伴淋巴上皮涎腺炎样特征的胸腺增生临床病理学观察  

Thymic hyperplasia with lymphoepithelial sialadenitis-like features:a clinicopathologic and immunohistochemical analysis of two cases

作　　者：张小鹰 梅开勇[2] 王浩 于倩 韩靖 郭明星 余斯曼 ZHANG Xiao-ying;MEI Kai-yong;WANG Hao;YU Qian;HANG Jing;GUO Ming-xing;YU Si-man(Department of Pathology,Panyu Central Hospital,Guangzhou 511400,China;Department of Pathology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)

机构地区：[1]广东省广州市番禺区中心医院病理科,广州511400 [2]广东省广州医科大学附属第二医院病理科,广州510260

出　　处：《诊断病理学杂志》2021年第5期362-366,共5页Chinese Journal of Diagnostic Pathology

基　　金：广州市番禺区科技局重大医疗项目(2019-Z04-02)。

摘　　要：目的探讨伴淋巴上皮涎腺炎样特征的胸腺增生临床病理学特征、免疫组化表型及鉴别诊断。方法收集2例LESA样胸腺增生患者的临床病理学资料,通过光镜形态学观察、免疫组织化学染色、原位杂交、Ig基因重排检测,并复习相关文献。结果2例患者中,男性1例,女性1例,发病年龄56和66岁(平均年龄61岁)。肿瘤最大径6 cm、13 cm。镜下:低倍镜下肿瘤呈分叶状结构,叶状结构周围为脂肪组织;具有生发中心的淋巴滤泡增多,滤泡间区可见浆细胞;胸腺上皮细胞增生,可见大量胸腺小体,胸腺上皮呈岛状、巢状,并相互汇合形成梁状结构;囊性变,囊壁内衬胸腺上皮,囊内见均质嗜酸性物及胆固醇裂隙,常伴异物巨细胞反应;淋巴细胞浸润胸腺上皮形成淋巴上皮病变。免疫组织化学CD20、CD79α示B细胞,CD3、CD5示T细胞,CK、CK19显示淋巴上皮病变,原位杂交EBER阴性,未检测到Ig基因发生单克隆重排。结论LESA样胸腺增生类似于涎腺良性淋巴上皮病变,是胸腺增生的一种新病理学形态,镜下主要表现为淋巴样组织浸润和淋巴上皮病变,预后良好,手术切除后,无复发和转移。Purpose To investigate the clinicopathological features,immunohistochemical phenotype and differential diagnosis of thymic lymphoepithelial sialadenitis(LESA)-like hyperplasia.Methods The clinical and pathological data of 2 patients with thymic LESA-like hyperplasia were collected and examined by light microscopic morphology,immunohistochemical staining,in situ hybridization,immunoglobulin(Ig)gene rearrangement technology and related literatures were reviewed.Results Among the 2 patients,ratio of male to female was 1∶1.The age of onset was 56 and66 years,respectively,with average 61 years.The largest diameter of the tumor was 6-13 cm.Microscopically,the tumor had a lobulated structure,surrounded by adipose tissue;lymphoid follicles with germinal centers increased at low power field;plasma cells were seen in the interfollicular area;thymic epithelial cells proliferated,and a large number of thymic bodies were noted,the thymic epithelium was island-like and nest-like,and merged with each other to form a beam-like structure;cystic changes,the cyst wall is lined with thymic epithelium,and homogeneous eosinophils and cholesterol fissures are seen in the cyst,often accompanied by foreign body giant cell reaction;lymphocytes infiltrated the thymus epithelium to form lymphoid epithelial lesions.Immunohistochemically,CD20 and CD79αwere positive for B cells,CD3 and CD5 were positive for T cells,and CK and CK19 were positive for lymphoepithelial lesions;in situ hybridization showed negative EBER;monoclonal rearrangement of the Ig gene was not detected in two cases.Conclusions Thymic LESA-like hyperplasia is similar to lymphoepithelial sialadenitis.It is a new pathological morphology of thymic hyperplasia.It mainly shows lymphoid tissue infiltration and lymphoepithelial lesions under microscope.The prognosis is good.After surgery,there is no recurrence and metastasis.

关 键 词：淋巴上皮病变 淋巴滤泡 涎腺特征 胸腺增生 胸腺小体 病理学特征 

分 类 号：R782.7[医药卫生—口腔医学] R583[医药卫生—临床医学]