【作者】 杨艳；

【导师】 刘斌；

【作者基本信息】 兰州大学 ， 病理学与病理生理学， 2008， 硕士

【摘要】 目的:1.探讨胸腺瘤螺旋CT影像特征与WHO病理学分型之间的相关性。2.探讨细胞角蛋白(cytokeratin pan,CKP)、血管内皮生长因子(vascular endothelialgrowth factor,VEGF)在胸腺瘤组织中的表达以及微血管密度(Microvessel density,MVD)与胸腺瘤螺旋CT(spiral computed tomography,SCT)表现的相关性。方法:1.分析84例经穿刺活检及手术病理证实的胸腺瘤病例的CT影像特征与其WHO分型之间的相关性。2.84例胸腺瘤标本行免疫组化SP法染色,分析CKP、VEGF及MVD表达水平与其CT征象之间的相关性。结果:1.SCT征象上表现分叶征、胸膜、心包及大血管受侵犯及尖角征/锯齿征的胸腺瘤,A型和AB型与B型和胸腺癌两大类之间有显著差异(P＜0.05),而肿块大小、肿块密度均匀与否、纵隔脂肪线存在与否,两者之间无显著差异(P＞0.05)。2.胸腺瘤组织CT强化幅度随VEGF表达水平和MVD计数的增高而增加(P＜0.01)。VEGF表达水平和MVD计数与胸腺瘤CT征象中的分叶征、尖角征/锯齿征、胸膜、心包及大血管侵犯有相关性(P＜0.05)。3.SCT征象表现有尖角征/锯齿征、胸膜、心包及大血管侵犯、密度均匀、纵隔脂肪线存在时,胸腺瘤细胞中CKP表达为中等阳性至强阳性,并与以上SCT征象有相关性(P＜0.05),而与强化幅度无相关性(P＞0.05)。结论:1.SCT对A型、AB型与B型、胸腺癌可以做出较为正确的分类,但较难区分A型与AB型及B型与胸腺癌。2.SCT征象能在一定程度上反映胸腺瘤的病理学特点,有利于术前无创性评估肿瘤生物学行为。更多还原

【Abstract】 Objective: The aim of this study was to investigate the relationship between helical computed tomography (CT) imaging and WHO histologic type in thymoma, and to study the correlation of spiral CT manifestations with microvessel density (MVD) and expressions of cytokeratin protein (CKP) and vascular endothelial growth factor (VEGF) in thymoma tissues.Methods: Helical CT scanning was performed in 84 patients with thymoma identified by postoperative pathological examination, and the expressions of CKP, VEGF and CD34 were detected by the streptavidin-peroxidase immunohistochemical method in the 84 biopsied samples. The correlations of the immunohistochemical results in thymoma tissues with the WHO histologic classification and spiral CT imaging were analyzed statistically by the chi square test.Results: Significant difference was found between two big types (Type A, AB and Type B, carcinoma of thymus) on lobular contours, cusp angle-like or sawtooth-like margins and the tumoral invasions to pleural membrane, pericardium and great vessels (P<0.05). No significant difference was found between the types on tumor size, density homogeneity and fatty line of mediastina (P>0.05).The density of tumor tissue in the CT arterial phase was enhanced with increase of VEGF expression level and MVD counting (P<0.01). There was a significant positive correlation of VEGF expression or MVD counting with lobular contours, cusp angle-like or sawtooth-like margins, and tumor invasions to pleural membrane, pericardium and great vessels (P<0.01).The CKP expression in thymoma tissue was moderate and strong when the CT arterial phase scan showed cusp angle-like or sawtooth-like margins, tumor invasions to pleural membrane, chest wall, pericardium and great vessels, homogenous density, and fat line in mediastinum(P<0.05). There was no significant difference statistically between the degree of enhanced CT imaging and the expression of CKP (P>0.05).Conclusions:1. SCT can correctly make classification for Type A, AB, B and carcinoma of thymus, but difficult to differentiate Type A from AB and Type B from carcinoma of thymus.2.To a certain extend, spiral CT imaging can reflect some pathological characteristics of thymoma, and it may be a better noninvansive tool for clinical evaluation of thymoma.更多还原