指突状细胞在胸腺瘤中的分布

采用Ｓ－１００蛋白免疫组化方法对１８例胸腺瘤指突状细胞（ＩＤＣ）的分布、形态和数量进行观察研究，并与胸腺瘤的组织学类型及临床分期相对照。发现：髓质型胸腺瘤多处于早期临床阶段，ＩＤＣ弥散地分布于瘤组织内，数量较多，形态多样。皮质型胸腺瘤多处于晚期临床阶段，ＩＤＣ多分布于血管周围及实质与间质交界处，数量较少。结果提示，ＩＤＣ的多少与胸腺瘤的组织学类型及预后有一定的关联。     

Immunohistochemical detection of bcl-2 protein in thymoma

The protooncogene bcl -2 encodes a protein that inhibits apoptosis. The protein is expressed in most epithelial cells of the fetal thymic medulla but, to the best of our knowledge, no data are available on bcl-2 expression in thymoma. Expression of bcl-2 protein was analysed in 30 cases of thymoma by immunohistological staining of paraffin-embedded tissue. All cases were examined and classified according to the Salyer and Eggleston and the Müller-Hermelink classification. In four cases, the protooncogene bcl -2 was abnormally expressed in spindle cells of pure medullary thymoma, whereas the non-spindle cells in mixed and in cortical thymoma were negative. All the lymphocytes were also strongly positive in medullary thymoma while a few lymphocytes showed light staining in other thymomas.     

Immune mediated agranulocytosis and anemia associated with thymoma

Thymoma has been associated with a variety of autoimmune disorders. We report a case of agranulocytosis and anemia in a 68-year-old woman with a spindle cell thymoma. She was unresponsive to treatment with antibiotics, granulocyte-colony stimulating factor (G-CSF), prednisone, and high-dose intravenous immunoglobulin. Serial bone marrow examinations on this therapy showed progression from a cellular marrow with mild my-eloid and erythroid hyperplasia and lymphocytosis, to granulocyte aplasia and severe erythroid hypoplasia. Her serum contained granulocyte-specific antibodies and inhibited the growth in culture of her own marrow cells and marrow cells from a normal donor. An IgG fraction from her serum also inhibited the growth of marrow cells. Although the patient's spindle cell thymoma was surgically removed, she remained neutropenic. She was treated with six plasma exchanges followed by 1,000 milligrams of intravenous cyclophosphamide 2 days after the final plasma exchange and daily G-CSF. Three weeks later her peripheral blood showed marked leukocytosis with pronounced neutrophilia and a left shift. Although her agranulocytosis resolved, she died of fungal sepsis. This case demonstrates that aggressive plasma exchange and immunosuppressive therapy may benefit patients with agranulocytosis associated with thymoma. © 1995 Wiley-Liss, Inc.     

七例侵犯性胸腺瘤的CT诊断

报告由手术或/和病理证实的7例侵犯性胸腺瘤的CT表现,CT所提供侵犯性胸腺瘤的资料比常规技术敏感,能提示胸腺瘤的良、恶性特征,病变有无侵犯邻近的组织及侵犯的范围。本病的预后与病理类型,有无侵犯或侵犯的范围有关,侵犯性胸腺瘤侵犯纵隔结构的脂肪、胸膜、心包、邻近肺、胸壁、心脏和大血管。并介绍了7例良性胸腺瘤的CT表现,且加以对比。     

Pleural dissemination of thymoma showing tumor regression after combined corticosteroid and tacrolimus therapy

We present the case of an elderly woman with myasthenia gravis who had pleural dissemination of thymoma reduced by treatments with a moderate dose of corticosteroids and a conventional dose of tacrolimus. A maintenance dose of prednisolone for myasthenia gravis could not shrink the size of the disseminated thymoma, but prednisolone (>30 mg daily) succeeded in reducing the size of the tumor. Moreover, a combination with tacrolimus enabled the daily dose of prednisolone to be tapered off without recurrence of myasthenia gravis, and the disseminated thymoma almost disappeared. A moderate or higher dosage of corticosteroids with tacrolimus may, in some cases, be an effective procedure for pleural dissemination of thymoma. Treatment should be undertaken on a trial basis for patients not indicated for surgery, radiotherapy, or chemotherapy.     

Mediastinum thymoma diagnosed by FNA and ThinPrep technique: a case report

Thymoma is a primary tumor of the thymus epithelial cells. It may be asymptomatic or accompanied with atypical clinical symptoms or paraneoplastic syndromes, such as myasthenia gravis. The biological behavior of thymomas is unpredictable. The invasion of the capsule or the adjacent tissues is the major diagnostic criterion for the malignant behavior of these tumors. This is an interesting case of thymoma diagnosed by fine-needle aspiration biopsy (FNA) and ThinPrep technique, in a 54-year-old female patient with a history of gastric adenocarcinoma. Cytology of the mediastinum mass revealed a mixed population of epithelial cells and lymphocytes. The tumor was excised and the histopathological examination supported the cytological diagnosis. Thymomas commonly constitute a problem in differential diagnosis of mediastinum masses. FNA biopsy in correlation with ThinPrep technique and immunocytochemistry may play a significant role in clarifying the nature of these lesions and may contribute to the early management and choice of the optimal therapeutic manipulation.     

Thymoma: current diagnosis and treatment

Objective To review the presentation,diagnosis,staging and treatment of thymoma.Data sources Data were obtained from papers on thymoma published in English within the last 30 years.No formal systematic...     

Interobserver variation in the classification of thymic tumours--a multicentre study using the WHO classification system

Aims:  To test the reproducibility of the current World Health Organization (WHO) classification of thymic epithelial tumours and to determine the level of interobserver variation within a group of pathologists, all with experience and expertise in thoracic pathology.
Methods and results:  Ninety-five thymic tumours were circulated to a group of 17 pathologists in the UK and The Netherlands over a 1-year period. Participants were asked to classify them according to WHO criteria. The diagnoses were subjected to statistical analysis and κ values calculated. The overall level of agreement was moderate (κ 0.45). When the categories were reduced in number by creating two groups, (A + AB + B1 + B2 and B3 + C), the level of agreement increased to 0.62. An alternative grouping (A + AB + B1 and B2 + B3 + C) increased it slightly further. The best agreement was in tumour types A and AB. Difficulties arose in distinguishing B1 tumours from B2 tumours and B2 tumours from B3 tumours.
Conclusions:  Although the WHO system describes a number of well-defined tumour types with clear diagnostic criteria, the overall level of agreement was moderate and improved if some groups were amalgamated.     

Patients with thymomas have an increased risk of developing additional malignancies: lack of immunological surveillance?

Granato F, Ambrosio M R, Spina D, Lazzi S, Rocca B J, Voltolini L, Bongiolatti S, Luzzi L, Gotti G, Leoncini L & Tosi P
(2012) Histopathology 60, 270–277
Patients with thymomas have an increased risk of developing additional malignancies: lack of immunological surveillance? Aims: To assess the risk, for patients with thymoma, of developing an additional malignancy (AM). Methods and results: We studied 68 patients with thymomas. Based on the World Health Organization classification, the tumours were categorised as A, AB or B (B1, B2, B3) thymomas. Control populations comprised 114 patients with colorectal cancer, 108 patients with lymphoma and 123 patients with thyroid carcinoma. Patients with thymomas showed a higher risk of developing an AM (22 of 68 patients versus 11 of 114, eight of 108, and eight of 123 patients, respectively; P = 0.0002). The association between thymomas and AMs was related to the thymoma histotype, with B1, B2, B3 and AB tumours showing a higher risk of developing an AM than A thymomas (P = 0.0474). Conclusions: Patients affected by thymomas showed a significantly higher risk of developing additional malignancies than those in the control groups, and cases that exhibited a predominantly cortical component were more likely to develop other neoplasms. This may be related to the functions of cortical thymic epithelial cells in providing for T lymphocyte maturation through interaction with major histocompatibility complexes.