the 5 cases,3 cases were detected for ETV6-NTRK3 gene fusion,which were all positive.Five patients all underwent surgical resection,among which 1 patient received radiotherapy.During follow-up,all the 5 patients had no tumor survival(followed up for 10,16,34,38,and 46 months).Conclusion SCSG is a rare low-grade malignant salivary gland tumor which is easy to be misdiagnosed as other malignancies.The combined application of immunohistochemical marker and ETV6-NTRK3 gene detection is of great value for the diagnosis and treatment of SCSG.

关 键 词：涎腺肿瘤 广谱细胞角蛋白 神经特异性蛋白 GATA结合蛋白-3 钙调理蛋白 酪氨酸激酶生长因子受体 鉴别诊断 预后 

分 类 号：R73[医药卫生—肿瘤]