胸腺上皮肿瘤WHO病理分型与CT特征的相关性

目的：探讨胸腺上皮性肿瘤（TETs）的WHO病理分型与CT表现的相关性，以提高其CT诊断及临床诊疗水平。方法：回顾性分析经穿刺活检或手术病理证实的66例TETs患者的CT影像学表现。所有患者均行胸部CT平扫及增强扫描，均经组织病理学及细胞免疫组化检查并进行WHO组织病理分型，分析TETs各种组织学类型的CT特征。结果：66例TETs中男39例，女27例，年龄6～77岁。病理分型：A型5例（7．6％），AB型15例（22．7％），B1型13例（19．7％），B2型10例（15．2％），B3型10例（15．2％）及胸腺癌13例（19．7％）。A、AB、B1型胸腺瘤均呈圆形或类圆形，而80．0％的B3型胸腺瘤及92．3％的胸腺癌呈不规则形；大部分（92．4％）胸腺肿瘤呈中度强化。80．0％B3型胸腺瘤及100％胸腺癌有包膜破坏并侵犯邻近结构；40．0％的B3型胸腺瘤及61．5％的胸腺癌出现心包和（或）胸膜腔积液；随着肿瘤病理分级的增加，周围结构受侵的发生率亦随之升高，分别为15．4％（B1）、40．0％（B2）、80．0％（B3）及100％（胸腺癌）。TETs组织学分类与侵袭危险度CT分级之间存在显著相关性（rs=0．736，P〈0．01）。结论：不同WHO病理分型的TETs的cT表现具有一定特征性，TETs的CT特征反映了其侵袭危险性及组织病理学分型。

Relationship between WHO pathology subtypes and CT features of thymic epithelial tumors

Objective：To study the relationship between WHO pathology subtypes and CT features of thymic epithelial tumors （TETs） for improving the diagnostic accuracy of CT. Methods： The plain and enhanced CT findings of 66 pa tients with TETs confirmed by pathology （needle biopsy/surgery and pathology） with WHO classification and histo-immunohistochemistry were retrospectively analyzed. The CT findings were correlated with pathology subtypes. Results：Of the 66 patients with TETs,there were 39 men and 27 women; the age ranged from 6 - 77y. The WHO pathology subtypes were： Type A （n=5,7.6%） ;Type AB （n= 15,22.7%） ;Type B1 （n=13,19.7%） ;Type B2 （n=10,15.2%）;Type B3 （n=10, 15.2 % ） ;and thymic carcinoma （n= 13,19.7 % ）. The shape of Type A, Type AB and Type B1 tumors were mostly round or oval,whereas 80.0% of Type B3 tumors and 92.3% of thymic carcinomas were irregular in shape. There was a moderate enhancement after contrast injection in most of the thymomas （92.4 % ）. Capsule destruction or invasion to the adjacent tissue occurred in 80.0% of Type B3 thymomas and 100% of thymic carcinomas,respectively. Pleural and/or pericardial effu sion occurred in 40.0% of Type B3 thymomas and 61.5% of thymic carcinomas, respectively. As the upgrading of malig- nancy degree of pathology, the incidence of adjacent structures invasion increased, which was： 15.4 % （Type B1）, 40.0 % （Type B2）,80.0% （Type B3） and 100% （thymic carcinomas）, respectively. There was a significant correlation between WHO pathology subtypes of TETs and the risk of aggressiveness graded by CT （rs= O. 736, P〈0.01）. Conclusion：Diffe rent WHO pathology subtypes of TET had their CT characteristics varied. CT features of TETs might reflect their pathology subtypes and aggressiveness.