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目的评价胸腺上皮肿瘤WHO各组织学亚型的CT特征,为术前诊断及组织学亚型预测提供依据。方法对84例经穿刺病理或手术病理确诊为胸腺上皮肿瘤患者的病理、临床及影像学资料进行回顾性分析。A型5例、AB型22例、B1型10例、B2型11例、B3型12例、C型24例。结果胸腺癌未出现重症肌无力。胸痛更常见于胸腺癌(50.0%)。C型胸腺瘤较A型长径更大;A、AB型较B2、B3、C型更可能表现为类圆形的形状(P=0.013,0.010,0.013;0.040,0.030,0.034);C型胸腺瘤较A、AB、B1型胸腺瘤的MCI更可能呈灌铸式生长(P=0.0001,0.011,0.001),B2、B3、C型较A型的MCI更可能呈灌铸式生长(P=0.009,0.012,0.0001);C型比A、AB、B1型的MCI更易增厚呈尖角或锯齿征(P=0.036,0.0001,0.005);瘤内坏死灶显著的少见于B1型较A、AB、B2、B3、C型(P=0.017,0.011,0.001,0.010,0.0001);C型较AB、B1型更易侵犯大血管(P=0.016,0.041);B2型较AB、B1型更易出现胸膜或心包结节(P=0.002,0.023),B3型较AB型更易出现胸膜或心包结节(P=0.037);C型较AB型更易出现胸膜或心包积液(P=0.038);C型较AB、B1、B2型更可能发生纵隔淋巴结转移(P=0.005,0.034,0.019)。结论胸腺癌多以胸痛为主要症状,极少出现重症肌无力。CT征象出现率在WHO组织学各亚型之间存在一些差异,为认识各亚型和初筛提供线索。但各亚型CT表现仍有很大程度重叠,缺乏特征性征象,难以精确定性诊断,仅实质成分无坏死可提示诊断B1型的可能性大。
Objective To evaluate the CT features of WHO histological subtypes of thymic epithelial tumors and provide evidence for preoperative diagnosis and histological subtype prediction. Methods The pathologic, clinical and imaging data of 84 patients with thymic epithelial tumor diagnosed by pathological or surgical pathology were retrospectively analyzed. 5 cases of type A, 22 cases of type AB, 10 cases of type B1, 11 cases of type B2, 12 cases of type B3 and 24 cases of type C. Results Thyroid cancer did not appear myasthenia gravis. Chest pain is more common in thymoma (50.0%). Type C thymoma was larger than Type A long diameter. Types A and AB were more likely to be round (P = 0.013,0.010,0.013; 0.040,0.030,0.034) than Type B2, Type B3 and Type C. Type C MCI of thymoma was more likely to be cast-cast than that of A, AB, B1 (P = 0.0001, 0.011, 0.001) = 0.009,0.012,0.0001); C type than the A, AB, type B1 MCI is more likely to thickening was sharp or sawtooth sign (P = 0.036,0.0001,0.005); tumor necrosis significantly less common in the B1 type than A (P = 0.017,0.011,0.001,0.010,0.0001). Type C was more likely to invade the major vessels than type AB and type B1 (P = 0.016, 0.041), type B2 was more likely than type AB and type B1 Pleural or pericardial nodules (P = 0.002, 0.023) were found in the pleural or pericardial nodules. Pleural or pericardial nodules were more likely to be found in type B3 than in type AB (P = 0.037). Pleural or pericardial effusion was more likely to occur in type C than in type AB Type C was more likely to develop mediastinal lymph node metastases than AB, B1, B2 (P = 0.005, 0.034, 0.019). Conclusions Thoracic carcinoma mostly has chest pain as the main symptom, and myasthenia gravis rarely occurs. There are some differences in the appearance rate of CT signs between WHO subtypes in histology, providing clues for understanding subtypes and screening. However, subtypes of CT performance is still a large degree of overlap, the lack of characteristic signs, it is difficult to accurately diagnose qualitatively, only the essence of non-necrosis can prompt the diagnosis of B1 type probability.