胸腺瘤合并重症肌无力的临床病理分析及手术治疗

目的探讨胸腺瘤最新WHO病理分型与重症肌无力(myasthenia gravis,MG)发生率的关系以及手术方式对预后的影响。方法回顾分析2001年10月—2010年7月42例胸腺瘤合并MG行胸腺切除术患者的临床资料,应用胸腺瘤的最新WHO分型标准及传统方法对胸腺瘤进行分类,采用胸骨正中切口24例,前胸切口13例,后外侧切口5例,观察MG发生率及手术预后。结果 (1)WHO病理分型A型+AB型良性病例较多,B型恶性病例较多,体现出A型及AB型胸腺瘤良性的特点。(2)B3型较A型及AB型易合并MG。B3型胸腺瘤合并MG的手术危象发生率比A型+AB型组、B1+B2型组高,(3)全组死亡7例,其余均缓解或治愈。胸腺瘤病理分期和手术方式为影响预后的主要因素。结论胸腺瘤最新WHO病理分型对于区别良、恶性肿瘤及预后有指导意义,结合Masaoka病理分期对提示术后MG危象有一定的应用价值。治疗原则应尽可能广泛切除肿瘤,术后根据具体情况辅以放疗、化疗。手术方式、病理分期对预后影响较大。     

胸腺瘤组织学分型与重症肌无力及临床分期关系

目的探讨胸腺瘤最新WHO病理分型与重症肌无力(MG)及临床分期之间的关系。方法回顾分析1980-2004年间74例因胸腺瘤行胸腺切除的患者,运用最新WHO分型标准(1999)对胸腺瘤进行重新分类,并运用统计软件对新的WHO组织学分型与MG的发生率及Masaoka临床分期之间的关系做进一步分析。结果(1)胸腺瘤A型2例,AB型23例,B1型4例,B2型27例,B3型16例,C型2例。其中B2型较AB、B1及B3型易合并MG(P<0.05),A型两例均合并MG,而C型则均未合并MG。(2)临床I期:1例,Ⅱ期:30例,Ⅲ期:38例,Ⅳ期:5例。新的WHO组织学分型与Masaoka分期之间关系密切(P<0.01)。结论新WHO组织学分型与胸腺瘤合并MG的发生率之间有一定关系,同时能反映其临床分期及评价患者的预后。     

胸腺瘤组织学分型与重症肌无力及临床分期关系(英文)

目的探讨胸腺瘤最新 WHO 病理分型与重症肌无力(MG)及临床分期之间的关系。方法回顾分析1980～2004年间74例因胸腺瘤行胸腺切除的患者,运用最新 WHO 分型标准(1999)对胸腺瘤进行重新分类,并运用统计软件对新的 WHO 组织学分型与 MG 的发生率及 Masaoka 临床分期之间的关系做进一步分析。结果 (1)胸腺瘤 A 型2例,AB 型23例,B1型4例,B2型27例,B3型16例,C 型2例。其中 B2型较 AB、B1及 B3型易合并 MG(P<0.05),A 型两例均合并 MG,而 C 型则均未合并 MG。(2)临床Ⅰ期:1例,Ⅱ期:30例,Ⅲ期:38例,Ⅳ期:5例。新的 WHO 组织学分型与 Masaoka 分期之间关系密切(P<0.01)。结论新 WHO 组织学分型与胸腺瘤合并 MG 的发生率之间有一定关系,同时能反映其临床分期及评价患者的预后。     

胸腺瘤组织学分型与重症肌无力及临床分期关系

目的:探讨胸腺瘤最新WHO病理分型与重症肌无力(MG)及临床分期之间的关系。方法:回顾分析1980~2004年间 74例因胸腺瘤行胸腺切除的患者,运用最新WHO分型标准 (1999)对胸腺瘤进行重新分类,并运用统计软件对新的WHO组织学分型与MG的发生率及Masaoka临床分期之间的关系做进一步分析。结果:①胸腺瘤A型 2例,AB型 23例,B1型 4例,B2型 27例,B3型 16例,C型 2例。其中B2型较AB、B1及B3型易合并MG(P<0. 05),A型两例均合并MG,而C型则均未合并MG。②临床Ⅰ期: 1例,Ⅱ期: 30例,Ⅲ期: 38例,Ⅳ期: 5例。新的WHO组织学分型与Masaoka分期之间关系密切(P<0. 01)。结论:新WHO组织学分型与胸腺瘤合并MG的发生率之间有一定关系,同时能反映其临床分期及评价患者的预后。     

恶性胸腺瘤的外科治疗

恶性胸腺瘤多无特殊临床表现。传统的病理诊断对胸腺瘤良、恶性鉴别帮助不大，而术中检查肿瘤包膜是否完整是否向周围组织、器官侵犯可良恶性判断提供重要依据。恶性胸腺瘤均予术后放疗以提高生存率。本组２８例恶性胸腺癌外科治疗经验，其中７例合并重症肌无力，占２５％。术后５年，１０年生存率分别为６３．２％和４０％，生存率和分期相关，我们认为Ｍａｓａｏｋａ分期法是一种实实用的分期法，其分期情况对指导术后治疗和判断予     

恶性胸腺瘤的外科治疗

胸腺瘤是较常见的成人前纵隔肿瘤之一,其中恶性胸腺瘤约占前纵隔肿瘤的10%。目前临床上主要采用WHO胸腺肿瘤组织学分型及Masaoka-koga分期。手术是目前公认的恶性胸腺瘤主要治疗方式。作者就多年的临床经验,对恶性胸腺瘤的临床表现、分期分型、影像学检查尤其是外科手术治疗方面进行了论述。     

胸腺瘤中Ⅳ型胶原分布的研究

采用Ⅳ型胶原抗体用ＬＳＡＢ免疫组化的方法对１８例胸腺瘤内Ⅳ型胶原阳性物质的分布进行观察研究。结果显示：皮质型胸腺瘤内Ⅳ型胶原阳性物质仅存在于间质、血管和血管周围间隙部位，肿瘤实质内则很少或无；而在髓质型胸腺瘤，肿瘤实质内可见弥散的Ⅳ型胶原阳性纤维存在，且纤维网络在几个或一团肿瘤细胞周围；在混合型胸腺瘤，上述两种类型均可出现。建议，此染色对胸腺瘤组织学分型及判断胸腺瘤的恶性程度方面均有一定意义。     

子宫平滑肌肿瘤细胞增殖活性的研究

子宫平滑肌肿瘤 (ｕｓＭＴ)包括良性的普通子宫平滑肌瘤(ＬＭ)、恶性的子宫平滑肌肉瘤 (ＬＭＳ)和介于二者之间的交界性子宫平滑肌瘤 (ＢＬＭ)。ＢＬＭ又可分为富于细胞型平滑肌瘤(ＣＬ)、奇异型平滑肌瘤 (ＢＬ)、核分裂活跃型平滑肌瘤(ＭＡＬ)、恶性潜能未定型平滑肌瘤 (ＵＭＰ )和不典型平滑肌瘤(ＡＬ)等 5种亚型。为探讨ｕｓＭＴ的细胞增殖活性 ,我们对 93例ｕｓＭＴ的增殖细胞核抗原 (ＰＣＮＡ)和银染核仁组织区(ＡｇＮＯＲ)进行了研究。一、材料与方法回顾性分析我院 1983～ 1999年手术切除后经病理诊断的 93例ｕｓＭＴ标本。其中ＬＭ …     

PCNA表达与胸腺瘤病理分型及临床分期的相关性分析

目的：研究胸腺瘤中的增殖细胞核抗原（ＰＣＮＡ）表达（增殖指数,ＰＩ）与病理分型和临床分期的相关性。方法：对５１例胸腺瘤采用免疫组织化学方法检测ＰＣＮＡ表达,并与Ｍａｓａｏｋａ’ｓ临床分期及Ｍ－Ｍ病理组织学分型结果作相关性分析。结果：Ａ组（非侵袭性胸腺瘤）２３例;Ｂ组（侵袭性胸腺病）２１例;Ｃ组（胸腺癌）７例,ＰＣＮＡ表达阳性大多为上皮样分化的瘤细胞。临床Ｉ期２５例：Ⅱ期１０例;Ⅲ期９例;Ⅳ期７例。     

82例胸腺瘤新组织学分型与患者临床特征和预后的相关性分析

背景与目的:世界卫生组织(WHO)于1999年制定了新的胸腺瘤组织学分型标准。本研究探讨胸腺瘤WHO组织学分型与临床特征和预后的相关性。方法:回顾性分析82例经外科治疗的胸腺瘤患者的临床资料,经有经验的病理科医生按WHO组织学分型标准重新做出诊断,并结合患者的临床特征和预后进行分析。结果:胸腺瘤A型5例(6.1%),AB型21例(25.6%),B1型14例(17.1%),B2型12例(14.6%),B3型14例(17.1%),C型16例(19.5%)。根据Masaoka临床分期,Ⅰ期29例(35.4%),Ⅱ期13例(15.8%),Ⅲ期32例(39.0%),Ⅳa期8例(9.8%)。临床分期与组织学分型的相关性有显著性意义(χ2=47.29,P<0.001)。肿瘤外侵的程度与组织学分型的相关性也有显著性意义(χ2=30.78,P<0.001)。A﹑AB﹑B1和B2型胸腺瘤合计切除率较B3和C型胸腺瘤合计切除率高(84.6%vs.50.0%,χ2=11.29,P=0.002)。临床Ⅰ、Ⅱ、Ⅲ、Ⅳa期胸腺瘤切除术后5年生存率分别为100%、100%、69.5%和37.5%;10年生存率分别为88.1%、57.1%、47.5%和0。不同临床分期患者生存率的差异(log-rank=40.31,P<0.001)与组织学分型间生存率的差异(log-rank=16.0,P=0.007)均有统计学意义。结论:WHO组织学分型可在一定程度上反映胸腺瘤的生物学行为和临床特征,对临床诊断和治疗胸腺瘤有指导意义。     

胸腺瘤临床病理的预后因素研究

目的 探讨胸腺瘤临床病理特点与预后的关系。方法 对130例胸腺瘤的重症肌无力、肿瘤大小、坏死、核分裂及包膜情况、组织学分型（按照L－B分类及M－H分类）、Massaoka临床分期等诸多因素进行分析,观察其5,10年生存率的差别,所得数据进行统计学U检验及χ^2检验。结果 重症肌无力的有无、肿瘤大小、坏死、核分裂及L－B分类均与预后无关（P＞0．05）;而肿瘤有无包膜、M－H分类及临床分期与生存率有明显相关性。有包膜者5,10年生存率分别为100％和93．1％,无包膜者分别为54．4%和40．0％（P＜0．05）。按M－H分类,髓质型5,10年生存生存率分别为100％和79．8％,混合型分别为97．5％和88．4％,皮质为主型分别为83．3％和50．1％,皮质型分别为60．2％和29．9％,分化好的胸腺癌（WDTC）分别为43．4％和0％（P＜0．05）。临床分期中Ⅰ期5,10年生存率分别为100％和93．2％,Ⅱ期分别为84．6％和78．4％,Ⅲ期分别为45．3％和19．8％,Ⅳ期分别为38．0％和0（P＜0．01）。其中以细胞的异型性及有无侵犯胸腺周围器官对预后尤为重要。结论 L－B分类与预后无关;M－H分类、临床分期与预后有关,尤其是瘤细胞呈多角形和大圆形、临床侵犯胸腺外器官者对预后影响较明显。     

胸腺癌患者临床病理特点和预后

目的 分析胸腺癌患者的临床病理特点,探讨影响预后的因素。方法 整理54例胸腺癌患者的临床资料和生存资料,按Masaoka标准分期。其中根治切除18例(其中类癌9例),姑息切除17例,探查10例。运用寿命表法计算累积生存率,采用Log rank检验和Cox多因素分析模型进行回顾性预后研究。结果 全组术后5年生存率为44．4％。肿瘤位于前纵隔和无钙化是其特点,在鉴别诊断中起重要作用。肿瘤大小、病理类型、手术方式、是否外侵和术后复发是影响预后的重要因素。类癌与其他胸腺癌相比,病变较早,切除率较高,预后较好。结论 肿瘤大小、病理类型、手术方式、是否外侵和术后复发是影响胸腺癌预后的主要因素,分期指标的选择应参照该结果。胸腺癌的治疗应首先考虑完整切除,并根据病理类型辅以放化疗。     

Trends in Incidence and Survival of Patients With Thymic Epithelial Tumor in a High-Incidence Asian Country: Analysis of the Korean Central Cancer Registry 1999 to 2017

IntroductionTo report the trends in incidence and survival associated with thymic epithelial tumors (TETs) in Korea.MethodsData from 1999 to 2017 were obtained from the Korean Central Cancer Registry. Age-standardized incidence rates and average annual percentage changes (AAPCs) were calculated. Net survival (NS) was estimated by the Pohar-Perme method.ResultsAmong 5812 patients diagnosed with having TETs, 58.9%, 38.1%, and 3.0% were diagnosed with having thymoma, thymic carcinoma, and thymic neuroendocrine tumor (NET), respectively. Age-standardized incidence rates were 0.50, 0.30, 0.18, and 0.02 per 100,000 for all TETs and the respective subtypes. There was an increase in incidence of all TETs (AAPC = 6.1%) and subtypes: thymoma (AAPC = 5.6%), thymic carcinoma (AAPC = 7.0%), and thymic NET (AAPC = 3.4%). Proportions of patients with thymoma, thymic carcinoma, and thymic NET were 58.9%, 38.1%, and 3.0%, respectively. For thymoma, the relative proportion of distant stage decreased (19.4% in 2005 to 8.8% in 2017) and low-grade WHO subtype (A, AB, B1) increased faster than high-grade WHO type (B2, B3) (AAPC = 19.8% versus 9.6%). For thymoma, the 5-year NS was 82.3%. This increased from 64.3% in 1999 to 2002 to 90.6% in 2013 to 2017. For thymic carcinoma, the 5-year NS was 46.2% and only slightly increased from 39.4% in 1999 to 2002 to 47.9% in 2013 to 2017.ConclusionsThis study indicates a high incidence of TET and its continuous increase in Korea. The proportion of thymic carcinoma was relatively higher than in the United States or Europe. Survival for thymoma improved during the study period, whereas this was not evident for thymic carcinoma or thymic NET.     

Enhanced expression of telomerase activity in thymoma and thymic carcinoma tissues: a clinicopathologic study

BACKGROUND: Telomerase is a nucleoprotein complex that caps the physical termini of all eukaryotic chromosomes. Because most malignant cells and reproductive cells have telomerase activity, which elongates telomeric DNA, telomerase may play important roles in unlimited cell division acquisition of the malignant phenotype. The current study examined the relation of telomerase activity in thymoma and thymic carcinoma with the clinicopathologic features of these lesions. METHODS: Tissue specimens were surgically resected from patients with thymoma and thymic carcinoma. Telomerase activity was evaluated according to a modified telomeric repeat amplification protocol assay. Paraffin sections of tumor were immunostained by MIC2 antibody, a marker of immature T cells. RESULTS: Telomerase activity was detected in all thymic epithelial tumors. The activity (mean +/- SD; unit per microg protein) in thymoma (n = 17) was significantly higher than that in thymic carcinoma (n = 7) (431.8 +/- 400.1 vs. 68.8 +/- 39.8; P < 0.01). Telomerase activities in thymoma and thymic carcinoma were significantly higher than that in primary lung adenocarcinoma (33.5 +/- 39.2, n = 47), studied as a control (P < 0.01). In patients with thymoma, telomerase activity did not correlate with tumor stage according to Masaoka classification (P = 0.776). In patients with thymic carcinoma, however, telomerase activity positively correlated with tumor stage (P = 0.02). In thymoma, telomerase activity positively correlated with the ratio of induced lymphocytes according to Rosai's classification (P = 0.045). MIC2-positive lymphocytes were identified in all cases of thymoma (n = 12). In contrast, lymphocytes infiltrating thymic carcinoma did not react with MIC2. CONCLUSIONS: In thymoma, telomerase activity reflects the presence of immature T-cell lymphocytes in tumor tissue rather than tumor stage or malignant phenotype. In thymic carcinoma, telomerase activity derived directly from cancer cells may relate to tumor stage.     

The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients

BACKGROUND: Although the histologic classification of thymic epithelial tumors has been confusing and controversial, an agreement on the universal classification system for thymic epithelial tumors was achieved by the World Health Organization (WHO) in 1999. The authors previously reported that the WHO histologic classification system reflects invasiveness and immunologic function of thymic epithelial tumors. In this subsequent study, they examined the prognostic significance of this classification system. METHODS: Clinical features as well as postoperative survival of patients with thymoma, but not thymic carcinoma, were examined with reference to WHO histologic classification based on an experience with 273 patients over a 44-year period. RESULTS: There were 18 type A tumors, 77 type AB tumors, 55 type B1 tumors, 97 type B2 tumors, and 26 type B3 tumors. In patients with type A, AB, B1, B2, and B3 tumors, the respective proportions of invasive tumor were 11.1%, 41.6%, 47.3%, 69.1%, and 84.6%; the respective proportions of tumors with involvement of the great vessels were 0%, 3.9%, 7.3%, 17.5%, and 19.2%; and the respective 20-year survival rates were 100%, 87%, 91%, 59%, and 36%. According to the Masaoka staging system, the 20-year survival rates were 89%, 91%, 49%, 0%, and 0% in patients with Stage I, II, III, IVa, and IVb disease, respectively. By multivariate analysis, the Masaoka staging system and the WHO histologic classification system were significant independent prognostic factors, whereas age, gender, association with myasthenia gravis, completeness of resection, or involvement of the great vessels were not significant independent prognostic factors. CONCLUSIONS: This study showed that histologic appearance reflects the oncologic behavior of thymoma when the WHO classification system is adopted. The WHO classification system may be helpful in clinical practice for the assessment and treatment of patients with thymoma.     

Treatment Outcome and Prognostic Factors of Malignant Thymoma - A Single Institution Experience

Objective: Our objectives are to investigate the clinicopathological features, treatment modalities, and prognostic and prognostic factors in order to estimate long-term outcomes for patients with thymoma and thymic carcinoma at our institution. Methods: We reviewed all patients diagnosed with thymic malignancies malignancies over a period of 38 years (from 1976 to 2014). Patients were identified using a single institution database at King Faisal Specialist Hospital and Research Center (KFSH and RC), Riyadh. Demographic data, clinical staging, histopathology classification, treatment approaches, and survival data were collected. Data Analysis was performed using both the Kaplan–Meier method and Cox proportional hazards modeling. Results: The fifty-six identified patients consists of 30 females (53.6%) and 26 males (46.4%). The median age at diagnosis was 39 years. About 37% of the patients were diagnosed with myasthenia gravis (MG). There was a significant association between the WHO histologic classification and the Masaoka stage (p= 0.018). The estimated 5-year overall survival rate was 88.6% for patients with thymic malignancies. The median survival time of thymoma and thymic carcinoma was 61 and 14 months, respectively. The univariate analysis suggested that histology (thymoma versus thymic carcinoma, p= 0.044) and Masaoka stage (II-III versus IV, p= 0.048) were independent prognostic factors affecting overall survival. Histology (p = 0.044) was found to be an independent predictor of overall survival. Conclusion: The findings of this study indicates that late Masaoka-Koga staging and histology types are significantly associated with extended overall survival. Similarly, surgical resection and multimodality treatments play a significant role in thymic malignancies neoplasms therapy strategies to prolong survival rates.     

常规检查淋巴结阴性胃癌的淋巴结微转移研究

目的 研究常规病理检查无淋巴结转移的胃癌之淋巴结转移的特点,分析微转移与各种临床病理因素及预后的关系。方法 选用抗低分子量细胞角蛋白抗体ＡＥ１,运用免疫组化方法,检测１０５例常规病理检查无淋巴结转移的胃癌根治根本的胃周淋巴结１２４５个,并进行统计处理。结果 ３１例（２９．５％）胃癌的８１个淋巴结（６．５％）出现微转移。弥漫型胃癌的淋巴结微转移阳性率（４１．５％,２２／５３）明显高于肠型胃癌（１７．     

Multimodality treatment program in invasive thymic epithelial tumor

Little is known regarding malignant thymoma and thymic carcinoma optimal therapy, and a multimodality approach could therefore be proposed in an attempt to improve the survival of patients. We report our experience with 8 cases of malignant thymoma or thymic carcinoma. These patients took part in a multimodality treatment program including neoadjuvant chemotherapy, surgery, and postoperative radiotherapy in our center between December 1995 and June 2001. The induction chemotherapy consisted of 4 courses of the CAP regimen (cyclophosphamide 600 mg/m2 day 1, doxorubicin 50 mg/m2 day 1, and cisplatin 80 mg/m2 day 2), every 3 weeks. Patients underwent surgical resection after complete hematological recovery pending sufficient tumor response with a postchemotherapy resectable status. Adjuvant radiotherapy up to 60 Gy in 30 fractions was attempted postsurgically or after best chemotherapeutic response in nonsurgical patients. Among the 8 patients, 3 had a thymic carcinoma and 5 a malignant thymoma; 5 had a stage IV and 3 a stage III disease (Masaoka). Six patients partially responded to the chemotherapy regimen. Three patients were operated upon, and complete resection was performed in 2 cases. Finally, 4 patients achieved the planned radiotherapy. Four patients are still alive without evidence of tumor activity (23-77 months from the diagnosis) and 1 patient is alive with relapse at 56 months. The low compliance with the program led us to an early discontinuation. The high proportion of thymic carcinoma and advanced disease in our limited series might be an explanation for this unsatisfactory result. Optimal multimodality treatment of epithelial thymic tumor remains to be defined in multicenter trials.     

胸腺瘤166例临床分析

目的 对166例胸腺瘤进行临床分析,以探讨不同分期胸腺瘤手术的特点及与预后的关系。方法 分析1985年2月－2000年2月收治的166例胸腺瘤患者。按Masaoka分期法进行分期,I期102例（61．4％）,Ⅱ期28例（16．9％）,Ⅲ期24例（14．5％）,Ⅳa期12例（7．2％）。对166例患者进行随访,分析不同分期胸腺瘤与生存率之间的关系。用寿命表法统计生存率。结果 手术后死亡1例（0．6％）,完整切除137例（82．5％）。随访所有患者,逐年失访30例。10年生存率为56．8％,其中I期为79．8％,Ⅱ期为51．6％,Ⅲ期为33．5％,Ⅳ期为0。结论 胸腺瘤诊断仍需依靠临床与病理结合判断,治疗原则应尽可能广泛切除肿瘤,以达到缓解症状、延长生存时间的目的。其预后与分期相关。