胸腺瘤的影像診斷及分期

1、會計學(xué)1胸腺瘤的影像診斷及分期胸腺瘤的影像診斷及分期病理特征流行病學(xué)臨床特征分期&治療小結(jié) 影像評價發(fā)病率相對較低，占所有成人惡性腫瘤的不到1%病理特征流行病學(xué)臨床特征分期&治療小結(jié) 影像評價分類依據(jù)1999年版WHO分類2004年版WHO分類梭形細胞梭形細胞AA梭形細胞和淋巴細胞混合構(gòu)成梭形細胞和淋巴細胞混合構(gòu)成ABAB淋巴細胞上皮細胞淋巴細胞上皮細胞B1B1淋巴細胞和上皮細胞混合構(gòu)成淋巴細胞和上皮細胞混合構(gòu)成B2B2主要由上皮細胞構(gòu)成主要由上皮細胞構(gòu)成B3B3胸腺癌胸腺癌C胸腺癌胸腺癌注：a. A型；b. B1型；c. B2型；d. B3型病理特征流行病學(xué)臨床特征分期&治療影像評價病理特征

2、流行病學(xué)臨床特征分期&治療小結(jié) 影像評價分期分期依據(jù)臨床處理有完整包膜有完整包膜完全外科切除完全外科切除a顯微鏡下包膜侵犯顯微鏡下包膜侵犯完全外科切除，如不能全切，輔以術(shù)后完全外科切除，如不能全切，輔以術(shù)后放療放療b肉眼可見的鄰近脂肪侵犯肉眼可見的鄰近脂肪侵犯鄰近器官受侵，如心包、鄰近器官受侵，如心包、大血管、或肺等大血管、或肺等先行新輔助化療，然后完全外科切除，先行新輔助化療，然后完全外科切除，如不能全切，輔以術(shù)后放療如不能全切，輔以術(shù)后放療a胸膜、心包播散胸膜、心包播散先行新輔助化療，然后完全外科切除，先行新輔助化療，然后完全外科切除，如不能全切，輔以術(shù)后放療如不能全切，輔以術(shù)后放療b經(jīng)淋

3、巴經(jīng)淋巴-血道轉(zhuǎn)移血道轉(zhuǎn)移姑息性化療姑息性化療基于術(shù)后病理的分期病理特征流行病學(xué)臨床特征分期&治療小結(jié) 影像評價女性，23歲，尤文氏肉瘤患者。a. 化療開始前 b. 化療結(jié)束后3個月，胸腺增生abab侵襲性胸腺瘤 男，55歲，無明顯臨床癥狀膈神經(jīng)受累（右膈面抬高）男，60歲Stage I in MDCT and Masaoka staging systemWHO type A ，Masaoka stage I stage II in MDCT and Masaoka staging systemstage in MDCT and Masaoka staging systemstage in M

4、DCT and Masaoka staging systemstage in MDCT and Masaoka staging systemstage in MDCT and Masaoka staging systemstage in MDCT and Masaoka staging systemWHO type B1 thymoma in a 47-year-old woman with left-sided neck pain. (a) Axial T1-weighted MR image shows a rounded intermediate-signal-intensity mas

5、s (M) in the anterior mediastinum. (b) Axial fat-suppressed T2-weighted MR image demonstrates a 6-cm anterior mediastinal mass (M) with high signal intensity at the level of the ascending aorta (Ao). The mass was diagnosed as a lymphocyte-rich WHO type B1 thymoma at resection. abStage III thymoma in

6、 a 52-year-old man with chest pain and dyspnea. (a) Axial double-inversion-recovery MR image demonstrates a 4-cm lobulated mass that abuts the pericardium (arrow). (b) Contrast-enhanced multiplanar double-inversion-recovery short-axis MR image demonstrates tumor invasion of the pericardium (arrow) a

7、nd epicardial fat (arrowhead), findings that were confirmed at thymectomy and pericardial resection.ab胸腺瘤期 女性，54歲，頭面部腫脹，腫瘤侵犯上腔靜脈，包繞右冠狀動脈Cystic thymoma in an asymptomatic 35-year-old woman. Coronal T2- weighted MR image shows an anterior mediastinal septate cystic thymoma with a septated soft-tissue

8、nodule (arrow). 囊性胸腺瘤 PET/CTThymic hyperplasia in a 16-year-old boy who had undergone chemotherapy for osteosarcoma 4 months earlier. (a) Contrast-enhanced chest CT scan shows thymic enlargement. (b) PET/CT scan obtained to monitor for osteosarcoma recurrence or metastases shows diffuse FDG uptake i

9、n the thymus (arrow). At 7-month follow-up PET/CT, the uptake had resolved, a finding consistent with thymic hyperplasia. ab PET/CTStage IVa thymoma in a 50-year-old man. (a) Contrast-enhanced chest CT scan shows a primary mass (M) and a pleural drop metastasis (arrow). (b) On an axial fused FDG PET

10、/CT image, the primary tumor (M) and the drop metastasis (arrow) are FDG avid. Pleural recurrence in a 38-year-old woman with previously treated stage IVa thymoma. (a) Postoperative baseline CT scan shows normal right basilar pleura adjacent to the attachment of the diaphragm to the chest wall (arrow). (b) Follow-up contrast-enhanced chest CT scan obtained 2 years later shows increased diaphragmatic pleural thickening (arrow). (c) Axial fused FDG PET/CT image shows FDG-avid pleural recurre