目的:探讨胸腺瘤的临床、病理、诊疗方法及预后.方法:总结1例AB型胸腺瘤伴多发胸腹壁皮下转移患者的临床资料及诊疗过程,并复习国内外文献.结果:患者男性,25岁,因侵袭性胸腺瘤术后复发并上腔静脉综合征急诊入院,肿瘤生长速度快、病情危急,遂予超分割放射治疗,纵隔占位照射DT 30Gy/20fx/12d,治疗过程中,患者胸腹壁无明显诱因下出现多发性结节灶,质硬,活动尚可,活检病理提示低度恶性肿瘤,考虑为“胸腺瘤”术后累及胸腹壁.予2周期TP方案静脉化疗后皮下转移灶逐渐增大、增多.行外周血基因检测,结果示外周血MGMT甲基化阳性,调整治疗方案予干扰素,300万单位,肌肉注射,每周3次；同时口服司莫司汀胶囊,50mg/(w·6w),治疗过程中查体、复查胸部CT提示皮下转移灶逐渐变小,甚至消失,患者病情控制.结论:胸腺瘤依据病理学检查确诊,其治疗以手术为主,术后复发或病灶呈侵袭性生长常规行放射治疗,对具有特殊临床表现、难治性病例,可考虑基因指导下个体化治疗方式.%Objective:To assess the pathology diagnosis and prognosis of AB thymoma. Methods: One case of AB thymoma with multiple subcutaneous metastasis was reported with review of literature. Results: A 25 years old male readmitted with chest tightness, suffocation,dizziness and headache. Computerized tomography revealed the invasive thymoma relapsed again,the condition was critical. Immediately,the patient was treated with hyperfractionated radiation therapy consisting of 3000 rad in 2 weeks. In the course of treatment, there were some nodules in the ven-trum,which were hard and movable. The pathologic diagnosis was low - grade malignant. After 2 cycles chemotherapy , the nodules were increased gradually. The gene test prompt the MGMT gene methylation, the treatment was adjusted by the guidance of gene test : Intramuscular injection with interferon while taking semustine capsules. Chest CT and examination prompt the disease was controled,the nodules were smaller or disappear. Conclusion: Diagnosis of thymoma still depends on both clinical and pathological findings which are correlated with stage. Surgery is the best treatment, the recurrence and invasive ones are supplemented by radiation therapy conventionally, the special or refractory cases can consider the individualized treatment by the guidance of gene test.
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