Hasserjian R P, Klimstra D S, Rosai J
Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Am J Surg Pathol. 1995 Jul;19(7):835-41. doi: 10.1097/00000478-199507000-00012.
We report eight cases of thymic carcinoma with clear-cell features and review the five previously reported cases. The tumor was composed of cells with clear cytoplasm and rather bland nuclear features, and showed a lobular or occasionally sheet-like growth pattern. Cytoplasmic glycogen was demonstrable in 92% of cases, whereas mucin was absent in all cases tested. The tumor cells were uniformly immunoreactive for low- and high-molecular-weight keratins and were reactive for epithelial membrane antigen in 22% of cases. The differential diagnosis includes mediastinal seminoma, parathyroid carcinoma, and metastatic clear-cell carcinoma. The diagnosis of primary thymic carcinoma depends on the exclusion of other primary sites clinically, particularly lung and kidney, and the demonstration of postivity for keratins and negativity for placental alkaline phosphatase. Thymic carcinoma with clear-cell features behaves as a high-grade thymic carcinoma: including our cases and the previously reported cases, nine of 13 patients (69%) are either dead of disease or have persistent disease at the latest follow-up. The importance of this entity is recognition of its aggressive clinical behavior and its distinction from other primary and metastatic clear-cell neoplasms of the mediastinum.
我们报告了8例具有透明细胞特征的胸腺癌，并回顾了之前报道的5例病例。肿瘤由具有透明细胞质和相对温和核特征的细胞组成，呈小叶状生长模式，偶尔呈片状。92%的病例中可检测到细胞质糖原，而所有检测病例中均未发现黏液。肿瘤细胞对低分子量和高分子量角蛋白均呈一致免疫反应，22%的病例对上皮膜抗原呈反应。鉴别诊断包括纵隔精原细胞瘤、甲状旁腺癌和转移性透明细胞癌。原发性胸腺癌的诊断取决于临床上排除其他原发部位，特别是肺和肾，以及角蛋白阳性和胎盘碱性磷酸酶阴性的证实。具有透明细胞特征的胸腺癌表现为高级别胸腺癌：包括我们的病例和之前报道的病例，13例患者中有9例（69%）在最近一次随访时死于疾病或疾病持续存在。认识到该实体侵袭性的临床行为及其与纵隔其他原发性和转移性透明细胞肿瘤的区别具有重要意义。
