Analysis Of Clinical Features And Prognosis Of Lacrimal Gland Adenoid Cystic Carcinoma With High-grade Transformation

Objective1.The purpose of this study is mainly through the comparison of general situation,clinical manifestations,imaging findings,TNM stage,pathological manifestations and clinical prognosis between lacrimal gland adenoid cystic carcinoma with high-grade transformation(LACC-HGT)and lacrimal gland adenoid cystic carcinoma with not high-grade transformation(LACC-NHGT),and concludes the clinical features and prognosis of LACC-HGT.2.Analyze basic research of adenoid cystic carcinoma with high-grade transformation(ACC-HGT)to provide theoretical basis for the further study of the molecular biology.Methods1.We sort clinical data of cases diagnosed LACC by Tianjin medical university eye hospital,and perform hematoxylin-eosin(HE staining)and immunohistochemical staining(IHC)to determine the cases of LACC-HGT.2.Contrast between the two groups of patients with general situation,clinical manifestations,imaging findings,TNM stage,Treatment protocols and clinical prognosis using Fisher's exact test,and compare patients' prognosis of two groups using Kaplan Meier survival analysis and Log-rank test to summarize the clinical characteristics and prognosis of LACC-HGT.Results1.According to the result of pathological HE staining and IHC,we diagnosed 6 patients as LACC-HGT,and 11 patients as LACC-NHGT.LACC-HGT has the following morphological features: typical pathological characteristic of LACC are visible in all 6 cases of LACC-HGT tissue.Most of typical pathological growth pattern are cribriform pattern and tubular pattern,while less are solid growth pattern.LACC-HGT region has a distinct boundary with typical LACC region,where tumor cells grow in sheets without lumen formation.High-grade transformation is characterized by irregular,jagged infiltrating islands of tumor cells or large confluent areas of solid growth,and the background stroma displays a fibrocellular desmoplasic change,which is typically not seen in conventional LACC.The tumor cells display greater atypia,a higher mitotic rate,and usually have more cytoplasm than conventional LACC cases.The nuclei of this higher-grade component were delineated from those of typical LACC by the presence of more than 2-fold nuclear enlargement,thickened irregular nuclear membranes and prominent nucleoli present in a majority of cells.Immunohistochemical staining: P63 and SMA expression are decreased significantly in LACC-HGT areas,which positive rate is about 0~20%,and in the local area even without expression.The positive rate of P53 expressed in LACC-HGT area is increased to 15%~30%,meanwhile Ki-67 is increased to 30%~50%.2.Contrasted with clinical data of patients diagnosed as LACC-HGT and LACC-NHGT,the differences of general situation,medical histories,clinical features,imaging features,TNM staging and treatment protocols have no statistical significance(all at P>0.05).The 2-year local recurrence rate,5-year distant metastasis rate and 5-year death rate of patients with LACC-HGT were significantly higher than patients with LACC(all at P<0.05).Survival analysis showed the survival time of LACC-HGT was obviously shorter than LACC.Conclusions1.The differences of general situation,medical histories,clinical features,imaging features,TNM staging and treatment protocols between LACC-HGT and LACC-NHGT have no statistical significance.Pathological examination is the only way to identify LACC-HGT and LACC-NHGT.2.The local recurrence rate,distant metastasis rate and death rate of LACC-HGT are significantly higher than LACC-NHGT,and survival time of LACC-HGT is obviously shorter than LACC-NHGT.LACC-HGT accelerated the invasion process of local recurrence and distant metastasis,and enhanced the death rate.3.The pathogenesis of ACC-HGT is not clear,and need to study deeply.The results of existing researchs provide new ideas for us,and we will continue in-depth study in the perspective of molecular genetics.