Nagao T, Sugano I, Matsuzaki O, Hara H, Kondo Y, Nagao K
Department of Surgical Pathology, Teikyo University, School of Medicine, Ichihara Hospital, Ichihara, Japan.
Arch Pathol Lab Med. 2000 Feb;124(2):291-5. doi: 10.5858/2000-124-0291-IPTOTM.
Intraductal papilloma is an extremely rare benign salivary gland tumor that occurs most commonly in the minor salivary glands. To our knowledge, a malignant counterpart of intraductal papilloma has not been described previously. We report one case each of benign and malignant intraductal papillary tumors. The benign tumor occurred in the sublingual gland and was a typical example of intraductal papilloma, with the exception that we found no previously published reports of this type of tumor in this location. The other patient had a left parotid gland tumor that was architecturally similar to the intraductal papilloma, with the addition of cytologic atypia, intraductal extension, microinvasion, and lymph node metastases. This tumor was diagnosed as intraductal papillary adenocarcinoma with an invasive component. Both patients were alive and well without evidence of recurrence 2 years and 6 months (case 1) and 6 years (case 2) after surgery. Immunohistochemical examination revealed that the tumor cells resembled duct luminal cells in both cases. The 2 tumors had different immunoreactivities for carcinoembryonic antigen, p53, and Ki-67. The malignant counterpart of intraductal papilloma should be considered in the differential diagnosis of salivary gland tumors with a predominantly papillary structure, even though this tumor is extremely rare.
导管内乳头状瘤是一种极其罕见的涎腺良性肿瘤，最常见于小涎腺。据我们所知，此前尚未描述过导管内乳头状瘤的恶性对应物。我们报告了1例良性和1例恶性导管内乳头状肿瘤。良性肿瘤发生于舌下腺，是导管内乳头状瘤的典型病例，只是我们未发现此前有关于该部位此类肿瘤的报道。另1例患者左侧腮腺有一肿瘤，其结构与导管内乳头状瘤相似，但伴有细胞学异型性、导管内浸润、微浸润及淋巴结转移。该肿瘤被诊断为伴有浸润成分的导管内乳头状腺癌。两名患者在手术后2年零6个月（病例1）和6年（病例2）均存活良好，无复发迹象。免疫组化检查显示，两例肿瘤细胞均类似于导管腔细胞。这两种肿瘤对癌胚抗原、p53和Ki-67具有不同的免疫反应性。尽管这种肿瘤极其罕见，但在以乳头状结构为主的涎腺肿瘤的鉴别诊断中应考虑导管内乳头状瘤的恶性对应物。
