Undifferentiated carcinoma of salivary gland
Introduction
Introduction to undifferentiated carcinoma of the parotid gland The undifferentiated carcinoma of the parotid gland is a very low- or undifferentiated salivary gland cancer that is so organized that it cannot be classified into any other type of malignant epithelial tumor of the parotid gland. It has some sensitivity to radiation therapy, but it is difficult to cure. At present, combined treatment methods such as radiotherapy, radical surgical resection and chemotherapy are used. Combined radical surgery is often used in surgery. basic knowledge The proportion of illness: the incidence rate is about 0.001% Susceptible people: no specific population Mode of infection: non-infectious complication:
Cause
The cause of undifferentiated carcinoma of the parotid gland
Undifferentiated carcinoma of the parotid gland occurs in Mongolian races and shows a tendency to family concentration. Its onset may be closely related to EBV (EBV) and is influenced by genetic and environmental factors. The tissue origin of small cell lung cancer is still unclear and may be derived from pluripotent bronchial precursor cells. In neuroendocrine tumors, small cell lung cancer is more similar in morphology and genetics to large cell neuroendocrine carcinoma.
Prevention
Undifferentiated cancer prevention of parotid gland
The prognosis of undifferentiated parotid gland is very poor. Because there are few tumors of this type, there are few reports about the survival rate at home and abroad. Blank reported that the 5-year survival rate of 75 cases of poorly differentiated carcinoma in the parotid gland is 32%, and the survival rate is 10 years. Only 18%.
Complication
Undifferentiated cancer complications of the parotid gland Complication
Skin involvement can be ulcerated, regional lymph node metastasis rate is high, and can also be accompanied by distant metastasis, such as metastasis to the lungs, liver, bones and other parts.
Symptom
Undifferentiated cancerous symptoms of the parotid gland Common symptoms Facial numb facial skin with nodular hyperplasia
The course of the disease is generally short, the tumor grows rapidly, and it grows invasively. The patient has a painful mass in the early stage. It occurs in the parotid gland. In the early stage, the facial nerve appears in the facial nerve, and it adheres to the surrounding tissue. The mass is fixed, and the skin may be broken in the late stage. Regional lymph node metastasis rate is high, and may also be associated with distant metastasis, such as metastasis to the lungs, liver, bones and other parts.
Microscopic examination showed that the cancer cells were round or fusiform, the size was extremely inconsistent, the morphology was different, scattered and arranged, extremely abnormal, mitotic figures were common, and significant bleeding and necrosis were common.
Examine
Examination of undifferentiated carcinoma of the parotid gland
1. Gross observation: The tumor is multi-nodular or invasive, some have an envelope, diameter 1cm~6cm, and the section is hard, pinkish white or grayish white.
2. Light microscopic observation: The tumor is lobulated or diffusely grown. The characteristic pathological manifestation is an irregular malignant epithelial island, separated by a large number of lymphoid interstitial phases, and the tumor cells are unclear, showing a syncytial cell cluster. Tablets or strips, some single tumor cells are mixed with lymphoid cells, like lymphoma, large tumor cells, a small amount of eosinophilic cytoplasm, nuclear ellipse, vesicular nucleus or coarse chromatin particles, one or two Obvious eosinophilic nucleoli, the division phase is somewhat different, some regional tumor cells are elongated in the shape of a short spindle, lymphoid stroma including lymphocytes, plasma cells, may have lymphoid follicle formation, some see tissue cells and multinucleated giant cells The epithelial and lymphoid components are closely intertwined, so that the boundaries of the two are unclear. In some areas, the lymphoid stroma is rarely replaced by fibrous connective tissue. Sometimes necrosis, focal squamous metaplasia, and residual gland are visible in the tumor tissue. Catheters, amyloidosis and calcification, etc., in some cases, tumors invade the nerves, lymph node metastases are similar to the primary lesions, and in distant metastases, lymphocytes decrease or disappear.
3. Ultrastructure: Observed by transmission electron microscopy, most of the tumor epithelial cells showed scattered desmosomes and more tension tow, no virus particles were found, which confirmed the squamous cell differentiation characteristics of tumor cells.
4. Immunohistochemical staining: EMA and AE1 were positive in tumor epithelial cells, and AE3 was negative. As in UNPC, it was confirmed that tumor cells were epithelial sources, while lymphoid stroma was mainly T cells.
Diagnosis
Diagnosis and differentiation of undifferentiated carcinoma of the parotid gland
diagnosis
Diagnosis can be based on medical history, clinical symptoms, and laboratory tests.
Differential diagnosis
1. Metastatic nasopharyngeal carcinoma: UCSL and UNPC are histologically indistinguishable. Although nasopharyngeal malignant tumors rarely metastasize to parotid lymph nodes, clinical examination of the upper and upper digestive tract must be performed carefully, and nasopharyngeal biopsy should be performed. In order to exclude nasopharyngeal carcinoma, it is believed that no obvious cortical and medullary structures are seen in UCLS, and residual glands and even acinar cells are seen, suggesting that they are derived from glands rather than intra-glandular or para-glandular lymph nodes.
2. Benign lymphatic epithelial lesions: BLEL is a non-neoplastic lesion whose histological manifestations occur in a variety of clinical conditions, such as Sjogren's syndrome, sarcoidosis, meteorites, etc., often manifested as bilateral or unilateral The parotid gland is swollen, and UCLS is generally a unilateral gland enlargement, without the clinical manifestations of Sjogren's syndrome. The two are not difficult to distinguish between histology, but when the specimen is too small, it still needs to be carefully identified: the epithelium of BLEL The cells in the island are benign, with a uniform ellipsoidal nucleus, fine chromatin, unclear nucleoli, and tumorous epithelial cells in UCLS are atypical, with overlapping vesicular nucleus, clear nucleoli, often visible Nuclear division.
3. Lymphoma: The cell atypia of UCLS is expressed in epithelial cells rather than lymphocytes. When scattered tumor cells are mixed with lymphocytes, it may be difficult to distinguish from large cell lymphoma, but if you look closely, you will find that the tumor cells are mutually The growth mode of the bond, if necessary, keratin staining.
