伴淋巴上皮涎腺炎样特征的胸腺增生临床病理特点  

Clinicopathological characteristics of thymic hyperplasia with lymphoepithelial sialadenitis-like features

作　　者：许文凤 王丽娜 应骐键 韩青青 王家双 郭德玉 XU Wenfeng;WANG Lina;YING Qijian;HAN Qingqing;WANG Jiashuang;GUO Deyu(Department of Pathology,Guiqian International Hospital,Guiyang,Guizhou Province,550000,China)

机构地区：[1]贵黔国际医院病理科,贵阳550000

出　　处：《陆军军医大学学报》2024年第15期1811-1816,共6页Journal of Army Medical University

摘　　要：目的认识并总结伴淋巴上皮涎腺炎样特征的胸腺增生(thymic hyperplasia with lymphoepithelial sialadenitis-like features,简称LESA样胸腺增生)临床病理特点及鉴别诊断要点,从而减少误诊、漏诊。方法收集贵黔国际医院病理科2019年10月1日至2023年9月1日诊断的LESA样胸腺增生病例的临床病理资料,并结合文献复习其流行病学、临床病理特点,以及治疗、预后情况。结果纳入2例LESA样胸腺增生女性患者,发病年龄分别为51岁和52岁。影像学上均表现为前纵隔肿物;大体上观测肿块最大径分别为7.5 cm和12.0 cm;镜下及免疫表型显示大量伴有生发中心的淋巴滤泡,滤泡间区见网状或巢状无异型增生的胸腺上皮、胸腺小体以及淋巴上皮病变,局灶可见囊性变、胆固醇结晶及其形成的胆固醇肉芽肿。复习文献报道的LESA样胸腺增生46例,其病理形态及免疫组化表型与本组2例相似,且预后良好,但有5例患者进展为淋巴瘤。结论LESA样胸腺增生是一种良性病变,具有独特的病理形态特征,预后良好,但少数患者可进展为淋巴瘤,需要定期密切随访。Objective To understand and summarize the clinicopathological characteristics and differential diagnosis of lymphoepithelial sialadenitis(LESA)-like thymic hyperplasia.Methods The clinicopathological data of patients with LESA-like thymic hyperplasia diagnosed in our hospital from October 1,2019 to September 1,2023 were collected,and the related literatures on their epidemiological characteristics,clinicopathological features,treatments and prognosis were reviewed.Results There were 2 female patients with LESA-like thymic hyperplasia included,at an onset age of 51 and 52 years,respectively.Imaging examination revealed an anterior mediastinal mass in both patients,with the largest diameter of 7.5 and 12.0 cm,respectively.Microscopic morphology and immunophenotype analysis showed there were florid lymphoid follicles with germinal centers.Reticular or nested thymic epithelial,thymic corpuscles and lymphoepithelial lesions without dysplasia were seen in the interfollicular areas as well.Focal cystic changes,cholesterol crystals and the formation of cholesterol granuloma were observed.Our results were similar to the pathological morphology and immunohistochemical phenotype of 46 cases with LESA-like thymic hyperplasia reported in the literature.They had favorable prognosis,except 5 patients progressed to lymphoma.Conclusion LESA-like thymic hyperplasia is a benign disease with unique morphological characteristics and of favorable prognosis.But rare patients can progress to lymphoma,therefore regular and close follow-up is still required.

关 键 词：胸腺增生 淋巴上皮涎腺炎样胸腺增生 淋巴滤泡 胸腺上皮 淋巴瘤 

分 类 号：R322.25[医药卫生—人体解剖和组织胚胎学] R446.8[医药卫生—基础医学] R583