Email Alert | RSS

北京大学学报（医学版） ›› 2022, Vol. 54 ›› Issue (1): 62-67. doi: 10.19723/j.issn.1671-167X.2022.01.010

• 论著 • 上一篇    下一篇

28例口腔基底样鳞状细胞癌的临床病理分析

周传香,周正,张晔,刘晓筱,高岩()   

  1. 北京大学口腔医学院·口腔医院口腔病理科,国家口腔医学中心,国家口腔疾病临床医学研究中心,口腔数字化医疗技术和材料国家工程实验室,口腔数字医学北京市重点实验室,国家卫生健康委员会口腔医学计算机应用工程技术研究中心,国家药品监督管理局口腔生物材料重点实验室,北京 100081
  • 收稿日期:2021-10-12 出版日期:2022-02-18 发布日期:2022-02-21
  • 通讯作者: 高岩 E-mail:gaoyan0988@163.com
  • 基金资助:
    北京市自然科学基金(7192232)

Clinicopathological study in 28 cases of oral basaloid squamous cell carcinomas

ZHOU Chuan-xiang,ZHOU Zheng,ZHANG Ye,LIU Xiao-xiao,GAO Yan()   

  1. Department of Oral Pathology, Peking University School and Hospital of Stomatology & National Center of Stomatology & National Clinical Research Center for Oral Diseases & National Engineering Laboratory for Digital and Material Technology of Stomatology & Beijing Key Laboratory of Digital Stomatology & NHC Research Center of Engineering and Technology for Computerized Dentistry & NMPA Key Laboratory for Dental Materials, Beijing 100081, China
  • Received:2021-10-12 Online:2022-02-18 Published:2022-02-21
  • Contact: Yan GAO E-mail:gaoyan0988@163.com
  • Supported by:
    Beijing Nature Science Foundation(7192232)

RICH HTML

 13   

PDF (PC)

160

摘要：

目的: 回顾性分析基底样鳞状细胞癌临床病理特征及预后相关因素。方法: 回顾性分析2002年1月至2020年12月在北京大学口腔医学院诊治并经病理确诊为基底样鳞状细胞癌患者的临床病理资料。选取诊断明确且组织学不伴有其他类型杂交瘤,并有明确手术治疗史及完善临床病理资料的基底样鳞状细胞癌28例,分析其临床病理特征,应用免疫组织化学染色筛选可用于鉴别诊断的特异性免疫标记,应用统计学方法进行生存分析,评估预后相关因素,同时随机选取28例临床分期相同的传统鳞状细胞癌患者作为对照组。结果: 28例基底样鳞状细胞癌最常发生的部位是舌及口底,为11例(11/28,39.3%),其余牙龈6例(6/28, 21.4%)、颊部5例(5/28, 17.9%)、腭部4例(4/28, 14.3%)、口咽部2例(2/28, 7.1%)。患者多为中晚期, 12例为Ⅱ期,16例为Ⅲ~Ⅳ期。经组织病理学检查证实伴淋巴结转移者12例,占总病例数42.9%(12/28),局部复发者9例,伴远处转移者1例(转移至肺)。28例传统鳞状细胞癌患者中经组织病理学检查证实伴淋巴结转移者13例,占总病例数46.4%(13/28)。局部复发者5例,伴远处转移者3例,其中2例转移至肺、1例转移至脑。临床分期相同的基底样鳞状细胞癌组和传统鳞状细胞癌组患者5年总生存率分别为54.6%、53.8%。基底样鳞状细胞癌组织学上表现为基底样细胞构成的实性癌巢,癌巢中心一般不形成角化,常可见粉刺样坏死结构。28例基底样鳞状细胞癌均呈现CK5/6、P63强阳性表达,而神经内分泌标志物CgA和Syn阴性表达,其中8例呈P16阳性表达,1例局灶阳性表达SOX10,但CK7阴性。结论: 口腔基底样鳞状细胞癌中晚期患者多见,淋巴结转移率较高,但与相同临床分期的传统鳞状细胞癌总生存率差异无统计学意义;P16阳性患者与人乳头瘤病毒感染相关,预后较好;CK7与SOX10免疫组织化学可用于基底样鳞状细胞癌与实性型腺样囊性癌的鉴别诊断。

关键词: 鳞状细胞癌, 腺样囊性癌, P16, 人乳头瘤病毒

Abstract:

Objective: To investigate the clinicopathologic features and prognostic factors in oral basaloid squamous cell carcinoma. Methods: Retrospective analysis of oral basaloid squamous cell carcinomas patients who underwent tumor resection during the period from January 2002 to December 2020 in the authors’ hospital, especially the clinicopathologic characteristics of 28 cases with confirmed diagnosis and follow-up data. Immunohistochemistry was performed to define the helpful markers for differentiation diagnosis. The factors influencing the prognosis were evaluated based on Kaplan-Meier method. Results: The tongue and mouth floor (11 cases, 39.3%) were the most frequently involved sites, followed by gingiva (6 cases, 21.4%), buccal (5 cases, 17.9%), palate (4 cases, 14.3%), and oropharynx (2 cases, 7.1%). The majority of basaloid squamous cell carcinomas were in advanced stage, with 12 cases in stage Ⅱ and 16 cases in stages Ⅲ-Ⅳ. Twelve of 28 patients were identified to have cervical lymph node metastasis, which was confirmed by histopathological examination. The incidence rate of lymph node metastasis was 42.9% (12/28). Nine tumors recurred, with one metastasized to the lung. At the meantime, the 28 conventional squamous cell carcinomas were matched with the same stage, among which 13 cases were identified with cervical lymph node metastasis. The incidence rate of lymph node metastasis was 46.4% (13/28). Five cases recurred, with two cases that metastasized to the lung and one to the brain. The 5-year overall survival rates of the basaloid squamous cell carcinoma and conventional squamous cell carcinoma patients were 54.6% and 53.8%, respectively. Histopathologically, basaloid cells consisted of tumor islands without evident keratinization but frequently with comedo-like necrosis within the tumor islands. CK5/6 and P63 exhibited strongly positive in all the 28 cases, whereas neuroendocrine markers, CgA and Syn, were negative. Eight cases positively expressed P16; one case showed focal SOX10 positive but CK7 negative. Conclusion: The majority of oral basaloid squamous cell carcinomas present in advanced stage with a high tendency to lymph node metastasis, but the overall survival rates are not significantly different from conventional squamous cell carcinomas matched with the same stage. The human papilloma virus (HPV),as HPV-positivity rate is high, correlates to good prognosis. In addition, CK7 & SOX10 immunohistochemistry could contribute to differential diagnosis for basaloid squamous cell carcinoma with solid adenoid cystic carcinoma.

Key words: Squamous cell carcinoma, Adenoid cystic carcinoma, P16, Human papilloma virus

中图分类号: 

  • R780.2

表1

BSCC患者与相同临床分期的传统SCC患者临床病理参数比较"

Case
no.		 BSCC Case
no.		 SCC
Agea/
gender		 Location Stage LN
metastasis		 Follow-up P16
IHC		 Agea/
gender		 Location Stage LN
metastasis		 Follow-up P16
IHC
1 77/M Palate Ⅲ + Dead/3 y - 1 67/M Palate Ⅲ - Alive/5 y +
2 71/M Tongue Ⅱ - Alive/11 y + 2 73/M Tongue Ⅱ - Alive/4 y -
3 57/M Floor of mouth Ⅳ + Alive/9 y + 3 48/M Floor of mouth Ⅳ + Alive/4 y +
4 70/M Gingiva Ⅱ - Alive/6 y + 4 68/F Gingiva Ⅱ - Alive/5 y -
5 62/M Oropharynx Ⅱ - Dead/4 y - 5 38/M Oropharynx Ⅱ - Alive/3 y -
6 75/F Buccal Ⅱ - Alive/5 y - 6 81/F Buccal Ⅱ - Dead/2.5 y -
7 60/M Gingiva Ⅱ - Dead/1 y - 7 46/M Gingiva Ⅱ - Alive/4 y -
8 33/F Palate Ⅱ - Alive/5 y + 8 71/M Palate Ⅱ - Alive/2 y -
9 58/M Gingiva Ⅱ - Alive/5 y + 9 62/M Gingiva Ⅱ - Dead/2 y +
10 60/M Gingiva & buccal Ⅳ - Dead/2 y - 10 79/M Gingiva Ⅳ + Dead/4 y -
11 52/M Floor of mouth
& Tongue		 Ⅳ + Alive/3 y - 11 54/M Floor of mouth Ⅳ + Alive/4 y -
12 67/M Gingiva Ⅳ - Alive/3 y - 12 71/F Gingiva Ⅳ + Dead/1.5 y -
13 41/M Palate Ⅲ + Alive/2 y - 13 56/M Palate Ⅲ - Alive/2 y -
14 53/M Floor of mouth Ⅳ + Alive/1.5 y - 14 60/M Floor of mouth Ⅳ + Dead/3 y -
15 68/M Tongue Ⅱ - Alive/1 y - 15 64/F Tongue Ⅱ - Alive/4 y -
16 60/M Floor of mouth Ⅲ + Alive/1 y - 16 74/M Floor of mouth Ⅲ - Dead/1 y -
17 62/M Tongue Ⅳ + Dead/2 y - 17 71/F Tongue Ⅳ + Dead/2.5 y -
18 51/M Gingiva Ⅳ - Alive/1 y - 18 73/F Gingiva Ⅳ + Dead/2.5 y +
19 67/M Floor of mouth Ⅱ - Alive/1 y - 19 52/M Floor of mouth Ⅱ - Alive/4 y -
20 58/M Buccal Ⅲ + Alive/2 y - 20 43/M Buccal Ⅲ + Alive/3 y +
21 39/M Tongue Ⅱ - Alive/1.5 y - 21 66/M Tongue Ⅱ - Alive/5 y -
22 34/M Palate Ⅲ + Alive/4 y + 22 62/M Palate Ⅲ + Alive/3 y -
23 57/M Oropharynx Ⅳ - Alive/1 y + 23 64/M Oropharynx Ⅳ + Dead/1 y -
24 58/M Buccal Ⅱ - Alive/2.5 y - 24 66/M Buccal Ⅱ - Dead/3 y -
25 66/M Buccal Ⅳ + Dead/3 y - 25 53/M Buccal Ⅳ + Alive/3 y +
26 44/F Tongue Ⅲ + Dead/3 y - 26 52/F Tongue Ⅲ + Alive/4 y -
27 47/M Gingiva Ⅱ - Alive/3 y + 27 72/M Gingiva Ⅲ - Dead/2 y -
28 50/M Floor of mouth Ⅳ + Dead/2 y - 28 76/M Floor of mouth Ⅳ + Dead/2 y -

图1

基底样鳞状细胞癌的病理学特征"

图2

基底样鳞状细胞癌的免疫组织化学染色"

图3

基底样鳞状细胞癌和传统鳞状细胞癌患者生存分析"

[1] Wain SL, Kier R, Vollmer RT, et al. Basaloid-squamous carcinoma of the tongue, hypopharynx, and larynx: report of 10 cases[J]. Hum Pathol, 1986, 17(11):1158-1166.
pmid: 3770734
[2] Paulino AF, Singh B, Shah JP, et al. Basaloid squamous cell carcinoma of the head and neck[J]. Laryngoscope, 2000, 110(9):1479-1482.
pmid: 10983946
[3] Soriano E, Faure C, Lantuejoul S, et al. Course and prognosis of basaloid squamous cell carcinoma of the head and neck: a case-control study of 62 patients[J]. Eur J Cancer, 2008, 44(2):244-250.
doi: 10.1016/j.ejca.2007.11.008
[4] Ramqvist T, Näsman A, Franzeén B, et al. Protein expression in tonsillar and base of tongue cancer and in relation to human papillomavirus (HPV) and clinical outcome.[J]. Int J Mol Sci, 2018, 19(4):978.
doi: 10.3390/ijms19040978
[5] Näsman A, Bersani C, Lindquist D, et al. Human papillomavirus and potentially relevant biomarkers in tonsillar and base of tongue squamous cell carcinoma[J]. Anticancer Res, 2017, 37(10):5319-5328.
[6] Xu Y, Zhao H, Tong Y, et al. Comparative analysis of clinicopathological characteristics, survival features, and protein expression between basaloid and squamous cell carcinoma of the esophagus[J]. Int J Gen Med, 2021, 14:3929-3939.
doi: 10.2147/IJGM.S314054
[7] Linton OR, Moore MG, Brigance JS, et al. Prognostic significance of basaloid squamous cell carcinoma in head and neck can-cer[J]. JAMA Otolaryngol Head Neck Surg, 2013, 139(12):1306-1311.
doi: 10.1001/jamaoto.2013.5308
[8] Thariat J, Badoual C, Faure C, et al. Basaloid squamous cell carcinoma of the head and neck: role of HPV and implication in treatment and prognosis[J]. J Clin Pathol, 2010, 63(10):857-866.
doi: 10.1136/jcp.2010.078154 pmid: 20876315
[9] de Sampaio Góes FC, Oliveira DT, Dorta RG, et al. Prognoses of oral basaloid squamous cell carcinomas and squamous cell carcinoma: a comparison[J]. Arch Otolaryngol Head Neck Surg, 2004, 130(1):83-86.
doi: 10.1001/archotol.130.1.83
[10] Yu GY, Gao Y, Peng X, et al. A clinicopathologic study on basaloid squamous cell carcinoma in the oral and maxillofacial region[J]. Int J Oral Maxillofac Surg, 2008, 37(11):1003-1008.
doi: 10.1016/j.ijom.2008.05.019
[11] 代璐岭, 杨秀秀, 赵好为, 等. 牙龈基底细胞样鳞状细胞癌1例[J]. 华西口腔医学杂志, 2020, 38(3):347-350.
[12] Sato F, Bhawal UK, Tojyo I, et al. Differential expression of claudin-4, occludin, SOX2 and proliferating cell nuclear antigen between basaloid squamous cell carcinoma and squamous cell carcinoma[J]. Mol Med Rep, 2019, 20(2):1977-1985.
[13] Schuch LF, Nóbrega KHS, Gomes APN, et al. Basaloid squamous cell carcinoma: a 31-year retrospective study and analysis of 214 cases reported in the literature[J]. Oral Maxillofac Surg, 2020, 24(1):103-108.
doi: 10.1007/s10006-020-00828-9
[14] Lee JH, Kang HJ, Yoo CW, et al. PLAG1, SOX10, and Myb expression in benign and malignant salivary gland neoplasms[J]. J Pathol Transl Med, 2019, 53(1):23-30.
doi: 10.4132/jptm.2018.10.12
[15] Hsieh MS, Lee YH, Chang YL. SOX10-positive salivary gland tumors: a growing list, including mammary analogue secretory carcinoma of the salivary gland, sialoblastoma, low-grade salivary duct carcinoma, basal cell adenoma/adenocarcinoma, and a subgroup of mucoepidermoid carcinoma[J]. Hum Pathol, 2016, 56:134-142.
doi: 10.1016/j.humpath.2016.05.021
[16] Adkins BD, Geromes A, Zhang LY, et al. SOX10 and GATA3 in adenoid cystic carcinoma and polymorphous adenocarcinoma[J]. Head Neck Pathol, 2020, 14(2):406-411.
doi: 10.1007/s12105-019-01046-w pmid: 31222589
[17] Nakaguro M, Tada Y, Faquin WC, et al. Salivary duct carcinoma: updates in histology, cytology, molecular biology, and treatment[J]. Cancer Cytopathol, 2020, 128(10):693-703.
doi: 10.1002/cncy.22288 pmid: 32421944
[18] Boon E, Bel M, van Boxtel W, et al. A clinicopathological study and prognostic factor analysis of 177 salivary duct carcinoma patients from The Netherlands[J]. Int J Cancer, 2018, 143(4):758-766.
doi: 10.1002/ijc.31353
[19] Santana T, Pavel A, Martinek P, et al. Biomarker immunoprofile and molecular characteristics in salivary duct carcinoma: clinicopathological and prognostic implications[J]. Hum Pathol, 2019, 93:37-47.
doi: 10.1016/j.humpath.2019.08.009
[20] Villada G, Kryvenko ON, Campuzano-Zuluaga G, et al. A limited immunohistochemical panel to distinguish basal cell carcinoma of cutaneous origin from basaloid squamous cell carcinoma of the head and neck[J]. Appl Immunohistochem Mol Morphol, 2018, 26(2):126-131.
doi: 10.1097/PAI.0000000000000394
[21] Mendelsohn AH, Lai CK, Shintaku IP, et al. Histopathologic findings of HPV and p16 positive HNSCC[J]. Laryngoscope, 2010, 120(9):1788-1794.
doi: 10.1002/lary.21044
[22] Begum S, Westra WH. Basaloid squamous cell carcinoma of the head and neck is a mixed variant that can be further resolved by HPV status[J]. Am J Surg Pathol, 2008, 32(7):1044-1050.
doi: 10.1097/PAS.0b013e31816380ec
[23] Lai K, Killingsworth M, Matthews S, et al. Differences in survival outcome between oropharyngeal and oral cavity squamous cell carcinoma in relation to HPV status[J]. J Oral Pathol Med, 2017, 46(8):574-582.
doi: 10.1111/jop.2017.46.issue-8
[24] Duncan LD, Winkler M, Carlson ER, et al. P16 immunohistochemistry can be used to detect human papillomavirus in oral cavity squamous cell carcinoma[J]. J Oral Maxillofac Surg, 2013, 71(8):1367-1375.
doi: 10.1016/j.joms.2013.02.019
[1] 苏俊琪,宋扬,谢尚. 口腔鳞状细胞癌患者修复重建术后感染的病原学特征及感染风险预测模型的构建[J]. 北京大学学报（医学版）, 2022, 54(1): 68-76.
[2] 苏雷震,陈洁,李显,季平. 沙利霉素对口腔鳞癌细胞增殖和凋亡的影响[J]. 北京大学学报（医学版）, 2020, 52(5): 902-906.
[3] 陶船思博,董凡,王佃灿,郭传瑸. 红外热成像技术诊断口腔鳞状细胞癌颈淋巴结转移[J]. 北京大学学报（医学版）, 2019, 51(5): 959-963.
[4] 刘洋,高岩,陈学杰,华红. 脱落细胞DNA 定量分析在口腔潜在恶性疾病诊断中的准确性[J]. 北京大学学报（医学版）, 2019, 51(1): 16-20.
[5] 张春凤,刘云,陆敏,杜晓娟. hUTP14a在非小细胞肺癌组织中的表达[J]. 北京大学学报（医学版）, 2019, 51(1): 145-150.
[6] 梁凌云*, 杜辉*, 王纯, 张薇, 陈芸, 渠新风, 杨斌, 吴波, 吴若松, Jerome L. Belinson, 吴瑞芳. 深圳人群人乳头瘤病毒感染亚型分布与宫颈上皮内瘤变现况横断面调查[J]. 北京大学学报（医学版）, 2013, 45(1): 114-118.
[7] 吕文平, 周开伦, 高彬, 陈永亮, 向昕, 苏明, 董家鸿. HBx诱导p16INK4a高甲基化在Chang细胞株恶性转化倾向中的作用[J]. 北京大学学报(医学版), 2012, 44(6): 932-936.
[8] 崔素萍, 王花丽, 彭伟, 刘海静, 侯琳, 张波. 乳腺癌组织P16异常表达的相关分析[J]. 北京大学学报（医学版）, 2012, 44(5): 755-759.
[9] 郭艳利, 耿力, 游珂, 乔杰, 刘从容. 外阴和阴道上皮内瘤变的临床初步研究[J]. 北京大学学报（医学版）, 2009, 41(5): 561-564.
[10] 董采萱, 邓大君, 周静, 张联, 马峻岭, 潘凯枫, 游伟程. 人群胃黏膜不确定性异型增生和异型增生组织p16甲基化及与幽门螺杆菌等暴露因素相关分析[J]. 北京大学学报（医学版）, 2008, 40(3): 280-284.
[11] 赵英芳, 田新霞, 杜娟, 张云岗, 刘松年, 林杰, 郑杰. 胃癌中p16INK4a和RB基因甲基化状况及其表达[J]. 北京大学学报（医学版）, 2003, 35(4): 382-385.
[12] 刘波, 李运海, 栾文忠, 梁冶矢, 虞有智, 郑爱萍. P16蛋白和Ki-67抗原在人脑胶质瘤中的表达及其意义[J]. 北京大学学报（医学版）, 2003, 35(2): 223-224.
[13] 武莎莎, 王申五, 林文玉, 白桃. 反义寡核苷酸减弱转染p16基因对包装细胞生长的抑制[J]. 北京大学学报（医学版）, 2002, 34(1): 36-38.
Viewed
Full text


Abstract

Cited
  Shared   
  Discussed   
[1] 卢恬, 朱晓辉, 柳世庆, 郑杰, 邱晓彦. 白细胞介素2促进宫颈癌细胞系HeLaS3免疫球蛋白G的表达[J]. 北京大学学报（医学版）, 2009, 41(2): 158 -161 .
[2] 钱秋谨, 杨莉, 王玉凤. 儿童注意缺陷多动障碍的研究进展[J]. 北京大学学报（医学版）, 2007, 39(3): 323 -328 .
[3] 钱英, 王玉凤. 共患病对注意缺陷多动障碍执行功能的影响[J]. 北京大学学报（医学版）, 2007, 39(3): 329 -332 .
[4] 于涛, 王振宇, 马长城. 椎管内非特异性外周T细胞淋巴瘤一例[J]. 北京大学学报（医学版）, 2007, 39(4): 343 -345 .
[5] 田雨, 刘建湘, 王化虹. 经皮肝穿刺活检确诊无症状原发性肝结核一例[J]. 北京大学学报（医学版）, 2007, 39(4): 365 -368 .
[6] 金红芳, 杜淑旭, 赵霞, 张素清, 田悦, 卜定芳, 唐朝枢, 杜军保. 内源性二氧化硫对心血管系统的调节意义[J]. 北京大学学报（医学版）, 2007, 39(4): 423 -425 .
[7] 谢蜀生. 物理学家与分子生物学革命[J]. 北京大学学报（医学版）, 2007, 39(4): 445 .
[8] 汤坚强, 万远廉, 刘玉村, 戎龙, 汪欣, 吴涛, 潘义生, 朱静. 组织因子/活化凝血Ⅶ因子复合物对大肠癌LoVo细胞系表达基质金属蛋白酶-7的调控作用[J]. 北京大学学报（医学版）, 2007, 39(5): 453 -457 .
[9] 王兴, 林野, 伊彪, 周彦恒, 梁成, 王晓霞, 李自力, 张震康. 内置式颌骨牵引成骨在疑难牙颌面畸形矫治中的应用--附88例报告[J]. 北京大学学报（医学版）, 2001, 33(3): 258 -262 .
[10] 王化冰, DONG Xiu-yun, 董秀云. 不同毒力的幽门螺杆菌对溃疡愈合的影响及机制[J]. 北京大学学报（医学版）, 2001, 33(3): 263 -265 .
ISSN 1671-167X
CN 11-4691/R
主管单位：中华人民共和国教育部
主办单位：北京大学
地址： 北京市海淀区学院路38号 北京大学医学部 《北京大学学报（医学版）》
邮编：100191
电话：010-82801551
Email： xbbjb2@bjmu.edu.cn

《北京大学学报（医学版）》
微信公众号
版权所有 © 2018 《北京大学学报（医学版）》编辑部