6例胸腺瘤转移至肺组织的临床病理观察

Clinical observation of the clinicopathological features of thymoma with lung metastases: a report of 6 cases

目的探讨6例胸腺瘤转移至肺组织的临床病理学特征、诊断、治疗和预后。方法收集本院2009年1月至2017年12月6例胸腺瘤转移至肺组织的临床病理资料,光镜下观察组织形态,结合免疫组化进行鉴别诊断,分析其临床表现、组织形态学特点、免疫组化特征及治疗和预后情况。结果 6例胸腺瘤转移至肺的患者,年龄23~75岁,3例男性、3例女性,以胸闷、咳嗽为主要首发症状,均行手术治疗,包括胸腺肿瘤及肺叶切除。组织学类型为B_1及B_2型胸腺瘤,肺转移灶的组织学类型也为B_1及B_2型胸腺瘤。免疫组织化学染色显示CK(上皮细胞+)、CK19(上皮细胞+)、CK5(-)、CD3(淋巴细胞+)、CD20(-)、Td T(淋巴细胞+)、CD99(淋巴细胞+)、EMA(上皮细胞灶+)、CD5淋巴细胞(+)、p53(部分+)、p63(上皮细胞+)、CD117(-)和Ki-67(20%~60%)。术后1例未行辅助治疗,2例仅行放疗,3例行放疗和化疗,6例患者均存活。结论任何组织学类型的胸腺瘤均有复发和远处转移的可能,需要长期随访,转移灶应该完整手术切除,可以实现长期生存的目的。

Objective To investigate the clinicopathological features of six cases of thymoma with lung metastases and thehistological types, diagnosis, treatment and prognosis for this disease. Methods From January 2009 to December 2017, the clinico-pathological data of 6 cases of thymoma metastases to lung tissues were collected. The histomorphology was observed under light micro-scope and the differential diagnosis was made by immunohistochemistry. The clinical manifestations, histomorphological features, im-munohistochemical characteristics, treatment and prognosis were analyzed. Results Six cases of thymoma with lung metastases weredetected, aged from 23 to 75, 3 males and 3 females, with chest tightness and cough as initial symptom. All patients underwent surgi-cal treatment, including excision of thymoma and lung lobe. The histological types included six cases of type B1 and B2 . The pathological diagnosis for these lung metastases were also type B1 and B2 . Immunohistochemistry staining showed CK（ ＋）, CK19（ ＋）, CD3（＋）, TdT （＋）, CD99（＋）, EMA（＋）, CD5 （＋）, p53 （＋）, p63（＋）, CD117（-） and Ki-67 positive cells （20%-60%）. No adju-vant therapy was performed in one case, radiotherapy were performed in two cases and both radiotherapy and chemotherapy were per-formed in three cases. All cases survived up to present. Conclusion Any type of thymoma might recur and develop distant metastases,requiring long-term follow-up. The metastases should be completely excised to achieve long-term survival.