摘要
目的探讨伴淋巴上皮涎腺炎样特征的胸腺增生临床病理学特征、免疫组化表型及鉴别诊断。方法收集2例LESA样胸腺增生患者的临床病理学资料,通过光镜形态学观察、免疫组织化学染色、原位杂交、Ig基因重排检测,并复习相关文献。结果2例患者中,男性1例,女性1例,发病年龄56和66岁(平均年龄61岁)。肿瘤最大径6 cm、13 cm。镜下:低倍镜下肿瘤呈分叶状结构,叶状结构周围为脂肪组织;具有生发中心的淋巴滤泡增多,滤泡间区可见浆细胞;胸腺上皮细胞增生,可见大量胸腺小体,胸腺上皮呈岛状、巢状,并相互汇合形成梁状结构;囊性变,囊壁内衬胸腺上皮,囊内见均质嗜酸性物及胆固醇裂隙,常伴异物巨细胞反应;淋巴细胞浸润胸腺上皮形成淋巴上皮病变。免疫组织化学CD20、CD79α示B细胞,CD3、CD5示T细胞,CK、CK19显示淋巴上皮病变,原位杂交EBER阴性,未检测到Ig基因发生单克隆重排。结论LESA样胸腺增生类似于涎腺良性淋巴上皮病变,是胸腺增生的一种新病理学形态,镜下主要表现为淋巴样组织浸润和淋巴上皮病变,预后良好,手术切除后,无复发和转移。
Purpose To investigate the clinicopathological features,immunohistochemical phenotype and differential diagnosis of thymic lymphoepithelial sialadenitis(LESA)-like hyperplasia.Methods The clinical and pathological data of 2 patients with thymic LESA-like hyperplasia were collected and examined by light microscopic morphology,immunohistochemical staining,in situ hybridization,immunoglobulin(Ig)gene rearrangement technology and related literatures were reviewed.Results Among the 2 patients,ratio of male to female was 1∶1.The age of onset was 56 and66 years,respectively,with average 61 years.The largest diameter of the tumor was 6-13 cm.Microscopically,the tumor had a lobulated structure,surrounded by adipose tissue;lymphoid follicles with germinal centers increased at low power field;plasma cells were seen in the interfollicular area;thymic epithelial cells proliferated,and a large number of thymic bodies were noted,the thymic epithelium was island-like and nest-like,and merged with each other to form a beam-like structure;cystic changes,the cyst wall is lined with thymic epithelium,and homogeneous eosinophils and cholesterol fissures are seen in the cyst,often accompanied by foreign body giant cell reaction;lymphocytes infiltrated the thymus epithelium to form lymphoid epithelial lesions.Immunohistochemically,CD20 and CD79αwere positive for B cells,CD3 and CD5 were positive for T cells,and CK and CK19 were positive for lymphoepithelial lesions;in situ hybridization showed negative EBER;monoclonal rearrangement of the Ig gene was not detected in two cases.Conclusions Thymic LESA-like hyperplasia is similar to lymphoepithelial sialadenitis.It is a new pathological morphology of thymic hyperplasia.It mainly shows lymphoid tissue infiltration and lymphoepithelial lesions under microscope.The prognosis is good.After surgery,there is no recurrence and metastasis.
作者
张小鹰
梅开勇
王浩
于倩
韩靖
郭明星
余斯曼
ZHANG Xiao-ying;MEI Kai-yong;WANG Hao;YU Qian;HANG Jing;GUO Ming-xing;YU Si-man(Department of Pathology,Panyu Central Hospital,Guangzhou 511400,China;Department of Pathology,the Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510260,China)
出处
《诊断病理学杂志》
2021年第5期362-366,共5页
Chinese Journal of Diagnostic Pathology
基金
广州市番禺区科技局重大医疗项目(2019-Z04-02)。
关键词
淋巴上皮病变
淋巴滤泡
涎腺特征
胸腺增生
胸腺小体
病理学特征
Lymphoepithelial sialadenitis
Lymphoid follicles
Salivary gland features
Thymic hyperplasia
Thymic bodies
Pathological features
