腮腺肌上皮瘤詳解課件

腮腺肌上皮瘤詳解課件1MyoepitheliomaoftheParotidGland:CTImagingfindingsHuanhuanSu2012-02-06MyoepitheliomaoftheParotid2MEisabenignsalivaryglandtumorcomposedalmostexclusivelyofsheets,islands,orcordsofcellswithmyoepithelialdifferentiationSpindlecells,plasmacytoidcells,epithelioidcells,clearcellpatterns.Othertermsmyoepithelialadenomabenignmyoepithelialtumor

IntroductionMEisabenignsalivarygland3Benignadenomasaccountfor65.5%ofsalivaryglandtumors.MEswererecognizedasahistologicallydistinctentityin1991bytheWorldHealthOrganization.IntroductionBenignadenomasaccountfor654MEsaccountfor1.5%ofallofthetumorsinthemajorandminorsalivaryglands,and40%ariseintheparotidglands.Minorsalivaryglandsfollowinfrequency,especiallyinthepalate(21%).IntroductionMEsaccountfor1.5%ofallof5TheageofpatientswithMErangesfrom9to85years,withanaverageof44yearsandthepeakageofoccurrenceinthethirddecade.Ittypicallypresentsasasolitary,slowlygrowing,otherwiseasymptomaticmass.MEsarelesspronetorecurthanpleomorphicadenomas.IntroductionTheageofpatientswithMEra6CTimagingfeaturesandpathologyCTimagingfeatures

homogenousenhancement(Fig1)inhomogeneousenhancementwithenhancingnodules,thepresenceofcysticareas(Fig2),slitlike-shapedarea(Fig3),andlinearbands(Fig4).smoothorlobulatedcontours

locatedinthesuperficiallobeoftheparotidgland,abuttedthecapsuleoftheglandCTimagingfeaturesandpathol7CTimagingfeaturesandpathologyA62-year-oldwomanwithME.A,PrecontrastaxialCTscanshowsaround,well-definedmass(27.39HU)inthesuperficiallobeoftherightparotidglandabuttingonthecapsuleofgland(arrow).B,Contrast-enhancedaxialCTscanshowsthemass(102.11HU)withhomogeneousstrongenhancement(arrow).C,Microscopicexamination(HE×2)showsthattheME(M)isseparatedfromtheparotidglandandthesurroundingsofttissuesbyafibrouscapsule(FC).Thestromaisscanty.D,Microscopicexamination(HE×100)showsthatthetumoriscomposedoftheplasmacytoidandspindlecells.Relativelylargevesselsareseeninthetumor(arrows).CTimagingfeaturesandpathol8CTimagingfeaturesandpathologyA66-year-oldwomanwithME.A,PrecontrastaxialCTscanshowsanindistinctmarginmassinthesuperficiallobeoftheleftparotidglandabuttingonthecapsuleoftheglandwithcalcification(arrow).B,Contrast-enhancedaxialCTscanshowsthemasswithinhomogeneousenhancement.Itcontainsacentralenhancingnodule(smallblackarrow)andanonenhancingperipheralcysticcomponent(whitearrow).C,Microscopicexamination(HE×10)showstheepithelioidnest(arrow)withalotofvesselsandacysticcomponentinthecenter(blackasterisk).D,Microscopicexamination(HE×20)showstheinflamedcells(longarrows)andthetumorcells(shortarrow).CTimagingfeaturesandpathol9CTimagingfeaturesandpathology

A56-year-oldwomanwithME.A,Contrast-enhancedmultiplanarreformattedcoronalCTscanshowsawell-definedmassinthetailoftherightparotidglandwithinhomogeneousenhancement(whitearrow).Notetheslitlike-shapednonenhancingarea(smallblackarrow).B,Microscopicexamination(HE×40)showsthattherearehemorrhage(stars)andtumorcells(arrow)inthestroma.CTimagingfeaturesandpathol10CTimagingfeaturesandpathologyA54-year-oldmanwithME.A,PrecontrastaxialCTscanshowsawell-definedmasswithalobulatedmargininthesuperficiallobeoftherightparotidglandabuttedonthecapsuleofthegland(arrow).B,Contrast-enhancedaxialCTscanshowsthemasswithinhomogeneousenhancement.Itcontainsenhancingnodules(arrows)andnonenhancinglinearband(arrowheads).C,Microscopicexamination(HE×2)showsthestroma(blackasterisks)andepithelioidnests(arrows)withalotofvessels.D,Microscopicexamination(HE×100)showsthatthenestiscomposedofplasmacytoid.CTimagingfeaturesandpathol11epithelialnestwithplentifulbloodvesselseithercollagenousormucoidstromastromasurroundinghemorrhagenonenhancinglinearbandsslitlike-shapednonenhancingareaEnhancingnodulesCTimagingfeaturesandpathologyepithelialnestwithplentifu12

highvascularityfaintenhancement

nosignificantattenuationchangebetweenearlyanddelayedphasescanningVariousenhancementpatternshighvascularityfaintenhance13ManybiologicalfactorsinfluencetheenhancementpatternsoftumorsVariousenhancementpatternshistologicalcomponentsofthetumorsvascularity

histopathologicalcelltypesManybiologicalfactorsinflue14spindlecelltypewithareasofhyalinizationplasmacytoidcelltypewithmyxoidstromafaintenhancementVariousenhancementpatternsspindlecelltypewithplasma15spindlecelltypewithfibrousstroma

Cellularmyoepitheliomaswithfibrousstromahavemorevascularityandenhancementthanthosewithrichmyxoidstroma.

intenseenhancementVariousenhancementpatternsspindlecelltypewith16wellcircumscribedenhancingmasslesionswithsmoothorlobulatedmarginslocatedchieflyinthesuperficiallobeandabuttedonthecapsuleoftheglandenhancingnodulesnonenhancingareasoflinearbands,slitlike-shapedorofcysticconfigurationConclusionswellcircumscribedConclusions17DifferentialdiagnosesPleomorphicadenomas

RelativelylargecysticchangesaremorefrequentinMEsthaninpleomorphicadenomashappeninsuperficialand/ordeeplobesoftheparotidandnotoftenabutthecapsuleoftheglandlittleornoenhancementintheimmediatepostcontrastscanbutmanifestincreasedenhancementinthedelayedscan.DifferentialdiagnosesPleomo18DifferentialdiagnosesWarthin’stumors

morecommoninelderlymenthaninwomenandcanbemultifocalandbilateralin10%–15%ofpatients.enhancingnodulesformationandlobulatedcontoursaremorefrequentinMEsthaninWarthintumorsenhancementintheimmediatepostcontrastscan.ThesefeaturesaresimilartoMEsDifferentialdiagnosesWarthin’19MyoepitheliomasoftheSoftPalateA66-year-oldmanwithME.A.AnearlyphaseaxialCTscanshowsawell-demarcatedsoftpalatetumorshowingfaintenhancement.B.AdelayedaxialCTscanshowsheterogenous,nodularenhancementofthetumor.MyoepitheliomasoftheSoftPa20MyoepitheliomasoftheSoftPalateA65-year-oldwomanwithME.A.AnearlyphasecoronalCTscanshowsanintenselyenhancingsoftpalatetumor.B.AdelayedaxialCTscanshowspersistenthomogenousenhancementofthetumor.MyoepitheliomasoftheSoftPa21HappyNewYearHappyNewYear22腮腺肌上皮瘤詳解課件23MyoepitheliomaoftheParotidGland:CTImagingfindingsHuanhuanSu2012-02-06MyoepitheliomaoftheParotid24MEisabenignsalivaryglandtumorcomposedalmostexclusivelyofsheets,islands,orcordsofcellswithmyoepithelialdifferentiationSpindlecells,plasmacytoidcells,epithelioidcells,clearcellpatterns.Othertermsmyoepithelialadenomabenignmyoepithelialtumor

IntroductionMEisabenignsalivarygland25Benignadenomasaccountfor65.5%ofsalivaryglandtumors.MEswererecognizedasahistologicallydistinctentityin1991bytheWorldHealthOrganization.IntroductionBenignadenomasaccountfor6526MEsaccountfor1.5%ofallofthetumorsinthemajorandminorsalivaryglands,and40%ariseintheparotidglands.Minorsalivaryglandsfollowinfrequency,especiallyinthepalate(21%).IntroductionMEsaccountfor1.5%ofallof27TheageofpatientswithMErangesfrom9to85years,withanaverageof44yearsandthepeakageofoccurrenceinthethirddecade.Ittypicallypresentsasasolitary,slowlygrowing,otherwiseasymptomaticmass.MEsarelesspronetorecurthanpleomorphicadenomas.IntroductionTheageofpatientswithMEra28CTimagingfeaturesandpathologyCTimagingfeatures

homogenousenhancement(Fig1)inhomogeneousenhancementwithenhancingnodules,thepresenceofcysticareas(Fig2),slitlike-shapedarea(Fig3),andlinearbands(Fig4).smoothorlobulatedcontours

locatedinthesuperficiallobeoftheparotidgland,abuttedthecapsuleoftheglandCTimagingfeaturesandpathol29CTimagingfeaturesandpathologyA62-year-oldwomanwithME.A,PrecontrastaxialCTscanshowsaround,well-definedmass(27.39HU)inthesuperficiallobeoftherightparotidglandabuttingonthecapsuleofgland(arrow).B,Contrast-enhancedaxialCTscanshowsthemass(102.11HU)withhomogeneousstrongenhancement(arrow).C,Microscopicexamination(HE×2)showsthattheME(M)isseparatedfromtheparotidglandandthesurroundingsofttissuesbyafibrouscapsule(FC).Thestromaisscanty.D,Microscopicexamination(HE×100)showsthatthetumoriscomposedoftheplasmacytoidandspindlecells.Relativelylargevesselsareseeninthetumor(arrows).CTimagingfeaturesandpathol30CTimagingfeaturesandpathologyA66-year-oldwomanwithME.A,PrecontrastaxialCTscanshowsanindistinctmarginmassinthesuperficiallobeoftheleftparotidglandabuttingonthecapsuleoftheglandwithcalcification(arrow).B,Contrast-enhancedaxialCTscanshowsthemasswithinhomogeneousenhancement.Itcontainsacentralenhancingnodule(smallblackarrow)andanonenhancingperipheralcysticcomponent(whitearrow).C,Microscopicexamination(HE×10)showstheepithelioidnest(arrow)withalotofvesselsandacysticcomponentinthecenter(blackasterisk).D,Microscopicexamination(HE×20)showstheinflamedcells(longarrows)andthetumorcells(shortarrow).CTimagingfeaturesandpathol31CTimagingfeaturesandpathology

A56-year-oldwomanwithME.A,Contrast-enhancedmultiplanarreformattedcoronalCTscanshowsawell-definedmassinthetailoftherightparotidglandwithinhomogeneousenhancement(whitearrow).Notetheslitlike-shapednonenhancingarea(smallblackarrow).B,Microscopicexamination(HE×40)showsthattherearehemorrhage(stars)andtumorcells(arrow)inthestroma.CTimagingfeaturesandpathol32CTimagingfeaturesandpathologyA54-year-oldmanwithME.A,PrecontrastaxialCTscanshowsawell-definedmasswithalobulatedmargininthesuperficiallobeoftherightparotidglandabuttedonthecapsuleofthegland(arrow).B,Contrast-enhancedaxialCTscanshowsthemasswithinhomogeneousenhancement.Itcontainsenhancingnodules(arrows)andnonenhancinglinearband(arrowheads).C,Microscopicexamination(HE×2)showsthestroma(blackasterisks)andepithelioidnests(arrows)withalotofvessels.D,Microscopicexamination(HE×100)showsthatthenestiscomposedofplasmacytoid.CTimagingfeaturesandpathol33epithelialnestwithplentifulbloodvesselseithercollagenousormucoidstromastromasurroundinghemorrhagenonenhancinglinearbandsslitlike-shapednonenhancingareaEnhancingnodulesCTimagingfeaturesandpathologyepithelialnestwithplentifu34

highvascularityfaintenhancement

nosignificantattenuationchangebetweenearlyanddelayedphasescanningVariousenhancementpatternshighvascularityfaintenhance35ManybiologicalfactorsinfluencetheenhancementpatternsoftumorsVariousenhancementpatternshistologicalcomponentsofthetumorsvascularity

histopathologicalcelltypesManybiologicalfactorsinflue36spindlecelltypewithareasofhyalinizationplasmacytoidcelltypewithmyxoidstromafaintenhancementVariousenhancementpatternsspindlecelltypewithplasma37spindlecelltypewithfibrousstroma

Cellularmyoepitheliomaswithfibrousstromahavemorevascularityandenhancementthanthosewithrichmyxoidstroma.

intenseenhancementVariousenhancementpatternsspindlecelltypewith38wellcircumscribedenhancingmasslesionswithsmoothorlobulatedmarginslocatedchieflyinthesuperficiallobeandabuttedonthecapsuleoftheglandenhancingnodulesnonenhancingareasoflinearbands,slitlike-shapedorofcysticconfigu