伴淋巴样间质的微结节型胸腺肿瘤17例临床病理与形态学分化谱系分析  

Spectrum of morphological differentiation of micronodular thymic neoplasms with lymphoid stroma:a clinical and pathological analysis of seventeen cases

作　　者：秦积龙[1] 何萍[1] 范蕾 林晓东[1] 姚小飞[2] 侯鹏[3] 魏建国[2] QIN Ji-long;HE Ping;FAN Lei;LIN Xiao-dong;YAO Xiao-fei;HOU Peng;WEI Jian-guo(Department of Pathology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Pathology,Shaoxing People’s Hospital,Shaoxing 312000,China;PET-CT Center,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院病理科,广州510120 [2]浙江省绍兴市人民医院病理科,绍兴312000 [3]广州医科大学附属第一医院PET-CT中心,广州510120

出　　处：《临床与实验病理学杂志》2023年第1期23-29,共7页Chinese Journal of Clinical and Experimental Pathology

基　　金：广东省基础与应用基础研究基金—广东省自然科学基金面上项目(2019A1515011390)。

摘　　要：目的探讨伴淋巴样间质的微结节型胸腺肿瘤(micronodular thymic neoplasms with lymphoid stroma,MNN)的临床病理学及免疫表型特征、形态学分化谱系。方法收集17例MNN的临床病理资料,采用免疫组化SP法进行检测,并复习相关文献。结果17例MNN中男性10例,女性7例,男女比为1.4∶1,年龄5~73岁,中位年龄55岁。肿瘤最大径1.4~6.0 cm,平均3.7 cm。Masaoka分期:Ⅰ期9例,Ⅱ期8例;TNM分级:17例均为Ⅰ期。随访时间2~97个月,平均随访50个月,所有患者均无复发。镜检:肿瘤呈结节状,间质大量淋巴细胞浸润伴淋巴滤泡形成。其中11例肿瘤结节细胞巢规则,瘤细胞形态温和。4例见肿瘤结节细胞巢不规则,细胞巢呈舌状及出芽式浸润淋巴样间质,瘤细胞多角形,伴轻~中度异型性。2例见肿瘤结节融合呈巢片状,部分呈条索状及岛状,可见粉刺样坏死,瘤细胞上皮样,核空泡状,见明显大核仁,间质见宽大的胶原纤维。11例为伴淋巴样间质的微结节型胸腺瘤(micronodular thymic thymomas with lymphoid stroma,MNT),4例为不典型MNT,2例为伴淋巴样间质的微结节型胸腺癌(micronodular thymic carcinomas with lymphoid stroma,MNC)。免疫表型:肿瘤细胞弥漫表达p40及CK19,间质淋巴细胞表达CD20,不典型MNT灶性表达CD5,p53>40%阳性,MNC弥漫表达CD5、CD117及p53。17例EBER原位杂交均阴性。结论MNN根据肿瘤细胞结节是否规则、细胞学的异型性、核分裂象、坏死及免疫表型特征,形成从良性至恶性(MNT→不典型MNT→MNC)的连续性形态学分化谱系。MNN为低度侵袭性肿瘤,预后相对较好。Purpose To investigate the clinical and pathological features,diagnosis,and differential diagnosis of micronodular thymic neoplasms with lymphoid stroma(MNN).Methods The clinical and pathological features with their immunophenotype were analyzed retrospectively in 17 cases of MNN and literatures were reviewed.Results There were 10 males and 7 females,with a male:female ratio of 1.4∶1.Mean age was 55 years,ranging from 5 to 73 years.Size of the tumors was 1.4 to 6.0 cm in greatest dimension(average 3.7 cm).Masaoka staging showed that 9 cases were stage I and 8 cases stageⅡ.TNM classification demonstrated that 17 cases were all stageⅠ.Follow-up time ranged from 2 to 97 months,average 50 months.No recurrence was identified in all 17 patients.The tumors were characterized by micronodular proliferation of tumor cells,separated by abundant lymphoid stroma with prominent germinal centers.Among them,11 cases showed regular tumor nodules and nests with mild cytologic morphology.While 4 cases displayed irregular tumor nodules and nests with tongue-shaped nodules,budding to the lymphoid stroma.The tumor cells were polygonal with mild to moderate cytologic atypia.In 2 cases,multiple smaller tumor nodules were merged to form large nodules,cords,and islands,with comedo necrosis.The tumor cells were epithelioid,with vacuolar nuclei with prominent large nucleoli,and extensive stromal fibrosis and collagenization.Altogether,11 cases were diagnosed as micronodular thymoma with lymphoid stroma(MNT),4 cases were atypical MNT,and 2 cases were micronodular thymic carcinoma with lymphoid stroma(MNC).The subtypes of MNN were variable in their immunophenotype:MNT,diffuse expression of p40 and CK19 in tumor cells,but CD20 expression in interstitial lymphocytes.Atypical MNT,focal expression of CD5,and p53 positive in more than 40%tumor cells.MNC,diffuse expression of CD5,CD117,and p53.Conclusion MNNs includes MNT,atypical MNT and MNC.According to the regularity of tumor cell nodules,cytological atypia,mitotic figures,necrosis and imm

关 键 词：微结节胸腺瘤 微结节胸腺癌 不典型微结节胸腺瘤 淋巴样间质 分化谱系 

分 类 号：R736.3[医药卫生—肿瘤]