恶性胸腺瘤的临床病理特点.docVIP

???? 恶性胸腺瘤的临床病理特点 ???? ????【摘要】　目的　探讨恶性胸腺瘤的形态特点、临床分期、治疗等与预后的关系。方法　回顾分析诊治的64例恶性胸腺上皮肿瘤，按照Levine等提出的恶性胸腺瘤的标准分为Ⅰ型(恶性胸腺瘤,MT)和Ⅱ型(胸腺癌,TC)。参照Mller-Hermelink等提出的组织学分型标准对MT进行分类，依Masaoka提示的标准进行临床分期。结果　MT 41例,TC 23例。MT中无一例髓质型及混合型。皮质为主型、皮质型、分化好的胸腺癌、鳞癌及淋巴上皮样癌5年生存率分别为75.3%、44.7%、43.3%、27.5%和60.0%；10年生存率分别为25.3%、10.0%、0、0和20.0%(P均0.05)。临床分期Ⅱ、Ⅲ及Ⅳ期5年生存率分别为66.4%、28.7%和22.6%；10年生存率分别为33.0%，0.04%和0(P均0.01)。22例仅行开胸活检,病例均为Ⅲ、Ⅳ期, 与相同临床分期切除肿瘤病例相比,5年和10年生存率前者为13.7%和0，后者为41.1%和0.04%(P0.01)。结论　细胞形态、异型性、 临床分期及切除肿瘤的范围可以从不同的方面提示预后。　　【主题词】　胸腺瘤/病理学　　胸腺肿瘤/病理学　　预后 Clinico-pathologic characteristics of malignant thymoma　　LIN Dongmei, Lü Ning, FENG Xiaoli, et al. Department of Pathology, Cancer Institute(Hospital),Chinese Academy of Medical Sciences. Peking Union Medical College, Beijing 100021　　【Abstract】　Objective　To assess the histopathology, clinical staging and treatment of malignant thymoma in relation to prognosis. Methods　Sixty four cases with malignant epithelial thymic tumors treated in the period of 1958～1995 were retrospectively studied. Archived specimens were categorized according to Levine and Rosai into type I malignant thymoma(MT) and type II thymic carcinoma (TC). MT was histologically classified accoroding to Müller-Hermelink(M-H). Clinical staging was ascertained accroding to Masaokas criteria. Results　There were 41 cases of MT and 23 cases of TC. No medullary or mixed thymoma was observed in this series of MT. The 5-year survival rate of patients with MT of predominantly cortical, cortical, and well-differentiated thymic carcinoma(MDTC) subtypes was 75.3%, 44.7% and 43.3%, respectively. That of patients with TC of squamous-cell carcinoma and lympho-epithelioid subtypes was 27.5%and 60.0%, respectively. The 10-year survival rate of these 5 subtypes was 25.3%, 10.0%, 0,0, 20.0%, respectively(P0.05). The 5-year and 10-year survival rates decreased with increase in staging. In 22 patients in stage III and IV who received thoracotomy with biopsy only, their survival rate was signifi