胸腺瘤病理与重症肌无力关系的临床研究

目的进行胸腺瘤分类标准的临床研究,以探讨胸腺瘤最新WHO病理分型与重症肌无力( MG)发生率、 Osserman分型及手术预后的关系.方法回顾分析1974/2000 105例因胸腺瘤行胸腺切除的患者,分别应用胸腺瘤的传统病理分类法、Levine Rosai分类法及最新 WHO分型标准对胸腺瘤分类,并在 MG发生率、Osserman分型及手术预后等方面统计比较.结果 ( 1) A型+ AB型良性例数较多,B型恶性例数较多,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(χ 2 = 3.294 8, P= 0.07), C型 13例均未合并 MG. B3型胸腺瘤合并MG的手术危象发生率比 A型+ AB型、 B1+ B2型高,但统计学上无显著差异.(3)手术危象与 Masaoka分期的良、恶性程度明显相关(χ 2= 4.218 8, P= 0.04) ,主要集中在Osserman改良分型Ⅱ b型及Ⅲ型(χ 2= 13.099 4, P< 0.001).结论胸腺瘤最新WHO病理分型对于区别良恶性肿瘤有指导意义;不同类型的胸腺瘤 MG易患性不同,并且结合Osserman临床分型、 Masaoka病理分期对提示术后危象有一定的应用价值.

Clinical study on the relationship between the pathology of thymoma and myasthenia gravis

Aim To investigate the relationship between the latest WHO criteria of thymic epithelial tumours(TET) and the incidence rates,Osserman classification and the postoperative crisis rates of MG by performing clinical study of classical criteria of thymoma.Methods To analyse the pathological sections of 105 cases with TET from 1974 to 2000 with Levine- Rosai's clinicopathological classification, traditional histological classification and WHO classification respectively,and invetigate their relevance with the incidence rate, Osserman classification and postoperative prognosis of MG.Results ( 1) The cases with benign tumors of type A and type AB were more than those of type B.( 2) Type B3 more likely accompanied MG than type A and type AB(χ 2=3.294 8,P=0.07) ,while none accompanied MG among 13 cses of type C. The postoperative crisis of type B3 with MG was higher than that of the other types, but no evidence was found( P >0.05) .( 3) Postoperative crisis closely correlated with Masaoka clinical stagings(χ 2=4.218 8, P=0.04) and mainly occurred in Osserman typeⅡ b and type Ⅲ(χ 2=13.099 4, P< 0.001) . Conclusion WHO classification is significant for distinguishing benign thymoma from malignant thymoma; the MG susceptibility of different type thymomas is also different; WHO classification is one of the important prognostic factors for postoperative crisis, as well as Masaoka clinical stagings and Osserman classification.