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目的探讨胸腺神经内分泌癌(TNC)的临床病理特征及鉴别诊断。方法报道5例TNC并结合文献从临床特征、影像学、病理学形态、免疫表型等方面进行讨论。结果男3例,女2例,中位年龄46.8岁,术前均有不同程度胸部症状,肿瘤临床分期Ⅱ期3例,Ⅲ期2例。巨检肿瘤呈结节状,平均最大径9.8cm,切面灰白、灰红,可有出血坏死。镜检组织学分级:高分化2例,瘤细胞形态较均一,核分裂象少于10个/10HPF,呈梁索状、器官样排列,有或无点灶状坏死;低分化3例,瘤细胞呈燕麦细胞样弥漫分布。免疫组化:5例CK,NSE,SyN,CgA呈不同程度阳性表达,低分化3例PCNA,Ki-67,p53弥漫阳性。结论TNC好发于中年人,且男性好发,具有复杂的组织学特点,根据肿瘤组织和细胞的异形性分为高、低分化两类;免疫组化有助于其与纵隔其他肿瘤相鉴别;TNC预后与组织学分级、临床分期及术后放疗、化疗密切相关。
Objective To investigate the clinicopathological characteristics and differential diagnosis of thymus neuroendocrine carcinoma (TNC). Methods Five cases of TNC were reported and their clinical characteristics, imaging, pathological morphology and immunophenotype were discussed in the literature. Results There were 3 males and 2 females with a median age of 46.8 years. Thoracic symptoms were found in all cases before operation. There were 3 cases of stage Ⅱ and 2 cases of stage Ⅲ in clinical stage. Giant tumor was nodular, the average maximum diameter of 9.8cm, section gray, red, may have hemorrhagic necrosis. Microscopical histological grading: 2 cases of well-differentiated tumor cells were more homogeneous, mitotic figures less than 10 / 10HPF, was beam-like, organ-like arrangement, with or without focal necrosis; poorly differentiated in 3 cases, tumor cells Oat cell-like diffuse distribution. Immunohistochemistry: 5 cases of CK, NSE, SyN, CgA were positive expression to varying degrees, 3 cases of poorly differentiated PCNA, Ki-67, p53 diffuse positive. Conclusion TNC occurs in middle-aged people, and men are prone to occur, with complex histological features, according to the tumor and cell dysmorphia were divided into high and low differentiation of two groups; immunohistochemistry contribute to its relationship with other mediastinal mediastinal phase Identification; TNC prognosis and histological grade, clinical stage and postoperative radiotherapy and chemotherapy are closely related.