唾液腺腫瘍

Salivary gland tumor

医系科学研究科 口腔外科学
 唾液腺腫瘍とは
What is salivary gland tumors?

広義；管腫、神経系腫瘍、リンパ腫などの
非上皮性腫瘍
Wide sense；nonepithelial tumor sucu as angioma,
nervous system neoplasm and lymphoma, et.al.

一般的；上皮性腫瘍
General sense；epithelial tumor
 唾液腺腫瘍の特徴
Characteristic of salivary gland tumors
発生率；全腫瘍の約１％
The salivary gland tumors are uncommon and represent
abut 1% of all neoplasms.

性差；なし There is no sex difference.

部位；耳下腺＞小唾液腺＞顎下腺＞舌下腺
site；
parotid gland＞minor salivary gland＞submandibular gland＞sublingual gland

Most (70%) salivary gland tumors (SGTs) originate in the parotid gland. The remaining tumors
arise in the minor salivary glands (22%) and in the submandibular gland (8%) . Although
75% of parotid gland tumors are benign, slightly more than 50% of tumors of the
submandibular gland and 60-80% of minor SGTs are found to be malignant.
唾液腺腫瘍の組織分類（WHO分類，2005）
Histological classification of salivary gland tumors
(WHO classification, 2005)
Malignant epithelial tumors (1)
Acinic cell carcinoma 腺房細胞癌
Mucoepidermoid carcinoma 粘表皮癌
Adenoid cystic carcinoma 腺様嚢胞癌
Polymorphous low grade adenocarcinoma
多型低悪性度腺癌
Epithelial-myoepithelial carcinoma 上皮筋上皮癌
☆Clear cell carcinoma, not otherwise specified 明細胞癌 NOS
Basal cell adenocarcinoma 基底細胞腺癌
Sebaceous carcinoma 脂腺癌
○ Sebaceous lymphadenocarcinoma 脂腺リンパ腺癌
Cystadenocarcinoma 嚢胞腺癌
☆ Low-grade cribriform cystadenocarcinoma 低悪性篩状嚢胞腺癌
☆These diseases are added newly (WHO classification, 2005).
○These diseases are undifferentiated carcinoma.
Malignant epithelial tumors (2)

Mucinous adenocarcinoma 粘液腺癌

Oncocytic carcinoma オンコサイト癌，好酸性細胞癌
Salivary duct carcinoma 唾液腺導管癌，唾液導管癌，唾液管癌
Adenocarcinoma, not otherwise specified 腺癌 NOS（非特殊型の腺癌）
Myoepithelial carcinoma 筋上皮癌
Carcinoma ex pleomorphic adenoma 多形腺腫由来癌
○ Carcinosarcoma 癌肉腫
○ Metastasizing pleomorphic adenoma 転移性多形性腺腫
Squamous cell carcinoma 扁平上皮癌
Small cell carcinoma 小細胞癌
○ Large cell carcinoma 大細胞癌
☆ Lymphoepithelial carcinoma リンパ上皮癌
☆ Sialoblastoma 唾液腺芽腫

計 ２４腫瘍型
Benign epithelial tumors 良性上皮性腫瘍

Pleomorphic adenoma 多形腺腫

Myoepithelioma 筋上皮腫
Basal cell adenoma 基底細胞腺腫
Warthin tumor ワルチン腫瘍，腺リンパ腫
Oncocytoma オンコサイトーマ，好酸性細胞腫
Canalicular adenoma 細管状腺腫
Sebaceous adenoma 脂腺腺腫
☆ Lymphadenoma リンパ腺腫
☆ Sebaceous 脂腺型, Non-sebaceous 非脂腺型
Ductal papillomas 導管乳頭腫
Inverted ductal papilloma 内反性（逆性）導管乳頭腫
Intraductal papilloma 導管内乳頭腫
Sialadenoma papilliferum 乳頭状唾液腺腫
Cystadenoma 嚢胞腺腫

計 １０（１５）腫瘍型
代表的な良・悪性唾液腺腫瘍の構成細胞の分化による分類
構成細胞の分化 良性 悪性
細管状腺腫 腺房細胞癌
粘表皮癌
導管乳頭腫
嚢胞腺癌
腺上皮細胞のみ 嚢胞腺腫 オンコサイト癌
オンコサイトーマ 唾液腺導管癌
ワルチン腫瘍 腺癌 NOS
明細胞癌 NOS
筋上皮細胞のみ 筋上皮腫 筋上皮癌
腺様嚢胞癌
基底細胞腺癌
腺上皮 多形腺腫
上皮筋上皮癌
＋ 基底細胞腺腫
筋上皮/基底細胞 多形低悪性度腺癌
癌肉腫
転移性多形腺腫

嚢胞腺腫、嚢胞腺癌、腺癌NOSに筋上皮/基底細胞を伴う例もある。
ワルチン腫瘍の基底細胞は、腺上皮へと分化する。
 Classification by differentiation of component cell
in typical salivary gland tumor
Differentiation of component cell benigh malignant
Canalicular adenoma Acinic cell carcinoma
Ductal papillomas Mucoepidermoid carcinoma
Cystadenocarcinoma
Grandular epithelial cell only Cystadenoma
Oncocytic carcinoma
Oncocytoma Salivary duct carcinoma
Warthin tumor Adenocarcinoma NOS
Clear cell carcinoma NOS
Myoepithelial cell only Myoepithelioma Myoepithelial carcinoma

Adenoid cystic carcinoma

Pleomorphic adenoma
Grandular epithelial cell only
＋ Basal cell adenoma
myoepithelial/basal cell
Basal cell adenocarcinoma
Epithelial-myoepithelial carcinoma
Polymorphous low grade adenocarcinoma
Carcinosarcoma
Metastasizing pleomorphic adenoma

In the case of cystadenoma, cystadenocarcinoma and adenocarcinoma, there is case with

Grandular epithelial cell and myoepithelial/basal cell.
The basal cell of Warthin tumor differentiates to a glandular epithelial
 良性上皮性腫瘍
Benign epithelial tumours
 多形腺腫
Pleomorphic adenoma
特徴
•上皮細胞成分と粘液，ヒアリン， 軟骨様組織
などの間葉系成分の混在により腫瘍が構成
されている腺腫
・被膜を形成
Special feature
Pleomorphic adenoma consists of mixed epithelial
and mesenchymal cell components such as mucoid,
cartilaginous and hyaline.
・This tumor has capsule.
 多形腺腫
Pleomorphic adenoma
唾液腺腫瘍の中で最も頻度が高い
全唾液腺腫瘍の約60%

Pleomorphic adenoma is high frequency (about 60%)

in salivary gland tumors.
＜大唾液腺中 Large salivary gland＞
耳下腺 (63.8%) > 顎下腺(9.5%) >舌下(0.1%)
Parotid gland (63.8%) > submandibular gland (9.5%) >subligual gland (0.1%)

＜小唾液腺中 Small salivary gland＞

口蓋(10.3%) > 口唇(4.3%) > 頬(1.8%)
Palate (10.3%) > lip (4.3%) > bucca (1.8%)

Data processing of AFIP (the Armed Forces Institute of Pathology)

 多形腺腫
性差
女性にやや多い

年齢
30～50歳
小児には少ない

臨床所見
発育は極めて遅い．周囲組織に対して圧迫性増殖を示す.
無痛性，不規則な類球形の腫瘤（時に分葉状）．
表面は通常平滑．潰瘍形成は普通ない．

硬度、色
上皮成分や軟骨様組織を含むもの⇒硬い、青白色
粘液腫様成分が多い⇒やわらかい、黄灰白色
 Pleomorphic adenoma
<Favorite age, sex difference>
Although pleomorphic adenoma occurs in all age groups, the
favorite age of onset is between ages 30 and 50. Also, it seems
to be slightly more common in female than in male.
< Clinical findings >
The tumor is usually solitary and presents as a slow
growing, painless, irregular spherical (occasionally lobular),
firm single nodular mass. The surface of mass is commonly
smooth. Ulcer formation is not usually found. Isolated
nodules are generally outgrowths of the main nodule rather
than a multinodular presentation.

< Hardness, color >

In the case the mass have epithelial and cartilaginous
ingredient, hardness is hard, color is blue-white. In the case the
mass have myxomatous ingredient a lot, hardness is soft, colar
is yellow-gray.
 多形腺腫
Pleomorphic adenoma
病理組織学的所見
Histopathological findings
症例によって，また同じ腫瘍内でも場所によって多種多様．
基本的には腺上皮系（腺腔を形成）の腺管構造と筋上皮系（外周に位置
する）の筋上皮細胞の増殖からなる.
間質は，線維性，粘液腫様，軟骨様組織などが複雑に混在している.
間質の硝子化は比較的よくみられ，まれに骨様組織，脂肪組織がみ
られる.
Pleomorphic adenoma shows a great variety of findings in same tumor by
different places. Basically, it is comprised of grand duct structure in
grandular epithelium system which form grandular cavity and the increase
of myoepithelial cell in myoepithelium system located periphery.
Stromal tissue (Stroma) are composed of epithelial cells arranged in nests,
cords, or glands intermingled with fibrous tissue, myxoid, hyaline,
chondroid, and even adipose and osseous tissue. Hyalinization of stromal
tissue is observed frequently.
 多形腺腫
Pleomorphic adenoma
経過と予後 progress and prognosis
術後再発をきたすことがある．
まれに悪性化することがある．(3～４％）
長期経過後、隣接組織浸潤や遠隔転移の報告あり
多形腺腫内癌腫（多形腺腫由来癌）
人為的血行性転移の報告
Pleomorphic adenoma can recur after resection. It invades normal
adjacent tissue and distant metastases have been reported after long
(+10 years) time intervals. The artificial hematogenous metastasis
has been reported.
Pleomorphic adenoma can give rise to malignant tumors,
in particular carcinoma , (Carcinoma ex (in) pleomorphic adenoma)
both in minor and major salivary glands. The risk for malignant
transformation of pleomorphic adenoma was calculated to be 3-4%.
 多形腺腫
Pleomorphic adenoma
治療 treatment

外科的に摘出
×被膜外切除（再発の恐れ）
×放射線（悪性化の可能性）
×化学療法
Surgical excision is curative, however as the tumor is poorly
encapsulated, there is a significant rate of recurrence in the
tumor bed. The radiation therapy and chemotherapy are a
little curative effect. Furthermore, pleomorphic adenoma is
likely to become malignant by radiation therapy.
 筋上皮腫myoepithelioma
筋上皮腺腫 myoepithelial adenoma
旧分類では多形性腺腫の亜型の１種
Myoepithelioma is one of the subtype of
pleomorphic adenoma by the old classification.
頻度・好発部位
•比較的まれ（全唾液腺腫瘍の1％以下）
•耳下腺，口蓋（腺）が好発部位，
顎下腺,その他の小唾液腺

Frequency・Favorite sites
Myoepithelioma is unusual and uncommon tumors that constitute
only 1% less of all salivary gland tumors.
The favorite sites of myoepithelioma are the parotid gland and
the palatine gland.
 筋上皮腫 myoepithelioma
臨床所見 Clinical findings
・限局性で通常被膜がある
•多形性腺腫に類似
•多形性腺腫より増殖能が高い
•まれに悪性化
・Myoepithelioma is localized tumor and generally has capsule.
•Myoepithelioma is similar to pleomorphic adenoma.
•Myoepithelioma is higher proliferation potency than
pleomorphic adenoma.
•Myoepithelioma can rarely give rise to malignant tumors.

治療 Treatment
・外科的摘出
The recommended management of myoepithelioma is surgical excision.
 筋上皮腫
病理組織学的所見

•多形性腺腫における2相性 •細胞増殖パターン
構造のうちほとんど筋上皮 ①充実性(solid type)
様細胞だけ ②粘液様(myxoid type)
③網状(reticular type)
•腫瘍性筋上皮様細胞
①紡錘形細胞 •被膜はしばしば不完全
②形質細胞様
③類上皮様細胞 •サイトケラチン，S-100，グリ
④明細胞 ア線維酸性タンパク(GFAP)，
ビメンチン，アクチン陽性
 Myoepithelioma
Histopathological findings
It is a benign salivary gland <Cell growth patterns>
tumor that consists entirely of
myoepithelial cells with variable ① solid type
② myxoid type
cellular morphologies. ③ reticular type

•Capsule is often inperfect.

<Myoepithelial cell morphologies> <Immunohistochemical analysis>

Myoepithelial cells exhibit 4 main cell cytokeratin，S-100，Glial fibrillary
morphologies: spindle (most common), acidic protein (GFAP)，vimentin，
epithelioid, plasmacytoid, and clear cells. actin (+)
基底細胞腺腫 basal cell adenoma
基底細胞様細胞からなる不均一な組織様式をもつ良性上皮
性腫瘍である。明らかな被膜をもつ限局した腫瘍
Basal cell adenoma is a benign epithelial neoplasm with a uniform
histologic appearance dominated by basaloid cells. It is localized tumor
with complete capsule.

発現頻度 Frequency
Basal cell adenoma are unusual and
全唾液腺腫瘍の１〜２％ uncommon tumors that constitute only
1-2% of all salivary gland tumors
好発部位 Favorite sites
耳下腺と上唇 Parotid gland, upper lip
治療 Treatment
外科的切除 surgical excision

予後 Prognosis
良好 good
 基底細胞腺腫 basal cell adenoma
病理組織学的所見 Histopathological findings
BCA is characterized by the presence of
uniform and regular basaloid cells. These cells
腫瘍細胞は主として２種からなり、 have two differenced morphologies and are
１つは細胞質に乏しい小円形の細 intermingled. One group consists in small cells
胞で、他は少し大型の多角形ある with little cytoplasm and intensive basaloid
いは長形の細胞で、エオジン好性 rounded nuclei that are usually located in the
の細胞質をもつ. periphery of the tumoral nests or islands. The
other group is formed by large cells with
間質に面する基底細胞は核の柵 abundant cytoplasm and pale nuclei that are
状配列がみられる.間質は乏しく、 located in the centre of the tumoral nests. A
ヒアリン様で実質と間質の境界に basal membrane-like structure rounds these
明瞭な基底膜構造が認められる. tumoral nests, separating them from the
surrounding connective tissue.
増殖パターンで、充実性、索状、
4 characteristic (cellular) patterns have been
管状、膜性の４型に分類
described: solid, trabecular, tubular and
membranous. It is characteristic the presence
of a basaloid cellular layer with a stockade
pattern and rounded by hyaline substance.
 ワルチン腫瘍 Warthin tumor
（腺リンパ腫 adenolymphoma)
リンパ組織と乳頭状に増殖した嚢胞状の腺腔構造
を呈する腺上皮性細胞からなる良性腫瘍
乳頭状嚢腺リンパ腫とも呼ぶ
Warthin tumor is known as papillary cystadenoma lymphomatosum. It is a
type of benign tumor of the salivary glands that consists of lymphoid tissue
and grandular epithelium cell. Grandular epithelium cell have cystic
grandular cavity that increased papillary.

唾液腺腫瘍の2～15%と報告
It is reported that warthin tumor is occurred 2-15% of all
salivary gland tumors.

日本は欧米より少ない
It has been reported predominantly in Europe and America, less
frequently in Japan.
 ワルチン腫瘍 Warthin tumor
好発部位 Favorite site
・耳下腺浅葉に多い Warthin tumor almost always arises
・多発例もある in the superficial lobes of parotid
・両側例もある（約10%） glands .
It is bilateral in approximately 10% at
・少ないが顎下腺や頬，口蓋 presentation , with multifocal
などの小唾液腺例も報告 lesions presenting occasionally.
It is reported rare cases of wartin
tumor arising from submandiblular
gland, minor salivary gland.

好発年齢・性差 Favorite age, sex difference

・50歳以上が多い It is thought to be more

（特に喫煙者） common in males and smokers
・男性に多い after the age of 50 years.
 ワルチン腫瘍 Warthin tumor
臨床所見 Clinical findings
・発育緩徐，境界明瞭な腫脹 In many cases, there are no other
・表面平滑，弾性硬ときに波動 symptoms present, although the swelling
・表在性で可動性である. may sometimes cause a feeling of
pressure or discomfort.

• 唾液腺シンチ(99mTc)で集積 The tumor is usually defined solitary

and presents as a slow growing.
• 肉眼的に薄い被膜 The surface of mass is commonly smooth.
The tumor is superficial and mobility.
The tumor is elastic hard,
undulation frequently.
The accumulation of 99mTc O is observed
by salivary scintigraphy.
The tumor has thin capsule macroscopically.
The accumulation of 99mTc O is observed
in gland tissue by salivary scintigraphy.
 ワルチン腫瘍 Warthin tumor
病理組織学的所見
•2層構造（内層は高円柱細胞、外層は多角形細胞）
•嚢胞腔を囲み乳頭状の増殖
•上皮細胞は好酸性で細顆粒状
•上皮の基底膜に隣接した大小のリンパ組織
（濾胞形成）

Histopathological findings
Wharthin tumor is well encapsulated lesions with cystic and solid areas.
This tumor consists of an oncocytic epithelial cell component arranged in
double layers. Wharthin tumor is encapsulated tumor mass consisting of
tall, columnar, finely granular, eosinophilic epithelial cells surrounding
lymphoid tissues. The epithelium typically forms papillary projections
into cystic spaces.
 ワルチン腫瘍 Warthin tumor

治療 Treatment
Most of warthin tumor is treated
・外科的摘出 with surgical removal.

予後 Prognosis
Warthin tumor is a benign lesion;
•再発はまれ however a very low rate of malignant
transformation to squamous cell
carcinoma or low grade lymphoma is
•悪性例の報告（もっとまれ） recognized. A low rate of recurrence
occurs.
オンコサイトーマ
好酸性の顆粒を有する大型の細胞（オンコサイト）
の増殖からなる腫瘍
発現頻度
まれな腫瘍（耳下腺腫瘍の１％以下）で多くは高齢女性
好発部位
耳下腺

臨床所見
発育緩慢で充実性腫瘤は硬く、境界明瞭で可動性
唾液腺シンチ(99mTc)で集積

治療
外科的切除
予後
良好
 Oncocytoma
An oncocytoma is an epithelial tumor composed of oncocytes,
large granular eosinophilic cells having small, round, benign-
appearing nuclei with no nucleoli
Frequency
Oncocytome is unusual and uncommon tumors that constitute only 1% less
of all salivary gland tumors. It is thought to be more common in old women.

Favorite sites
Parotid gland
Clinical findings
The tumor is usually well defined solid and presents as a slow
growing. Also, it is elastic hard and mobility.
The accumulation of 99mTc O is observed by salivary scintigraphy.

Treatment
surgical excision
Prognosis
good
細管状腺腫（canalicular adenoma)
実質が管状構造を呈する腫瘍

多くは５０歳以上の上口唇腺に生じる

臨床所見
腫瘤は硬く、境界明瞭で可動性
治療
外科的切除
予後
良好
 Canalicular adenoma
Parenchyma shows tubular structure in case of candicular adenoma.
Favorite age
People aged over 50 are likely to develop canalicular adenoma.

Favorite sites
Upper lip

Clinical findings
The tumor is usually well defined solid , elastic hard and mobility.

Treatment
surgical excision
Prognosis
good
脂腺腺腫 sebaceous adenoma

・脂腺細胞の増殖からなるまれな良性腫瘍
・主に耳下腺

Sebaceous adenoma is an uncommon benign organoid

tumor composed of proliferating, incompletely
differentiated sebocyte (sebaceous glands).

The favorite site is parotid gland.

リンパ腺腫 Lymphadenoma
脂腺型（Sebaceous）, 非脂腺型（Non-sebaceous）

・リンパ組織と上皮細胞巣からなるきわめてまれな腫瘍
・脂腺への分化を示すものは脂腺リンパ腺腫として従来から
報告あり

Lymphadenomas (LADs) are rare benign tumors of the major

salivary glands comprising biphasic tumor cell population
that show groups of epithelial cells with or without sebaceous
differentiation admixed with intense, reactive lymphoid
proliferation.
It is reported as sebaceous lymphadenoma for a long time in
case of showing groups of epithelial cells with sebaceous
differentiation admixed with intense, reactive lymphoid
proliferation.
 導管乳頭腫（Ductal papillomas)
・唾液腺導管上皮が扁平上皮乳頭腫に類似した
特異な構造をとる腫瘍
・きわめてまれに小唾液腺に発生
a) 内反性（逆性）導管乳頭腫
小唾液腺の排泄管から生じ、扁平上皮細胞からなる腫瘍が周囲の
線維性結合組織側に乳頭状に発育
b) 導管内乳頭腫
嚢胞状に拡張した導管の内腔へ向かって導管上皮が乳頭状に増殖
する腫瘍
c) 乳頭状唾液腺腫
きわめてまれな腫瘍で６０％以上は口蓋に発生し、発生年齢は５０歳
以上
肉眼的には外方性増殖を示す半球形腫瘤
病理学的に唾液腺導管上皮が外方性に増殖し重層扁平上皮に移行
している
Ductal papilloma
This tumor has singular structure and ductal epithelium of
salivary gland is similar to squamous papilloma.
This tumor occurs to small salivary gland very rarely.

a) Inverted ductal papilloma

Inverted ductal papilloma is arising from excretory duct of small salivary
gland. Also, The tumors composed squamous cell show papillary
development at surrounding fibrous connective tissue side.
b) Intraductal papilloma
Ductal epithelium shows papillary proliferation toward
expanded cystoid ductal lumen.
c) Sialadenoma papilliferum
Sialadenoma papilliferum is a very rare benign tumor. Favorite site , age
are palate ( more than 60%) and over 50 years old.
The hemispherical mass is exophytic macroscopically.
The ductal epithelium is exophytic and transits to stratified squamous
epithelium pathologically.
 嚢胞腺腫 Cystadenoma
・まれな良性腫瘍で腺様に増殖する上皮が多数の大きな嚢胞を形成する
・嚢胞腔内に乳頭状の増殖を示すものは従来から乳頭状嚢胞腺腫とよばれる
・女性に多い傾向で、口唇や頬粘膜の小唾液腺に好発する
・PASやムチカルミン陽性の粘液産生を特徴とし大きな嚢胞を形成す
るものは粘液性嚢胞腺腫ともよばれる
・オンコサイト様の高円柱細胞と小型の多角形細胞の２層上皮が嚢
胞腔を囲む、Warthin腫瘍にきわめて類似した上皮組織構造をとる
The epithelium of adenoids forms a large number of big cyst.
It is called as a papillary cystadenoma in the past in case of showing
papillary increase into cyst cavity.
Cystadenoma is a very rare benign tumor. Favorite sites are lip and small
salivary gland of buccal mucosa. It is thought to be more common in women.
It is called as a mucinous cystadenoma in case of characterizing by mucous
production such as PAS, mucicarmine positivity and forming big cyst.
The surface epithelium consists of a double layer: tall columnar oncocytic cells
and small polygonal cells. This epithelium surrounds the cyst cavity. The
epithelium structure of cystadenoma is similar to that of warthin’s tumor.
Malignant epithelial tumors
悪性上皮性腫瘍
 腺房細胞癌 acinic cell carcinoma
漿液性腺房細胞に類似した細胞増殖が特徴
高分化で良性にみえても再発・遠隔転移する
This tumor features cell proliferation similar to a serous
acinar cell. Though it is high differenciation, it occurs
recurrence and distant metastasis.

頻度，好発部位・年齢・性差
•唾液腺腫瘍の約1%
•80%以上が耳下腺
•30～50歳，性差なし
Frequency・Favorite sites・age・sex
Acinic cell carcinoma is rare tumor that constitute only about 1% of all
salivary gland tumors.
The favorite site is the parotid gland in more than 80%.
The favorite age of onset is between ages 30 and 50.
There is no sex difference in acinic cell carcinoma.
 腺房細胞癌 acinic cell carcinoma
臨床所見
•発育緩慢
•無痛性腫瘤が多い
•肉眼的に単一または多発性結節
•腫瘤表面は一般的にはなめらか
•被膜に包まれるもの，包まれないものがある
•経過は長く、徐々に進行性に大きくなる

< Clinical findings >

The tumor presents as a slow growing, painless, single or
multiple nodular mass macroscopically. The surface of mass
is commonly smooth.
The tumor is covered by capsule or not.
Generally, the progress is long and the tumor gradually
grows progressively.
 腺房細胞癌
＜病理組織学的所見＞
•主として腺房細胞
•介在部細胞，空胞化細胞，明細胞もある
•介在部導管と似た小管腔構造もみられる
•間質に乏しい
•腫瘍細胞は充実性，小嚢胞性，乳頭状濾胞性の胞巣
形成
•腺房細胞は好塩基性で細顆粒を持つ細胞質
•核は偏位
•異型性，核分裂像は少ない
•PAS陽性
 acinic cell carcinoma
Histopathological findings
It is a malignant salivary gland tumor that consists mainly of
acinar cells with variable cellular morphologies.
It exists intercalated cell, vacuolated cell and clear cell .
The small lumen structure that is similar to intercalated duct
is observed.
The stromal tissue is poor.
The tumor cell forms solid, small cystic, papillary follicular
cancer cell nest.
The acinar cell is basophilic and has cytoplasm with fine granule.
The nuclear shift is found.
There are few cellular atypia and nuclear fission.
The PAS (periodic acid Sciff) reaction is positive.
 腺房細胞癌 acinic cell carcinoma
治療 Treatmenｔt

外科的摘出 surgical excision

予後 Prognosis
耳下腺の腺房細胞癌は比較的予後は良好
5年生存率 約90%，20年生存率50%以上
局所再発，所属リンパ節転移，遠隔転移もある
Prognosis is good for acinic cell carcinoma of the
parotid gland, with 5-yr survival rates approaching is
90%, and 20-year survival exceeding 50%.
There occurs local recurrences, regional lymph node
metastasis and distant metastasis in ACC.
 粘表皮癌 mucoepidermoid carcinoma
扁平上皮、粘液産生細胞および中間型細胞の存在を特徴とする腫瘍
This tumor features the existence of squamous, mucinous
(mucus secreting) and intermediate cells.
発生頻度，好発部位，年齢
•比較的まれ（全唾液腺腫瘍の約１０％）
•耳下腺が最も多い
•小唾液腺では口蓋が多い
•まれに顎骨中心性（ほとんど下顎）
•30~50歳，性差なし
Frequency・Favorite sites・age
Mucoepidermoid carcinoma is comparatively rare tumor that constitute
about 10% of all salivary gland tumors.
The parotid gland is the predominant site of origin. In case of small
salivary gland, the favorite site is palate.
It occurs in jaw bone (almost mandible) very rarely.
The favorite age of onset is between ages 30 and 50.
There is no sex difference in mucoepidermoid carcinoma.
 粘表皮癌 mucoepidermoid carcinoma
臨床所見
•発育は比較的緩徐（時に速い）
•無痛性腫瘤
•低悪性型（高分化型）では限局性
高悪性型（低分化型）では境界不明瞭,浸潤性
•粘膜潰瘍，骨破壊吸収を認めることもある
•顎骨中心性の唾液腺腫瘍では最も多い（X線上歯原性腫瘍や嚢胞と鑑別必要）
< Clinical findings >
The tumor presents as a relatively slow growing (sometimes
fast growing), painless nodular mass macroscopically.
The tumor is localized in low grade (well differenciation) type.
The tumor shows invasive (infiltrative) growth pattern in high grade
(poorly differenciation) type. Aiso , the tumor is not well defined.
The mucosal ulceration, bone destruction and resorption are sometimes
observed.
The mucoepidermoid carcinome is highest frequency in central salivary
gland tumors of jaw bone.
 粘表皮癌
病理組織学的所見

・扁平上皮（類上皮）（表皮様）細胞，粘液産生細胞，中間型細胞
・低悪性型（高分化型）
50%以上が粘液産生細胞とよく分化した扁平上皮（類上皮）細胞で核分裂
像や核多形性はほとんどない
高悪性型（低分化型）
大部分が未分化中間細胞か低分化扁平上皮（類上皮）細胞で核分裂像や
核多形性も多い（粘液産生細胞は10%以下）
•すべてにおいて被膜形成なし
•中間細胞が粘液産生細胞や扁平上皮（類上皮）細胞へ分化する
 mucoepidermoid carcinoma
Histopathological findings
This tumor is not encapsulated and is characterized by squamous
(epithelioid) cells, mucus-secreting cells, and intermediate cells.
・low grade (well differenciation) tumors
There are more than 50% of mucus-secreting cells and well differentiated
squamous (epithelioid) cells.
There are few nuclear division and nuclear pleomorphism.

・high grade (poorly differenciation) tumors

There are undifferentiated intermediate cells or poorly differentiatiated
squamous (epithelioid) cells for the most part ( less than 10% of mucus-
secreting cells).
There are many nuclear division and nuclear pleomorphism.

・The capsule formation is not found.

・The intermediate cells differentiate into squamous and mucus-secreting cells.
 粘表皮癌の病理組織像
Histopathological image of mucoepidermoid carcinoma

low grade (well differenciation) tumors high grade (poorly differenciation) tumors

undifferentiated intermediate cells

mucus-secreting cells
poorly differentiated squamous cells
 粘表皮癌 mucoepidermoid carcinoma
治療 Treatment
外科的摘出 surgical excision

予後 Prognosis
•高分化型は低分化型より予後がよい
•5年生存率は70%（低悪性型では90%）

・Generally, low-grade tumors have a much better

prognosis than high-grade tumors.
・The 5-year overall survival rate is about 70%.
(about 90% in low grade tumors, about 50% in high grade tumors)
腺様嚢胞癌 Adenoid cystic carcinoma
特徴 characteristic
•極めて緩徐な発育と著明な浸潤性増殖
•篩状（ふるい）の胞巣形成
・Adenoid cystic carcinoma is often very slow-growing but locally
aggressive and shows prominent invasive growth.
・Pathologically, the swiss cheese (cribriform) pattern is often quite prominent.
発生頻度，好発部位，年齢 Frequency・Favorite sites・age
•小唾液腺腫瘍の約25%（多形腺腫の次）
•顎下腺と口蓋に多い。
•大唾液腺では顎下腺腫瘍の15~20%
•40~70歳で女性に多い
・It accounts for about 25% of small salivary gland tumors. ACC is
the second common tumor of all salivary gland tumors.
・The favorite sites are submandibular gland and palate.
・It accounts for 15~20% of submandibular gland tumors in case of
major salivary gland.
・The favorite age of onset is between ages 40 and 70.
・There is a slight female preponderance (female to male ratio
approximately 3 to 2).
 腺様嚢胞癌 Adenoid cystic carcinoma
臨床所見
•極めて発育の緩慢な限局性の腫瘤
•疼痛や麻痺などの神経症状
→周囲の神経、血管、結合組織などへの浸潤性増殖が
著しいため
•緩徐な発育のため，受診時肺、肝、骨転移例もある

< Clinical findings >

The tumor presents as a relatively slow growing, localized
mass macroscopically.
ACC shows prominent invasive growth. Therefore, more
advanced tumors may invade surrounding nerves, blood
vessels and connective tissue causing paralysis and pain.
Because of slowing growth, there are the distant metastasis
(lung, liver and bone metastasis) cases at the first visit to a
doctor .
 腺様嚢胞癌
病理組織学的所見

•篩状（スイスチーズ様）の胞巣形成
（上皮細胞が多数の小腔を含む）
・３つの組織増殖パターンがあり（篩状、管状、充実性）、
充実性は経過が悪い
•部位によっては腺管構造や充実性胞巣を形成
•腔内はアルシアンブルー強陽性の粘液性またはヒアリン
様基質
•腫瘍細胞は主として導管上皮細胞と筋上皮細胞
 Adenoid cystic carcinoma
Histopathological findings
・The nest formation of the swiss cheese (cribriform) pattern
is observed.
(The epithelium cells include a large number of loculus.)
・There are three major variant histologic growth patterns of ACC:
cribriform, tubular and solid. The solid pattern is associated with
a more aggressive disease course.

・The duct structure and solid nests are formed in a

certain region.
・There are mucous or hyaline-like matrix of alcian blue
strongly positive into cavity.

・This tumors are mainly comprised of ductal epithelium

cell and myoepithelial cell .
・The duct structure and solid nests are observed.

・There are mucous or hyaline-like matrix of alcian blue strongly positive into cavity.

・This tumors are mainly comprised of ductal epithelium cell and myoepithelial cell .
 腺様嚢胞癌 Adenoid cystic carcinoma
治療 Treatment
外科的摘出 Surgery is the most effective treatment.
予後 Prognosis
•経過は長いが予後は極めて不良
•5年生存率は約90%，15年生存率は約40%
•局所再発，遠隔転移がしばしば起こる
•転移は血行性でリンパ節転移は少ない
•遅延的または治療後に遠隔転移は主に肺で，他に肝，骨，脳など
・The progress is long, but the prognosis is relatively poor.
・This gives good survival figures at 5 years but poor figures at 15 years.
The five year survival rate of people with ACC is about 90%.
The 15-year survival rate of people with ACC is about 40%.
・There occasionally occurs local recurrences and distant metastasis .
・Generally, the metastasis is hematogenous. There are few lymph node
metastasis in ACC.
・ACC may present late or after treatment failure, with distant
metastases (most commonly lung, followed by liver, bone, brain et.al).
 多型低悪性度腺癌

小唾液腺に発生する低悪性の腺癌の一型として分類
介在部導管前駆細胞に由来する腫瘍
好発部位、年齢
•50%以上は口蓋に発生
•50～80歳代に好発
臨床所見
•粘膜に覆われた類円形の限局性腫瘤
•被膜はなく、浸潤性発育を特徴とし、特に神経浸潤の傾向が強く、
筋、脂肪、骨などへも浸潤する

予後
良好（まれにリンパ節転移あり）
 Polymorphous low grade adenocarcinoma
This tumor is classified as one type of a low malignant
adenocarcinoma occurring to small salivary gland.
This tumor is derived from precursor cell of intercalated
duct.
Favorite sites, age
The favorite sites is the palate in more than 50%.
The favorite age of onset is between ages 50 and 90.

Clinical finding
This tumor is localized oval mass covered by mucous membrane.
This tumor has no capsule.
This tumor shows prominent invasive growth. Therefore, this tumor
invades surrounding nerves especially, muscle, fat and bone et.al.

prognosis
good （There is rarely lymph matastasis）
 上皮筋上皮癌
内層を構成する介在部導管上皮類似の立方形細胞と
外層の筋上皮様細胞の２種類の細胞からなる腫瘍
頻度、好発部位、年齢
•唾液腺腫瘍の1%以下と低い
•約75%は耳下腺で顎下腺や小唾液腺にも発生
•60～80歳に好発
臨床所見
•限局した分葉状、充実性腫瘤
•滑面では腫瘍は辺縁不規則で多結節性の増殖を示す
予後
術後再発はしばしばで多発性に再発もあり
転移にも注意
 Epithelial-myoepithelial carcinoma
This tumor is composed of two kinds of cells: the cuboidal
cells resembling the intercalated duct epithelium that form
an inner layer and the myoepithelial like cells that form an
outer layers .
Frequency, Favorite sites, age
Epithelial-myoepithelial carcinoma is very rare tumor that constitute only
less than 1% of all salivary gland tumors.
The favorite sites is the parotid gland in about 75%. It occurs in
submandibular gland and small salivary gland.
The favorite age of onset is between ages 60 and 80.
Clinical finding
This tumor is lobular, solid mass.
This tumor shows multinodular growth, and is border irregularity
in smooth surface.
Prognosis
The postoperative recurrence frequently occurs in this tumor
(occasionally multiple recurrence or metastasis).
基底細胞腺癌 (basal cell adenocarcinoma)
特徴
•基底細胞腺腫の悪性型
•被膜をもたず、び漫性に増殖

発生頻度，好発部位，年齢
•唾液腺腫瘍の約2%
•耳下腺が約90%
•50歳以降に多い

臨床症状
•唾液腺の無痛性腫脹（ときに疼痛あり）

予後
•悪性度は低く、比較的予後は良好
 Basal cell adenocarcinoma
Characteristic
・Basal cell adenocarcinoma is malignant form of basal cell adenoma.
・This tumor has no capsule. It shows diffuse growth.

Frequency・Favorite sites・age
・Basal cell adenocarcinome is rare tumor that constitute only about 2%
of all salivary gland tumors.
・The favorite sites is the parotid gland in about 90%.
・It is thought to be more common in people after the age of 50 years.

Clinical symptom
The clinical symptom is usually the painless swelling of salivary gland.
(It is sometimes painful.)

prognosis
This tumor has low malignancy. The prognosis is relatively good.
 基底細胞腺癌の病理組織像
Histopathological findings (Basal cell adenocarcinoma)

好酸性細胞質の基底細胞様細胞が 腺腔形成を示す管状構造が主体を
充実性胞巣を形成 占め、細胞異型に乏しい

The acidophilic cytoplasmic basal cell-like Tubular structure indicating the glandular
cells form solid nests. cavity formation occupies mainly and lacks
in a cellular atypia.
 脂腺癌、脂腺リンパ腺癌
脂腺細胞からなるきわめてまれな癌腫であり、脂腺癌と脂腺リン
パ腺癌の２種のタイプがある。
耳下腺に好発

粘液腺癌
結合組織で囲まれた嚢胞腔内に多量のムチンと上皮細胞巣か
らなるきわめてまれな腫瘍

嚢胞腺癌
嚢胞腺腫の悪性型とみなされる腫瘍で、嚢胞形成を特徴とする。
新分類では、嚢胞腺癌を他の腫瘍の特性を欠く嚢胞形成を特徴
とする悪性腫瘍と定義
Sebaceous carcinoma
Sebaceous lymphadenocarcinoma
There are two kind of tumors, sebaceous carcinoma and sebaceous
lymphadenocarcinoma that composed of sebocyte.
These tumors are extremely rare.

Mucinous adenocarcinoma
Mucinous adenocarcinoma is extremely rare tumor that composed of
a large quantity of mucin and epithelial cell nests into cystic cavity
surrounding by connective tissue .

Cystadenocarcinoma
Cystadenocarcinoma is malignant form of cystadenoma, and is
characterized by the cyst formation.
In the new classification, cystadenocarcinoma is defined as a
malignant tumor characterized by the cyst formation to lack in the
characteristic of other tumors.
オンコサイト癌 Oncocytic carcinoma
特徴 Characteristic
オンコサイトからなるきわめてまれな腫瘍
Oncocytic carcinoma is extremely rare tumor that composed of oncocyte.

好発部位，年齢 Favorite sites・age

•耳下腺に好発 The favorite sites is the parotid gland
•高齢者に多い It is thought to be more common in old person.

予後 prognosis
•高頻度で再発がみられ、リンパ節転移や遠隔転移の頻度も高い
The recurrence, lymph node metastasis and distant metastasis
are frequently occurred.
 唾液腺導管癌
好発部位、年齢、性差
•約85%は耳下腺で、まれに小唾液腺にも発生
•50歳以上に好発
•男性に多い
臨床所見
•増殖がきわめて速いび漫性腫瘤
•初診時でのリンパ節転移は50%以上
病理組織学的所見
•内方に増殖する導管細胞の腫瘍巣からなり、充実性、乳頭状、
篩状構造を示す
•特徴的には導管細胞は管状あるいはRoman-bridge様の篩状構
造を示す
予後 きわめて不良（約65%が4年以内に死亡）
 Salivary duct carcinoma
Favorite site・age・sex
・The favorite site is the parotid gland in about 85%. It rarely occurs
in small salivary gland.
・Favorite age, sex are male after the age of 50 years.

Clinical findings
・Salivary duct carcinoma is extremely fast-growing diffuse tumor.
・More than 50% of lymph node metastases are found at the first
medical examination.
Histopathological findings
・Salivary duct carcinoma is composed of tumor nests of duct cell increased
inward, and shows solid, papillary and cribriform structure.
・Duct cells show tubular or roman-bridge (low papillary pattern) like
cribriform structure.
Prognosis Salivary duct carcinoma is an aggressive tumor with a worse
prognosis. Nearly 65% of the patients die within 4 years.
 腺癌 NOS
Adenocarcinoma NOS
(not otherwise specified)
管状や乳頭状に増殖するなど，癌細胞に腺性分化が明
らかであっても，他の特定の癌腫型に当てはめることが
出来ない場合はこの診断名を用いる

Though the tumors increase papillary, tubular and the

glandular differentiation is found in tumors, when we cannot
apply it to the other specific cancer type, we use this diagnosis.
 多形腺腫由来癌
Carcinoma ex pleomorphic adenoma
最初（新規）あるいは再発の多形腺腫から生じた癌腫として定義
非浸潤性、浸潤性に分類
粘液腫様あるいは軟骨様組織が肉腫様構造をとったもの
は癌肉腫または悪性混合腫瘍とよんでいる

This tumor is defined as a carcinoma arising from a primary

(de novo) or recurrent benign pleomorphic adenoma .
This tumor is classified into non-invasive or invasive.

We call a carcinosarcoma or malignant mixed tumor if the

myxoma-like or chondroid tissue have sarcoma-like structure.
 多形腺腫由来癌

発生頻度，好発部位

•多形性腺腫の3～10%程度

•大唾液腺では耳下腺、小唾液腺では口蓋腺に多い

臨床所見

•多形腺腫と異なり増殖はきわめて速く，浸潤性増殖が特徴

•疼痛，麻痺などの神経症状がみられる

•周囲皮膚・粘膜との癒着、潰瘍形成がみられる
 Carcinoma ex pleomorphic adenoma

Frequency・Favorite sites
・It accounts for 3~10% of pleomorphic adenoma.
・The favorite sites are parotid gland and palate.

Clinical findings
・This tumor shows extremely fast and invasive growth.
This point is different from pleomorphic adenoma.
・Neurologic symptoms such as sharp pain, the paralysis occur
in the case of this tumor.

・The adhesion with surrounding skin and mucous membrane,

ulcer formation are observed.
 多形腺腫由来癌
Carcinoma ex pleomorphic adenoma

病理組織学的所見
細胞異型，核分裂像，異型細胞の被膜や周囲組織への
浸潤性増殖，細胞の脈管侵入，粘液腫様または軟骨様
組織中の異型細胞の増殖

Histopathological findings
.The cellular atypism, nuclear division, capsule of atypical cells are observed.
.The invasive growth to surrounding tissue, cellular vessels invasion
and the increase of atypical cells in myxoma-like or chondroid tissue
are found histologically.
 多形腺腫由来癌
Carcinoma ex pleomorphic adenoma
予後
・予後不良（特に大唾液腺原発）
・5年生存率は約50%
・耳下腺原発は術後3年以内に死亡
・小唾液腺原発は15年生存率20%

Prognosis
・This tumor has high malignancy. The prognosis is extremely bad , if
primary is major salivary gland.

・The 5-year overall survival rate is about 50%.

・The patients die within 3 years, if the primary is parotid gland.
・The 15-year overall survival rate is about 20%, if the primary is small
salivary gland.
 転移性多形腺腫
Metastasizing pleomorphic adenoma

病理組織学的に良性所見を示す多形腺腫が転
移したもの
転移は骨と肺の頻度が高い
・Metastasizing pleomorphic adenoma is tumor that
metastasized from benign pleomorphic adenoma
histopathologically.

・The bone and the lungs are common in the metastasis.

 扁平上皮癌
唾液腺の扁平上皮癌は大唾液腺原発扁平上皮癌を意味
し他臓器から唾液腺に転移した扁平上皮癌はこの分類か
ら除かれる
発生頻度，好発部位
•唾液腺腫瘍の1.6～3.6%
•耳下腺が80%で他は顎下腺にみられる
臨床所見
•腫瘍の増殖は速く，20%程度に神経麻痺や疼痛などの神経症状
がみられる
•皮膚への癒着や深部への浸潤がみられる
•腫瘍は唾液腺実質内でび漫性に増殖し腺実質と腫瘍の境界は
不明瞭

予後 ５年生存率は約25%
 Squamous cell carcinoma
Squamous cell carcinoma of the salivary gland means squamous
cell carcinoma of primary major salivary gland.
Squamous cell carcinoma which metastasized to salivary
gland from other organs is removed from this classification.
Frequency・Favorite sites
・Squamous cell carcinoma of salivary gland is rare tumor that constitute
1.6~3% of all salivary gland tumors.
・The favorite sites is the parotid gland in about 80%.
Clinical findings
・The increase of tumors is fast, and neurologic symptoms such as
nerve paralysis, sharp pain occur in about 20%.
・The adhesion to skin and the invasion to the deep part are found.
・The tumors show diffuse growth in salivary gland substance.
・The boundary between the salivary gland substance and tumors is unclear.
Prognosis ・The 5-year overall survival rate is about 25%.
 唾液腺腫瘍の治療法
Treatment of salivary gland tumor
Ⅰ.外科療法 Surgical treatment
唾液腺腫瘍に対する治療としては最も効果的
Surgical treatment is most effective cure for
salivary gland tumor.
それぞれの腫瘍の悪性度、進展範囲、予後
などを考慮して切除範囲を決定する
An extent of resection is decided in
consideration of the malignancy, a progress
range and prognosis of each tumor.
 唾液腺腫瘍の治療法
Ⅰ.外科療法
1)良性腫瘍：多形腺腫、Warthin腫瘍など
被膜外切除では再発の危険性あり

周囲組織を含めたlow malignancyとしての手術を選択する

２)低悪性腫瘍：腺房細胞癌、粘表皮癌（低悪性型)
低悪性度腺癌、基底細胞腺癌など
悪性度の低い場合でも、腫瘍が完全に被包されていることが少
ないことを考慮し、周囲組織を十分に含めて切除
 Treatment of salivary gland tumor
Ⅰ. Surgical treatment
1) Benign tumor: Pleomorphic adenoma, Warthin’s tumor et.al
There is a danger of the recurrence by the extracapsular resection.
An operation as low malignancy including people organization
is chosen.

2) Low grade (well differenciation) tumor:

Acinic cell carcinoma, Mucoepidermoid carcinoma (low grade),
Adenocarcinoma (low grade), Basal cell adenocarcinoma et.al
If the malignancy is low, it is resected the tumor including
enough surrounding tissue because it is uncommon that the
tumor is covered by capsule perfectly.
 唾液腺腫瘍の治療法
Ⅰ.外科療法
３)高悪性腫瘍：腺様嚢胞癌、粘表皮癌（高悪性型）、
多形腺腫由来癌、唾液腺導管癌、
扁平上皮癌など
局所の浸潤増殖性は口腔粘膜癌に比較して著しいことを考慮
し、十分に周囲組織を含めたen block切除を行う
耳下腺腫瘍：耳下腺部分切除術
耳下腺浅葉切除術
耳下腺全摘出術
拡大切除術
顎下腺腫瘍：顎下腺摘出術
舌下腺腫瘍：周囲の正常組織を含めて切除
 Treatment of salivary gland tumor
Ⅰ. Surgical treatment
3) High grade (poorly differenciation) tumor:
Adenoid cystic carcinoma, Mucoepidermoid carcinoma (high
grade), Carcinoma ex pleomorphic adenoma, Salivary duct
carcinoma, Squamous cell carcinoma et.al
Because the local invasive growth potency is very high in comparison with
oral mucosal tumor, we should perform en block resection including
enough surrounding tissue .
Parotid gland tumor: Partial parotidectomy
Superficial parotidectomy
Tortal (radical) parotidectomy
Extended radical parotidectomy
submandibular gland tumor: Removal of the submandibular gland
sublingual gland tumor: Resection the tumor including surrounding
normal tissue
 唾液腺腫瘍の治療法
Ⅱ.放射線療法
・局所再発率の低下を期待して、主として術後照射として
用いられる

・口腔扁平上皮癌に対する場合よりもやや多い線量を用いる

Ⅲ.化学療法
・化学療法単独での腫瘍抑制効果はあまり期待できない
（放射線療法との併用）

・広範囲進展例や再発症例

・adjuvant chemotherapyとして施行されることが多い
 Treatment of salivary gland tumor
Ⅱ. Radiation therapy
It is mainly used as postoperative radiation in the hope of the decrease of
local recurrence.
The radiation dose for the salivary gland tumor generally uses a little more
doses than squamous cell carcinoma.

Ⅲ. chemotherapy
We cannot expect the tumor suppressant effect in chemotherapy only for
the salivary gland tumor.
The chemotherapy for salivary gland tumor is generally used in
combination with the radiation therapy.
The chemotherapy for salivary gland tumor is generally used for an
extensive progress and recurrence cases.
It is mainly used as adjuvant chemotherapy.