1、三、涎腺 第十六章- 涎腺上皮性恶性肿瘤,目录,目录,(一)Acinic Cell Carcinoma （腺泡细胞癌）,肿瘤细胞含有酶原颗粒，呈现浆液性腺泡细胞分化 Low grade malignancy 低度恶性,Acinic Cell Carcinoma,Introduction,Acinic Cell Carcinoma,Pathology,Histological Examination 5 cell types Acinar cells 腺泡样细胞 Vacuolated cells 空泡样细胞 Intercalated duct cells闰管样细胞 Clear cells 透明细
2、胞 Non-specific glandular cells,Acinic Cell Carcinoma,Acinic Cell Carcinoma,Acinic Cell Carcinoma,Vacuolated cells,Acinic Cell Carcinoma,Amphophilic cytoplasm, indistinct cell borders, imparting syncytial合体样 appearance Nuclei are larger, more vesicular and more pleomorphic,Non-specific glandular cell
3、s,histological patterns,Solid 实体型 Microcystic 微囊型 Follicular 滤泡型 Papillocystic 乳头囊状型,Acinic Cell Carcinoma,Solid,Composed predominantly of acinar cells, closely mimic normal salivary gland,Acinic Cell Carcinoma,Microcystic Prominent cellular vacuolization and intercellular cystic change Appears to b
4、e the result of secretion accumulation, probably as a result of lack of ducts,Acinic Cell Carcinoma,Microcystic Duct-type and acinar-type cells intermingled to varying degrees,Acinic Cell Carcinoma,Follicular Appears to be an exaggerated acinar-microsystic pattern Dilated acini are lined by a flatte
5、ned epithelium and contain colloid-like material,Scant and composed of thin, delicate strands of fibrovascular tissue Some tumors have a prominent lymphoid infiltrate in the stroma that may be follicular and may contain germinal centers,Stroma,Acinic Cell Carcinoma,Biological Characteristics,Metasta
6、ses to lymph nodes: 5%16%Metastases to lung, bone: 15% Survival：5 years 76% 90%beyond 15 years 44% 67%,Acinic Cell Carcinoma,（二）粘液表皮样癌,Mucoepidermoid Carcinoma,21,Introduction,在涎腺恶性肿瘤中属多见者（30） 3050岁多见，儿童涎腺恶性肿瘤 临床表现无特殊性。,Mucoepidermoid Carcinoma,Mucoepidermoid Carcinoma,Clinical Features,High grade R
7、apidly enlarging lesion, present as a painful mass Mass tends to be firmer and less movable Ulceration has been encountered in minor glands Associated with facial nerve palsy(面瘫) when parotid is involved,Mucoepidermoid Carcinoma,24,Mucoepidermoid Carcinoma,25,病理变化,肉眼观察：肿瘤可以不完整包膜或无包膜形状圆形或不规则。切面灰白色或粉红
8、色，其中可见大小不等的囊腔，内含粘液。,Mucoepidermoid Carcinoma,26,Mucoepidermoid Carcinoma,病理变化,镜下观察：肿瘤由表皮样细胞、粘液细胞和中间细胞构成。 根据三种细胞的比例和分化，可将其分为高、中、低分化三种。,Mucoepidermoid Carcinoma,Mucous cell,Cuboidal, columnar or goblet-like Containing fine, reticular(网状的) cytoplasm that tends to compress the small, dark peripheral neu
9、cleus Cytoplasm is positive with both mucicarmine(黏液卡红) and PAS,Mucoepidermoid Carcinoma,Mucoepidermoid Carcinoma,Epidermoid cell,Similar in shape with squamous cell, but intercellular bridge is seldom encountered polygonal, with vesicular(泡状的) nuclei and abundant cytoplasm Show individual keratiniz
10、ation(角化), but pearl(角化珠) formation and extensive keratinization not frequent,Mucoepidermoid Carcinoma,Mucoepidermoid Carcinoma,Intermediate cell,Oval(卵圆的) and resemble basal cell(基底细胞), smaller than either epidermoid or mucous cells, with scarce cytoplasm and dark nucleus Be capable of differentiat
11、ing into epidermoid or mucous cells,Mucoepidermoid Carcinoma,Mucoepidermoid Carcinoma,Low grade,Presence of large numbers of mucous cells, over 50% Epidermoid cells also present, intermediate cells are much fewer Nuclei are uniform, mitoses(有丝分裂) are extremely rare,Low grade,Numerous cysts lined by
12、mucous and epidermoid cells Cystic spaces are filled with eosonophilic mucin(黏液 ),Low grade,Mucoid material may leak into the surrounding stroma, resulting in inflammatory reaction Grow with more of a pushing (推进的), rather than infiltrating(浸润的) margins,Histological Examination,High grade Predominan
13、tly epidermoid and intermediate cells, mucous cell are less than 10%,Histological Examination,High grade:Solid nests are preponderant,Nuclear pleomorphism(多形性) and mitoses,Histological Examination,High grade Perineural and vascular invasion, along with soft tissue invasion, are also the features,His
14、tological Examination,Intermediate grade Intermediate and epidermoid cells prediminate and form solid islands Have fewer and smaller cysts than low grade Slight to moderate pleomorphism and occasional mitotic figures,Histological Examination,Clear cells(透明细胞), oncocytic cells(嗜酸细胞), sebaceous cells(
15、皮脂细胞) could present in the tumors,Histological Examination,Connective stroma Dense connective tissues, could accompanied by hyalinization Lymphocytes, cholesterol clefts and giant cells are frequently seen,Biological Characteristics,Prognosis(预后) correlates with the histological grade(组织学分级)High gra
16、de is associated with a high recurrence and metastases rates5-year determinate cure rate low grade 90%intermediate grade 80%high grade 27%,Biological Characteristics 生物学特点,Wide local excision(局部切除)Low grade, Intermediate grade Neck dissection(颈清)High grade,Histogenesis,Basal cell of execratory duct
17、(排泄管) Basal cell of epithelium of oral mucosa (intraoral),49,（三）腺样囊性癌,上皮、肌上皮细胞排列成管状、筛状和实性巢等不同形态结构。 生长慢，浸润性 圆柱瘤（cylindroma）,adenoid cystic carcinoma,临床表现,常见，27% 4060，腮腺、腭腺、颌下腺、舌下腺、口底较多见 临床过程似多形性腺瘤，界限不清，浸润神经，与周围组织粘连等症状 疼痛,神经累及,53,病理变化,肉眼观察：圆形、结节状或不规则形。无包膜、界不清；切面灰白，可见出血和囊性变,病理变化,细胞：导管内衬上皮细胞和变异肌上皮细胞。 分型
18、： 1.腺性（筛状）型 2.管状型 3.充实型,55,病理变化,镜下观察： 结构： 腺性（筛状）型：最典型最常见结构 管状型：小管或条索状 实性型：排列成上皮团块，中心可变性、坏死 复发转移早 预后差,adenoid cystic carcinoma,56,腺性（筛状）型,58,涎腺肿瘤/腺样囊性癌/病理,管状型,60,腺样囊性癌,adenoid cystic carcinoma,adenoid cystic carcinoma,62,腺样囊性癌累及神经,adenoid cystic carcinoma,63,adenoid cystic carcinoma,64,生物学特点,复发、转移率较高
19、，恶性程度较高者与细胞形态不一致（“ it is a wolf in sheep clothing”）。 Survival (生存率)5 years 75% 10 years 40%15 years 25% 20 years 20% 组织发生：闰管或闰管储备细胞,adenoid cystic carcinoma,（四）上皮-肌上皮瘤,(epithelio-myoepithelial carcinoma),66,上皮肌上皮癌,老年女性，腮腺 上皮与肌上皮形成导管样结构 低度恶性肿瘤,上皮-肌上皮癌,肿瘤细胞排列成双层管状结构,分叶或结节状，包膜不完整或无包膜，剖面实性，灰白色，可见出血，坏死和囊性变 镜下肿瘤有两种细胞构成，形成典型的双层管状结构，内层是闰管样上皮细胞，外层是肌上皮细胞,68,作业：,粘液表皮样癌 腺泡细胞癌 腺样囊性癌,总结,掌握常见恶性肿瘤的临床病理特点。粘液表皮样癌 腺样囊性癌 癌在混合瘤中 腺泡细胞癌 淋巴上皮癌,谢谢大家,
