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目的探讨伴有淋巴样间质的微结节型胸腺瘤(MNT)的临床病理学特点。方法对4例伴有淋巴样间质的微结节型胸腺瘤进行组织学观察和免疫组化染色,观察其临床影像学特点,并复习相关文献。结果 4例中,男女各2例,发病年龄52~69岁,平均61岁。CT均提示纵隔内胸腺区不规则软组织密度影,密度较均匀。肉眼观察:肿物最大径2~6 cm,切面实性,灰白、灰黄色,质地中等。镜下见肿瘤大部分包膜完整,境界清楚,只有1例一小处似有包膜侵犯;高倍镜下显示上皮样肿瘤细胞呈结节状分布,结节呈多发性散在或局部融合,细胞形态温和,呈短梭形或卵圆形,胞质粉染,细胞核卵圆形,核仁不明显,未见明显核异型及核分裂象。间质内可见丰富的淋巴细胞,部分区域可见初级淋巴滤泡或伴有生发中心的次级淋巴滤泡。免疫组化:结节内肿瘤细胞CK5/6、CK19、CD57和p63均(+),EMA(-);上皮细胞巢内可见个别CD3、Td T阳性的T淋巴细胞;淋巴间质内淋巴滤泡主要为CD20阳性的B淋巴细胞,CD3和CD5阳性的T淋巴细胞分布在淋巴滤泡间区,非生发中心区域尤其是套区bcl-2(+);Ki-67增殖指数在上皮性结节中低表达,在未成熟的淋巴细胞中高表达;并发现langerhans细胞标记物CD1α和Langerin在上皮细胞巢内散在星状分布。结论 MNT非常罕见,肿瘤细胞p63和CK5/6弥漫(+),推测MNT可能来源于胸腺髓质上皮细胞;另外本文主要强调MNT中langerhans细胞的增生及其特有的组织病理学特征,从而更好、更全面地了解这种罕见的肿瘤。
Objective To investigate the clinicopathological features of MNT associated with lymphoid stroma. Methods Four cases of lymph node-bearing microtome thyroid adenoma were observed by histology and immunohistochemistry, and their clinical imaging features were observed. The related literatures were reviewed. Results In 4 cases, there were 2 males and 2 females, the age of onset was 52-69 years old, with an average of 61 years. CT were prompted irregular mediastinal thymus soft tissue density, density more uniform. Macroscopic observation: the maximum diameter of tumor 2 ~ 6 cm, section solid, gray, gray, medium texture. Microscopically, most of the tumors showed complete envelopment and clear state with only a small encroachment on the surface of the tumor. High-power microscope showed epithelioid tumor cells showing nodular distribution with multiple scattered or local nodules, Morphology was mild, was short spindle or oval, cytoplasm pink, nucleus oval, nucleoli are not obvious, no obvious nuclear atypia and mitotic. Interstitial rich in visible lymphocytes, some areas can be seen in primary lymphoid follicles or secondary lymphoid follicles with germinal center. Immunohistochemistry: Tumor cells CK5 / 6, CK19, CD57, and p63 (+) and EMA (-) in the nodules were seen in the nests. Some CD3 and Td T positive T lymphocytes were seen in the nests of epithelial cells. The main vacuoles were CD20-positive B lymphocytes. CD3 and CD5-positive T lymphocytes were distributed in the lymphoid follicular area, especially in the non-germinal center area, especially in the bcl-2 (+) zone. Ki- Low expression in mid-section and high expression in immature lymphocytes, and found that langerhans cell markers CD1α and Langerin scattered in the epithelial cell nests within the star-shaped distribution. Conclusions MNT is very rare, and diffuse (+) cells of p63 and CK5 / 6 in tumor cells suggest that MNT may originate from thymus medulla epithelial cells. In addition, this article mainly emphasizes the proliferation of langerhans cells in MNT and its unique histopathological features, , A more complete understanding of this rare tumor.