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目的探讨化生性胸腺瘤的临床病理特点。方法应用光镜、免疫组织化学(EnVision法)染色[单克隆抗体选用AE1/AE3、波形蛋白、上皮膜抗原(EMA)、CD3、CD5、CD20、CD34、CD57、CD99、末端脱氧核苷酸转移酶(TdT)、HMBE-1、calretinin、p53和Ki-67]和透射电镜观察3例化生性胸腺瘤的组织学特点、免疫学表型和超微结构。结果3例化生性胸腺瘤均为女性,年龄为33、58和45岁。组织学表现为双相分化特征,上皮细胞区域与梭形细胞区域交错分布并相互移行。上皮细胞区域的细胞轻度异型,有核沟和核内假包涵体,核分裂象罕见,呈岛状和条索状排列并相互吻合;梭形区域细胞形态温和,未见核分裂象,排列成束状或席纹状结构。免疫组织化学染色:上皮细胞区域AE1/AE3强阳性表达,不表达波形蛋白和CD5,Ki-67指数3%~5%;梭形细胞区域波形蛋白弥漫表达,EMA阳性,不表达CD5和CD20;间质淋巴细胞CD3阳性,不表达TdT和CD99。超微结构示上皮细胞区域细胞间有桥粒和半桥粒结构,而梭形细胞区域缺乏。结论化生性胸腺瘤是一类罕见的具有独特临床病理特征的良性或低度恶性胸腺上皮来源肿瘤。
Objective To investigate the clinicopathological features of metaplastic thymoma. [Methods] Immunohistochemistry (EnVision method) was used to stain the monoclonal antibody (AE1 / AE3, vimentin, EMA, CD3, CD5, CD20, CD34, CD57, CD99, terminal deoxynucleotidyl transferase (TdT, HMBE-1, calretinin, p53 and Ki-67) and transmission electron microscopy were used to observe the histological features, immunological phenotype and ultrastructure of 3 patients with metaplastic thymoma. Results All three cases of metaplastic thymoma were female and were 33, 58 and 45 years old. Histological manifestations of bipolar differentiation characteristics, epithelial cells and spindle cells interspersed and staggered migration. Epithelial cells in the region of mild dysplasia, a nuclear ditch and nuclear fusiform inclusion bodies, mitotic figures rare, was island and cord-like arrangement and mutual agreement; fusiform zone cell morphology was mild, no mitotic figure, arranged in a bundle Striped or satin-like structure. Immunohistochemical staining: Strong positive expression of AE1 / AE3 in the epithelial cell region, no expression of vimentin and CD5, 3% ~ 5% of Ki-67 index; diffusive expression of vimentin in the spindle cell region, positive in EMA, no expression of CD5 and CD20; Interstitial lymphocytes CD3 positive, do not express TdT and CD99. The ultrastructure shows epithelial cells with desmosomes and hemidesmosomes in the intercellular regions, but a lack of spindle cells. Conclusions Metaphyseal thymoma is a rare type of benign or low-grade thymic epithelial tumor with unique clinical and pathological features.