粘表-腺样囊性癌-腺泡细胞癌-上皮肌上皮癌.ppt

Acinic cell carcinoma: behavior Low grade, indolent malignancy Grading or histologic variant has no prognostic significance Recurrence 35% (may be delayed to 30 yr) Metastasis 16-19% (often delayed after many years) Lymph node Distant (lungs, bone) Survival: 5-yr 90%; 20-yr 56% Acinic cell carcinoma:unfavorable prognostic factors Gross invasion High stage disease Desmoplasia Significant cellular atypia Increased mitotic activity or MIB1 index (5%: 62% unfavorable outcome) J Pathol 1994;173:13-21 Dedifferentiated acinic cell carcinoma Atypia Dedifferentiated acinic cell CA Acinic cell carcinoma:favorable prognostic factors Small size ( 3 cm) Rich in lymphoid stroma Hum Pathol 1997;28:595-600 Adequate initial excision** (recurrence 11%, versus 90% for incomplete excision) Acinic cell carcinoma:essence of diagnosis Identification of acinic cell differentiation in the tumor cells (which is often focal) Can be helped by: PAS-diastase stain (intracytoplasmic granules) Amylase immunohistochemistry (not readily available) Only luminal cell, but not abluminal cell, differentiation ADENOID CYSTIC CARCINOMA An infiltrative carcinoma having various features of three growth patterns: glandular (cribriform), tubular or solid Two cell type: ductal-lining cells myoepithelial / basal type cells Usually a slow-growing tumor Bone invasion may occur without radiological evidence Adenoid cystic carcinoma: pathology Gross: Invasive borders; solid appearance Tubules, cribriform structures, solid masses Variable amounts of hyalinized stroma (sometimes “drowning” the tumor) May have lattice-like pattern, and abundant stromal mucin/hyaline material Perineural invasion is characteristic (but not essential for diagnosis) Adenoid cystic carcinoma:cell types Ductal epithelium Cuboidal Surrounds distinct small lumina (often with eosinophilic secretion) Eosinophilic cytoplasm; vesicular nuclei Can be difficult to appreciate Small basaloid cells (modified myoepithelium) Often predominant Hy