唾液腺の腫瘍
T1 ≤ 2 cm intraparanchymal;
T2 ≤ 4 cm, intraparenchymal
T3, > 4 cm and/or extracapsular
T4a, skin/mandible/ear canal/facial nerve
T4b, skull base/pterygoid/carotid artery encasement
pN0 No regional lymph node metastasis
pN1 Metastasis in a single ipsilateral lymph node, 3 cm or less in great
est dimension without extranodal extension
pN2a Metastasis in a single ipsilateral lymph node,
more than 3 cm but not more than 6 cm in greatest dimension without
extranodal extension
or single <3 cm with extranodal extension
pN2b Metastasis in multiple ipsilateral lymph nodes,
none more than 6 cm in greatest dimension without extranodal extension
pN2c Metastasis in bilateral or contralateral lymph
nodes, none more than 6 cm in greatest dimension without extranodal
extension
pN3a Metastasis in a lymph node more than 6 cm in greatest dimension without extranodal extension
pN3b > 3 cm with extranodal or multiple, ipsilateral or contralateral or bilateral with extranodal extension
pN と Staging はhypopharynxと同じ
Stage I, T1; Stage II, T2
Stage III, T3N0 or T123N1
Stage IVA, T123N2 or T4aN012
Stage IVB, T4b or N3
Stage IVC, M1
Tumours
of salivary glands (Please subscribe to see the links)
悪性腫瘍 | 主な遺伝子変化
|
Mucoepidermoid
carcinoma 粘表皮癌 | t(11;19)(q21;p13) or t(11;15)(q21;q26) translocation
CRTC1/3-MAML2 gene fusion |
Adenoid
cystic carcinoma腺様嚢胞癌 | t(6;9)(q22- 23;p23-24) translocation
MYB-NFIB gene fusion, Strong diffuse nuclear staining of MYB
t(8;9)(q13;p22) translocation
MYBL1-NFIB gene fusion
|
Acinic
cell carcinoma腺房細胞癌 | t(4;9)(q13;q31)
NR4A3 (9q31.1) nuclear expression
|
Polymorphous
adenocarcinoma多形腺癌 | activating mutation of PRKD1 E710D (p.Glu710Asp, exon 15)
|
Clear
cell carcinoma明細胞癌 | EWSR1-ATF1 gene fusion |
Basal
cell adenocarcinoma基底細胞腺癌 | CTNNB1, CYLD alterations |
Intraductal
carcinoma導管内癌 |
|
Adenocarcinoma,
NOS腺癌,NOS |
|
Salivary
duct carcinoma唾液腺導管癌 | AR copy-number gain and splice variants
ERBB2 gene amplification (25%)
|
Myoepithelial
carcinoma筋上皮癌 |
|
Epithelial–myoepithelial
carcinoma上皮筋上皮性癌 |
|
Carcinoma
ex pleomorphic adenoma多形腺腫由来癌 | PLAG1, HMGA2 + TP53 (50-75%), MDM2 and HMGA2 amplification (50%), ERBB2 amplification (31-38%)
|
Secretory
carcinoma分泌癌 | t(12;15)(p13;q25) translocation
ETV6-NTRK3 gene fusion, NTRK3 immunohistochemistry
|
Sebaceous
adenocarcinoma脂腺腺癌 |
|
Carcinosarcoma癌肉腫 |
|
Poorly
differentiated carcinoma低分化癌(未分化癌,大細胞神経内分泌癌,小細胞神経内分泌癌) |
|
Lymphoepithelial
carcinomaリンパ上皮癌 | Associated with EBV infection |
Squamous
cell carcinoma扁平上皮癌 |
|
Oncocytic
carcinomaオンコサイト癌 |
|
Sialoblastoma唾液腺芽腫 |
|
|
|
良性腫瘍 |
|
|
|
Pleomorphic
adenoma多形腺腫 | PLAG1 fusion, HMGA2 fusion, HRAS
|
Myoepithelioma筋上皮腫 |
|
Basal
cell adenoma基底細胞腺腫 | CTNNB1 alterations (nuclear expression)
|
Warthin
tumorワルチン腫瘍 |
|
Oncocytomaオンコサイトーマ |
|
Lymphadenomaリンパ腺腫 |
|
Cystadenoma嚢胞腺腫 |
|
Sialadenoma
papilliferum乳頭状唾液腺腺腫 |
|
Ductal
papillomas導管乳頭腫 |
|
Sebaceous
adenoma脂腺腺腫 |
|
Canalicular
adenoma and other ductal adenomas細管状腺腫と他の導管腺腫 |
|
Non-neoplastic
epithelial lesions |
|
Sclerosing
polycystic adenosis硬化性多嚢胞性腺症 | 耳下腺
|
Nodular
oncocytic hyperplasia結節性オンコサイト過形成 |
|
Lymphoepithelial
sialadenitisリンパ上皮性唾液腺炎 |
|
Intercalated
duct hyperplasia介在部導管過形成 |
|
唾液腺病変その他
Mucocele (mucous retention and extravasation cysts):
下口唇などにできる。
Sjogren syndrome: benign lymphoepithelial lesions (BLL)
Ranula: 舌下腺にできる。
Lymphoepithelial cyst: 耳下腺にできる。
Oncocytosis/diffuse oncocytic hyperplasia: 高齢者にできる。
Necrotizing sialometaplasia: 口腔。
Radiation-induced change: 上記と同様mucoepidermoidca.との鑑別
Acute sialadenitis: mumps, coxsackie ECHO, EBV, CMV.
Kuttner tumor (chronis sclerosing sialadenitis);
a member of family of IgG4-related sclerosing disease.
MALT lymphomaが出ることも。
Granulomatous sialadenitis:
サルコイドーシス、心筋、抗酸菌。猫ひっかきの2-3%