Palicelli Andrea, Barbieri Paola, Mariani Narciso, Re Paola, Galla Stefania, Sorrentino Raffaele, Locatelli Francesca, Salfi Nunzio, Valente Guido
Laboratory of Pathology, Department of Translational Medicine, UPO School of Medicine, Novara, Italy.
Pathology Unit, Arcispedale Santa Maria Nuova-IRCCS, Reggio Emilia, Italy.
APMIS. 2018 Sep;126(9):771-776. doi: 10.1111/apm.12882.
Intraductal carcinoma of the salivary glands is a rare, not well-characterized tumor. We reviewed the literature and report the first case of a high-grade unicystic intraductal carcinoma of the parotid. Formalin-fixed/paraffin-embedded blocks were sectioned and stained for hematoxylin and eosin and immunostains (CAM5.2, EMA, CK5, p53, p63, SMA, S100 protein, DOG1, mammaglobin, AR, ER, PR, Her-2, and Ki67). A 72-year-old man showed a painless nodule (2 cm) in the right parotid region. A 'tumor of uncertain malignant potential' (low grade) was diagnosed by fine-needle aspiration cytology (FNAC). Preoperative magnetic resonance imaging revealed a well-delimited, oval cyst without evidence of parenchymal invasion (T1-scans: homogeneously isointense with hypointense thin peripheral ring; T2-scans: strongly hyperintense). Histological examination confirmed a unilocular cyst lined by a multistratified epithelium arranged in solid, pseudopapillary, cribriform, and 'incomplete cribriform/microcystic' patterns. Tumor cells were CAM5.2+, EMA+, mammaglobin+, AR+, p63+ (focal), CK5+ (focal), p53 (+, 20%), ER-, PR-, S100 protein-, DOG1-, and Her-2-. A continuous peripheral layer of p63+/CK5+/SMA+ myoepithelial cells proved the 'in situ' nature of the tumor. The evidence of focal severe nuclear atypia, high mitotic index (12 mitoses/10HPFs), and high proliferation index (40%) favored a high-grade intraductal carcinoma. Preoperative FNAC and clinic-pathologic correlation are very helpful. Discrepancy in dysplasia grade between FNAC and resected specimen can occasionally occur (especially in case of focal high-grade features). Total sampling should exclude invasive areas or other cystic malignancies.
涎腺导管内癌是一种罕见的、特征尚不明确的肿瘤。我们回顾了相关文献，并报告了首例腮腺高级别单囊性导管内癌病例。将福尔马林固定/石蜡包埋的组织块切片，进行苏木精-伊红染色和免疫染色（CAM5.2、EMA、CK5、p53、p63、SMA、S100蛋白、DOG1、乳腺珠蛋白、AR、ER、PR、Her-2和Ki67）。一名72岁男性右侧腮腺区出现一个无痛性结节（2厘米）。细针穿刺细胞学检查（FNAC）诊断为“恶性潜能不确定的肿瘤”（低级别）。术前磁共振成像显示一个边界清晰的椭圆形囊肿，无实质侵犯迹象（T1扫描：均匀等信号，周边有低信号薄环；T2扫描：强烈高信号）。组织学检查证实为单房囊肿，内衬多层上皮，呈实性、假乳头、筛状和“不完全筛状/微囊状”模式。肿瘤细胞CAM5.2阳性、EMA阳性、乳腺珠蛋白阳性、AR阳性、p63阳性（局灶性）、CK5阳性（局灶性）、p53阳性（20%）、ER阴性、PR阴性、S100蛋白阴性、DOG1阴性、Her-2阴性。连续的周边层p63阳性/CK5阳性/SMA阳性肌上皮细胞证实了肿瘤的“原位”性质。局灶性严重核异型性、高有丝分裂指数（12个有丝分裂/10个高倍视野）和高增殖指数（40%）支持高级别导管内癌的诊断。术前FNAC及临床病理相关性非常有帮助。FNAC与切除标本之间的发育异常分级偶尔会出现差异（特别是在存在局灶性高级别特征的情况下）。全面取材应排除浸润区域或其他囊性恶性肿瘤。
