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目的分析泪腺腺样囊性癌的组织病理学特征,明确肿瘤侵袭相关的组织病理学特征与分型的关系。设计回顾性病例系列。研究对象经病理诊断证实的泪腺腺样囊性癌标本49例。方法观察组织学形态特征并以WHO标准分型,根据Szanto法分级。免疫组化检查选用的一抗有S-100和CD34。主要指标各种组织病理学分型的特征,与肿瘤侵袭相关的病理学特征在各分级组的阳性率,包括侵犯神经、脂肪、肌肉、血管内瘤栓等。侵犯神经在有无疼痛症状患者间的阳性率。结果泪腺腺样囊性癌组织学病理分型分为管状、筛状和实性型3种,SzantoⅠ级19例,Ⅱ级9例,Ⅲ级21例。S-100和CD34分别标记肿瘤内的神经纤维和血管内皮。肿瘤侵犯神经表现为两种显微镜下形态,共22例,占45%,其中Ⅰ级中1例,Ⅱ级中6例,Ⅲ级中15例。Ⅰ级和Ⅱ级间侵犯神经的例数有统计学差异(P=0.001);Ⅰ级和Ⅲ级问侵犯神经的例数有统计学差异(P=0.000)。分别有12例和7例显微镜下可见到肿瘤侵犯脂肪和肌肉,但三级间均无统计学差异。仅1例可见静脉血管内瘤栓。有疼痛者32例,无疼痛者17例,各有15例和7例显微镜下可见肿瘤侵犯神经,两者比较无统计学差异(P=0.703)。结论泪腺腺样囊性癌中Ⅲ级比例较高。侵犯神经是该肿瘤重要的侵袭方式,也是特征性病理表现,在高分级的肿瘤中发生率较高。侵犯脂肪、肌肉以及血管内瘤栓发生率较低。疼痛症状与镜下肿瘤侵犯神经无明显对应关系。
Objective To analyze the histopathological features of adenoid cystic carcinoma of the lacrimal gland and clarify the relationship between the histopathological features and the typing of tumor invasion. Design retrospective case series. 49 cases of lacrimal adenoid cystic carcinoma confirmed by pathology. Methods Histological features were observed and classified according to the WHO standard, according to the Szanto method. Immunohistochemistry used the primary antibody selected S-100 and CD34. The main indicators of various histopathological characteristics of the type of pathological features associated with tumor invasion in the grading group of positive rates, including violations of nerve, fat, muscle, intravascular tumor thrombus and so on. Violation of nerve in the presence or absence of pain in patients with positive rates. Results The histological classification of adenoid cystic carcinoma of lacrimal gland was divided into three types: tubular, sieve and solid. There were 19 cases of Szanto Ⅰ, 9 cases of Ⅱ and 21 cases of Ⅲ. S-100 and CD34 mark the intra-tumor nerve fibers and vascular endothelium, respectively. Tumor invasion of nerve showed two kinds of microscopic morphology, a total of 22 cases, accounting for 45%, of which Ⅰ grade in 1 case, Ⅱ grade in 6 cases, Ⅲ grade in 15 cases. There was a statistically significant difference in the number of violations of nerves between grade I and grade II (P = 0.001); there was a statistically significant difference in the number of patients with grade I and III involvement (P = 0.000). There are 12 cases and 7 cases of microscopic tumor can be seen violations of fat and muscle, but no significant difference between the three levels. Only one case showed venous endovascular emboli. There were 32 cases of pain, 17 cases of no pain, each of 15 cases and 7 cases of tumor-infiltrating nerve can be seen under the microscope, the two showed no significant difference (P = 0.703). Conclusions Grade III adenocarcinoma of lacrimal adenocarcinoma is higher. Invasion of the nerve is an important invasion of the tumor, but also a characteristic pathological manifestations, high incidence of high-grade tumors. Invasion of fat, muscle and intravascular tumor emboli lower incidence. No significant correlation was found between painful symptoms and microscopic tumor invasion of nerves.