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目的探讨肉瘤样变异型涎腺导管癌(SSDC)的临床病理特征、诊断与鉴别诊断要点。方法对1例肉瘤样变异型SDC进行临床病理观察和免疫组化结果分析,并复习文献。结果患者男性,69岁。肿块位于右侧颌下腺区,边界不清。切面灰白、灰红色。组织学见肿瘤由上皮及间质两种成分组成,上皮成分具有典型的SDC特征,约占40%,肉瘤成分由间变的梭形细胞、多核巨细胞、横纹肌样细胞形成,约占60%,细胞非典型性明显,部分呈血管外皮瘤样结构;癌及肉瘤样成分相互移行。免疫组化显示上皮细胞CK、EMA、AR、GCDFP-15均(+),vimentin、Her-2部分(+);肉瘤成分vimentin(+),S-100、CK、EMA、Myo D1、myogenin部分(+),p63弱(+),CEA、CK7、CK20、calponin、GCDFP-15、AR、Her-2均为阴性。结论肉瘤样变异型SDC是SDC的一个罕见亚型,其肉瘤成分主要为纤维肉瘤,并可见横纹肌肉瘤等异源性分化,该亚型预后明显差于经典型SDC,其诊断与鉴别诊断主要依赖于组织学形态和免疫表型。
Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of sarcoidosis-like salivary duct carcinoma (SSDC). Methods A case of sarcomatoid deformable SDC was observed by clinicopathological and immunohistochemical analysis and reviewed. Results The patient was male, 69 years old. Lumps located in the right submandibular gland area, the border is unclear. Section gray, gray-red. Histologically, tumors are composed of epithelial and interstitial components. The epithelial component has typical SDC characteristics, accounting for about 40%. The sarcoma component is formed by an intervertebral transformed spindle cell, multinucleated giant cell, and striated muscle-like cells, accounting for about 60% , Cell atypia was obvious, part of the vascular endothelial tumor-like structure; cancer and sarcoma-like components of mutual migration. Immunohistochemistry showed that the vimentin (+), S-100, CK, EMA, MyoD1 and myogenin parts of the epithelial cells were positive for CK, EMA, AR and GCDFP- (+), p63 weak (+), CEA, CK7, CK20, calponin, GCDFP-15, AR, Her-2 were negative. Conclusions Sarcomatoid variant SDC is a rare subtype of SDC. The main component of sarcoma is fibrosarcoma. Heterotopic differentiation of rhabdomyosarcoma can be seen. The prognosis of this subtype is obviously worse than that of classic SDC. The diagnosis and differential diagnosis of sarcoma mainly depend on Histological morphology and immunophenotype.