Kusafuka Kimihide, Kawasaki Takuya, Onitsuka Tetsuro, Hamaguchi Noriko, Morita Kotaro, Mukaigawa Takashi, Nishiya Yukio, Kamijo Tomoyuki, Iida Yoshiyuki, Nakajima Takashi, Sugino Takashi
Pathology Division, Shizuoka Cancer Center, 1007 Shimonagakubo, Nagaizumi-cho, Sunto-gun, Shizuoka, 411-8777, Japan.
Division of Head and Neck Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Head Neck Pathol. 2020 Mar;14(1):230-238. doi: 10.1007/s12105-018-0987-2. Epub 2018 Nov 27.
Carcinoma ex pleomorphic adenoma (CXPA) is a malignant tumor of the salivary gland that arises from pleomorphic adenoma (PA). Squamous cell carcinoma (SCC) is extremely rare in the salivary glands. We report two cases of acantholytic SCC (ASCC) ex PA. Case 1 involved a 72-year-old female, and case 2 involved a 67-year-old male. Histologically, both cases involved PA, and salivary duct carcinoma (SDC) components, which were positive for androgen receptor (AR) and gross cystic disease fluid protein (GCDFP)-15 but negative for HER2, were seen in the intracapsular regions. The invasive components consisted of ASCC, which were positive for cytokeratin 5/6 and p63 but negative for AR and GCDFP-15. The SDC and ASCC components were positive for the epidermal growth factor receptor. In both cases, the cytoplasmic localization or decreased expression of E-cadherin was observed in the ASCC. In the early phase, CXPA might emerge as SDC, and it might change into SCC as it invades beyond the capsule due to changes in microenvironment. Also, the aberrant expression of E-cadherin is related to acantholysis in SCC.
多形性腺瘤恶变（CXPA）是一种起源于多形性腺瘤（PA）的涎腺恶性肿瘤。鳞状细胞癌（SCC）在涎腺中极为罕见。我们报告了2例源自PA的棘层松解性SCC（ASCC）病例。病例1为一名72岁女性，病例2为一名67岁男性。组织学上，两例均累及PA，且在囊内区域可见涎腺导管癌（SDC）成分，其雄激素受体（AR）和总囊性病液蛋白（GCDFP）-15呈阳性，但HER2呈阴性。浸润成分由ASCC组成，其细胞角蛋白5/6和p63呈阳性，但AR和GCDFP-15呈阴性。SDC和ASCC成分表皮生长因子受体呈阳性。在两例中，ASCC中均观察到E-钙黏蛋白的细胞质定位或表达降低。在早期，CXPA可能以SDC形式出现，并且由于微环境的变化，当其侵犯至包膜外时可能转变为SCC。此外，E-钙黏蛋白的异常表达与SCC中的棘层松解有关。
