Pleomorphic adenoma.
Pleomorphic adenoma.
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多形性腺瘤。
DOI：
10.1097/00000478-199806000-00017
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发表时间：
1998
期刊：
影响因子：
--
通讯作者：
É. Dulmet
中科院分区：
文献类型：
--
作者：
J. Klijanienko;V. Servois;P. Jammet;P. Validire;P. Pouillart;P. Vielh;A. El‐Naggar;É. Dulmet
软组织多形性腺瘤是一种罕见但已知的实体。在Kilpatrick等人最近的一篇文章中，2对19例软组织多形性腺瘤和肌上皮瘤的临床病理特征进行了分析。作者报告称，19例患者中有2例发生致命性转移进展，因此可归类为转移性软组织多形性腺瘤。我们在此报告另一例经细针取样诊断为转移性多形性腺瘤的细胞学和临床病理学特征，该肿瘤具有不寻常的多转移临床结局，一名66岁女性于1979年因双侧肺转移（最大转移灶为3 cm× 3 cm）和椎旁小肿块（< 1 cm）入院。患者因其中一个肺结节接受手术，诊断为多形性腺瘤（图2）。患者接受化疗（甲氨蝶呤、长春新碱、5-氟尿嘧啶、异环磷酰胺）。8年后，她的椎旁肿块明显增大（7 cm× 8 cm），细针取样显示多形性腺瘤（图3）。患者接受化疗（环磷酰胺、博来霉素），然后局部照射，对肿瘤大小无影响。8年后，患者出现2.1× 1.7 cm乳腺转移。细针取样显示在丰富的软骨粘液样间质中有浆样肌上皮细胞簇，与多形性腺瘤一致。她接受了他莫昔芬治疗，肿瘤明显消退。一年后，她因严重呼吸困难伴大量肺转移而再次入院。经细针穿刺及活检证实为多形性腺瘤。流式细胞仪分析显示DNA二倍体（S期= 0.3%）直方图。唾液腺检查结果无异常。患者在椎旁活检和姑息治疗后存活了10个月。
Soft tissue pleomorphic adenoma is a rare but known entity. In a recent article by Kilpatrick et al., 2 19 cases of pleomorphic adenoma and myoepithelioma of soft tissue were studied with particular reference to their clinicopathologic features. The authors reported that two of 19 patients had fatal metastatic evolution, allowing classification as metastasizing pleomorphic adenoma of soft tissue. We herein report the cytologic and clinicopathologic characteristics of an additional extrasalivary metastasizing pleomorphic adenoma diagnosed by fine-needle sampling with an unusual polymetastatic clinical outcome.A 66-year-old woman was admitted in 1979 for bilateral pulmonary metastases (the largest metastasis measured 3 cm× 3 cm)(Fig. 1) and a small (< 1 cm) paravertebral mass. The patient underwent surgery for one of the pulmonary nodules, and a diagnosis of pleomorphic adenoma was rendered (Fig. 2). She was treated by chemotherapy (methotrexate, vincristine, 5-fluorouracil, ifosfamide). After 8 years her paravertebral mass markedly enlarged (to 7 cm× 8 cm), and fine-needle sampling showed pleomorphic adenoma (Fig. 3). The patient was treated with chemotherapy (cyclophosphamide, bleomycin) and then irradiated locally, with no effect on tumor size. After another 8 years the patient developed a 2.1× 1.7 cm breast metastasis. Fine-needle sampling of this lesion showed clusters of plasmalike myoepithelial cells within abundant chondromyxoid stroma consistent with pleomorphic adenoma. She was treated by tamoxifen with significant tumor regression. One year later she was readmitted to the hospital for severe dyspnea with numerous pulmonary metastases. Fine-needle sampling and biopsy of the paravertebral mass were performed and the specimens were confirmed as pleomorphic adenoma. Flow cytometric analysis showed a DNA diploid (S phase= 0.3%) histogram. Results of salivary gland examination were unremarkable. The patient is alive 10 months after paravertebral biopsy with palliative treatment.