腮腺肌上皮瘤－病例報告

Myoepithelioma of the Parotid Gland-Case Report

陳立欣(Li-Hsin Chen) ； 黃博琪(Po-Chi Huang) ； 黃弘孟(Hung-Meng Huang)

《台灣耳鼻喉頭頸外科雜誌》 56卷4期 (2021/12) Pp. 259-263

https://doi.org/10.6286/jtohns.202112_56(4).259

摘要

肌上皮瘤（myoepithelioma）於1991年才被世界衛生組織確診。它是一種罕見的唾液腺腫瘤。它們最常影響大唾液腺和小唾液腺，其中以腮腺最為常見，約佔了40％。在所有的唾液腺腫瘤中，肌上皮瘤只佔了其中的1％。肌上皮瘤是一種良性唾液腺腫瘤，完全由肌上皮細胞組成。我們在此報告1名70歲男性，他的左側腮腺有一個逐漸增大的硬塊。患者於2016年接受了超音波下導引切片，病理報告懷疑為肌上皮腫瘤或多形性腺瘤等。然而，我們建議的手術因患者個人原因而推遲。患者於2019年回到本院接受左側腮腺淺葉切除術，發現組織是一塊粉紅色的彈性組織，大小約3.5 × 3 × 2.5 cm。顯微鏡下，切片顯示具有薄纖維囊且界限清楚的多細胞腫瘤（hypercellular tumor）。腫瘤細胞主要由梭形基質細胞（spindle stromal cell）組成（佔90％）。腫瘤細胞核呈梭形或卵圓形，具有輕度核多形性，及少量的有絲分裂。SMA、CK5、P63染色陽性；S100和CD10染色局部陽性；GFAP染色散在性陽性；CD34染色陰性。在腺體部分（佔10％），腫瘤細胞核呈卵圓形或圓形，具有少量的核多形性，及少量的有絲分裂。未見有絲分裂增加或核異型性（nuclear atypia）增加，或其他惡性腫瘤跡象。在尋求過台大醫院頭頸部次專科病理學家會診後，診斷為良性肌上皮瘤。

關鍵字

myoepithelioma ； parotid tumor ； salivary gland tumor（肌上皮瘤 ； 腮腺腫瘤 ； 唾液腺腫瘤）

並列摘要

Myoepithelioma was recognized as a histological distinct entity by the World Health Organization in 1991. It is a rare salivary gland neoplasm. Myoepitheliomas most commonly affect the major and minor salivary glands with the parotid gland being the most common, approximately 40%. Only 1% of all salivary gland neoplasms are myoepitheliomas. Myoepithelioma is a benign salivary gland tumor that consists entirely of myoepithelial cells. We report a 70-year-old male who presented with a hard mass of the left parotid gland behind his left ear which was gradually increasing in size. The patient had undergone a core-needle biopsy in 2016. According to the immunohistochemical studies and the histopathologic pictures, a myoepithelial tumor or a cellular pleomorphic adenoma, etc. were suspected. However, the operation we suggested was postponed due to the patient's personal reason. In 2019, left superficial parotidectomy was thus performed and the tissue was found to be a piece of pink and elastic tissues, 3.5 × 3 × 2.5 cm, fixed in formalin. Microscopic examination revealed that tumor cells have spindle or ovoid nuclei, high nuclear/cytoplasmic ratio, and mild nuclear pleomorphism, but scanty mitosis, which are positive staining for SMA, CK5, P63 and focally positive staining for S100 and CD10 and scattered positive staining for GFAP, but not for CD 34. In the glandular part (10%), the tumor cells have ovoid or round nuclei, little nuclear pleomorphism, and scanty mitosis. No increase of mitosis or nuclear atypia or other evidence of malignancy is seen. The second opinion from the consultation to the head and neck subspecialty pathologist in National Taiwan University Hospital, more favored a benign myoepithelioma.

並列關鍵字

myoepithelioma ； parotid tumor ； salivary gland tumor