Simpson Roderick H W, Prasad Anil R, Lewis Jean E, Skálová Alena, David Leonor
Department of Histopathology, Royal Devon and Exeter Hospital, Exeter, UK.
Am J Surg Pathol. 2003 Aug;27(8):1070-9. doi: 10.1097/00000478-200308000-00004.
Salivary duct carcinoma is a relatively uncommon aggressive neoplasm, typically found in the parotid glands of older men. The histologic appearance is that of an in situ and invasive high-grade adenocarcinoma, and it closely resembles ductal carcinoma of the breast. Several variants of the latter are very well known, but only papillary, sarcomatoid, and low-grade subtypes have so far been reported in salivary duct carcinoma. This study describes the clinicopathologic and immunohistochemical findings in four examples of an additional previously undescribed variant, rich in mucin. Each tumor showed areas of typical salivary duct carcinoma, but in addition there were lakes of epithelial mucin-containing malignant cells, i.e., mucinous (colloid) carcinoma. All four tumors expressed androgen receptors, cytokeratins, epithelial membrane antigen, gross cystic disease fluid protein-15, and carcinoembryonic antigen, but S-100 protein, other myoepithelial markers, and estrogen and progesterone receptors were negative. The mucin antigen profile showed positivity for MUC2, MUC5B, and MUC6 in all cases but only rare staining with MUC5AC and MUC7. Strong immunohistochemical overexpression of HER2/neu was demonstrated in one tumor, together with amplification by fluorescence in situ hybridization; another case was weakly positive with just one antiserum, but the remaining two tumors were completely negative. Small quantities of mucin have often been described in salivary duct carcinoma but not large extracellular mucinous lakes, which though prominent in the present series, were not as extensive as in mucinous adenocarcinoma. The relatively poor clinical outcome of the patients in our study mirrored that seen in usual-type salivary duct carcinoma and emphasizes the importance of differentiating mucin-rich salivary duct carcinoma from pure mucinous (colloid) adenocarcinoma, a tumor not fully defined, but possibly with a better prognosis.
涎腺导管癌是一种相对罕见的侵袭性肿瘤，通常发生于老年男性的腮腺。其组织学表现为原位和浸润性高级别腺癌，与乳腺导管癌极为相似。乳腺导管癌的几种变异型广为人知，但涎腺导管癌目前仅报道了乳头状、肉瘤样和低级别亚型。本研究描述了4例另一种先前未描述的富含黏液的变异型涎腺导管癌的临床病理及免疫组化结果。每例肿瘤均有典型涎腺导管癌区域，但除此之外还有充满含黏液上皮恶性细胞的湖，即黏液性（胶样）癌。所有4例肿瘤均表达雄激素受体、细胞角蛋白、上皮膜抗原、巨大囊肿病液体蛋白-15和癌胚抗原，但S-100蛋白、其他肌上皮标志物以及雌激素和孕激素受体均为阴性。黏液抗原谱显示所有病例中MUC2、MUC5B和MUC6呈阳性，但MUC5AC和MUC7仅呈罕见染色。1例肿瘤中HER2/neu免疫组化呈强过表达，荧光原位杂交显示有扩增；另1例仅对一种抗血清呈弱阳性，其余2例肿瘤完全阴性。涎腺导管癌中常可见少量黏液，但未见大的细胞外黏液湖，尽管在本系列中黏液湖较为突出，但不如黏液腺癌广泛。我们研究中患者相对较差的临床结局与普通型涎腺导管癌相似，强调了将富含黏液的涎腺导管癌与纯黏液性（胶样）腺癌区分开来的重要性，后者是一种尚未完全明确但预后可能较好的肿瘤。
