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- 右颌下肿块，新加免疫组化-唾腺中鲜见的肿瘤类型
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诊断癌在腺瘤中需要见到较多的多形性腺瘤的良性成分，即要见到较多的（不是偶见）唾腺腔面腺细胞。
肌上皮癌有不同的肌上皮细胞类型组成，可以是梭形、星形和上皮样，也可以是浆细胞样，偶有印戒细胞样或胞浆空泡状（透明细胞变异），多见以梭形细胞为主。本例可能是梭形细胞为主。
瘤细胞生长的结构可以是实性、梁状、片状，抑或呈网状（肿块1图5）。
肌上皮癌可富含黏液样或玻璃样变的间质，肿瘤细胞可在这样的背景下生长。
肿块2的图片中，结节局部或周边含有淋巴结结构（有的还见生发中心），转移癌的可能性最大。由于该类型癌细胞有产基质作用，"粗大间质结构"可能是转移癌细胞产基质或生长较长时间（肿块2cmx1cmx1cm）而促纤维增生的缘故。
- 王军臣
请见下文关于唾腺肌上皮癌中肌上皮标志物的表达，我们就可以理解为什么S-100表达在本例为阴性。本文也帮助我们理解为什么标记肌上皮至少要做两个标记。
1）文中51例唾腺肌上皮癌的标记（蓝字为肌上皮标志物）显示：
肿瘤细胞表达肌上皮标志物阳性率（其中S-100 阳性率82%）
CD10 (62%)
SMA (35%)
S-100 (82%)
p63 (28%)
calponin (98%)
2）唾腺肌上皮癌中其他阳性表达率：vimentin (100%)、CK (74%),、EMA (27%)
3）唾腺肌上皮癌表达CEA (100%) 阴性。
Arch Otolaryngol Head Neck Surg. 2010 Jul;136(7):702-12.
Myoepithelial carcinoma of the salivary glands: a clinicopathologic study of 51 cases in a tertiary cancer center.
Abstract
OBJECTIVE: To analyze the importance of unique cytoarchitectural patterns and the immunohistochemical profile in the diagnosis of myoepithelial carcinomas.
DESIGN: Retrospective case analysis.SETTING: Tertiary cancer center.
PATIENTS:
A total of 51 patients with myoepithelial-rich carcinomas diagnosed over a 14-year period were studied for demographic data and tumor histologic characteristics and biologic behavior.
MAIN OUTCOME MEASURES:
We analyzed various histopathologic parameters and an immunohistochemical profile consisting of pan-cytokeratin (Pan-CK), epithelial membrane antigen (EMA), CD10, smooth-muscle actin (SMA), S-100 protein, p63, calponin, and carcinoembryonic antigen (CEA).
RESULTS:
The parotid gland (n = 15) and the palate (n = 15) were common sites involved. The cell types encountered were epithelioid, stellate, plasmacytoid, spindle, clear, and mixed with myxoid, hyaline, or myxohyaline stroma. Immunohistochemical analysis revealed vimentin (100%), CK (74%), EMA (27%), CD10 (62%), SMA (35%), S-100 protein (82%), p63 (28%), and calponin (98%) positivity and CEA (100%) negativity. Cervical node dissection was performed in 17 cases: 7 showed nodal metastasis, 2 with pure spindle-cell morphologic characteristics and 3 with spindle cells mixed with other cells. Distant metastasis was noted in 3 of these 7 cases: 2 of these 3 cases showed spindle-cell morphologic characteristics.
CONCLUSIONS:
Myoepithelial carcinomas showed varied cell types and patterns leading to a wide range of differential diagnoses. Immunohistochemical analysis helped determine the diagnosis. Spindle morphologic characteristics were observed with nodal and distant metastasis.
- 王军臣
