以胸腺囊肿为首发症状的胸腺肠型腺癌1例并文献复习  

A case of thymic enteric adenocarcinoma with the first symptom of thymic cyst and literature review

作　　者：李杨 郭昆亮[2] 詹必成[2] 高慧敏 宣兰兰[1] LI Yang;GUO Kunliang;ZHAN Bicheng;GAO Huimin;XUAN Lanlan(Department of Pathology,Anqing Municipal Hospital,Anqing,Anhui 246002,China;Department of Cardiothoracic Surgery,Anqing Municipal Hospital,Anqing,Anhui 246002,China)

机构地区：[1]安庆市立医院病理科,安徽安庆246002 [2]安庆市立医院心胸外科,安徽安庆246002

出　　处：《安徽医药》2024年第8期1636-1639,I0003,共5页Anhui Medical and Pharmaceutical Journal

基　　金：安徽医科大学校科研基金项目(2020XKJ240)。

摘　　要：目的探讨胸腺肠型腺癌(TEAC)的临床病理学特征、免疫表型特征、诊断及鉴别诊断。方法回顾性分析2023年4月20日安庆市立医院收治的1例TEAC的临床病理学特征,行免疫组化EnVision两步法进行检测,并复习相关文献。结果病人女性,47岁,因咳嗽10 d,体检发现纵膈占位1 d入院行肿瘤切除术,镜下病变呈多房囊性病变,肿瘤呈多灶性,散在分布囊壁的纤维及脂肪内,组织学表现为管状腺癌及黏液腺癌,主要由柱状上皮、胞质含黏液上皮细胞及潘氏样细胞组成。部分区域可见肿瘤细胞与温和的梭形胸腺上皮过渡移行。免疫表型:肿瘤细胞CDX2、CK7、MUC-2、CD117、SATB2、CEA、CK20均阳性,P53错义突变,CD20、P63阴性,Ki67增殖指数约20%。Masaoka-Koga分期:Ⅰ期;TNM分期:Ⅰ期。结论胸腺肠型腺癌是一种罕见胸腺的原发腺癌,临床症状无特异性,常与胸腺囊肿伴随,具有与结直肠腺癌相同的组织学和免疫组化特征,无特异性分子诊断指标。诊断及鉴别诊断重点是排除转移性恶性肿瘤。病人术后无进展,治疗建议参考其他常见胸腺癌。Objective To investigate the clinicopathological features,immunophenotypic features,diagnosis and differential diagnosis of thymic enteric adenocarcinoma(TEAC).Methods The clinicopathological features of 1 case of TEAC admitted to Anqing Municipal Hospital on April 20,2023 were analyzed retrospectively,and a two-step immunohistochemical EnVision assay was performed and the relevant literature was reviewed.Results The patient,a 47-year-old female,was admitted to the hospital for tumor resection due to cough for 10 days and mediastinal occupancy found on physical examination for 1 day.The lesions were multilocular cystic lesions under the microscope,and the tumors were scattered in the fibers and fats of the cyst wall.The tumor was tubular adenocarcinoma and mucinous adenocarcinoma,mainly composed of columnar epithelium,cytoplasmic mucous epithelium and Panoid cells.In some areas,transition of tumor cells to mild fusiform thymus epithelium was observed.Immunophenotype:CDX2,CK7,MUC-2,CD117,SATB2,CEA and CK20 expression were positive,P53 showed missense mutation,CD20 and P63 expression was negative,Ki-67 proliferation index was about 20%.Masaoka-Koga stage:Ⅰstage;TNM stage:Ⅰstage.Conclusions Thymic intestinal adenocarcinoma is a rare primary adenocarcinoma of the thymus,with no specific clinical symptoms,often associated with thymic cysts,with the same histological and immunohistochemical features as colorectal adenocarcinoma,no specific molecular diagnostic indicators.The diagnostic and differential diagnosis focuse on the exclusion of metastatic malignancies.The patient had no postoperative progression and the treatment recommendations refer to other common thymic carcinomas.

关 键 词：胸腺肿瘤 肠型腺癌 病理学特征 免疫表型 诊断 鉴别诊断 

分 类 号：R736.3[医药卫生—肿瘤]