胸腺上皮肿瘤:临床、CT特征与WHO组织学分型的相关性研究  

Correlation of CT Findings and Clinical Manifestation and World Health Organization Classification in Thymic Epithelial Tumors

作　　者：国小钰[1] 肖湘生[1] 于红[1] 

机构地区：[1]上海市第二军医大学附属长征医院影像科,200003

出　　处：《临床放射学杂志》2013年第11期1571-1575,共5页Journal of Clinical Radiology

基　　金：国家自然基金(编号:81071155;81271572);上海市科学技术委员会科研计划项目(编号:10411952800;10JC1418100)

摘　　要：目的评价胸腺上皮肿瘤WHO各组织学亚型的CT特征,为术前诊断及组织学亚型预测提供依据。方法对84例经穿刺病理或手术病理确诊为胸腺上皮肿瘤患者的病理、临床及影像学资料进行回顾性分析。A型5例、AB型22例、B1型10例、B2型11例、B3型12例、C型24例。结果胸腺癌未出现重症肌无力。胸痛更常见于胸腺癌(50.0%)。C型胸腺瘤较A型长径更大;A、AB型较B2、B3、C型更可能表现为类圆形的形状(P=0.013,0.010,0.013;0.040,0.030,0.034);C型胸腺瘤较A、AB、B1型胸腺瘤的MCI更可能呈灌铸式生长(P=0.0001,0.011,0.001),B2、B3、C型较A型的MCI更可能呈灌铸式生长(P=0.009,0.012,0.0001);C型比A、AB、B1型的MCI更易增厚呈尖角或锯齿征(P=0.036,0.0001,0.005);瘤内坏死灶显著的少见于B1型较A、AB、B2、B3、C型(P=0.017,0.011,0.001,0.010,0.0001);C型较AB、B1型更易侵犯大血管(P=0.016,0.041);B2型较AB、B1型更易出现胸膜或心包结节(P=0.002,0.023),B3型较AB型更易出现胸膜或心包结节(P=0.037);C型较AB型更易出现胸膜或心包积液(P=0.038);C型较AB、B1、B2型更可能发生纵隔淋巴结转移(P=0.005,0.034,0.019)。结论胸腺癌多以胸痛为主要症状,极少出现重症肌无力。CT征象出现率在WHO组织学各亚型之间存在一些差异,为认识各亚型和初筛提供线索。但各亚型CT表现仍有很大程度重叠,缺乏特征性征象,难以精确定性诊断,仅实质成分无坏死可提示诊断B1型的可能性大。Objective To assess the CT features of various subtypes of thymic epithelial tumors on the basis of the World Health Organization classification and to provide the foundation for the： diagnosis and forecast prognosis. Methods Histopathologic, clinical and radiological data of 85 cases with thymic epithelial tumors confirmed by surgery or biopsy pa- thology were retrospectively analyzed. There were 5 type A, 22 type AB, 10 type B1,11 type B2 and 12 type B3,and 24 thymic carcinomas（type C）. Results MG was not found in thymic carcinomas. Chest pain was more often seen in thymic carcinomas（50.0% ）. Long axis diameters of type C tumors were significantly greater than those of type A. Type A and AB tumors were more likely to have a round shape than type B2, B3, type C （P = 0. 013,0. 010,0. 013;0. 040, O. 030, 0.034 ）. Type C tumors had a higher prevalence of mass cardiovascular interface with fleezing sign than type A, AB, B1 （ P =0.0001,0.011,0. 001 ）. Type 132, B3, C tumors had a higher prevalence of mass cardiovascular interface with fleezing sign than type A （P =0. 009,0.012,0. 0001 ）. Type C tumors had a higher prevalence of mass pulmonary interface with ir regular shape than type A, A, B1 （ P = 0. 036,0. 0001,0. 005 ）. Necrosis were less seen in type B1 （ 1/10,10% ） than other types tumors （P =0.017,0.011,0.001,0.010,0.0001 ）. Great vessel invasion was more often seen in type C than that in type AB , B1 （P =0.016,0. 041 ）. Pleural or pericardial effusions seeding were more often seen in type B2 than that in type AB ,B1 （P =0.002,0.023） ; Pleural or pericardial effusions were more often seen in type C than that in type AB （P =0.038）. Mediastinal and hilar lymphadenopathy were more often seen in type C than that in type AB ,B1 ,B2（P = 0.005,0. 034,0.019）. Conclusion Chest pain is commonly seen in thymic carcinomas, MG is rarely found in thymiccarcinomas. CT has limited value in differentiating histologic subtypes according to the WHO classification, homogeneous soft

关 键 词：胸腺 胸腺上皮肿瘤 组织学分型 体层摄影术 X线计算机 

分 类 号：R736.3[医药卫生—肿瘤]