化生性胸腺瘤9例临床病理分析及文献复习  

Clinicopathological Analysis of Nine Metaplastic Thymoma and Literatures Review

作　　者：刘静 李扬[2] LIU Jing;LI Yang(Qinpu Branch of Zhongshan Hospital Affiliated to Fudan University,Shanghai,201700)

机构地区：[1]复旦大学附属中山医院青浦分院,201700 [2]南京医科大学第一附属医院,210029

出　　处：《实用癌症杂志》2021年第7期1116-1119,共4页The Practical Journal of Cancer

基　　金：上海市青浦区科技发展基金项目(编号:QKY2020-17)。

摘　　要：目的探讨化生性胸腺瘤的临床病理学特点,以提高对该肿瘤的认识。方法回顾性分析9例纵隔化生性胸腺瘤的临床影像学特征、病理组织学形态和免疫组化特点,并复习相关文献。结果9例肿瘤均位于前纵隔,均显示双相分化特点,上皮样细胞区域与梭形细胞区域交错分布,部分区可见两者相互移行,部分病例可见核内假包涵体。免疫组化特点:上皮细胞CK、CK5/6、CK19、P63均呈弥漫阳性,梭形细胞Vimentin均弥漫阳性,部分病例梭形细胞EMA局灶阳性,7例Ki-67增殖指数均较低(<5%),2例Ki-67热点区达8%、15%。绝大多数病例间质内缺乏未成熟淋巴细胞,少数病例可见少量成熟T、B淋巴细胞。结论化生性胸腺瘤是胸腺肿瘤中非常少见的类型,临床及影像学无特异性,确诊主要依靠病理学形态和免疫组化检查,预后可能与肿瘤能否完整切除及临床Masaoka分期相关,但尚有待于更多病例的长期随访观察。Objective To investigate the clinicopathological features, diagnosis and differential diagnosis of metaplastic thymoma, with emphasis on increasing the recognition of this rare neoplasm.Methods The clinical and pathological data of 9 patients with metaplastic thymoma were retrospectively reviewed.And the literatures were reviewed.Results All cases occurring in anterior mediastinum, tumors were characterized with biphasic pattern composed of epithelial components and spindle cells.Epithelial cells and spindle cells migrated to each other.Pseudoinclusions were seen in some cases.Immunohistochemically, the epithelial cells were diffusely and strongly positive for CK,CK5/6,CK19 and P63.The spindle cells were diffusely positive for vimentin, focal positive for EMA.The Ki-67 proliferation index of 7 cases was low(<5%),but reached 8% and 15% in the hot spot area of the other 2 cases.The vast majority of cases lack immature lymphocytes, and a small amount of mature T and B lymphocytes can be seen in a few cases.Conclusion Metaplastic thymoma is a rare thymoma with no specific clinical and imaging characteristics.The diagnosis mainly relies on its special morphological features and immunohistochemical profiles.The prognosis may be related to the Masaoka staging and the complete resection of the tumor.And more cases with long-term follow-up observation are needed for understanding its really biologic behavior.

关 键 词：纵隔 化生性胸腺瘤 双相性 预后 

分 类 号：R736.3[医药卫生—肿瘤]