胸腺类癌(附13例报告)

Thymic Carcinoid:A Report of 13 Cases

目的:探讨胸腺类癌临床表现、治疗及预后。方法:对天津市肿瘤医院自1960年1月～2006年6月间共收治胸腺类癌13例。本组男11例,女2例,年龄36～59岁,平均48.8岁,病期1～14个月,平均5.3个月。结果:完整切除3例,2例生存超过8年,7年后失访,1例生存7年半死亡,5例不完全切除,1年左右均死亡,探查2例,1例术后放疗生存13年,1例有异位上腔静脉综合征,探查后3个月死于广泛转移,3例放化疗,2例1年死亡,1例放化疗有效,目前生存5个月,仍在治疗中。结论:胸腺类癌病理分为典型与不典型类癌,不典型者预后差,电镜示胸腺类癌在细胞浆内有致密核心颗粒,大小由600～5000埃(angstromes),可有细胞间桥小体,宽阔张力丝及基底层在胸腺癌内缺如,电镜可作鉴别诊断,有利胸腺类癌诊断,手术彻底切除预后好,尤其典型者,不彻底切除,放疗、化疗均较差。

Objective： To investigate clinical manifestations, methods of treatment and prognosis of thymie carcinoid tumors. Methods： From January 1960 to June 2006, 13 cases with thymie carcinoid were treated. There were 11 male and 2 female patients, ranging in age from 36 to 59 years with a mean age of 48.8 years and an average course of disease of 5.3 months. Results： In the group, 3 patients underwent complete resection, among which 2 survived for 8 years but one was not followed up past the 7th year and 1 survived for 7.5 years. Five patients received an incomplete excision and died of metastasis within 1 year. Two patients underwent exploratory thoracotomy, among which one received postoperative radiotherapy with a 13-year survival, and the other patient with ectopic superior vena cava syndrome （SVCS） died 3 months after exploratory surgery. Three patients were treated with chemotherapy and radiotherapy, among which 2 died within 1 year and 1 who received radiotherapy is currently surviving with ongoing treatment. Conclusion： The disease is pathologically classified as typical and atypical thymie earcinoid. The latter is highly malignant and has a poor prognosis. There are some difficulties in clinical diagnosis of typical thymic carcinoid. The characteristics of typical cardnoid include ultrastrueturally dense core granules in the cytoplasm. The size of the granules vary from 600 to 5000 angstroms. Desmosomes can be found in some cases but the broad tonofilament and basal lamina of thymoma were absent. Electron microscopy may be needed for a differential diagnosis.