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目的探讨坏死性涎腺化生(NS)的临床症状、病理特点及鉴别诊断。方法复习1例发生于鼻甲黏膜的坏死性涎腺化生的临床资料、镜下形态和免疫组化标记,并复习相关文献。结果坏死性涎腺化生组织形态特点:①组织基本结构保存;②形态改变具有分层变化,黏膜表面继发鳞状上皮假上皮瘤样增生,涎腺腺泡、导管鳞状细胞化生;化生的鳞状上皮团保留了原导管或腺泡的组织结构,细胞无明显异型;③鳞化的导管上皮p63和34βE12(+),p53(-),Ki-67阳性细胞数≤5%。结论坏死性涎腺化生是可识别的继发性良性病变,具有慢性缺血坏死后继发的鳞状上皮巢状增生现象;免疫组化结果提示鳞状细胞巢周围有肌上皮样细胞的存在。掌握坏死性涎腺化生的诊断与鉴别诊断标准对临床治疗具有重要意义。
Objective To investigate the clinical symptoms, pathological features and differential diagnosis of necrotizing salivary gland metaplasia (NS). Methods One case of necrotizing salivary gland metaplasia that occurred in the nasal mucosa was retrospectively reviewed. The morphological and immunohistochemical findings of the specimens were reviewed and relevant literature reviewed. Results The morphological features of necrotic salivary gland metaplasia were as follows: (1) the basic structure of the tissue was preserved; (2) the morphological changes were stratified; squamous pseudopothelioma hyperplasia, salivary gland acinar ductal squamous metaplasia secondary to mucosal surface; The squamous metaplasia of the metaplasia retained the original structure of the duct or acini, and the cells showed no obvious atypia. The number of p63 and 34βE12 (+), p53 (-) and Ki-67 positive cells in the squamous ductal epithelium was less than 5% . Conclusions Necrotic salivary gland metaplasia is a recognized secondary benign lesion with squamous neoplasia secondary to chronic ischemic necrosis. Immunohistochemistry results suggest the existence of myoepithelial cells around the nests of squamous cells . To master the diagnosis and differential diagnosis of necrotizing salivary gland is of great significance to clinical treatment.