Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY 10075, USA.
Hum Pathol. 2010 Jul;41(7):927-34. doi: 10.1016/j.humpath.2009.12.011. Epub 2010 Mar 24.
Carcinoma ex pleomorphic adenoma is a rare salivary gland neoplasm, especially when the malignant component is only intracapsular/minimally invasive. Moreover, only few studies have assessed the behavior of carcinoma ex pleomorphic adenoma according to the histologic subtype. Forty-three cases of carcinoma ex pleomorphic adenoma were identified over a 27-year period and subjected to a detailed histopathologic analysis. There were 13 intracapsular/minimally invasive and 30 widely invasive carcinomas. There were 15 myoepithelial carcinomas, 25 salivary duct carcinomas, 2 adenocarcinomas not otherwise specified, and 1 carcinosarcoma. There was a trend toward a higher frequency of myoepithelial carcinomas in widely invasive tumors (13/30, 43%) than in intracapsular/minimally invasive (2/13, 15%) carcinoma ex pleomorphic adenoma (P = .095). Adequate follow-up was available for 38 patients. Vascular invasion and distant metastases correlated with decreased disease-free survival and disease-specific survival (P < .05), whereas the extent of invasion and the presence of a high mitotic rate or atypical mitoses correlated with decreased disease-free survival only (P < .05). There was a trend toward worse disease-free survival and disease-specific survival in patients with myoepithelial carcinoma (P = .08). Within the intracapsular/minimally invasive carcinoma ex pleomorphic adenoma group, both myoepithelial carcinoma (2/2, 100%) had metastatic disease, whereas only 1 of 11 nonmyoepithelial carcinoma relapsed (P = .038). Vascular invasion, high mitotic rate, and histologic subtype were found to correlate with recurrence in carcinoma ex pleomorphic adenoma. Patients with intracapsular/minimally invasive tumor have a more favorable outcome than patients with widely invasive neoplasm, but intracapsular/minimally invasive carcinoma ex pleomorphic adenoma can recur and cause death. The presence of myoepithelial carcinoma subtype increases the risk of recurrence in carcinoma ex pleomorphic adenoma, especially within the group of intracapsular/minimally invasive tumors.
癌在多形性腺瘤中是一种罕见的涎腺肿瘤，特别是当恶性成分仅为囊内/微创性时。此外，仅有少数研究根据组织学亚型评估癌在多形性腺瘤中的行为。在 27 年的时间里，确定了 43 例癌在多形性腺瘤，并进行了详细的组织病理学分析。其中 13 例为囊内/微创性，30 例为广泛侵袭性。有 15 例肌上皮癌、25 例唾液腺癌、2 例非特异性腺癌和 1 例癌肉瘤。广泛侵袭性肿瘤中肌上皮癌的频率较高（13/30，43%），而囊内/微创性癌在多形性腺瘤中（2/13，15%）（P =.095）。38 例患者的随访资料充足。血管侵犯和远处转移与无病生存率和疾病特异性生存率降低相关（P <.05），而侵袭程度、高有丝分裂率或非典型有丝分裂与无病生存率降低相关（P <.05）。肌上皮癌患者的无病生存率和疾病特异性生存率呈下降趋势（P =.08）。在囊内/微创性癌在多形性腺瘤组中，2 例肌上皮癌（2/2，100%）均发生转移，而非肌上皮癌中仅有 1 例复发（P =.038）。血管侵犯、高有丝分裂率和组织学亚型与癌在多形性腺瘤中的复发相关。囊内/微创性肿瘤患者的预后优于广泛侵袭性肿瘤患者，但囊内/微创性癌在多形性腺瘤仍可复发并导致死亡。肌上皮癌亚型的存在增加了癌在多形性腺瘤中的复发风险，尤其是在囊内/微创性肿瘤组中。
