摘要：肌上皮癌(myoepithelial carcinoma, MECA) 是1种认知不足的极富争议实体，具有宽广的形态学谱系。MECA的误诊并不少见，因为与富于肌上皮成分的多形性腺瘤(pleomorphic adenoma, PA) 鉴别开来非常困难。我们描述了21例组织学上疑难的MECA病例(包括16例源于PA的MECA和5例原发的MECA)。除3例病例外，其他所有源于PA的MECA均为包膜内型或微浸润型。18例(86%)MECA最初误判为良性肿瘤，包括PA (10例)、非典型PA(5例)和肌上皮瘤(3例)。另外3例初诊为恶性(源于PA的MECA)，但组织学上仍具有挑战性。MECA最有诊断价值的恶性组织学特征包括：一致性的肌上皮呈膨胀性分叶结节状生长模式(所有病例)，以及交错的细胞致密区和稀疏区带状排列方式(76%的病例)。随访的16例MECA患者中，14例(87.5%)病情进展：10例出现局部复发，5例出现远处转移。相反，在33例富细胞型PA患者(对照组)中，仅有1例出现局部复发。在14例进展MECA患者中，10例曾被诊断为源于PA的MECA，而12例(85%)最初曾诊断为良性。2例诊断为源于PA的MECA患者最终死于该病；其中1例最初诊断为PA。MECA在组织学上诊断困难，形态与PA非常类似且复发风险极高。当出现丰富的肌上皮细胞一致性改变、分叶结节状膨胀生长模式以及细胞区带状分布特征时，可识别大多数MECA，也可作为其与相似良性病变鉴别的重要组织学特征。
关键词：肌上皮癌，多形性腺瘤，非典型多形性腺瘤
(Am J Surg Pathol 2019;43:601609)
美国外科病理学杂志中文版2019年第四期正文NO.2
（李佳丽 翻译 唐 峰 审校）
美国外科病理学杂志中文版2019年第四期正文NO.2
（李佳丽 翻译 唐 峰 审校）
The American Journal of Surgical Pathology 中文版版权说明：
©2019 Wolters Kluwer Health.
This material is from Wolters Kluwer Health, and authorize to 91360 Medical Group（Shen Zhen）Co.,Ltd. (91360 Pathologist group) and Shanghai EBM Info Tech Co., Ltd. (CME Window) freely distribute such material to medical professionals. No part of this material may be reproduced in any form, stored in a retrieval system or transmitted in any form, by any means.
Opinions expressed in this material are not necessarily those of Wolters Kluwer or associates. No responsibility is assumed by Wolters Kluwer or associates, for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.
【本文经《美国外科病理学杂志》授权发布，其他媒体转载或引用须经《美国外科病理学杂志》同意 ，否则追究法律责任；所有文章仅供公益交流，不代表本站立场。欢迎提供素材、资料等，投稿邮箱： tougao@91360.com，一经采纳将给予稿费】
©2019 Wolters Kluwer Health.
This material is from Wolters Kluwer Health, and authorize to 91360 Medical Group（Shen Zhen）Co.,Ltd. (91360 Pathologist group) and Shanghai EBM Info Tech Co., Ltd. (CME Window) freely distribute such material to medical professionals. No part of this material may be reproduced in any form, stored in a retrieval system or transmitted in any form, by any means.
Opinions expressed in this material are not necessarily those of Wolters Kluwer or associates. No responsibility is assumed by Wolters Kluwer or associates, for any injury and/or damage to persons or property as a matter of products liability, negligence or otherwise, or from any use or operation of any methods, products, instructions, or ideas contained in the material. Because of rapid advances in the medical sciences, in particular, independent verification of diagnoses and drug dosages should be made.
【本文经《美国外科病理学杂志》授权发布，其他媒体转载或引用须经《美国外科病理学杂志》同意 ，否则追究法律责任；所有文章仅供公益交流，不代表本站立场。欢迎提供素材、资料等，投稿邮箱： tougao@91360.com，一经采纳将给予稿费】
苏公网安备 32011402010112号