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目的 研究M櫣ｌｌｅｒ Hermelink组织发生学分类及其临床意义。方法 76例胸腺瘤采用M櫣ｌｌｅｒ Hermelink分类方法进行分类 ,分析胸腺瘤类型与伴发重症肌无力、浸润性及患者预后关系。结果 髓质型和混合型胸腺瘤大多包膜完整 (72 % ) ,仅少数病例 (2 8% )浸润包膜或周围脂肪组织 ;皮质为主型胸腺瘤中度浸润 ;皮质型胸腺瘤和分化良好胸腺癌浸润性较大 ,56 %浸润周围器官 ,2 0 %浸润包膜或周围脂肪组织 ,仅 2 4 %包膜完整 ;其它类型胸腺癌均浸润周围器官、胸腔内或淋巴转移。皮质型胸腺瘤和分化良好胸腺癌较髓质型和混合型更易伴发重症肌无力 (分别为 92 %和 32 % ,P <0 0 5)。髓质型和混合型患者生存期较皮质型胸腺瘤和分化良好胸腺癌明显长 (5年生存率分别为 87 5%和 54 5% ,P <0 0 5)。结论 胸腺瘤类型与肿瘤浸润、伴发重症肌无力和预后明显相关。
Objective To study the histological classification and clinical significance of M櫣ller Hermelink. Methods 76 cases of thymoma were classified using M櫣ller Hermelink classification method. The relationship between thymoma type and myasthenia gravis, invasiveness and prognosis was analyzed. Results Most medulla and mixed thymoma capsules were intact (72%), only a few cases (28%) were infiltrating the envelope or surrounding adipose tissue; cortico-dominant thymoma was moderately infiltrated; cortical thymoma and differentiation Good thymic carcinoma infiltrates, 56% infiltration of the surrounding organs, 20% infiltration of the capsule or surrounding adipose tissue, only 24% of the capsule intact; other types of thymic carcinoma infiltrate the surrounding organs, intrathoracic or lymphatic metastasis. Cortical thymomas and well-differentiated thymic carcinomas were more likely to be associated with myasthenia gravis than medulla and mixed types (92% and 32%, respectively; P < 0.05). The survival time of medulla and mixed patients was significantly longer than that of cortical thymoma and well-differentiated thymus carcinoma (5-year survival rates were 87 5% and 54 5%, respectively, P 0 05). Conclusion The type of thymoma is significantly associated with tumor infiltration, myasthenia gravis, and prognosis.