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Salivary duct carcinoma: the predominance of apocrine morphology, prevalence of histologic variants, and androgen receptor expression.

涎腺导管癌:大汗腺形态为主、组织学亚型的发生率以及雄激素受体表达情况

Williams L,Thompson LD,Seethala RR,Weinreb I,Assaad AM,Tuluc M,Ud Din N,Purgina B,Lai C,Griffith CC,Chiosea SI

Abstract

Salivary duct carcinoma (SDC) is a prototypic aggressive salivary gland carcinoma. Our aim is to determine the prevalence of histologic variants (micropapillary, basal-like) and androgen receptor (AR) expression in a large multi-institutional series of SDC. AR status was determined by immunohistochemistry (IHC). Most SDCs were characterized by an apocrine phenotype and AR expression. Cases with a nonapocrine phenotype and AR-negative status were studied by additional IHC and fluorescence in situ hybridization for ETV6 or MYB/NFIB. The diagnosis of SDC was confirmed in 187 of 199 (94%) cases. Variant morphologies were identified in 12 cases: micropapillary (n=6), sarcomatoid (n=3), mucinous (n=2), and basal-like (n=1). AR IHC was performed in 183 cases, of which 179 (97.8%) showed AR expression. On the basis of morphologic appearance and results of additional studies, 12 cases were reclassified as squamous cell carcinoma (SCC) (n=4), epithelial-myoepithelial carcinoma with high-grade transformation (HGT) (n=2), myoepithelial carcinoma (n=2), mammary analogue secretory carcinoma, high grade (ETV6 translocated; n=1), adenoid cystic carcinoma with HGT (n=1), acinic cell carcinoma with HGT (n=1), and adenosquamous carcinoma (n=1). AR-negative SDC is extremely rare, and the majority of such cases are more accurately classified as other entities. HGTs of other salivary carcinomas and squamous cell carcinoma are the most common mimics of SDC. SDCs with variant morphologies still show at least a minor component of conventional apocrine appearance. Thus, apocrine morphology defines SDC.

摘要

涎腺导管癌(SDC)是一种本质为侵袭性的涎腺癌。

本文对来自多家医疗机构的系列SDC病例进行研究,旨在确定SDC组织学亚型(微乳头型,基底样型)的发生率和雌激素受体(AR)表达情况。AR状态通过免疫组化(IHC)测定。大多数SDC以表达大汗腺表型和AR为特点。对非大汗腺表型和AR阴性的病例,另行IHC和FISH检测ETV6或MYB/NFIB。

199例研究对象中有187例(94%)确诊为SDC,有12例形态学表现为变异型:微乳头(6例)、肉瘤样(3例)、黏液性(2例)和基底样(1例)。183例进行了IHC检测AR表达,其中179例(97.8%)显示AR阳性。根据形态学表现和其它检测结果,对12例重新归类:鳞状细胞癌(SCC)4例、上皮-肌上皮癌伴高级别转化(HGT)2例、肌上皮癌2例、类似于乳腺分泌性癌的涎腺肿瘤(高级别,有ETV6易位)1例、腺样囊性癌伴HGT1例、腺泡细胞癌伴HGT1例和腺鳞癌1例。AR阴性的SDC相当少见,其中大多数应更准确地归类为其它肿瘤。

SDC最常见的相似肿瘤是其它伴HGT的涎腺癌和鳞状细胞癌。SDC不同形态学亚型仍至少会有少量常见的大汗腺形态。因此,大汗腺形态可帮助诊断SDC。

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