Ceruminous adenomas - A clinicopathologic study of 41 cases with a review of the literature
Ceruminous adenomas - A clinicopathologic study of 41 cases with a review of the literature
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DOI：
10.1097/00000478-200403000-00003
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发表时间：
2004-03-01
影响因子：
5.6
通讯作者：
Barnes, EL
中科院分区：
文献类型：
--
作者：
Thompson, LDR;Nelson, BL;Barnes, EL
背景：陶瓷腺肿瘤是一种罕见的肿瘤。到目前为止，良性宫颈腺瘤的大型临床病理研究还没有报道。设计：从军队病理研究所的档案中检索出1970年至2000年间诊断的41例宫颈腺瘤病例。结果：本组病例中男22例，女19例，年龄24~85岁，平均54.2岁。临床表现为外耳道外半部无痛性肿块(33例)或听力改变(11例)。症状出现的平均时间为16.3个月。息肉样肿块仅累及外耳道，最大径0.4~2 cm，平均1.1 cm。组织学上，肿瘤表现为腺体和小的包囊，内颈细胞(有断头分泌物的宫颈分泌上皮)呈管状腺样增生，由纺锤形至立方的肌上皮层覆盖。玻璃化间质形成浸润性生长模式；表面受累(n=8)。肿瘤分型：宫颈腺瘤36例，宫颈多形性腺瘤4例，乳头汗管囊腺瘤1例。腔上皮细胞CK7呈强而弥漫阳性反应，基底细胞CK5/6、S-100蛋白和p63呈强阳性反应。CD 117优先突出显示腔内细胞。增殖标记物显示低指数。腺癌和中段腺瘤是主要的鉴别考虑因素。所有患者均行手术切除。4例患者因切除不全而复发。所有患者在最后一次随访时均无疾病迹象：存活28例，平均16.3岁；死亡12例，平均11.8年。结论：陶瓷腺瘤是最常见的外耳道肿瘤。表现为基底肌上皮型细胞和腔内宫颈(宫颈)细胞的双重细胞群。Cerumen色素、CK7和P63有助于将该肿瘤与发生在该区域的其他肿瘤区分开来。完全手术切除可获得良好的长期临床结果。
Background: Ceruminous gland neoplasms are rare neoplasms. To date, a large clinicopathologic study of benign ceruminous gland neoplasms has not been reported.Design: Forty-one cases of ceruminous gland adenomas diagnosed between 1970 and 2000 were retrieved from the files of the Armed Forces Institute of Pathology. Histologic features were reviewed, immunohistochemical analysis was performed (n = 2 1), and patient follow-up was obtained (n = 40).Results: The patients included 22 men and 19 women, 24 to 85 years of age (mean, 54.2 years). Patients presented clinically with a painless mass of the outer half of the external auditory canal (n = 33) or with hearing changes (n = 11). Symptoms were present for an average of 16.3 months. The polypoid masses affected the external auditory canal only and ranged in size from 0.4 to 2 cm in greatest dimension (mean, 1.1 cm). Histologically, the tumors demonstrated glands and small cysts lined by a tubuloglandular proliferation of inner ceruminous cells (cerumen-secreting epithelium with decapitation secretion) subtended by a spindled to cuboidal myoepithelial layer. A hyalinized stroma created an infiltrative pattern of growth; surface involvement (n = 8) was seen. Tumors were divided into ceruminous adenoma (n = 36), ceruminous pleomorphic adenoma (n = 4), and syringocystadenoma papilliferum (n = 1) types. The luminal cells were strongly and diffusely immunoreactive with CK7, while the basal cells were highlighted with CK5/6, S-100 protein, and p63. CD 117 highlighted the luminal cells preferentially. The proliferation markers revealed a low index. Adenocarcinoma and middle car adenoma are the principal differential consideration. Surgical excision was used in all patients. Four patients developed a recurrence due to incomplete excision. All patients were without evidence of disease at the last follow-up: alive (n = 28, mean 16.3 years) or dead (n = 12, mean 11.8 years).Conclusion: Ceruminous gland adenomas are the most common external auditory canal tumors. They demonstrate a dual cell population of basal myoepithelial-type cells and luminal ceruminous (ceruminal) cells. Cerumen pigment, CK7, and p63 can help to distinguish this tumor from other neoplasms that occur in the region. Complete surgical excision results in an excellent long-term clinical outcome.