外科学教学课件：胸腺瘤肌无力巡诊.pptx

Thymoma and myasthenia gravisAnatomy Blood supplyArteries:Internal thoracic arteries; inferior thyroid and pericardiophrenic arteries.Veins:Left brachiocephalic vein (innominate vein), and the thyroid veins.Nerves Roggero E, Besedovsky H, O, del Rey A, The Role of the Sympathetic Nervous System in the Thymus in Health and Disease. Neuroimmunomodulation 2011;18:339-349Sympathetic nerve and parasympathetic nerve fibers, sympathetic nerve fibers from the thoracic ganglion and other small ganglion neurons;Adrenergic nerve fibers -- thymus cortex.Cholinergic nerve fibers -- parenchymal cells of the medulla and the cortex and medulla.Histology Epidemiology of thymoma1 Rare thoracic cancers, including peritoneum mesothelioma.Siesling S, van der Zwan JM, Izarzugaza I, Jaal J, Treasure T, Foschi R, Ricardi U, Groen H, Tavilla A, Ardanaz E; RARECARE Working Group.Eur J Cancer. 2012 May;48(7):949-60. doi: 10.1016/j.ejca.2012.02.047. Epub 2012 Mar 9.2 Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Engels EA, Pfeiffer RM. Int J Cancer. 2003 Jul 1;105(4):546-51.3 Chen KN, Fang WT. Thymic Tumors Preface. Zhongguo Fei Ai Za Zhi, 2014, 17(2):73-74. [陈克能, 方文涛. 胸腺肿瘤专题前言. 中国肺癌杂志, 2014, 17(2): 73-74.] doi: 10.3779/j.issn.1009-3419.2014.02.02.Rare, 0.17/100,000 in europe1, 0.15/100,000 in US20.3-0.4/100,000 in Asia390% of thymic tumors are thymoma20-25% of all mediastinal tumors50% of anterior mediastinal masses20-50 yrsNo sexual predilection exists.Pathology 71% associated with myasthenia gravisMasaoka’s staging Follow-up study of thymomas with special reference to their clinical stages.Masaoka A, Monden Y, Nakahara K, Tanioka T.Cancer. 1981 Dec 1;48(11):2485-92Modified Masaoka’s staging Stage I: Grossly and microscopically encapsulated. Stage II: The thymoma invades beyond the and into the nearby fatty tissue or to the pleura. Sometimes divided into:Stage IIa: Microscopic transcapsular invasionStage IIb: Macrosco