以下是引用xljin8在2010-4-17 17:59:00的发言：
非常好的病例！同意Dr.Fangg的诊断：脂肪瘤样多形性腺瘤。自1999年
Seifert首例报道至今，文献报道病例不到10例，国内尚未见报道。
1. Kondo T.
A case of lipomatous pleomorphic adenoma in the parotid gland: a case
report. Diagn
Pathol. 2009;4:16.
Division of
Pathology, Department of Pathology, Kobe University Graduate School
of
Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe 650-0017, Japan.
INTRODUCTION:
Pleomorphic adenoma is the most common benign neoplasm of the
salivary
glands. Extensive lipomatous involvement of the tumor is, however, a
very rare
finding. CASE REPORT: Herein, a rare case of lipomatous pleomorphic
adenoma
arising in the parotid gland of a 14-year-old Japanese woman is
presented.
CONCLUSION: This is the sixth case of lipomatous pleomorphic adenoma
in the
English literature. Recognition of this rare subtype of pleomorphic
adenoma is
important for clinical diagnosis and management. On CT scan, it may
not be
detected possibly due to the extensive fatty component.
2. Leroy X,
Wacrenier A, Augusto D, Leteurtre E, Desaulty A, Gosselin B. [Lipomatous
pleomorphic adenoma of the parotid] Ann Pathol. 2002 Jun;22(3):219-21.
Service
d'Anatomie et de Cytologie Pathologiques, pôle Huriez, CHRU, 59045
Lille,France.
x-leroy@chru-lille.fr
Lipomatous
tumors rarely occur in the salivary glands. We report an unusual case of
lipomatous
pleomorphic adenoma in a 47-year-old man. The patient had no
significant
medical history and presented with a well circumscribed nodule
measuring 3
cm in the right parotid. Histologically, the tumour was predominantly
composed of
sheets of mature fat cells. Rare myoepithelial cells and exceptional tubules
were
intermingled with the mature adipose tissue. One year after surgery
the patient
was alive without recurrence. In conclusion, it is a rare neoplasm
who needs
to be recognized and discussed with true fatty tumors and lipomatosis.
3. Korkmaz
H, Adsay NV, Jacobs JR, Lucas DR. Lipomatous pleomorphic adenoma of
parotid
gland. Histopathology. 2002;40:487-8.
4. Skálová
A, Stárek I, Simpson RH, Kucerová V, Dvorácková J, Curík R, Dusková M.
Spindle
cell myoepithelial tumours of the parotid gland with extensive
lipomatous metaplasia.
A report of four cases with immunohistochemical and ultrastructural
findings. Virchows
Arch. 2001;439:762-7.
We report
four cases of parotid gland tumours composed predominantly of
spindle-shaped
myoepithelial cells and mature adipocytes. The central portion of one
tumour
showed extensive adipose differentiation, whereas in the peripheral
parts there
were small foci of ductal epithelium arranged in cords and tubules
within an
abundant myxoid stroma. The other cases were adipose spindle cell
myoepitheliomas
without an obvious glandular component. Under high-power examination, a
transition between modified spindle-shaped myoepithelial cells and
adipocytes
was observed, and this was confirmed with immunohistochemistry.
Ultrastructurally,
the modified myoepithelial cells showed intracytoplasmic tonofilaments,
bundles
of actin microfilaments and lipid droplets. A possible pathogenesis is
proposed
of true metaplastic transformation of myoepithelial cells to adipocytes.
This
lesion is important to identify correctly, as inadequate surgery can
lead to
recurrence.
5.Seifert
G, Donath K, Schäfer R. Lipomatous pleomorphic adenoma of the parotid
gland.
Classification of lipomatous tissue in salivary glands.
Pathol Res
Pract. 1999;195:247-52.
Institute
of Pathology, University of Hamburg, Germany.
Lipomatous
pleomorphic adenoma is an unusual subtype with a lipomatous stromal
component
of more than 90% of the tumour tissue. This special type of pleomorphic
adenoma
must be distinguished from other types of lipomatous tumours or
non-tumourous
lipomatosis of the salivary glands. Until now only two cases of
lipomatous
pleomorphic adenoma have been reported in the literature. We report of a
36-year old woman who developed a well circumscribed nodule measuring
3.5 x 2.5
x 2 cm in the right parotid gland. The cut surface was grey-yellowish.
Histologically,
more than 90% of the tumour tissue was fatty tissue with univacuolar
adipocytes. The pleomorphic epithelial elements were duct-like cells
forming
small lumina and spindle-shaped myoepithelial cell with surrounding
mucoid
stroma. Components of pleomorphic adenoma were intermingled with mature
adipose
tissue which was more concentrated in the central portion of the
adenoma.Some
compressed epithelial cords in the adipose tissue formed a septa-like
pattern.
The differential diagnosis to other lipomatous tumours
(lipoadenoma,lipoma) and
to non-tumourous interstitial lipomatosis as well as the possible
pathogenesis
as metaplastic change or epithelial-mesenchymal transdifferentiation are
discussed. | 
