胸腺癌58例临床病理分析

Clinicopathological features of thymic carcinoma: a report of 58 cases

目的总结胸腺癌的临床病理特点。方法光镜观察肿瘤形态,并根据WHO(2004)分类标准对肿瘤进行分类和分期,并用免疫组化染色观察AE1、AE3、Syn、CgA、CD5表达。结果本组58例胸腺癌,Ⅲ期和Ⅳ期患者为40例,Ⅱ期患者为11例,Ⅰ期患者为7例。其中包括21例(36.2%)鳞癌、6例(10.3%)淋巴上皮瘤样癌、1例(1.7%)未分化癌、2例(3.4%)肉瘤样癌、5例(8.6%)典型类癌、13例(22.4%)不典型类癌、10例(17.2%)小细胞癌。28例神经内分泌癌、14例鳞癌和1例淋巴上皮瘤样癌Syn和CgA(+),18例鳞癌、2例淋巴上皮瘤样癌及1例肉瘤样癌CD5(+)。结论借助临床资料和免疫组化染色,胸腺癌可与转移癌及恶性间皮瘤、滑膜肉瘤、生殖细胞肿瘤、副节瘤和淋巴瘤等鉴别。完整切除肿瘤及术后辅以放、化疗可提高胸腺癌患者的生存率。

Objective To summarize the clinicopathological characteristics of thymic carcinomas. Methods 58 cases of thymic carcinoma were observed microscopically and classified based on the WHO classification standards in 2004. The expression of AE1, AE3, Syn, CgA and CD5 was detected by immunohistochemical staining in all the cases. Results The 58 cases included 40 cases of stages Ⅲ and Ⅳ ,11 cases of stage Ⅱ , and 7 cases of stage Ⅰ. There were 21 （36.2%） cases of squamous cell carcinomas, 6 （ 10.3% ） cases of lymphoepithelioma-like carcinomas, 1 （ 1.7% ） case of undifferentiated carcinoma, 2 （3.4%） cases of sarcomatoid carcinomas, 5 （8.6%） cases of typical carcinoids, 13 （22.4%） cases of atypical carcinoids and 10 cases of small cell carcinomas. Syn and CgA were expressed in 28 cases of neuroendocrine carcinomas, 14 cases of squamous cell carcinomas and 1 case of lymphoepithelioma-like carcinoma. CD5 was positive in 18 cases of squamous cell carcinomas, 2 cases of lymphoepithelioma-like carcinomas and I case of sarcomatoid carcinoma. Conclusion In virtue of clinic data and immunochemical staining thymic carcinoma could be differentiated from metastatic carcinomas, mesothelioma, synovial sarcoma, germ cell tumors, paraganglioma, lymphoma and others. Surgical resection, postoperative radiotherapy and chemotherapy are the main treatments to increase the rate of survival.