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目的探讨化生性胸腺瘤的临床病理特征、鉴别诊断及预后。方法对2例化生性胸腺瘤进行光镜观察及免疫组化研究,并复习相关文献。结果 2例化生性胸腺瘤均为女性,年龄分别为52岁和46岁。镜下肿瘤显示双相分化特点,上皮细胞与梭形细胞交错分布并相互移行。上皮细胞呈岛状排列并相互吻合,细胞轻度异型,可见核沟和核内假包涵体;梭形细胞形态温和,呈束状排列;两种类型细胞中均偶见核分裂象。免疫组化:上皮细胞AE1/AE3强(+),EMA灶状(+),vimentin和CD20(-),Ki-67为3%～4%;梭形细胞vimentin弥漫(+),EMA和CgA弱(+),CD20(-);间质淋巴细胞CD3(+),TdT(-)。患者均无重症肌无力。术后无复发和转移。结论化生性胸腺瘤是一类罕见的良性或低度恶性的胸腺肿瘤,其独特的组织学特征及免疫组化有助于诊断和鉴别诊断。
Objective To investigate the clinicopathological features, differential diagnosis and prognosis of metaplastic thymoma. Methods Two cases of metaplastic thymoma were observed by light microscopy and immunohistochemistry, and the related literatures were reviewed. Results 2 cases of metaplastic thymoma were female, aged 52 and 46 respectively. Microscopic tumor showed biphasic differentiation, epithelial cells and spindle cells staggered distribution and mutual migration. Epithelial cells were arranged in the island and mutual agreement, mild dysmorphic cells, showing the ditch and nucleus dorsal inclusion bodies; spindle cells in mild, were arranged in bundles; both types of cells are occasionally seen mitosis. The expression of vimentin diffuse (+), EMA and CgA in spindle cells was significantly higher than that in epithelial cells (+), EMA (+), vimentin and CD20 Weak (+), CD20 (-); interstitial lymphocytes CD3 (+), TdT (-). Patients without myasthenia gravis. No recurrence and metastasis after surgery. Conclusions Metaphyseal thymoma is a rare type of benign or malignant thymoma. Its unique histological features and immunohistochemistry contribute to the diagnosis and differential diagnosis.