Ihrler Stephan, Sendelhofert Andrea, Weiler Christoph, Hagedorn Hjalmar, Harrison John D
Institute of Pathology, Ludwig Maximilian University, Thalkirchnerstrasse 36, 80337 Munich, Germany.
Virchows Arch. 2006 Aug;449(2):159-63. doi: 10.1007/s00428-006-0208-3. Epub 2006 May 4.
Preinvasive intraductal neoplasia of the salivary glands has only been identified in the rare salivary-duct carcinoma, whereas, it is an established feature of carcinomas of other glands. A fortuitous observation of what appeared to be intraductal tumor in a salivary adenocarcinoma, not otherwise specified, led to the present investigation to determine whether intraductal neoplasia is a significant feature of this carcinoma. Intraductal tumor confined by normal CK14-positive, actin-negative ductal basal cells was identified in 15 of 22 cases (68%). The degree of cellular atypia and the pattern of growth of intraductal tumor was similar to that of the invasive tumor. Cases with intraductal tumor devoid of invasive tumor were not found. Intraductal tumor is identified as the pre-invasive precursor of adenocarcinoma, not otherwise specified, and apparently develops in excretory ducts. The findings support the possibility that different salivary tumors arise from different types of parenchymal cell. Possibly intraductal neoplasia is a universal feature of many types of salivary tumor, but has been overlooked because of the need to use immunohistology to demonstrate it and because it may no longer be present as such when the tumor presents as a clinical lesion.
涎腺的原位导管内瘤变仅在罕见的涎腺导管癌中被发现，而在其他腺体的癌中却是一个既定特征。对一例未另行特指的涎腺腺癌中看似导管内肿瘤的偶然观察，引发了本研究，以确定导管内瘤变是否为此类癌的一个显著特征。在22例病例中的15例（68%）中发现了被正常CK14阳性、肌动蛋白阴性的导管基底细胞所局限的导管内肿瘤。导管内肿瘤的细胞异型程度和生长模式与浸润性肿瘤相似。未发现有导管内肿瘤而无浸润性肿瘤的病例。导管内肿瘤被确定为未另行特指的腺癌的原位前体，且显然发生于排泄导管。这些发现支持了不同涎腺肿瘤起源于不同类型实质细胞的可能性。导管内瘤变可能是多种涎腺肿瘤的普遍特征，但由于需要使用免疫组织化学来证实它，且当肿瘤表现为临床病变时它可能已不复存在，因而一直被忽视。
