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目的探讨胸腺上皮性肿瘤的临床病理特征。方法96例胸腺瘤根据WHO(2004)胸腺肿瘤分类标准进行分类,并进行Masaoka分期,同时运用免疫组化方法检测CK、CD5、Syn、CgA、TdT,结合临床影像特征和病理组织形态进行研究。结果本组96例胸腺瘤中A型8例,AB型6例,B1型18例,B2型15例,B3型23例,C型26例。Masaoka分期Ⅰ期23例,Ⅱ期9例,Ⅲ期26例,Ⅳ期38例。96例胸腺瘤上皮细胞CK均(+),10例B3型和21例C型胸腺瘤上皮细胞CD5(+),9例B3型胸腺瘤和16例C型胸腺瘤上皮细胞Syn、CgA(+),A型、AB型、B1型、B2型胸腺瘤淋巴细胞均TdT(+),仅有3例B3型胸腺瘤淋巴细胞TdT(+)。随访资料结果显示,Masaoka临床分期中Ⅰ、Ⅱ期的3年和5年生存率分别为100%和66·3%,Ⅲ期为68·4%和39·9%,Ⅳ期为36·3%和19·4%;且患者生存率与Masaoka分期密切相关。结论结合组织病理形态、免疫组化染色和临床资料可对胸腺瘤进行诊断和鉴别诊断,Masaoka分期是影响患者预后的重要因素。
Objective To investigate the clinicopathological features of thymic epithelial tumors. Methods Ninety-six cases of thymoma were classified according to WHO (2004) thymic tumor classification criteria and Masaoka staging. CK, CD5, Syn, CgA, and TdT were detected by immunohistochemical method, combined with clinical imaging characteristics and histopathological morphology. Results Of the 96 cases of thymoma in this group, 8 were type A, 6 were type AB, 18 were type B1, 15 were type B2, 23 were type B3, and 26 were type C. Masaoka stage I stage 23 cases, stage II 9 cases, stage III 26 cases, stage IV 38 cases. 96 cases of thymoma epithelial cells were all CK (+), 10 cases of B3 type and 21 cases of type C thymoma epithelial cells CD5 (+), 9 cases of type B3 thymoma and 16 cases of type C thymoma epithelial cells Syn, CgA (+ ), Type A, AB, B1, and B2 thymoma lymphocytes were all TdT(+), and only 3 B3 thymoma lymphocytes had TdT(+). Follow-up data showed that the 3-year and 5-year survival rates of stage I and II in Masaoka clinical stage were 100% and 66.3%, respectively, 68.4% and 39.9% in stage III, and 36. 3 in stage IV. % and 19.4%; and the patient survival rate is closely related to the Masaoka staging. Conclusion The diagnosis and differential diagnosis of thymoma can be performed by combining histopathological morphology, immunohistochemical staining and clinical data. Masaoka stage is an important factor influencing the prognosis of patients.