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Purpose 1. Analysis of adenoid cystic carcinoma (ACC) clinical pathological type, in-depth understanding of their pathological morphology, explore its perineural invasion (PNI) and the clinical relationship between factors. (2) explore the possibility of perineural invasion ACC mechanisms, to improve clinical outcomes and improve the quality of life of patients to provide a theoretical reference. Method 1. Retrospective study between 1983-2007 Dental Hospital of Tianjin Medical University, 42 cases of patients with ACC, the patient's age, sex, location, size, symptoms, morphological characteristics, perineural invasion and TNM stage and other factors were statistically analysis. 2 immunohistochemical staining detected 42 cases of ACC paraffin specimens, smooth muscle actin (SMA), glial fibrillary acidic protein (GFAP), glial cell line-derived neurotrophic factor (GDNF), tyrosine kinase receptor Body Ret and nuclear antigen Ki-67 expression. Results 1.42 cases in the ACC, 25 females, 17 males; age range 22-74 years, mean age was 47.29 years old. Occurred in the major salivary glands tumors in 18 cases, minor salivary gland tumors in 23 cases, other parts of the one case, palate gland is the most common site. Pain is a relatively common symptom, 54.76% of the patients had pain performance. 30 cases occurred perineural invasion, invasion, 71.43%, of which 2 cases of vascular invasion, one case of cervical lymph node metastasis. Preliminary clinical diagnosis of ACC in 9 patients, diagnosed as malignant pleomorphic adenoma or malignant salivary gland tumors, 11 cases; diagnosis of pleomorphic adenoma in 6 cases; diagnosed with gum cancer in 2 patients, the rest are not attending. TNM staging shows, Ⅰ 5 cases, Ⅱ of eight cases, Ⅲ of 13 cases, Ⅳ of 16 cases. ACC, perineural invasion with sex, age, disease location was not statistically significant (P gt; 0.05); Ⅲ Ⅳ period perineural invasion stronger than Ⅰ Ⅱ period, a significant difference (P lt; 0.05). Tubular type, solid type of perineural invasion is stronger than cribriform type, tubular type and cribriform type between cribriform type and solid type statistically significant difference between (P lt; 0.05), tubular type with solid type no significant difference (P gt; 0.05). 2 SMA myoepithelial cell marker and Schwann cell marker GFAP in co-expression of ACC neoplastic myoepithelial cell cytoplasm; GDNF, Ret were ACC cytoplasm of tumor cells were positive; in the nerve fibers in GDNF expression was positive, while Ret weakly positive or no expression; Ki-67 in the ACC nucleus of tumor cells were positive. Statistics show that in the ACC tumor cells, GFAP, GDNF expression and perineural invasion, histological type, and there are significant differences between the clinical stage (P lt; 0.05); Ret expression and perineural invasion were significantly different between (P lt; 0.05), while the clinical stage and pathological type and no significant difference between (P gt; 0.05); Ki-67 expression and perineural invasion was no significant difference between (P gt; 0.05), while and pathological types and clinical stages were significantly different between (P lt; 0.05); GDNF and GFAP expression was positively correlated (r = 0.327, P lt; 0.05), GDNF and Ret expression was positively correlated (r = 0.446, P lt; 0.05), while GDNF and Ki-67 expression was not associated (P gt; 0.05). Conclusions 1. Perineural invasion as ACC unique biological behavior, its incidence is higher. And with clinical stage, histological type are closely related. ACC nerve involvement symptoms are more common clinical manifestations. With typical pain, numbness symptoms, clinical diagnosis easier. 2.ACC perineural invasion occurs multiple factors involved in the process, and its histopathological basis for the neoplastic myoepithelial cells into nerve Schwann cell differentiation, GDNF and the corresponding receptors on tumor cells Ret, and promotes tumor cell neural migration. GDNF, Ret signaling pathways are involved in the ACC perineural invasion play an important role. 3.GDNF its receptor Ret evaluation ACC is expected to become one of the indicators perineural invasion by detecting GDNF and its receptor Ret expression of tumor cells in the ACC, ACC perineural invasion to understand the situation, to the early detection of neural invasion, guidance clinical treatment. And can affect the GDNF signaling pathway, inhibition of tumor cell neural invasion, to improve clinical outcomes. 4.Ki-67 can be considered to evaluate the progress of the ACC and its relationship with perineural invasion needs further study.
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