CAJ | 학술논문

目的：探讨胸腺上皮性肿瘤（TETs）的 WHO病理分型与CT表现的相关性，以提高其CT 诊断及临床诊疗水平。方法：回顾性分析经穿刺活检或手术病理证实的66例TETs患者的CT影像学表现。所有患者均行胸部CT平扫及增强扫描，均经组织病理学及细胞免疫组化检查并进行 WHO 组织病理分型，分析TETs 各种组织学类型的CT特征。结果：66例TETs中男39例，女27例，年龄6～77岁。病理分型：A 型5例（7．6％），AB 型15例（22．7％），B1型13例（19．7％），B2型10例（15．2％），B3型10例（15．2％）及胸腺癌13例（19．7％）。A、AB、B1型胸腺瘤均呈圆形或类圆形，而80．0％的B3型胸腺瘤及92．3％的胸腺癌呈不规则形；大部分（92．4％）胸腺肿瘤呈中度强化。80．0％ B3型胸腺瘤及100％胸腺癌有包膜破坏并侵犯邻近结构；40．0％的B3型胸腺瘤及61．5％的胸腺癌出现心包和（或）胸膜腔积液；随着肿瘤病理分级的增加，周围结构受侵的发生率亦随之升高，分别为15．4％（B1）、40．0％（B2）、80．0％（B3）及100％（胸腺癌）。TETs组织学分类与侵袭危险度 CT 分级之间存在显著相关性（rs＝0．736，P＜0．01）。结论：不同 WHO 病理分型的TETs的CT表现具有一定特征性，TETs的CT特征反映了其侵袭危险性及组织病理学分型。
목적：탐토흉선상피성종류（TETs）적 WHO병리분형여CT표현적상관성，이제고기CT 진단급림상진료수평。방법：회고성분석경천자활검혹수술병리증실적66례TETs환자적CT영상학표현。소유환자균행흉부CT평소급증강소묘，균경조직병이학급세포면역조화검사병진행 WHO 조직병리분형，분석TETs 각충조직학류형적CT특정。결과：66례TETs중남39례，녀27례，년령6～77세。병리분형：A 형5례（7．6％），AB 형15례（22．7％），B1형13례（19．7％），B2형10례（15．2％），B3형10례（15．2％）급흉선암13례（19．7％）。A、AB、B1형흉선류균정원형혹류원형，이80．0％적B3형흉선류급92．3％적흉선암정불규칙형；대부분（92．4％）흉선종류정중도강화。80．0％ B3형흉선류급100％흉선암유포막파배병침범린근결구；40．0％적B3형흉선류급61．5％적흉선암출현심포화（혹）흉막강적액；수착종류병리분급적증가，주위결구수침적발생솔역수지승고，분별위15．4％（B1）、40．0％（B2）、80．0％（B3）급100％（흉선암）。TETs조직학분류여침습위험도 CT 분급지간존재현저상관성（rs＝0．736，P＜0．01）。결론：불동 WHO 병리분형적TETs적CT표현구유일정특정성，TETs적CT특정반영료기침습위험성급조직병이학분형。
Objective:To study the relationship between WHO pathology subtypes and CT features of thymic epithe-lial tumors (TETs)for improving the diagnostic accuracy of CT.Methods:The plain and enhanced CT findings of 66 pa-tients with TETs confirmed by pathology (needle biopsy/surgery and pathology)with WHO classification and histo-immu-nohistochemistry were retrospectively analyzed.The CT findings were correlated with pathology subtypes.Results:Of the 66 patients with TETs,there were 39 men and 27 women;the age ranged from 6~77y.The WHO pathology subtypes were:Type A (n= 5,7.6%);Type AB (n= 15,22.7%);Type B1 (n= 13,19.7%);Type B2 (n= 10,15.2%);Type B3 (n= 10, 15.2%);and thymic carcinoma (n= 13,19.7%).The shape of Type A,Type AB and Type B1 tumors were mostly round or oval,whereas 80.0% of Type B3 tumors and 92.3% of thymic carcinomas were irregular in shape.There was a moderate enhancement after contrast injection in most of the thymomas (92.4%).Capsule destruction or invasion to the adjacent tis-sue occurred in 80.0% of Type B3 thymomas and 100% of thymic carcinomas,respectively.Pleural and/or pericardial effu-sion occurred in 40.0% of Type B3 thymomas and 61.5% of thymic carcinomas,respectively.As the upgrading of malig-nancy degree of pathology,the incidence of adjacent structures invasion increased,which was:15.4% (Type B1),40.0%(Type B2),80.0% (Type B3)and 100% (thymic carcinomas),respectively.There was a significant correlation between WHO pathology subtypes of TETs and the risk of aggressiveness graded by CT (rs= 0.736,P<0.01).Conclusion:Diffe-rent WHO pathology subtypes of TET had their CT characteristics varied.CT features of TETs might reflect their patholo-gy subtypes and aggressiveness.