6例胸腺瘤转移至肺组织的临床病理观察#br# #br#

目的探讨6例胸腺瘤转移至肺组织的临床病理学特征、诊断、治疗和预后。 方法收集本院2009年1月至2017年12月6例胸腺瘤转移至肺组织的临床病理资料，光镜下观察组织形态，结合免疫组化进行鉴别诊断，分析其临床表现、组织形态学特点、免疫组化特征及治疗和预后情况。 结果6例胸腺瘤转移至肺的患者，年龄23～75岁，3例男性、3例女性，以胸闷、咳嗽为主要首发症状，均行手术治疗，包括胸腺肿瘤及肺叶切除。组织学类型为B1及B2型胸腺瘤，肺转移灶的组织学类型也为B1及B2型胸腺瘤。免疫组织化学染色显示CK（上皮细胞+）、CK19（上皮细胞+）、CK5（-）、CD3（淋巴细胞+）、CD20（-）、TdT（淋巴细胞+）、CD99（淋巴细胞+）、EMA（上皮细胞灶+）、CD5淋巴细胞（+）、p53（部分+）、p63（上皮细胞+）、CD117（-）和Ki 67（20％～60％）。术后1例未行辅助治疗，2例仅行放疗，3例行放疗和化疗，6例患者均存活。 结论任何组织学类型的胸腺瘤均有复发和远处转移的可能，需要长期随访，转移灶应该完整手术切除，可以实现长期生存的目的。

Clinical analysis of the setup errors in intensity modulate radiotherapy for tumor colli by cone beam CT

Objective：To investigate the set-up errors in intensity modulated radiotherapy for tumor colli by using cone beam CT scanning technique of linear accelerator airborne.Methods：Ninty-five patients were scanned by cone beam CT before the first radiotherapy and afterward once a week to record the errors of the position of target centre（longitudinal,lateral,vertical）.Results：There were 95 times scanning of CBCT in the first positioning,the average error in three directions was longitudinal 1.025±0.098mm,lateral 1. 102 ±0. 089mm and vertical 1. 075 ± 0. 042mm, respectively. Besides the first setup, there were 570 times scanning of CBCT and the other average error was 1. 040 ± 0. 030mm, 0. 995 ± 0. 057mm and 1. 089 ± 0. 037mm, respectively. Condusion： The daily use of CBCT system can help us not only decrease the random mistakes in positioning, but also detect and correct them. The replacement repeatability is improved by using the equipment in positioning the patients, which reduces the size of irradiation field and toxicity of radiotherapy.