泪腺多形性腺瘤组织病理学研究

摘要

Background Lacrimal gland pleomorphic adenoma (LGPA) is the most common epithelialneoplasms of the lacrimal glands.Though its histopathological feature is benign,recurrence and malignant transition iscommon.The histopathologica feature of LGPA vary and resemble other lacrimal gland tumors.Objective Thissurvey was to explore the histopathological features of different subtypes of LGPA and their relationships with tumorrecurrence,and improve the knowledge of histopathological characteristics of LGPA.Methods A retrospectivestudy of 181 consecutive cases pathologically diagnosed as LGPA during 1966- 2010 years was performed toinvestigate the clinical and histopathological characteristics.Results One hundred and eighty-one LGPAs wereclassified as cell-rich type in 90(49.7％ ),stroma-rich type in 38 cases(21％ ),and intermediate type in 53 cases(29.3％ ).91.7％ of all tumors showed areas with thin( ＜20 μm) capsules independent of the tumor subtype.Tumorsof stroma-rich subtype showed greater thin-capsule regions.86.5％ recurrent LGPAs belonged to stroma-rich subtype(x2 =120.896,P =0.000 ),which had a higher rate of pseudopodia or satellite nodules in the capsules than other twosubtypes did(x2 =80.715,P =0.000 ).Cuboidal cells were the most commonly found cellular type followed bysquamous cells.Duct-like structures were the most frequent patterns formed mainly by epithelial cells.Myxoid stromawas the most frequently found mesenchymal-like tissue.Conclusions The tendency of recurrence and invadationof capsule may contributed to the high recurrence rate in stroma-rich type of LGPAs.The knowledge of the immensevariety of cells,architectures and morphological characteristics of LGPA are essential for a correction of pathologicaldiagnosis.%背景 泪腺多形性腺瘤是眼眶部最常见的泪腺上皮性肿瘤,组织学上虽表现为良性,但具有易复发和恶变的特点.其组织学表现呈现多样性,常具有与其他泪腺上皮性肿瘤相同的组织学结构.目的 探讨泪腺多形性腺瘤不同病理亚型的组织学特点及其与肿瘤复发的关系,并提高对其组织病理学类型的认识.方法 收集1966-2010年在中山大学中山眼科中心病理室存档的181例泪腺多形性腺瘤的基本临床资料和组织石蜡标本,并重新切片行苏木精—伊红染色,观察肿瘤内各组分形态、结构特点及其与肿瘤复发的关系.结果 181例泪腺多形性腺瘤可分为上皮细胞为主型90例(49.7％)、间质丰富型38例(21％)以及中间型(上皮和间质成分比例相当)53例(29.3％).86.5％的复发泪腺多形性腺瘤为间质丰富型,显著高于其他两种类型(x2=120.896,P=0.000).在159例有包膜的肿瘤中,138例(86.7％)可见包膜较薄(局部厚度＜20 μm),尤其在间质丰富型肿瘤中往往有大片的薄包膜区域,间质丰富型包膜内肿瘤卫星灶或芽状突起比例显著高于其他两种类型(x2=80.715,P=0.000).肿瘤上皮成分包含立方形、鳞状上皮、浆细胞样、梭形、透明样和基底样细胞,其中立方形细胞最为常见,鳞状细胞次之.上皮细胞排列方式多样,有导管状、囊状、片状实体及小梁网状结构,其中以导管状结构最为常见.肿瘤内的间质成分包括黏液基质、玻璃样变组织、脂肪细胞以及软骨或钙化组织,其中黏液成分最为常见.结论 复发性泪腺多形性腺瘤以间质丰富型常见,其包膜受侵犯可能是肿瘤复发的原因之一.掌握泪腺多形性腺瘤上皮及间质成分的多种形态及排列结构,有助于病理医师的正确诊断.