伴淋巴样间质微结节型胸腺瘤合并其它类型胸腺瘤6例临床病理分析

Clinical and pathological analysis of 6 cases of lymphoid stromal micronodular thymoma with other types of thymoma

目的探讨伴淋巴样间质微结节型胸腺瘤(micronodular thymoma with lymphoid stroma,MNT)合并其它类型胸腺瘤的临床病理学特征、免疫表型、治疗及预后。方法收集33例MNT患者(包括MNT合并其它类型胸腺瘤)的临床资料,采用免疫组化EnVision法检测CD5、CD20、CD117、CK19、p63、TdT、Ki-67等的表达,分析其临床病理特征、免疫表型,并复习相关文献。结果33例MNT中单纯性MNT 27例,MNT合并其它类型胸腺瘤6例。27例单纯性MNT中男性15例,女性12例,平均年龄63.9岁,肿瘤平均最大径3.2 cm。MNT合并其它类型胸腺瘤中男性5例,女性1例,平均年龄59.3岁,中位年龄62岁,肿瘤平均最大径4.5 cm。33例中仅有3例出现胸痛、胸闷症状,其余患者均为体检或因其他疾病检查时发现。6例MNT合并其它类型胸腺瘤中4例合并A型胸腺瘤,1例合并AB型胸腺瘤,1例合并B3型胸腺瘤。与单纯性MNT相比,MNT合并其它类型胸腺瘤患者性别、年龄及肿瘤最大径差异无统计学意义(P>0.05)。患者均行手术治疗,6例MNT合并其它类型胸腺瘤中有4例获得随访,单纯性MNT中19例获得随访,随访时间1~59个月,均无复发。结论MNT合并其它类型胸腺瘤临床罕见,预后相对较好,有特征性的组织学结构,诊断主要依靠组织学结合免疫表型。

Purpose To investigate the clinicopathological features,histological morphology,immunohistochemistry,treatment and prognosis of micronodular thymoma with lymphoid stroma(MNT)combined with other types of thymomas.Methods The clinical data of 33 patients with MNT(including MNT with other types of thymoma)were collected.The expression of CD5,CD20,CD117,CK19,p63,TdT,Ki-67,etc.was detected by immunohistochemical EnVision method,and their clinicopathological characteristics and immunophenotype were analyzed,and the related literatures were reviewed.Results Among the 33 MNT patients,there were 6 cases of MNT combined with other types of thymomas,27 cases of simple MNT.Among the 27 simple MNTs,there were 15 males and 12 females with an average age of 63.9 and an average diameter of 3.2 cm.There were 5 cases of male and 1 case of female in the MNT with other types of thymomas,with an average age of 59.3,the median age was 62,and the average diameter of the tumor was 4.5 cm.Chest pain and tightness were occurred in 3 of all cases,and the rest were found in physical examination or other diseases,and all cases occurred in the anterior mediastinum.Among the 6 cases with other types of MNT,4 cases whit thymoma type A,1 case whit thymoma type AB,and 1 case whit thymoma type B3.Compared with simple MNT,there were no significant differences in gender,age and maximum tumor diameter(P>0.05).All patients treatment with surgery,4 of the 6 MNT patients complicated with other types of thymoma and 19 cases of simple MNT were followed up from 1 to 59 months,all case without recurrence.Conclusion MNT combined with other types of thymoma is rare in clinic,with relatively good prognosis and characteristic histological structure.The diagnosis mainly depends on histology and immunophenotype.