Seifert G, Bull H G, Donath K
Virchows Arch A Pathol Anat Histol. 1980;388(1):13-38. doi: 10.1007/BF00430674.
Cystadenolymphomas (CAL) of the parotid gland are variable in their epithelial differentiation and the ratio of the epithelial tumor component to lymphoid stroma. Two hundred and seventy five cases of CAL from the files of the Salivary Glands Register of the Institute of Pathology, University of Hamburg (1965-1979) were analysed. Their pathogenesis from parenchyma included in regional lymph nodes is discussed. The following subclassification was established. 1. Depending on to the ratio of epithelial tumor component to lymphoid stroma, three subtypes were distinguished. Subtype 1, "typical CAL" with an epithelial tumor component of 50%, amounted to 77% of all cases of CAL studied. Oncocytic differentiation and focal metaplasia to goblet cells or squamous epithelium was also found. 13.5% of CAL were classified as subtype 2, "stroma-poor CAL" with an epithelial tumor component of 70 to 80%. The tumor structure was similar to that of an oncocytoma in places. Two per cent of the CAL were in subtype 3, "stroma-rich CAL" with an epithelial tumor component of only 20 to 30%. Subtype 3 was found solely in men. The average age at presentation (61 years) was slightly lower than that of all the cases studied (65 years). 2. In 7.5% of the cases large areas of squamous cell metaplasia and regressive changes was found within a CAL. These cases were classified as subtype 4 ("metaplastic CAL"). The average age was 67 years. The case histories showed that 20% of these metaplastic CAL had previously been irradiated. 3. Bilateral CAL was found in 7.5% of the cases. In 4% multifocal CAL occurred in the parotid gland unilaterally. Recurrences were observed in 2% of all CAL. 4. Carcinoma in CAL is rare (we found two cases in our own material). In 50% of all cases reported radiotherapy was mentioned in the case histories. 5. Malignant tumors coincident with CAL were recorded in 3% of the cases. 6. The lymphoid stroma showed reaction patterns similar to those of the regional lymph nodes. These included granulomatous changes (foreign body granuloma with cholesterol deposits, tuberculosis) and tumor metastases. In the neighborhood of oncocytic tumor epithelium focal accumulations plasma cells forming IgA and IgG were found. Metaplasia to squamous epithelium is believed to be caused by circulatory disturbances, irradiation, and other noxae. In the differential diagnosis of the stroma-poor subtype 2, oncocytoma and cystic sialadenoma must be excluded, and in the differential diagnosis of subtype 4 (the metaplastic CAL), sebaceous adenoma, mucepidermoid tumor, squamous cell carcinoma, lymphoepithelioma, and other non-tumorous lesions of the parotid gland (lymphoepithelial cysts, myoepithelial parotitis) must be ruled out. Our findings suggest that CAL develops from parenchyma included in parotid lymph nodes with the oncocytic ductal epithelium representing the neoplastic component.
腮腺囊性腺淋巴瘤（CAL）在其上皮分化以及上皮肿瘤成分与淋巴样间质的比例方面存在差异。对汉堡大学病理学研究所唾液腺登记处档案中的275例CAL病例（1965 - 1979年）进行了分析。讨论了其起源于区域淋巴结内实质的发病机制。建立了以下分类。1. 根据上皮肿瘤成分与淋巴样间质的比例，区分出三种亚型。亚型1，“典型CAL”，上皮肿瘤成分占50%，占所研究的所有CAL病例的77%。还发现了嗜酸性细胞分化以及向杯状细胞或鳞状上皮的局灶性化生。13.5%的CAL被归类为亚型2，“间质少的CAL”，上皮肿瘤成分占70%至80%。肿瘤结构在某些部位与嗜酸性细胞瘤相似。2%的CAL属于亚型3，“间质丰富的CAL”，上皮肿瘤成分仅占20%至30%。亚型3仅在男性中发现。出现时的平均年龄（61岁）略低于所研究的所有病例的平均年龄（65岁）。2. 在7.5%的病例中，在CAL内发现大片鳞状上皮化生和退行性改变。这些病例被归类为亚型4（“化生型CAL”）。平均年龄为67岁。病史显示，这些化生型CAL中有20%先前接受过放疗。3. 7.5%的病例中发现双侧CAL。4%的病例中腮腺单侧出现多灶性CAL。所有CAL中有2%观察到复发。4. CAL中的癌很罕见（我们在自己的材料中发现了两例）。在所有报告病例的50%中，病史中提到了放疗。5. 3%的病例记录有与CAL同时存在的恶性肿瘤。6. 淋巴样间质显示出与区域淋巴结相似的反应模式。这些包括肉芽肿性改变（伴有胆固醇沉积的异物肉芽肿、结核）和肿瘤转移。在嗜酸性细胞瘤上皮附近发现形成IgA和IgG的局灶性浆细胞聚集。鳞状上皮化生被认为是由循环障碍、放疗和其他有害因素引起的。在间质少的亚型2的鉴别诊断中，必须排除嗜酸性细胞瘤和囊性涎腺腺瘤，在亚型4（化生型CAL）的鉴别诊断中，必须排除皮脂腺腺瘤、黏液表皮样瘤、鳞状细胞癌、淋巴上皮瘤以及腮腺的其他非肿瘤性病变（淋巴上皮囊肿、肌上皮性腮腺炎）。我们的研究结果表明，CAL起源于腮腺淋巴结内的实质，嗜酸性导管上皮代表肿瘤成分。
