Regauer S, Beham A, Mannweiler S
Institute of Pathology, University of Graz Medical School, Austria.
Hum Pathol. 2000 Sep;31(9):1096-101. doi: 10.1053/hupa.2000.6279.
Primary carcinomas of the Waldeyer's ring area are typically nonkeratinizing squamous cell carcinomas (SCC). Their cervical lymph node metastases are not uncommonly cystic and filled with necrotic tumor cells. Some cysts, however, contain clear fluid. During the investigation of SCC producing "fluid-filled" cystic metastases, we evaluated hematoxylin and eosin (H&E) sections of 90 primary SCC for their site of origin. We analyzed the cytokeratin (CK) profile of primary and metastatic carcinoma with special focus on the expression of CK7, a putative marker for ductal differentiation. CK7 was expressed in submucosal minor salivary gland acini and ducts, but not in the squamous surface epithelium of the Waldeyer's ring. CK7 was expressed in 11 primary SCC (8 base of tongue/3 palatine tonsil). The CK7-positive SCC were deep-seated, arose from large excretory ducts of submucosal minor salivary glands, and showed only insignificant surface involvement. They were characterized by a solid infiltrative growth pattern of basaloid cells with focal ductal differentiation. Salivary ducts adjacent to the carcinoma showed extensive intraductal hyperplasia and metaplasia. All CK7-positive carcinomas produced CK7-positive cystic nodal metastases, most of which contained paucicellular fluid. No solid CK7-positive nodal metastases were identified. In summary, a subset of carcinomas occurring in the Waldeyer's ring area appear to arise from large excretory ducts of submucosal minor salivary glands with only limited surface involvement, express CK7, and produce CK7-positive cystic "fluid-filled" nodal metastases. The histomorphology and immunophenotype suggest that these carcinomas represent basaloid SCC arising from excretory ducts of the submucosal minor salivary glands.
瓦尔代尔环区域的原发性癌通常为非角化性鳞状细胞癌（SCC）。其颈部淋巴结转移灶常见为囊性，内充满坏死的肿瘤细胞。然而，有些囊肿含有清亮液体。在对产生“液性”囊性转移灶的SCC进行研究时，我们评估了90例原发性SCC苏木精-伊红（H&E）切片的起源部位。我们分析了原发性和转移性癌的细胞角蛋白（CK）谱，特别关注CK7的表达，CK7是导管分化的一个假定标志物。CK7在黏膜下小唾液腺腺泡和导管中表达，但在瓦尔代尔环的鳞状表面上皮中不表达。11例原发性SCC（8例舌根/3例腭扁桃体）表达CK7。CK7阳性的SCC位置较深，起源于黏膜下小唾液腺的大排泄管，仅见轻微的表面受累。其特征为基底样细胞呈实性浸润性生长模式，伴有局灶性导管分化。癌旁的唾液腺导管显示广泛的导管内增生和化生。所有CK7阳性癌均产生CK7阳性的囊性淋巴结转移灶，其中大多数含有少量细胞的液体。未发现实性CK7阳性淋巴结转移灶。总之，瓦尔代尔环区域发生的一部分癌似乎起源于黏膜下小唾液腺的大排泄管，仅伴有有限的表面受累，表达CK7，并产生CK7阳性的囊性“液性”淋巴结转移灶。组织形态学和免疫表型提示这些癌代表起源于黏膜下小唾液腺排泄管的基底样SCC。
