恶性胸腺瘤WHO病理分类及其CT表现

CT appearance and WHO-classification of malignant thymoma

目的:分析恶性胸腺瘤的CT表现,以便于分类、分期和选择治疗。方法:分析21例手术及病理证实的WHO分类恶性胸腺瘤的CT表现,与手术病理相对照。结果:恶性胸腺瘤WHO分类B1型3例,B2型6例,B3型4例,C型(胸腺癌)8例。CT表现:心脏大血管受侵11例,主要表现肿块的心脏大血管接触面(mass-cardiovascular inferface,MCI)呈灌铸型生长。纵隔胸膜-肺受侵13例,主要表现为肿块-肺接触面(mass-pulmonary interface,MPI)增厚呈尖角或锯齿征。胸膜种植3例。肺门、肺内转移4例。C型(胸腺癌)更具侵袭性,远处转移多见。结论:CT能准确显示恶性胸腺瘤周围侵犯范围、胸膜种植及远隔转移。可准确分期和决定治疗方案,并对分类及预后作出评估。

Objective-To study the cr manifestations of malignant thymoma for classification evaluating, staging and treatment planning. Methods： We reviewed and analyzed the CT scans of 21 cases with malignant thymoma cofirmed by surgery and pathology.Results： The resuits showed WHO-classification Type B1 in 3, Type B2 in 6, Type B3 in 4, Typ C in 8. The main findings were as follow： cardiovascular involvement in 11, mass-cardiovascular inferface with freezing sign, mediastinal pleural and lung invasion in 13, mass-pulmonary interface with irregular shape, as well as pleural seeding in 3 and extra-mediastinal metastases in 4. The type C is higher invasiveness and distant metastases than type B. Conclusion： cr provides the most reliable assessment of the invasion and extra-mediastinal metastases, it allows accurate stagimg and treatment planning, and hes value in evaluating classification and prognosis.