胸腺上皮肿瘤WHO组织学分型与CT征象相关性分析
天津医科大学附属肿瘤医院 叶兆祥
[摘要] 目的 探讨胸腺上皮肿瘤的最新WHO组织学分型(2004)与各种CT征象的相关性。方法 回顾复习63例经手术病理证实为胸腺上皮肿瘤并且术前行CT检查的病例，所有的病例按照2004年的WHO组织学分型进行重新分型，复习CT图像，最后将观测的CT征象与简化的组织学分型组(低危组胸腺瘤，高危组胸腺瘤，胸腺癌组)进行对照。结果 本研究包括低危组胸腺瘤35例，高危组胸腺瘤16例，胸腺癌组12例，在CT图像上，胸腺癌组更多见不规则轮廓、边缘毛糙/不清、纵隔脂肪层浑浊/消失、淋趋承肿大、胸膜侵犯、其它脏器侵犯和远处转移这些征象，低危和高危组胸腺瘤更多见光滑边缘、分叶和类圆形轮廓、清晰的纵隔脂肪层(P<0.05)。结论 尽管各种CT征象在各组之间存在一定的重叠，不规则轮廓、边缘毛糙/不清、纵隔脂肪层浑浊/消失、淋趋承肿大、胸膜侵犯、其它脏器侵犯和远处转移这些征象的出现应当提示胸腺癌的诊断，而边缘光滑、分叶和类圆形轮廓、纵隔脂肪层清晰则提示低危组和高危组胸腺瘤的诊断，CT在鉴别低危组和高危组胸腺瘤方面存在一定困难。
Correlations of the WHO Histological Classification of Thymic Epithelial Tumors to Their CT Findings
[Abstract] Objective To explore the correlations of the new WHO histological classification of thymic epithelial tumors to their CT findings. Methods Sixty-three patients with thymic epithelial tumors confirmed by surgery and pathology were retrospectively reviewed. All of them underwent computed tomography before surgery. All of cases were classified according to the 2004 WHO classification.The CT findings were compared with the simplifid subgroups of WHO histologic classification (low-risk thymomas, high-risk thymomas, thymic carcinomas )eventually. Results The study found 35 low-risk thymomas, 16 high-risk thymomas, 12 thymic carcinomas.On CT imaging, thymic carcinomas were more likely to have irregular contours, rough margin or no clear boundary, mediastinal fat invasion, lymph node enlargement, pleural invasion, other tissue invasion, extrathymic metastasis ; smooth margin,lobulated and round/oval shape, clear mediastinal fat plane are more commonly seen in low-risk thymomas and high-risk thymomas (P<0.05). Conclusion Though the CT findings of the thymic epithelial tumors have many degrees of overlap between subgroups of the simplified WHO classification, the presence of irregular contours, rough margin or no clear boundary, mediastinal fat invasion, lymph node enlargement, pleural invasion, other tissue invasion, extrathymic metastasis are suggestive of thymic thymic carcinomas; smooth margin,lobulated and round/oval shape, clear mediastinal fat plane are suggestive of low-risk thymomas or high-risk thymomas. It’s difficult for CT to identify low-risk thymomas and high-risk thymomas.
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