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目的:提高对涎腺淋巴上皮癌(LEC)临床、影像学及病理特点的认识。方法:收集、分析12例涎腺LEC的临床表现、影像学资料、病理组织学及免疫组化检测结果、手术治疗效果资料。结果:12例LEC患者中,病变位于腮腺10例,颌下腺2例;2例为单侧多发肿块,其余10例为单侧单发肿块;4例合并颈部淋巴结转移,1例合并周围性面神经麻痹。10例EB-VCA-IgA阳性。所有病例CT平扫均为等密度,增强扫描均有明显强化。8例肿块形态不规则,境界不清或部分不清,强化不均匀。4例包膜不完整;6例无明显包膜;组织学检查肿瘤由片巢状分布的、呈浸润性生长的肿瘤上皮细胞和丰富的间质淋巴样组织构成,免疫组织化学检测示pan-CK、CD20和CD3阳性表达。12例均行原发灶及累及涎腺根治性切除加同侧选择性或治疗性颈清扫术加术后放疗,2例同时辅助化疗。所有病例均得到随访,9例无瘤生存3~11年,其余3例于明确诊断后1~2年局部复发或(和)远处转移而死亡。结论:涎腺LEC与EB病毒感染有关,多为单侧单发肿块,颈部淋巴结转移率高;CT显示涎腺LEC的肿块多呈恶性肿瘤征;确诊依赖于病理检查;手术联合放疗有可能取得较好的效果,局部复发和远处转移是致死的主要原因。
Objective: To improve the clinical, imaging and pathological features of lymphoepithelial carcinoma (LEC) in salivary gland. Methods: The clinical manifestations, imaging data, histopathological and immunohistochemical results of 12 cases of salivary gland were collected and analyzed. The data of surgical treatment were collected. Results: Of the 12 patients with LEC, the lesions were located in 10 cases of parotid gland and 2 cases of submandibular gland; 2 cases were unilateral multiple mass and the other 10 cases were single unilateral mass; 4 cases were complicated with cervical lymph node metastasis and 1 case complicated with peripheral facial nerve paralysis. 10 cases of EB-VCA-IgA positive. CT scan in all cases were equal density, enhanced scanning were significantly enhanced. 8 cases of irregular shape of the tumor, unclear or partially unclear, uneven reinforcement. 4 cases of incomplete capsule; 6 cases without significant envelope; histological examination of the tumor by the nested distribution was invasive growth of tumor epithelial cells and abundant interstitial lymphoid tissue, immunohistochemical detection showed pan- CK, CD20 and CD3 positive expression. All 12 cases underwent radical resection combined with radical salivary gastrectomy plus ipsilateral selective or therapeutic neck dissection plus postoperative radiotherapy, and two concurrent adjuvant chemotherapy. All patients were followed up, 9 patients survived 3 to 11 years without disease, and the remaining 3 patients died of local recurrence or (or) distant metastasis 1 to 2 years after the definite diagnosis. Conclusions: LEC in salivary glands is related to Epstein-Barr virus infection, most of them are unilateral single lumps, with high lymph node metastasis rate in the neck. Most of the LECs in the salivary glands show signs of malignancy; CT is dependent on pathological examination; Get better results, local recurrence and distant metastasis is the main cause of death.