Primary Intrapulmonary Thymoma: A Clinicopathologic and Immunohistochemical Study of Eight Cases
Primary Intrapulmonary Thymoma: A Clinicopathologic and Immunohistochemical Study of Eight Cases
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DOI：
10.1097/00000478-199503000-00008
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发表时间：
1995-03
期刊：
影响因子：
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通讯作者：
C. Moran;S. Suster;N. Fishback;M. Koss
中科院分区：
文献类型：
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作者：
C. Moran;S. Suster;N. Fishback;M. Koss
我们描述了8例原发性肺内胸腺瘤，发生在7名女性和1名男性，年龄在25岁到77岁之间。临床上，所有患者都有肺内实质性肿块的初步放射学发现，无论是放射学还是外科手术，都没有纵隔受累的证据。病变最大直径为0.5~10 cm。5个肿瘤位于肺门附近，另外3个肿瘤位于肺深处和胸膜下。在一个病例中，病变似乎出现在支气管内，并渗透到周围的实质。在另一例中，除了主要的肺门肿块外，在同一肺深处还发现了两个较小的肿瘤结节。组织学上，病变的特征是胸腺瘤典型的双相细胞成分，即不同比例的上皮细胞和淋巴细胞的混合物。4例的特点是淋巴细胞片状混杂着散在的上皮细胞，这些细胞被纤维带分隔成小叶。3例以片状上皮细胞为主，夹杂着散在的小淋巴细胞，并含有明显的血管周围间隙。在其中两个案例中，细胞旋转的焦点区域被注意到。1例以梭形细胞增生为主，伴有血管周围间隙和大量小淋巴细胞。6例角蛋白和上皮膜抗原免疫组织化学染色显示上皮细胞散在淋巴细胞背景下。7例患者接受了手术治疗。在1例患者中，由于广泛的胸膜浸润，肿瘤在探查时被认为是不能手术的，并接受了术后放射治疗；8年后，肿瘤在胸膜局部复发。术后随访3例，分别在术后10个月、2年和8年存活，无疾病迹象。其中两名患者在肿瘤切除前常规胸片发现肺部肿块后，进行了2年和4年的临床随访。2例患者死于无关疾病，其中1例患者手术前临床随访6年，6个月后死于冠状动脉疾病，无复发或转移。我们的发现表明，肺内胸腺瘤是生长缓慢的肿瘤，当局限于肺部时，手术切除可能会有很好的反应。与纵隔肿瘤一样，侵袭性肿瘤需要额外治疗才有可能复发转移。
We describe eight cases of primary intrapulmonary thymoma occurring in seven women and one man between the ages of 25 and 77 years. Clinically, all patients had initial radiographic findings of a parenchymatous intrapulmonary mass without evidence of mediastinal involvement either radiologically or at surgery. The lesions varied from 0.5 to 10 cm in greatest diameter. Five tumors were located close to the hilum, while the other three were discovered deep within the lung and in subpleural locations. In one case, the lesion appeared to arise endobronchially and infiltrate the surrounding parenchyma. In another case, in addition to the main hilar mass, there were two smaller tumor nodules found deep within the same lung. Histologically, the lesions were characterized by the classic biphasic cellular composition of thymomas, i.e., an admixture in varying proportions of epithelial cells and lymphocytes. Four cases were characterized by sheets of lymphocytes admixed with scattered epithelial cells that were separated by fibrous bands into lobules. Three cases were composed predominantly of sheets of epithelial cells admixed with scattered small lymphocytes and containing prominent perivascular spaces. In two of these cases, focal areas of spinding of the cells were noted. One case was composed predominantly of a spindle cell proliferation with perivascular spaces and numerous small lymphocytes. Immunohistochemical stains for keratin and epithelial membrane antigen in six cases highlighted the epithelial cells scattered against the lymphoid cell background. Seven patients were treated by surgery. In one patient the tumor was deemed inoperable at the time of exploration owing to extensive pleural infiltration and was treated by postoperative radiation; the lesion recurred locally in the pleura 8 years later. Clinical follow-up in three patients after-surgical excision showed them to be alive and well without evidence of disease at 10 months, 2 years, and 8 years, respectively. Two of the patients had been followed clinically for 2 and 4 years following discovery of their lung masses on routine chest radiograph before resection of their tumors. Two patients died of unrelated conditions; in one of them, the lesion had been followed clinically for 6 years before surgery; this patient died 6 months later from coronary artery disease, without evidence of recurrence or metastasis. Our findings suggest that intrapulmonary thymomas are slow-growing tumors that may respond well to surgical resection when confined to the lung. As with their mediastinal counterparts, invasive tumors will require additional treatment for the possibility of recurrence of metastasis.