胸腺上皮肿瘤CT表现与WHO病理分型的相关性研究

目的:探讨胸腺上皮肿瘤CT表现与WHO病理分型之间的关系。方法:对105例胸腺上皮肿瘤采用2004年WHO分类法进行病理分型。利用CT资料统计肿瘤大小、形状、钙化、坏死或囊变、包膜完整性、邻近组织侵犯、淋巴结肿大及有无胸水,对不同病理类型胸腺瘤的CT表现进行χ2检验或精确概率法检验,分析其CT表现间的差异性,以P<0.05为差异具有显著性。结果:105例中男性52例,女性53例;年龄18-75岁,平均(47.98±12.54)岁。不同病理类型胸腺肿瘤中大小、形状、坏死或囊变、包膜完整性、邻近组织侵犯、淋巴结肿大及有无胸水差异有显著性(P<0.05)。B2型、B3型及胸腺癌较其它型瘤体大,B3型胸腺瘤及胸腺癌超过50%瘤体大于10cm。A、AB及B1型多为圆形或类圆形,B3型胸腺瘤75%及胸腺癌85%瘤体不规则。B3型胸腺瘤及胸腺癌出现坏死或囊变分别为67%、57%。B3型胸腺瘤83%、胸腺癌100%包膜破坏。随着恶性程度增高瘤周组织侵犯率升高,B2型为33%、B3型为75%、胸腺癌为81%。B3型50%、胸腺癌48%出现胸水。钙化多见于B型胸腺瘤。结论:不同病理类型胸腺上皮肿瘤有不同的CT表现,CT表现能反映胸腺肿瘤病理特点。

Relationship Between CT Manifestations of Thymic Epithelial Tumors and the WHO Pathological Classification

Objective: To explore the relationship between CT manifestations of thymoma and its WHO pathological classification.Methods: One hundred and five histopathologically confirmed cases were collected for their pathological and CT characteristics.CT manifestations between different pathological types of thymoma were statistically compared.Results: Tumor size,shape,necrosis or cystic change,capsule integrity,invasion to the adjacent tissue,lymphadenopathy,and the presence of pleural effusion were significantly different among different pathological types of thymomas(P<0.05).Type B2,B3 tumors and thymic carcinoma were greater in size than other types.More than 50% of type B3 tumors and thymic carcinomas had a tumor size greater than 10 cm.The shape of types A,AB,and B1 tumors were mostly round or oval,whereas 75% of type B3 tumors and 85% of thymic carcinomas were irregular in shape.Necrosis or cystic change occurred in 67% of type B3 thymomas and 57% of thymic carcinomas,respectively.Capsule destruction occurred in 83% of type B3 thymomas and 100% of thymic carcinomas.Increases in the degree of malignancy were associated with increases in the incidence of surrounding tissue invasion as the incidence was 33%,75%,and 81% respectively in type B2,type B3,and thymic carcinomas.Pleural effusion occurred in 48% of thymic carcinomas,while calcification was observed mostly in type B thymomas.Conclusion: Different pathological types of thymic epithelial tumors have different CT manifestations.Distinctive CT features of thymomas may reflect their pathological types.