Clinical And CT Findings Of Thymic Epithelial Tumours

PartⅠCorrelation of CT findings and Simplified Histologic Types of Thymic Epithelial TumoursObjective:To assess the CT imaging findings of thymic epithelial tumors classified according to simplified pathological typing and to determine useful findings in differentiating the main subtypes.Methods: 66 cases of thymic epithelial tumors confirmed with pathologically in our hospital from 2008 to 2016 were reviewed retrospectively.33 cases were male,33 female,age range(8-81),mean age 53.5 ±19 years old.All patients completed the whole chest CT enhanced scan,including 256 layers of Brillance iCT machine,Philips layer Brillance iCT machine,Siemens 64 layer dual source CT Philips.After scanning,the thickness of the reconstruction layer is 1mm and 5mm,the scanning tube voltage is 120 KV,and the tube current is 30-100 mAs.According to the 2015 histological classification of WHO,the patients were divided into three groups: low-risk group((n = 9),high risk group(n=42)and thymic carcinoma(n = 15).Low risk group includes: A,AB,B1 type;high risk group includes: B2,B3 type.Imaging and clinical characteristics of the three main subtypes were compared using the chi-square test and One-Way ANOVA.Results: Myasthenia gravis was more frequent in high-risk thymomas.Chest pain was more frequent in thymic carcinomas.Thymic carcinomas were larger and were more likely to have blurry margins,irregular or lobulated contours,heterogeneous internal density,mass-cardiovascular inferface with fleezing sign,peripheral tissues invasion,mediastinal lymphadenectasis and pleural metastasis.Thymic carcinomas and high-risk thymomas were more likely to have elevated hemidiaphragm and irregular mass-pulmonary interface.Low-risk thymomas and thymic carcinomas were more likely to have higher degree of enhancement.Conclusion: The simplified histologic subtypes of thymic epithelial tumours have characteristic CT findings and preoperative enhanced CT sacan is valuable for distinguishing simplified pathological types.Part Ⅱ Study of uniform diagnostic criteria for Simplified Histologic Types of Thymic Epithelial TumoursObjective:Try to establish a CT diagnostic model based on simplified pathological typing.Methods: 66 cases of thymic epithelial tumors confirmed with pathologically in our hospital from 2008 to 2016 were reviewed retrospectively.33 cases were male,33 female,age range(8-81),mean age 53.5 ±19 years old.All patients completed the whole chest CT enhanced scan.According to the 2015 histological classification of WHO,the patients were divided into three groups: low-risk group(n = 9),high risk group(n=42)and thymic carcinoma(n = 15).Low risk group includes: A,AB,B1 type;high risk group includes: B2,B3 type.According to literatures and the results of our study,try to establish the CT diagnostic model based on simplified pathological type.thymic carcinoma: 1.metastis,2.irregular contour,adjacent structure invasion,3.huge mass with obvious necrosis;high risk: 1.focal calcification,2.lobulation,3.pouring growth,4.inhomogeneous enhancement and the enhanceent degree was lesser than 30 HU,5.prominent cystic changes;low risk: tend to be a well defined lesion with homogeneous attenuation.Two radiologist on different level were invited to pratice the model after the were explained the diagnostic criteria in detail.The results of two groups were compared using the chi-square test.Results: 1.The diagnostic accuracy of the uniform diagnostic criteria based on simplified histologic group was: 61.1% in the low risk group,40.5% in high risk group,and 43.3% in thymic carcinoma group,the correct rate for all thymic epithelial tumors was 43.9%.2.The accuracy of two radiologist have no statistical difference.Conclusion: The results of uniform diagnostic criteria for simplified histologic subtypes of thymic epithelial tumours were not influened by seniority.But it is difficult to build a standardized diagnostic pattern and the results have not looked good.So we need work harder and deeper.Part Ⅲ Correlation of Clinical and CT characteristics of Thymic Epithelial tumors and Other Autoimmune and Endocrine diseaseObjective: To investigate the correlation of thymic epithelial tumors and other autoimmune and endocrine diseases on clinical and CT findings.Material and methods: Pathological records between 2008 and 2016 were reviewed to identify patients with thymic epithelial tumors.Results: There were 75 cases with TET,15 TET cases were complicated with myasthenia gravis,1 with pure red cell aplasia,1 with hyperthyroidism and thyroid cancer,1 with suspicious Stiffman syndrome,1 with lung adenocarcinoma,1 with prostatic cancer,1 with intraductal papillary carcinoma of breast;2 cases had a history of thyroid cancer and 2 case had a history of renal carcinoma.The CT expression between the patients with or without other autoimmune and endocrine diseases were different: combined group were more likely to be more invasive;howerer the non-combined group were more likely show calcification on CT images.Conclusion:TETs were related to autoimmune and endocrine diseases,clinical treatment should consider the general condition and made individualized treatment plan.The CT findings with or with other immune and endocrine diesases shows some differences and were valuable for diagnosis.