Liao Qiu-lin, Li Lian-hua, Lai Ri-quan, Chen Xiao-dong, Chen Jing-wen, Zhou Yong-mei
Department of Pathology, General Hospital of Guangzhou Military Area, Guangzhou 510010, China.
Zhonghua Bing Li Xue Za Zhi. 2005 Apr;34(4):211-4.
To analyze the clinical features, morphology and biologic behavior of primary malignant myoepithelioma (MME) of salivary glands.
The H&E sections of 16 MME cases were reviewed. Immunohistochemical study using EnVision method for cytokeratin (CK), epithelial membrane antigen (EMA), vimentin, S-100 protein, desmin, muscle-specific actin (MSA), smooth muscle actin (SMA), Myo, proliferation cell nuclear antigen (PCNA), leukocyte common antigen (LCA) and glial fibrillary acidic protein (GFAP) was carried out.
Of the 16 patients studied, 6 were males and 10 were females. Their ages ranged from 12 to 65 years (with an average age of 44 years). The tumor occurred predominantly in the parotid gland and minor salivary gland of the palate. Common clinical features included sudden and rapid tumor growth, superficial ulceration, bony destruction and nerve infiltration. Seven of the 16 patients developed local recurrences, while 2 patients had metastasis in the lymph nodes of submandibular or other cervical regions. Most tumors infiltrated adjacent normal salivary gland, adipose, muscular and bony tissues. The extent of local invasion however varied. Histologically, MME showed a wide range of morphologic appearance, with various combinations of clear, spindle, epithelioid or plasmacytoid cells. The tumor cells were atypical and demonstrated high mitotic activity. In this study, 9 cases were composed predominantly of clear tumor cells. Immunohistochemically the tumor cells were positive for CK, EMA, MSA, desmin and S-100 protein.
In general, MME is a rare and low-grade malignant salivary gland tumor. It carries a low potential for lymph node or distant metastasis but relatively high tendency for local recurrences, resulting in destruction of adjacent soft and bony tissues. The biologic behavior also varies, depending on the site of involvement. Morphologic diagnosis of MME can be difficult in view of the wide spectrum of histologic changes. A definitive diagnosis however is possible with the application of immunohistochemistry.
分析涎腺原发性恶性肌上皮瘤（MME）的临床特征、形态学及生物学行为。
回顾16例MME病例的苏木精-伊红（H&E）切片。采用EnVision法对细胞角蛋白（CK）、上皮膜抗原（EMA）、波形蛋白、S-100蛋白、结蛋白、肌肉特异性肌动蛋白（MSA）、平滑肌肌动蛋白（SMA）、肌分化抗原（Myo）、增殖细胞核抗原（PCNA）、白细胞共同抗原（LCA）和胶质纤维酸性蛋白（GFAP）进行免疫组织化学研究。
在研究的16例患者中，男性6例，女性10例。年龄范围为12至65岁（平均年龄44岁）。肿瘤主要发生于腮腺及腭部小涎腺。常见临床特征包括肿瘤突然迅速生长、表面溃疡、骨质破坏及神经浸润。16例患者中有7例发生局部复发，2例出现下颌下或其他颈部区域淋巴结转移。多数肿瘤侵犯相邻的正常涎腺、脂肪、肌肉及骨质组织，但局部侵犯范围各异。组织学上，MME呈现广泛的形态学表现，有透明细胞、梭形细胞、上皮样细胞或浆细胞样细胞的各种组合。肿瘤细胞异型性明显，有较高的有丝分裂活性。本研究中，9例以透明肿瘤细胞为主。免疫组织化学显示肿瘤细胞CK、EMA、MSA、结蛋白及S-100蛋白呈阳性。
总体而言，MME是一种罕见的低度恶性涎腺肿瘤。其发生淋巴结或远处转移的可能性较低，但局部复发倾向相对较高，可导致相邻软组织及骨质破坏。生物学行为也因受累部位而异。鉴于组织学变化范围广泛，MME的形态学诊断可能困难。然而，应用免疫组织化学可作出明确诊断。
