涎腺分泌癌3例临床病理观察
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摘要
目的探讨涎腺分泌癌(SC)的临床病理学特征、诊断及鉴别诊断。方法回顾性分析3例SC的临床病理特征、免疫表型及分子特征等,并复习相关文献。结果 3例肿瘤均与周围涎腺组织的分界比较清楚,2例为实性结节,1例为囊性病变。肿瘤组织由大囊、微囊、实性、管状及乳头状结构构成,大量的嗜酸性均质蛋白样分泌物存在于微囊及管状腔隙内(类似甲状腺滤泡),3例均未见神经侵犯、脉管内癌栓形成,未见坏死。3例肿瘤细胞均具有低级别的形态学特征:细胞大小一致,胞质空泡状或嗜酸性细颗粒状,小到中等大的胞核,明显小核仁。均未见胞质内酶原颗粒及核分裂象。肿瘤细胞均S-100、mammaglobin弥漫强(+),GCDFP-15弱(+),DOG-1(-)。3例ETV6的FISH检测结果均为(+)。结论 SC为实体病变,易误诊。熟悉其临床病理学特点、免疫表型及分子特征,有助于其正确诊断。
Objective To investigate the clinicopathological characteristics,diagnosis and differential diagnosis of secretory carcinoma( SC) of the salivary gland. Methods The clinical manifestations, morphological,immunohistochemical and molecular pathological features were analyzed in three cases of SC with review of the associated literatures. Results Grossly,the boundary between the tumor and the surrounding salivary gland in 3 cases was clear. 2 cases were solid nodule and 1 case was cystic lesion. Microscopically,the tumors consisted of varying proportions of macrocystic,microcystic,solid,tubular and papillary growth patterns. Tumor cells secreted eosinophilic material( similar to thyroid follicles). No nerve invasion,intravascular tumor thrombi,and necrosis were found. All 3 cases had low grade cytological characteristics: the uniform cells with an abundant pink or bubble cytoplasm,and the small to medium-sized nuclei with prominent small nucleoli. No cytoplasmic zymogen granules and mitotic figures were seen.Immunohistochemically,tumor cells( 3/3) were strongly and diffusely positive for S-100 and mammaglobin,weak positive for GCDFP-15 and negative for DOG-1. Three SCs were tested by fluorescence in situ hybridization( FISH) and the ETV6 gene rearrangement was confirmed. Conclusions SC is a newly listed entity in the 4 th Edition of the World Health Organization Classification of Head and Neck Tumors,which is easily misdiagnosed. The comprehensive evaluation of clinical manifestations,pathologic features,immunohistochemical findings and ETV6 gene rearrangement by FISH are essential for definitive diagnosis.
Objective To investigate the clinicopathological characteristics,diagnosis and differential diagnosis of secretory carcinoma( SC) of the salivary gland. Methods The clinical manifestations, morphological,immunohistochemical and molecular pathological features were analyzed in three cases of SC with review of the associated literatures. Results Grossly,the boundary between the tumor and the surrounding salivary gland in 3 cases was clear. 2 cases were solid nodule and 1 case was cystic lesion. Microscopically,the tumors consisted of varying proportions of macrocystic,microcystic,solid,tubular and papillary growth patterns. Tumor cells secreted eosinophilic material( similar to thyroid follicles). No nerve invasion,intravascular tumor thrombi,and necrosis were found. All 3 cases had low grade cytological characteristics: the uniform cells with an abundant pink or bubble cytoplasm,and the small to medium-sized nuclei with prominent small nucleoli. No cytoplasmic zymogen granules and mitotic figures were seen.Immunohistochemically,tumor cells( 3/3) were strongly and diffusely positive for S-100 and mammaglobin,weak positive for GCDFP-15 and negative for DOG-1. Three SCs were tested by fluorescence in situ hybridization( FISH) and the ETV6 gene rearrangement was confirmed. Conclusions SC is a newly listed entity in the 4 th Edition of the World Health Organization Classification of Head and Neck Tumors,which is easily misdiagnosed. The comprehensive evaluation of clinical manifestations,pathologic features,immunohistochemical findings and ETV6 gene rearrangement by FISH are essential for definitive diagnosis.
引文
[1] Seethala RR,Stenman G. Update from the 4th Edition of the World Health Organization classification of head and neck tumours:tumors of the salivary gland[J]. Head Neck Pathol,2017,11(1):55-67.
[2] SklovA,Vanecek T,Sima R,et al. Mammary analogue secretory carcinoma of salivary glands, containing the ETV6-NTRK3 fusion gene:a hitherto undescribed salivary gland tumor entity[J]. Am J Surg Pathol,2010,34(5):599-608.
[3] Stevens TM,Kovalovsky AO,Velosa C,et al. Mammary analog secretory carcinoma, low-grade salivary duct carcinoma, and mimickers:a comparative study[J]. Mod Pathol,2015,28(8):1084-1085.
[4] Urano M, Nagao T, Miyabe S, et al. Characterization of mammary analogue secretory carcinoma of the salivary gland:discrimination from its mimics by the presence of the ETV6-NTRK3 translocation and novel surrogate markers[J]. Hum Pathol,2015,46(1):94-103.
[5] Ni H,Zhang XP,Wang XT,et al. Extended immunologic and genetic lineage of mammary analogue secretory carcinoma of salivary glands[J]. Hum Pathol,2016,58:97-104.
[6] Said-Al-Naief N,Carlos R,Vance GH,et al. Combined DOG1and mammaglobin immunohistochemistry is comparable to ETV6-breakapart analysis for differentiating between papillary cystic variants of acinic cell carcinoma and mammary analogue secretory carcinoma[J]. Int J Surg Pathol,2017,25(2):127-140.
[7] Hsieh MS,Lee YH,Chang YL. SOX10-positive salivary gland tumors:a growing list,including mammary analogue secretory carcinoma of the salivary gland,sialoblastoma,low-grade salivary duct carcinoma, basal cell adenoma/adenocarcinoma, and a subgroup of mucoepidermoid carcinoma[J]. Hum Pathol,2016,56:134-142.
[8] SklovA,Vanecek T,Simpson RH,et al. Mammary analogue secretory carcinoma of salivary glands:molecular analysis of 25ETV6 gene rearranged tumors with lack of detection of classical ETV6-NTRK3 fusion transcript by standard RT-PCR:report of 4cases harboring ETV6-X gene fusion[J]. Am J Surg Pathol,2016,40(1):3-13.
[9] Baghai F,Yazdani F,Etebarian A,et al. Clinicopathologic and molecular characterization of mammary analogue secretory carcinoma of salivary gland origin[J]. Pathol Res Pract,2017,1(17):338-344.
[2] SklovA,Vanecek T,Sima R,et al. Mammary analogue secretory carcinoma of salivary glands, containing the ETV6-NTRK3 fusion gene:a hitherto undescribed salivary gland tumor entity[J]. Am J Surg Pathol,2010,34(5):599-608.
[3] Stevens TM,Kovalovsky AO,Velosa C,et al. Mammary analog secretory carcinoma, low-grade salivary duct carcinoma, and mimickers:a comparative study[J]. Mod Pathol,2015,28(8):1084-1085.
[4] Urano M, Nagao T, Miyabe S, et al. Characterization of mammary analogue secretory carcinoma of the salivary gland:discrimination from its mimics by the presence of the ETV6-NTRK3 translocation and novel surrogate markers[J]. Hum Pathol,2015,46(1):94-103.
[5] Ni H,Zhang XP,Wang XT,et al. Extended immunologic and genetic lineage of mammary analogue secretory carcinoma of salivary glands[J]. Hum Pathol,2016,58:97-104.
[6] Said-Al-Naief N,Carlos R,Vance GH,et al. Combined DOG1and mammaglobin immunohistochemistry is comparable to ETV6-breakapart analysis for differentiating between papillary cystic variants of acinic cell carcinoma and mammary analogue secretory carcinoma[J]. Int J Surg Pathol,2017,25(2):127-140.
[7] Hsieh MS,Lee YH,Chang YL. SOX10-positive salivary gland tumors:a growing list,including mammary analogue secretory carcinoma of the salivary gland,sialoblastoma,low-grade salivary duct carcinoma, basal cell adenoma/adenocarcinoma, and a subgroup of mucoepidermoid carcinoma[J]. Hum Pathol,2016,56:134-142.
[8] SklovA,Vanecek T,Simpson RH,et al. Mammary analogue secretory carcinoma of salivary glands:molecular analysis of 25ETV6 gene rearranged tumors with lack of detection of classical ETV6-NTRK3 fusion transcript by standard RT-PCR:report of 4cases harboring ETV6-X gene fusion[J]. Am J Surg Pathol,2016,40(1):3-13.
[9] Baghai F,Yazdani F,Etebarian A,et al. Clinicopathologic and molecular characterization of mammary analogue secretory carcinoma of salivary gland origin[J]. Pathol Res Pract,2017,1(17):338-344.