重新评估唾液性淋巴腺瘤：通过 MAML2 重排的分子研究鉴定为沃辛样黏液表皮样癌的亚组。

Reevaluation of Salivary Lymphadenoma: A Subgroup Identified as Warthin-like Mucoepidermoid Carcinoma Following Molecular Investigation for MAML2 Rearrangement.

机构信息

From the Department of Oral Pathology, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai.

National Clinical Research Center for Oral Disease, Shanghai.

出版信息

Arch Pathol Lab Med. 2021 Jun 1;145(6):744-752. doi: 10.5858/arpa.2019-0702-OA.

DOI:10.5858/arpa.2019-0702-OA

PMID:32960941

Abstract

CONTEXT.—: Both salivary lymphadenomas (LADs) and Warthin-like mucoepidermoid carcinoma (MEC) contain components of epithelium and lymphoid stroma and their differential diagnosis can be difficult on the basis of morphology alone.

OBJECTIVE.—: To clarify whether Warthin-like MEC was diagnosed as a LAD, and to compare their clinicopathologic features.

DESIGN.—: A total of 16 LAD cases were analyzed for MAML2 rearrangement by using fluorescence in situ hybridization, and the clinical, histologic, immunohistochemical, and prognostic features were compared between MAML2 rearrangement-positive and MAML2 rearrangement-negative groups.

RESULTS.—: Among the 16 cases investigated, 9 harbored a MAML2 rearrangement and were reclassified as Warthin-like MEC. The remaining 7 cases were classified as LADs with 1 nonsebaceous and 6 sebaceous cases. The patients with Warthin-like MEC had a wider age range (10-75 years) than the patients with LADs (36-68 years). Histologically, 2 of the 9 Warthin-like MECs (22.2%) showed focal invasion, whereas all the LADs had complete capsules. Warthin-like MECs exhibited a diverse epithelial cell morphology, including basaloid, glandular, cuboidal, epidermoid, with mucinous cells, although these cytologic features were seen only focally in some cases. Nonsebaceous LAD was composed of basaloid and glandular epithelial cells predominantly. In sebaceous LAD, the epithelial cells were composed of basaloid and large foamy sebaceous cells. In all cases, the stroma was composed mainly of lymphocytes accompanied by lymphoid follicles, although plasma cell infiltration could be much heavier in Warthin-like MEC. All the patients had a good outcome after a longer follow-up (3-166 months).

CONCLUSIONS.—: Warthin-like MEC can be misdiagnosed as a LAD owing to overlap in clinicopathologic features of the 2 entities. Careful histologic evaluation and detection of MAML2 rearrangement can facilitate their differential diagnosis.

摘要

背景

唾液性淋巴腺瘤（LAD）和沃辛样黏液表皮样癌（MEC）均含有上皮和淋巴间质成分，仅基于形态学特征，两者的鉴别诊断可能较为困难。

目的

阐明沃辛样 MEC 是否被误诊为 LAD，并比较两者的临床病理特征。

设计

采用荧光原位杂交技术分析了 16 例 LAD 病例的 MAML2 重排情况，并比较了 MAML2 重排阳性组和 MAML2 重排阴性组的临床、组织学、免疫组织化学和预后特征。

结果

在所研究的 16 例病例中，有 9 例存在 MAML2 重排，被重新归类为沃辛样 MEC。其余 7 例被归类为 LAD，其中 1 例为非皮脂型，6 例为皮脂型。沃辛样 MEC 患者的年龄范围较宽（10-75 岁），而 LAD 患者的年龄范围较窄（36-68 岁）。组织学上，9 例沃辛样 MEC 中有 2 例（22.2%）表现为局灶性浸润，而所有 LAD 均有完整的包膜。沃辛样 MEC 的上皮细胞形态多样，包括基底样、腺状、立方状、表皮样，伴有黏液细胞，但这些细胞学特征仅在某些病例中局灶性出现。非皮脂型 LAD 主要由基底样和腺状上皮细胞组成。在皮脂型 LAD 中，上皮细胞由基底样和大泡沫状皮脂细胞组成。在所有病例中，基质主要由淋巴细胞组成，并伴有淋巴滤泡，尽管沃辛样 MEC 中的浆细胞浸润可能更为严重。所有患者在随访 3-166 个月后均获得了良好的预后。