原发性支气管粘液表皮样癌的临床研究
摘要
目的：粘液表皮样癌好发于唾液腺,在肺部的发病率低,临床特点及预后因素尚未被完全掌握。原发性支气管粘液表皮样癌属于非小细胞肺癌的一种,但目前对高级别支气管粘液表皮样癌的治疗方案仍存在争议。本研究通过回顾支气管粘液表皮样癌的病例,总结其临床特征,分析与该病生存情况相关的预后因子,探讨合适的治疗方案。
方法：选取复旦大学附属中山医院2004年至2009年经手术病理确诊的原发性支气管粘液表皮样癌21例,占同期肺部肿瘤手术病例的0.69%,其中男性10例(47.6%),女性11例(52.4%),年龄14—73岁,平均43.4岁。研究患者主诉、影像学表现、纤维支气管镜检查结果、治疗方法、病理分期,并以免疫组化技术分析肿瘤组织EGFR和HER2的表达情况；通过统计方法探索性别、吸烟、年龄、分化程度、肿瘤大小、淋巴结转移、TNM分期、EGFR/HER2表达是否与生存相关。
结果：多数患者(13/21)表现为咳嗽,CT影像可见肺部占位(18/21),部分可伴有肺不张或阻塞性肺炎。在行纤维支气管镜检查的14名患者中,只有2名患者通过纤维支气管镜检查于术前明确诊断为粘液表皮样癌。所有患者均接受了手术治疗,其中肺叶切除术最多见(13/21)。术后病理表明17例为低级别肿瘤,4例为高级别肿瘤。1例低级别肿瘤患者发生围手术期死亡,其余低级别肿瘤患者随访时间为5-77个月,平均46.6个月,1名患者于术后40个月复发,一个月后死亡；高级别肿瘤患者随访时间为23.65个月,平均41.5个月,3名患者死亡。所有21例患者中,EGFR和HER2表达阳性率分别为28.6%(6/21)和0,与性别、吸烟、分化程度、淋巴结转移及生存无明显相关。年龄、分化程度、淋巴结转移和TNM分期与术后生存有关,通过多因素回归分析发现,淋巴结转移是支气管粘液表皮样癌的预后因子(总生存时间：风险比=0.06,95%置信区间：0.01.0.62,p=0.018,无瘤生存期：风险比=0.06,95%置信区间：0.01-0.61,p=0.017)。
结论：支气管粘液表皮样癌患者的症状无特异性,术前诊断主要依靠CT及纤维支气管镜检查,但由于该病临床表现不典型,术前往往难以得到明确诊断。低级别粘液表皮样癌患者手术后生存情况好于高级别患者。年龄、分化程度、淋巴结转移和TNM分期与术后生存有关,其中淋巴结转移是最显著的预后因子。
Objectives:Mucoepidermoid carcinoma is dominant in salivary glands, and rarely occurs in lung. Primary pulmonary mucoepidermoid carcinoma is one type of non-small cell lung cancer, but the optimal treatment remains controversial. The purpose of this investigation was to review the cases of pulmonary mucoepidermoid carcinoma. We analyzed the prognosis and discussed treatment strategy.
Methods:A cohort of21patients with pathologically proven pulmonary mucoepidermoid carcinoma was included in the investigation. The patients presented at Zhongshan Hospital of Fudan University, and the cases accounted for0.69%of all resected pulmonary neoplasm in that period. There were10male (47.6%) and11female (52.4%) patients, and their average age was43.4years, range14-73years. Clinical features, treatment, expression of EGFR/HER2and prognosis were retrospectively studied.
Results:Thirteen patients presented cough, and pulmonary occupying lesion was dominant in18patients, and some were accompanied with atelectasis or obstructive pneumonia. Fourteen patients received bronchoscopic examination, and2patients were diagnosed to be pulmonary mucoepidermoid carcinoma before surgery. All patients received operations, and lobectomy was the most common (13/21). After surgery,17tumors were diagnosed to be low grade and4tumors were high grade malignancy by pathology. One patient with low-grade tumor died perioperatively. Of the other16low-grade tumor cases, follow-up time ranged from5to77months (mean,46.6months), and1patient developed recurrence40months after surgery, and died one month later. Of the4high-grade tumor cases, follow-up time ranged from23to65months (mean,41.5months), and3patients died. Among the total21cases, expression rates of EGFR and HER2were28.6%and0, which were irrelevant with gender, smoke, grade, or survival. Age, grade, lymph node metastasis and TNM stage were associated with survival. Based on multivariate analysis, lymph node metastasis was significantly prognostic (Overall survival:Hazard ratio=0.06,95%CI:0.01-0.62, p=0.018; Progression-free survival:Hazard ratio=0.06,95%CI:0.01-0.61, p=0.017.)
Conclusion:The preoperative diagnosis of pulmonary mucoepidermoid carcinoma relied on computer tomography and bronchoscopic examination. Because the clinical manifestations were untypical, it was difficult to get definite diagnosis before operation. Survival of patients with low-grade tumors was better than that of patients with high-grade tumors. Age, grade, lymph node metastasis and TNM stage were associated with survival, and lymph node metastasis was the prognostic factor.
方法：选取复旦大学附属中山医院2004年至2009年经手术病理确诊的原发性支气管粘液表皮样癌21例,占同期肺部肿瘤手术病例的0.69%,其中男性10例(47.6%),女性11例(52.4%),年龄14—73岁,平均43.4岁。研究患者主诉、影像学表现、纤维支气管镜检查结果、治疗方法、病理分期,并以免疫组化技术分析肿瘤组织EGFR和HER2的表达情况；通过统计方法探索性别、吸烟、年龄、分化程度、肿瘤大小、淋巴结转移、TNM分期、EGFR/HER2表达是否与生存相关。
结果：多数患者(13/21)表现为咳嗽,CT影像可见肺部占位(18/21),部分可伴有肺不张或阻塞性肺炎。在行纤维支气管镜检查的14名患者中,只有2名患者通过纤维支气管镜检查于术前明确诊断为粘液表皮样癌。所有患者均接受了手术治疗,其中肺叶切除术最多见(13/21)。术后病理表明17例为低级别肿瘤,4例为高级别肿瘤。1例低级别肿瘤患者发生围手术期死亡,其余低级别肿瘤患者随访时间为5-77个月,平均46.6个月,1名患者于术后40个月复发,一个月后死亡；高级别肿瘤患者随访时间为23.65个月,平均41.5个月,3名患者死亡。所有21例患者中,EGFR和HER2表达阳性率分别为28.6%(6/21)和0,与性别、吸烟、分化程度、淋巴结转移及生存无明显相关。年龄、分化程度、淋巴结转移和TNM分期与术后生存有关,通过多因素回归分析发现,淋巴结转移是支气管粘液表皮样癌的预后因子(总生存时间：风险比=0.06,95%置信区间：0.01.0.62,p=0.018,无瘤生存期：风险比=0.06,95%置信区间：0.01-0.61,p=0.017)。
结论：支气管粘液表皮样癌患者的症状无特异性,术前诊断主要依靠CT及纤维支气管镜检查,但由于该病临床表现不典型,术前往往难以得到明确诊断。低级别粘液表皮样癌患者手术后生存情况好于高级别患者。年龄、分化程度、淋巴结转移和TNM分期与术后生存有关,其中淋巴结转移是最显著的预后因子。
Objectives:Mucoepidermoid carcinoma is dominant in salivary glands, and rarely occurs in lung. Primary pulmonary mucoepidermoid carcinoma is one type of non-small cell lung cancer, but the optimal treatment remains controversial. The purpose of this investigation was to review the cases of pulmonary mucoepidermoid carcinoma. We analyzed the prognosis and discussed treatment strategy.
Methods:A cohort of21patients with pathologically proven pulmonary mucoepidermoid carcinoma was included in the investigation. The patients presented at Zhongshan Hospital of Fudan University, and the cases accounted for0.69%of all resected pulmonary neoplasm in that period. There were10male (47.6%) and11female (52.4%) patients, and their average age was43.4years, range14-73years. Clinical features, treatment, expression of EGFR/HER2and prognosis were retrospectively studied.
Results:Thirteen patients presented cough, and pulmonary occupying lesion was dominant in18patients, and some were accompanied with atelectasis or obstructive pneumonia. Fourteen patients received bronchoscopic examination, and2patients were diagnosed to be pulmonary mucoepidermoid carcinoma before surgery. All patients received operations, and lobectomy was the most common (13/21). After surgery,17tumors were diagnosed to be low grade and4tumors were high grade malignancy by pathology. One patient with low-grade tumor died perioperatively. Of the other16low-grade tumor cases, follow-up time ranged from5to77months (mean,46.6months), and1patient developed recurrence40months after surgery, and died one month later. Of the4high-grade tumor cases, follow-up time ranged from23to65months (mean,41.5months), and3patients died. Among the total21cases, expression rates of EGFR and HER2were28.6%and0, which were irrelevant with gender, smoke, grade, or survival. Age, grade, lymph node metastasis and TNM stage were associated with survival. Based on multivariate analysis, lymph node metastasis was significantly prognostic (Overall survival:Hazard ratio=0.06,95%CI:0.01-0.62, p=0.018; Progression-free survival:Hazard ratio=0.06,95%CI:0.01-0.61, p=0.017.)
Conclusion:The preoperative diagnosis of pulmonary mucoepidermoid carcinoma relied on computer tomography and bronchoscopic examination. Because the clinical manifestations were untypical, it was difficult to get definite diagnosis before operation. Survival of patients with low-grade tumors was better than that of patients with high-grade tumors. Age, grade, lymph node metastasis and TNM stage were associated with survival, and lymph node metastasis was the prognostic factor.
引文
[1]Yousem S A, Hochholzer L. Mucoepidermoid tumors of the lung.[J]. Cancer. 1987,60(6):1346-1352.
[2]Smetana H F, Iverson L, Swan L L. Bronchogenic carcinoma; an analysis of 100 autopsy cases.[J]. Mil Surg.1952,111(5):335-351.
[3]Anton-Pacheco J, Jimenez M A, Rodriguez-Peralto J L, et al. Bronchial mucoepidermoid tumor in a 3-year-old child[J]. Pediatr Surg Int.1998,13(7): 524-525.
[4]Kim T S, Lee K S, Han J, et al. Mucoepidermoid carcinoma of the tracheobronchial tree:radiographic and CT findings in 12 patients.[J]. Radiology. 1999,212(3):643-648.
[5]Shilo K, Foss R D, Franks T J, et al. Pulmonary mucoepidermoid carcinoma with prominent tumor-associated lymphoid proliferation[J]. Am J Surg Pathol.2005,29(3): 407-411.
[6]Niggemann B, Gerstner B, Guschmann M, et al. An 11-yr-old male with pneumonia and persistent airway obstruction[J]. Eur Respir J.2002,19(3):582-584.
[7]Martin-Ucar A E, Rocco G. Mucoepidermoid carcinoma in unilateral hypoplastic lung:a rare tumor in a rarer condition[J]. Ann Thorac Surg.2003,75(3):1020-1021.
[8]Sanchez J, Serrano J, Gomez P, et al. Bronchial mucoepidermoid carcinoma after allogeneic bone marrow transplantation[J]. J Clin Pathol.1997,50(11):969-970.
[9]Stenman G, Petursdottir V, Mellgren G, et al. A child with a t(11;19)(q14-21;p12) in a pulmonary mucoepidermoid carcinoma[J]. Virchows Arch.1998,433(6): 579-581.
[10]Dinopoulos A, Lagona E, Stinios I, et al. Mucoepidermoid carcinoma of the bronchus.[J]. Pediatr Hematol Oncol.2000,17(5):401-408.
[11]Pandya H, Matthews S. Case report:Mucoepidermoid carcinoma in a patient with congenital agenesis of the left upper lobe.[J]. Br J Radiol.2003,76(905): 339-342.
[12]Heitmiller R F, Mathisen D J, Ferry J A, et al. Mucoepidermoid lung tumors.[J]. Ann Thorac Surg.1989,47(3):394-399.
[13]Turnbull A D, Huvos A G, Goodner J T, et al. Mucoepidermoid tumors of bronchial glands[J]. Cancer.1971,28(3):539-544.
[14]Klacsmann P G,Olson J L, Eggleston J C. Mucoepidermoid carcinoma of the bronchus:an electron microscopic study of the low grade and the high grade variants[J]. Cancer.1979,43(5):1720-1733.
[15]Ozlu C, Christopherson W M, Allen J J. Mucoepidermoid tumors of the bronchus[J]. J Thorac Cardiovasc Surg.1961,42:24-31.
[16]Dowling E A, Miller R E, Johnson I M, et al. Mucoepidermoid tumors of the bronchi[J]. Surgery.1962,52:600-609.
[17]Reichle F A, Rosemond G P. Mucoepidermoid tumors of the bronchus [J]. J Thorac Cardiovasc Surg.1966,51(3):443-448.
[18]Green L K, Gallion T L, Gyorkey F. Peripheral mucoepidermoid tumour of the lung.[J]. Thorax.1991,46(1):65-66.
[19]Vadasz P, Egervary M. Mucoepidermoid bronchial tumors:a review of 34 operated cases.[J]. Eur J Cardiothorac Surg.2000,17(5):566-569.
[20]Heitmiller R F, Mathisen D J, Ferry J A, et al. Mucoepidermoid lung tumors.[J]. Ann Thorac Surg.1989,47(3):394-399.
[21]Roggenbuck C, Hau T, de Wall N, et al. [Simultaneous occurrence of tracheobronchopathia osteochondropastica and mucoepidermoid carcinoma][J]. Chirurg.1995,66(3):231-234.
[22]Han S W, Kim H P, Jeon Y K, et al. Mucoepidermoid carcinoma of lung: potential target of EGFR-directed treatment[J]. Lung Cancer.2008,61(1):30-34.
[23]Laurie S A, Licitra L. Systemic therapy in the palliative management of advanced salivary gland cancers[J]. J Clin Oncol.2006,24(17):2673-2678.
[24]Torres A M, Ryckman F C. Childhood tracheobronchial mucoepidermoid carcinoma:a case report and review of the literature.[J]. J Pediatr Surg.1988,23(4): 367-370.
[25]Ishizumi T, Tateishi U, Watanabe S, et al. Mucoepidermoid carcinoma of the lung:high-resolution CT and histopathologic findings in five cases.[J]. Lung Cancer. 2008,60(1):125-131.
[26]Fauroux B, Aynie V, Larroquet M, et al. Carcinoid and mucoepidermoid bronchial tumours in children.[J]. Eur J Pediatr.2005,164(12):748-752.
[27]Swinson D E, Jones J L, Richardson D, et al. Tumour necrosis is an independent prognostic marker in non-small cell lung cancer:correlation with biological variables[J]. Lung Cancer.2002,37(3):235-240.
[28]Gilbert J, Li Y, Pinto H A, et al. Phase Ⅱ trial of taxol in salivary gland malignancies (E1394):a trial of the Eastern Cooperative Oncology Group[J]. Head Neck.2006,28(3):197-204.
[29]Macarenco R S, Uphoff T S, Gilmer H F, et al. Salivary gland-type lung carcinomas:an EGFR immunohistochemical, molecular genetic, and mutational analysis study.[J]. Mod Pathol.2008,21(9):1168-1175.
[30]Lujan B, Hakim S, Moyano S, et al. Activation of the EGFR/ERK pathway in high-grade mucoepidermoid carcinomas of the salivary glands[J]. Br J Cancer.2010, 103(4):510-516.
[31]Janmaat M L, Rodriguez J A, Gallegos-Ruiz M, et al. Enhanced cytotoxicity induced by gefitinib and specific inhibitors of the Ras or phosphatidyl inositol-3 kinase pathways in non-small cell lung cancer cells[J]. Int J Cancer.2006,118(1): 209-214.
[1]Yousem S A, Hochholzer L. Mucoepidermoid tumors of the lung.[J]. Cancer. 1987,60(6):1346-1352.
[2]Smetana H F, Iverson L, Swan L L. Bronchogenic carcinoma; an analysis of 100 autopsy cases.[J]. Mil Surg.1952,111(5):335-351.
[3]Anton-Pacheco J, Jimenez M A, Rodriguez-Peralto J L, et al. Bronchial mucoepidermoid tumor in a 3-year-old child[J]. Pediatr Surg Int.1998,13(7): 524-525.
[4]Shilo K, Foss R D, Franks T J, et al. Pulmonary mucoepidermoid carcinoma with prominent tumor-associated lymphoid proliferation[J]. Am J Surg Pathol.2005,29(3): 407-411.
[5]Kim T S, Lee K S, Han J, et al. Mucoepidermoid carcinoma of the tracheobronchial tree:radiographic and CT findings in 12 patients.[J]. Radiology. 1999,212(3):643-648.
[6]Niggemann B, Gerstner B, Guschmann M, et al. An 11-yr-old male with pneumonia and persistent airway obstruction[J]. Eur Respir J.2002,19(3):582-584.
[7]Martin-Ucar A E, Rocco G. Mucoepidermoid carcinoma in unilateral hypoplastic lung:a rare tumor in a rarer condition[J]. Ann Thorac Surg.2003,75(3):1020-1021.
[8]Sanchez J, Serrano J, Gomez P, et al. Bronchial mucoepidermoid carcinoma after allogeneic bone marrow transplantation[J]. J Clin Pathol.1997,50(11):969-970.
[9]Stenman G, Petursdottir V, Mellgren G, et al. A child with a t(11;19)(q14-21;p12) in a pulmonary mucoepidermoid carcinoma[J]. Virchows Arch.1998,433(6): 579-581.
[10]Dinopoulos A, Lagona E, Stinios I, et al.Mucoepidermoid carcinoma of the bronchus.[J]. Pediatr Hematol Oncol.2000,17(5):401-408.
[11]Pandya H, Matthews S. Case report:Mucoepidermoid carcinoma in a patient with congenital agenesis of the left upper lobe.[J]. Br J Radiol.2003,76(905): 339-342.
[12]Heitmiller R F, Mathisen D J, Ferry J A, et al. Mucoepidermoid lung tumors.[J]. Ann Thorac Surg.1989,47(3):394-399.
[13]Turnbull A D, Huvos A G, Goodner J T, et al. Mucoepidermoid tumors of bronchial glands[J]. Cancer.1971,28(3):539-544.
[14]Vadasz P, Egervary M. Mucoepidermoid bronchial tumors:a review of 34 operated cases.[J]. Eur J Cardiothorac Surg.2000,17(5):566-569.
[15]Ishizumi T, Tateishi U, Watanabe S, et al. Mucoepidermoid carcinoma of the lung:high-resolution CT and histopathologic findings in five cases.[J]. Lung Cancer. 2008,60(1):125-131.
[16]Fauroux B, Aynie V, Larroquet M, et al. Carcinoid and mucoepidermoid bronchial tumours in children.[J]. Eur J Pediatr.2005,164(12):748-752.
[17]Klacsmann P G, Olson J L, Eggleston J C. Mucoepidermoid carcinoma of the bronchus:an electron microscopic study of the low grade and the high grade variants[J]. Cancer.1979,43(5):1720-1733.
[18]Heitmiller R F, Mathisen D J, Ferry J A, et al. Mucoepidermoid lung tumors.[J]. Ann Thorac Surg.1989,47(3):394-399.
[19]Roggenbuck C, Hau T, de Wall N, et al. [Simultaneous occurrence of tracheobronchopathia osteochondropastica and mucoepidermoid carcinoma][J]. Chirurg.1995,66(3):231-234.
[20]Gilbert J, Li Y, Pinto H A, et al. Phase II trial of taxol in salivary gland malignancies (E1394):a trial of the Eastern Cooperative Oncology Group[J]. Head Neck.2006,28(3):197-204.
[21]Laurie S A, Licitra L. Systemic therapy in the palliative management of advanced salivary gland cancers[J]. J Clin Oncol.2006,24(17):2673-2678.
[22]Han S W, Kim H P, Jeon Y K, et al. Mucoepidermoid carcinoma of lung: potential target of EGFR-directed treatment[J]. Lung Cancer.2008,61(1):30-34.
[23]Janmaat M L, Rodriguez J A, Gallegos-Ruiz M, et al. Enhanced cytotoxicity induced by gefitinib and specific inhibitors of the Ras or phosphatidyl inositol-3 kinase pathways in non-small cell lung cancer cells[J]. Int J Cancer.2006,118(1): 209-214.
[24]Ozlu C, Christopherson W M, Allen J J. Mucoepidermoid tumors of the bronchus[J]. J Thorac Cardiovasc Surg.1961,42:24-31.
[25]Dowling E A, Miller R E, Johnson I M, et al. Mucoepidermoid tumors of the bronchi [J]. Surgery.1962,52:600-609.
[26]Reichle F A, Rosemond G P. Mucoepidermoid tumors of the bronchus [J]. J Thorac Cardiovasc Surg.1966,51(3):443-448.
[27]Green L K, Gallion T L, Gyorkey F. Peripheral mucoepidermoid tumour of the lung.[J]. Thorax.1991,46(1):65-66.
[28]Okabe M, Miyabe S, Nagatsuka H, et al. MECT1-MAML2 fusion transcript defines a favorable subset of mucoepidermoid carcinoma[J]. Clin Cancer Res.2006, 12(13):3902-3907.
[29]Behboudi A, Enlund F, Winnes M, et al. Molecular classification of mucoepidermoid carcinomas-prognostic significance of the MECT1-MAML2 fusion oncogene[J]. Genes Chromosomes Cancer.2006,45(5):470-481.
[2]Smetana H F, Iverson L, Swan L L. Bronchogenic carcinoma; an analysis of 100 autopsy cases.[J]. Mil Surg.1952,111(5):335-351.
[3]Anton-Pacheco J, Jimenez M A, Rodriguez-Peralto J L, et al. Bronchial mucoepidermoid tumor in a 3-year-old child[J]. Pediatr Surg Int.1998,13(7): 524-525.
[4]Kim T S, Lee K S, Han J, et al. Mucoepidermoid carcinoma of the tracheobronchial tree:radiographic and CT findings in 12 patients.[J]. Radiology. 1999,212(3):643-648.
[5]Shilo K, Foss R D, Franks T J, et al. Pulmonary mucoepidermoid carcinoma with prominent tumor-associated lymphoid proliferation[J]. Am J Surg Pathol.2005,29(3): 407-411.
[6]Niggemann B, Gerstner B, Guschmann M, et al. An 11-yr-old male with pneumonia and persistent airway obstruction[J]. Eur Respir J.2002,19(3):582-584.
[7]Martin-Ucar A E, Rocco G. Mucoepidermoid carcinoma in unilateral hypoplastic lung:a rare tumor in a rarer condition[J]. Ann Thorac Surg.2003,75(3):1020-1021.
[8]Sanchez J, Serrano J, Gomez P, et al. Bronchial mucoepidermoid carcinoma after allogeneic bone marrow transplantation[J]. J Clin Pathol.1997,50(11):969-970.
[9]Stenman G, Petursdottir V, Mellgren G, et al. A child with a t(11;19)(q14-21;p12) in a pulmonary mucoepidermoid carcinoma[J]. Virchows Arch.1998,433(6): 579-581.
[10]Dinopoulos A, Lagona E, Stinios I, et al. Mucoepidermoid carcinoma of the bronchus.[J]. Pediatr Hematol Oncol.2000,17(5):401-408.
[11]Pandya H, Matthews S. Case report:Mucoepidermoid carcinoma in a patient with congenital agenesis of the left upper lobe.[J]. Br J Radiol.2003,76(905): 339-342.
[12]Heitmiller R F, Mathisen D J, Ferry J A, et al. Mucoepidermoid lung tumors.[J]. Ann Thorac Surg.1989,47(3):394-399.
[13]Turnbull A D, Huvos A G, Goodner J T, et al. Mucoepidermoid tumors of bronchial glands[J]. Cancer.1971,28(3):539-544.
[14]Klacsmann P G,Olson J L, Eggleston J C. Mucoepidermoid carcinoma of the bronchus:an electron microscopic study of the low grade and the high grade variants[J]. Cancer.1979,43(5):1720-1733.
[15]Ozlu C, Christopherson W M, Allen J J. Mucoepidermoid tumors of the bronchus[J]. J Thorac Cardiovasc Surg.1961,42:24-31.
[16]Dowling E A, Miller R E, Johnson I M, et al. Mucoepidermoid tumors of the bronchi[J]. Surgery.1962,52:600-609.
[17]Reichle F A, Rosemond G P. Mucoepidermoid tumors of the bronchus [J]. J Thorac Cardiovasc Surg.1966,51(3):443-448.
[18]Green L K, Gallion T L, Gyorkey F. Peripheral mucoepidermoid tumour of the lung.[J]. Thorax.1991,46(1):65-66.
[19]Vadasz P, Egervary M. Mucoepidermoid bronchial tumors:a review of 34 operated cases.[J]. Eur J Cardiothorac Surg.2000,17(5):566-569.
[20]Heitmiller R F, Mathisen D J, Ferry J A, et al. Mucoepidermoid lung tumors.[J]. Ann Thorac Surg.1989,47(3):394-399.
[21]Roggenbuck C, Hau T, de Wall N, et al. [Simultaneous occurrence of tracheobronchopathia osteochondropastica and mucoepidermoid carcinoma][J]. Chirurg.1995,66(3):231-234.
[22]Han S W, Kim H P, Jeon Y K, et al. Mucoepidermoid carcinoma of lung: potential target of EGFR-directed treatment[J]. Lung Cancer.2008,61(1):30-34.
[23]Laurie S A, Licitra L. Systemic therapy in the palliative management of advanced salivary gland cancers[J]. J Clin Oncol.2006,24(17):2673-2678.
[24]Torres A M, Ryckman F C. Childhood tracheobronchial mucoepidermoid carcinoma:a case report and review of the literature.[J]. J Pediatr Surg.1988,23(4): 367-370.
[25]Ishizumi T, Tateishi U, Watanabe S, et al. Mucoepidermoid carcinoma of the lung:high-resolution CT and histopathologic findings in five cases.[J]. Lung Cancer. 2008,60(1):125-131.
[26]Fauroux B, Aynie V, Larroquet M, et al. Carcinoid and mucoepidermoid bronchial tumours in children.[J]. Eur J Pediatr.2005,164(12):748-752.
[27]Swinson D E, Jones J L, Richardson D, et al. Tumour necrosis is an independent prognostic marker in non-small cell lung cancer:correlation with biological variables[J]. Lung Cancer.2002,37(3):235-240.
[28]Gilbert J, Li Y, Pinto H A, et al. Phase Ⅱ trial of taxol in salivary gland malignancies (E1394):a trial of the Eastern Cooperative Oncology Group[J]. Head Neck.2006,28(3):197-204.
[29]Macarenco R S, Uphoff T S, Gilmer H F, et al. Salivary gland-type lung carcinomas:an EGFR immunohistochemical, molecular genetic, and mutational analysis study.[J]. Mod Pathol.2008,21(9):1168-1175.
[30]Lujan B, Hakim S, Moyano S, et al. Activation of the EGFR/ERK pathway in high-grade mucoepidermoid carcinomas of the salivary glands[J]. Br J Cancer.2010, 103(4):510-516.
[31]Janmaat M L, Rodriguez J A, Gallegos-Ruiz M, et al. Enhanced cytotoxicity induced by gefitinib and specific inhibitors of the Ras or phosphatidyl inositol-3 kinase pathways in non-small cell lung cancer cells[J]. Int J Cancer.2006,118(1): 209-214.
[1]Yousem S A, Hochholzer L. Mucoepidermoid tumors of the lung.[J]. Cancer. 1987,60(6):1346-1352.
[2]Smetana H F, Iverson L, Swan L L. Bronchogenic carcinoma; an analysis of 100 autopsy cases.[J]. Mil Surg.1952,111(5):335-351.
[3]Anton-Pacheco J, Jimenez M A, Rodriguez-Peralto J L, et al. Bronchial mucoepidermoid tumor in a 3-year-old child[J]. Pediatr Surg Int.1998,13(7): 524-525.
[4]Shilo K, Foss R D, Franks T J, et al. Pulmonary mucoepidermoid carcinoma with prominent tumor-associated lymphoid proliferation[J]. Am J Surg Pathol.2005,29(3): 407-411.
[5]Kim T S, Lee K S, Han J, et al. Mucoepidermoid carcinoma of the tracheobronchial tree:radiographic and CT findings in 12 patients.[J]. Radiology. 1999,212(3):643-648.
[6]Niggemann B, Gerstner B, Guschmann M, et al. An 11-yr-old male with pneumonia and persistent airway obstruction[J]. Eur Respir J.2002,19(3):582-584.
[7]Martin-Ucar A E, Rocco G. Mucoepidermoid carcinoma in unilateral hypoplastic lung:a rare tumor in a rarer condition[J]. Ann Thorac Surg.2003,75(3):1020-1021.
[8]Sanchez J, Serrano J, Gomez P, et al. Bronchial mucoepidermoid carcinoma after allogeneic bone marrow transplantation[J]. J Clin Pathol.1997,50(11):969-970.
[9]Stenman G, Petursdottir V, Mellgren G, et al. A child with a t(11;19)(q14-21;p12) in a pulmonary mucoepidermoid carcinoma[J]. Virchows Arch.1998,433(6): 579-581.
[10]Dinopoulos A, Lagona E, Stinios I, et al.Mucoepidermoid carcinoma of the bronchus.[J]. Pediatr Hematol Oncol.2000,17(5):401-408.
[11]Pandya H, Matthews S. Case report:Mucoepidermoid carcinoma in a patient with congenital agenesis of the left upper lobe.[J]. Br J Radiol.2003,76(905): 339-342.
[12]Heitmiller R F, Mathisen D J, Ferry J A, et al. Mucoepidermoid lung tumors.[J]. Ann Thorac Surg.1989,47(3):394-399.
[13]Turnbull A D, Huvos A G, Goodner J T, et al. Mucoepidermoid tumors of bronchial glands[J]. Cancer.1971,28(3):539-544.
[14]Vadasz P, Egervary M. Mucoepidermoid bronchial tumors:a review of 34 operated cases.[J]. Eur J Cardiothorac Surg.2000,17(5):566-569.
[15]Ishizumi T, Tateishi U, Watanabe S, et al. Mucoepidermoid carcinoma of the lung:high-resolution CT and histopathologic findings in five cases.[J]. Lung Cancer. 2008,60(1):125-131.
[16]Fauroux B, Aynie V, Larroquet M, et al. Carcinoid and mucoepidermoid bronchial tumours in children.[J]. Eur J Pediatr.2005,164(12):748-752.
[17]Klacsmann P G, Olson J L, Eggleston J C. Mucoepidermoid carcinoma of the bronchus:an electron microscopic study of the low grade and the high grade variants[J]. Cancer.1979,43(5):1720-1733.
[18]Heitmiller R F, Mathisen D J, Ferry J A, et al. Mucoepidermoid lung tumors.[J]. Ann Thorac Surg.1989,47(3):394-399.
[19]Roggenbuck C, Hau T, de Wall N, et al. [Simultaneous occurrence of tracheobronchopathia osteochondropastica and mucoepidermoid carcinoma][J]. Chirurg.1995,66(3):231-234.
[20]Gilbert J, Li Y, Pinto H A, et al. Phase II trial of taxol in salivary gland malignancies (E1394):a trial of the Eastern Cooperative Oncology Group[J]. Head Neck.2006,28(3):197-204.
[21]Laurie S A, Licitra L. Systemic therapy in the palliative management of advanced salivary gland cancers[J]. J Clin Oncol.2006,24(17):2673-2678.
[22]Han S W, Kim H P, Jeon Y K, et al. Mucoepidermoid carcinoma of lung: potential target of EGFR-directed treatment[J]. Lung Cancer.2008,61(1):30-34.
[23]Janmaat M L, Rodriguez J A, Gallegos-Ruiz M, et al. Enhanced cytotoxicity induced by gefitinib and specific inhibitors of the Ras or phosphatidyl inositol-3 kinase pathways in non-small cell lung cancer cells[J]. Int J Cancer.2006,118(1): 209-214.
[24]Ozlu C, Christopherson W M, Allen J J. Mucoepidermoid tumors of the bronchus[J]. J Thorac Cardiovasc Surg.1961,42:24-31.
[25]Dowling E A, Miller R E, Johnson I M, et al. Mucoepidermoid tumors of the bronchi [J]. Surgery.1962,52:600-609.
[26]Reichle F A, Rosemond G P. Mucoepidermoid tumors of the bronchus [J]. J Thorac Cardiovasc Surg.1966,51(3):443-448.
[27]Green L K, Gallion T L, Gyorkey F. Peripheral mucoepidermoid tumour of the lung.[J]. Thorax.1991,46(1):65-66.
[28]Okabe M, Miyabe S, Nagatsuka H, et al. MECT1-MAML2 fusion transcript defines a favorable subset of mucoepidermoid carcinoma[J]. Clin Cancer Res.2006, 12(13):3902-3907.
[29]Behboudi A, Enlund F, Winnes M, et al. Molecular classification of mucoepidermoid carcinomas-prognostic significance of the MECT1-MAML2 fusion oncogene[J]. Genes Chromosomes Cancer.2006,45(5):470-481.