2017中文nccn指南2胸腺瘤

1、CCN Clinical Practice Guidelines icology (Guidelines)2016V3.本文由第四唐都医院肿瘤科，康翻译，医脉通核发Ver3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofPr ed by Maria Che7/18

2、/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network 小组成员Guidelines Index Table of ContentsDiscusVer3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM

3、,Guidelines and this illustration may not be reproduced in any form without the express written permisofPred by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network 目录Guideline

4、s Index Table of ContentsDiscus胸腺瘤和胸小组指南更新概览初始评估(THYM-1)初始治疗 (THYM-2) 术后处理 (THYM-3)局部晚期，晚期或复 (THYM-4)手术切除原则 (THYM-A)放射治疗原则 (THYM-B)胸腺的化疗原则 (THYM-C) 世界卫生组织组织分型 (THYM-D)分期 (ST-1)Ver3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustratio

5、n may not be reproduced in any form without the express written permisofTheGuidelines are a sement of evidence and consensus of the authors regarding their views of currently accepted approaches to treatment. Any clinin seeking to apply or consult theGuidelines is expected to use independent medical

6、 judgmenthe context of individual clinical circumstanto determine any patients care or treatment. The National Comprehensive Cancer Network () makes no represenions or warranties of any kind regarding their content, use or application and dis any responsibility for their application or use in any wa

7、y. TheEvidence BlocksTM andGuidelines are copyrighted by National Comprehensive Cancer Network.s. TheEvidence BlocksTM,Guidelines, and the illustrations hereay not be reproduced in any form without the express written permisof. 2016.Clinical Trials:bevest the best management for any cancer patient i

8、s in a clinical trial.Participation in clinical trials is espelly encouraged.To find clinical trials online at Member Institutions, click here:./clinical_trials/physin.html.Categories of Evidence and Consensus: Allmendations are category 2A unless otherwise specified.SeeCategories of Evidence and Co

9、nsensus.Pr ed by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network 更新Guidelines Index Table of ContentsDiscus指南从 2016 年第 2 版更新至 2016 年第 3 版的更新内容包括：THYM-1影像学THYM-3：根据临床指征，胸部增

10、强 MRI ,影像学THYM-4：胸部 CT 检测复发：术后 2 年内每 6 月 1 次；随后胸5 年内每年随访，胸腺瘤 10 年内每年随访。影像学：重新手术评估胸部增强 CT 及 PET-CT。指南从 2016 年第 1 版更新至 2016 年第 2 版的更新内容包括：MS-1更新了部分。指南从 2015 年第 1 版至 2016 年第 1 版未更新内容。Ver3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustr

11、ation may not be reproduced in any form without the express written permisofPred by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network Guidelines Index Table of ContentsDiscu

12、s参见初始治疗(THYM-2)胸腺肿瘤可能 a纵膈包块不可能胸腺肿瘤 aa 胸腺床部位前纵隔包块定义为：肿瘤标记物，没有其他的淋肿大病变，并与甲状腺无连续性关系。. THYM1Ver3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofAllmendations ar

13、e category 2A unless otherwise indicated.Clinical Trials:be vest the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is espelly encouraged.有需要，参见的疾病指南(Table of Contents)胸部增强 CT需要，检测beta-HCG, AFP血常规, 血小板可选择 PET-CT 扫描根据临床指征，肺功能测试根据临床指征，胸部增强MRI ,初步评估P

14、red by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network Guidelines Index Table of ContentsDiscus胸腺肿瘤可能 aa 胸腺床部位前纵隔包块定义为：肿瘤标记物，没有其他的淋肿大病变，并与甲状腺无连续性关系。b 可否手术切除应由有资质的胸腔外科医师决定，

15、首选胸部肿瘤学专科。. c 参见手术切除原则 (THYM-A). THYM2Ver3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofAllmendations are category 2A unless otherwise indicated.Clinical

16、Trials:be vest the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is espelly encouraged.参见见后续治疗(THYM-4)空芯针或切开活检（避免胸膜腔）局部进展，不可切除 b所有患者均应由胸腺瘤和胸 诊疗经验丰富的多学科团队进行诊疗参见术后治疗(THYM-3)手术切除（全胸腺和肿瘤切除）c手术可切除 b初步治疗Pred by Maria Che7/18/2016 2:30:41 AM. Foral use

17、only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network Guidelines Index Table of ContentsDiscus术后处理 C胸部 CT 检测复发：术后2 年内每 6 月 1 次；随后胸5 年内每年随访g，胸腺瘤 10 年内每年随访考虑术后放疗 e（2B）胸部 CT 检测复发：术后2 年内每 6 月 1 次；随后术后放疗 e化疗 f胸5 年内每年随访g，胸腺瘤

18、 10 年内每年随访根治放疗 e化疗 f根治放疗 e + 化疗 fc 参见手术切除原则(THYM-A).dR0 =无肿瘤残留r, R1 = 镜下可见肿瘤残留, R2 = 肉眼可见肿瘤残留.e 参见放疗 (THYM-B).f 参见胸腺化疗原则(THYM-C). THYM3Ver3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form witho

19、ut the express written permisofAllmendations are category 2A unless otherwise indicated.Clinical Trials:be vest the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is espelly encouraged.胸R2 切除 d胸腺瘤胸复发参见THYM-4R1 切除 d胸腺瘤病理评估胸腺瘤或胸腺 癌，包膜II- IV 期R0 切除 d

20、复发参见THYM-4胸腺瘤，无包膜术后放疗 e术后治疗 CPr ed by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network Guidelines Index Table of ContentsDiscus胸腺瘤或胸：所有患者均应由经验丰 富的多学科团队协作进行诊疗b 可否手术切除应由有资质的胸

21、腔外科医师决定，首选胸部肿瘤学专科.c 参见手术切除原则 (THYM-A).e 参见放射治疗原则 (THYM-B).f 参胸腺化疗原则见 (THYM-C). THYM4Ver3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofAllmendations are ca

22、tegory 2A unless otherwise indicated.Clinical Trials:be vest the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is espelly encouraged.化疗 f确认胸腔外转移考虑化疗 f 或放疗 e化疗f或孤立转移灶或同侧胸膜转移放疗 e化疗 f不可切除 b化疗 f局部晚期重新手术评估胸部增强 CTPET-CT可切除 b,c考虑术后放疗 e手术切除肿瘤和孤立转移病灶治疗局部晚

23、期、晚期或复发Pred by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network Guidelines Index Table of ContentsDiscus外科手术切除原则患者手术切除前应由有资质对的胸腔外科医生认真评估。局部晚期（不可切除病变）和可切除的但II 期的患者应由多学科团队进行评

24、估。基于临床和影像学特征，高度怀疑为可切除的胸腺瘤则需避免进行手术活检。避免对可疑胸腺瘤采用经胸膜腔的方法进行活检。手术前，应注意评估患者重症肌无力的症状和体征，在手术前要接受药物控制。手术的目的是要切除全部胸腺及相邻或不相邻的全部病灶。和完整切除可能需要切除的组织包括：心包膜、膈神经、胸膜、肺，甚至大并发症，所以应该避免。在进行胸腺切除术时，要注意检查胸膜表面有无转移病灶。如果可以的话，切除胸膜转移病灶获得肉眼的完整切除是可取的。结构部位。由于双侧膈神经切除会带来严重的呼吸系统的由于缺少长期随访数据，不微创手术方法。但是，如果能满足标准手术方法下所有肿瘤病灶的治疗目标，并在专科由经验丰富的医

25、生进行操作，可以考虑进行微创手术治疗。1-51Pennathur A, Qureshi I, Schubert MJ, et al. Comparison of surgical techniques for early stage thymoma: feasibility of minimally invasive thymectomy and comparison with open resection. J Thorac Cardiovasc Surg 2011;141:694-701.2Ye B, Tantai JC, Ge XX, et al. Surgical techniques

26、 for early-stage thymoma: Cardiovasc Surg 2014;147:1599-1603.-assisted thorascopic thymectomy versus transsternal thymectomy. J Thorac3Saaki Y, Oda T, Kanazawa G, et al.ermediate-term oncologices after-assisted thorascopic thymectomy for early-stage thymoma. J ThoracCardiovasc Surg 2014;148:1230-123

27、7.4Manoly I, Whistance RN, Sreekumar R, et al. Early and mid-term Surg 2014;45:e187-193.es of trans-sternal and-assisted thoracoscopic surgery for thymoma. Eur J Cardiothorac5Liu TJ, LW, Hsieh MS, et al. Oncol 2014;322-328.-assisted thoracoscopic surgical thymectomy to treat early thymoma: a compari

28、son with the conventional transsternal approach. Ann Surg. THYM-AVer3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofAllmendations are category 2A unless ot

29、herwise indicated.Clinical Trials:be vest the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is espelly encouraged.Pred by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer N

30、etwork, Inc.,s.National Comprehensive Cancer Network Guidelines Index Table of ContentsDiscus放射治疗原则（1/2）1,2总原则放疗建议应由资质丰富的肿瘤放疗医师给出。对于不可切除的病灶（在诱导化疗中进展的病灶）或是未完整切除的侵袭性的胸腺瘤或胸的放疗。，或局部晚期疾病在化疗和手术后的辅助，患者均应接受根治性肿瘤放疗医师应与外科手术医生沟通，获悉术中所见，有助于确定复发风险的目标靶区；同时还应与病理科医师详细病理组织类型和疾病范围，无包膜以及手术切缘等问题。放疗相关缩略语与非小细胞肺癌放疗的缩略语类似。

31、参见非小细胞肺癌章节. SeeGuidelines for-Small Cellg Cancer.放射剂量放疗的剂量和分割计划是根据放疗的指征及术后对于不可切除病灶应给予 60-70Gy 的剂量。手术切除程度而定。对于辅助放疗来说，如果切缘清晰或近切缘者剂量为 45-50Gy，镜下阳性切缘者给予 54Gy 剂量。肉眼切缘阳性者（类似于不可切除病灶）3,4 给予 60Gy 或更高放疗剂量。以上放疗采用常规分割方法 1.8-2Gy/日See Radiation Volume andRadiation Techniques (THYM-B 2 of 2)1Gomez D, Komaki R, Yu

32、J, et al. Radiation therapy definitions and reporting guidelines for thymic malignancies. J Thorac Oncol 2011;6:S1743-1748.2Gomez D, Komaki R. Technical advanof radiation therapy for thymic malignancies. J Thorac Oncol 2010;5:S336-343.3Mornex F, Resbeut M, Richaud P, et al. Radiotherapy and chemothe

33、rapy for invasive thymomas: a multicentric retrospective review of 90 cases. The FNCLCC trialists. Federation Nationale des Centres de Lutte Contre le Cancer.J Radiat Oncol Biol Phys 1995;32:651-659.4Myoj, Choi NC, Wright CD, et al. Stage III thymoma: pattern oilure after surgery andtoperative radio

34、therapy and its implication for future study.J Radiat Oncol BiolPhys. 2000;46(4):927-933. THYM-BVer3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofAllmenda

35、tions are category 2A unless otherwise indicated.Clinical Trials:be vest the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is espelly encouraged.Pred by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016

36、National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network Guidelines Index Table of ContentsDiscus放射治疗原则（2/2 ）放疗靶区大体肿瘤靶区为肉眼可见的肿瘤病灶。术中可在残余肿瘤部位放置标记金属夹，以便于术后辅助放疗的定位。术后辅助放疗的临床靶区（CTV）应包含全部胸腺（部分切除病例）、手术标记夹以及任何可能残留肿瘤的部位。CTV 的范围应与胸腔外科医生共同探讨制定。不进行广泛选择性淋放疗（全纵膈、双侧锁骨上淋区），胸腺瘤很少在这些部位发生转移

37、。计划靶区（PTV）应考虑靶病灶的运动和日常摆位的误差。PTV 定位应基于个患者的运动情况、模拟技术（有无考虑运动），以及每间诊室的摆位可重复性。放疗技术强烈CT。CT 扫描采取高举过顶头顶的治疗。尽可能模拟靶区的运动。CT 扫描可以在自然吸气、呼气末进行，正常呼吸下定位或不能进行主动呼吸控制者，需要用更精准的设备如 4-D CT、呼吸门控 CT 进行定位。靶目标的运动处理方法与非小细胞肺癌放疗原则一样。参见非小细胞肺癌章节。SeeGuidelines for-Small Cellg Cancer. 静脉造影剂扫描可定位不可切除病灶。辐射束分布应该根据 PTV 设定，旨在为靶区提供预计的高剂量

38、，并使重要组织接受的辐射剂量最小。前-后位或后-前位放疗以前位放疗野为重点（胸腺组织位于前纵隔），也可以采取组合楔形技术放疗。这些方法应用传统的 2-D 技术，会使正常组织接受更高的剂量。需仔细评估计划中肺、心脏和脊髓的剂量体积直方图。放疗应采用 3-D 适形技术以减少对周围正常组织的损伤（如心脏、肺、食管、脊髓）。调强适形放疗（IMRT）可以进一步优化剂量的分布并较少正常组织的辐射剂量。如使用 IMRT 技术，应严格遵循 ASTRO/ACR IMRT 指南。除了注意正常组织剂量限制参照非小细胞肺癌放疗原则外在合理范围内应尽可能减少心脏的平均剂量。See General Principles

39、and Radiation Dose (THYM-B 1 of 2)正常组织均使用更为保守的剂量限制。考虑到这部分患者年轻，大部分具有较长的预计生存期，5Ruffini E, Mancuso M, Oliaro A, et al. Recurrence of thymoma:ysis of clinicopathologic features, treatment, ande. J Thorac Cardiovasc Surg 1997;113:55-63.6Moran JM, Dempsey M, Eisbruch A, et al. Safety considerations for IM

40、RT: executive summary. Med Phys 2011;38:5067-5072.7Hartford AC, Palisca MG, Eichler TJ, et al. American Society for Therutic Radiology and Oncology (ASTRO) and American College of Radiology (ACR) Practice Guidelines forensity-Modulated Radiation Therapy (IMRT).J Radiat Oncol Biol Phys 2009;73:9-14.

41、THYM-BVer3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofAllmendations are category 2A unless otherwise indicated.Clinical Trials:be vest the best manageme

42、nt of any patient with cancer is in a clinical trial. Participation in clinical trials is espelly encouraged.Pred by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network Guidel

43、ines Index Table of ContentsDiscus胸腺化疗原则二线化疗方案尼 (仅限于胸培美曲赛 8依维莫司 9紫杉醇 10-11奥曲肽 (包括 LAR) +/-他汀 13一线联合化疗方案CAP1 (胸腺瘤首选)顺铂 50 mg/m2 IV day 1多柔比星 50 mg/m2 IV day 1环磷酰胺 500 mg/m2 IV day 1PE4顺铂)760 mg/m2 IV day 1依托泊苷 120 mg/m2/d IV days 13每 3药一次强的松 12每 3药一次CAP 联合强的松 2顺铂 30 mg/m2 days 13多柔比星, 20 mg/m2/d IV 持

44、续 days 13环磷酰胺 500 mg/m2 IV on day 1强的松 100 mg/day days 15VIP5依托泊苷亚叶酸钙 14-155-FU75 mg/m2 on days 14E 依托泊苷 4异环磷酰胺 16异环磷酰胺 1.2 g/m2 on days 14顺铂 20 mg/m2 on days 14每 3药一次每 3药一次ADOC3顺铂 50 mg/m2 IV day 1多柔比星 40 mg/m2 IV day 1长春新碱 0.6 mg/m2 IV day 3环磷酰胺 700 mg/m2 IV day 4卡铂/紫杉醇 6 (胸卡铂 AUC 6紫杉醇 225 mg/m2首选

45、)每 3药一次每 3药一次Referenon THYM-C 2. THYM-CVer3.2016, 07/13/16 National Comprehensive Cancer Network, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofAllmendations are category 2A unless otherwise indicated.Clinical

46、 Trials:be vest the best management of any patient with cancer is in a clinical trial. Participation in clinical trials is espelly encouraged.Pr ed by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National C

47、omprehensive Cancer Network Guidelines Index Table of ContentsDiscusPRINCIPLES OF CHEMOTHERAPY FOR THYMIC MALIGNANCIESREFEREN1LoehrJ Sr, Kim K, Aisner SC, et al. Cisplatin plus doxorubicin plus cyclophosphamideetas ic or recurrent thymoma: final results of anergroup trial. The EasternCooperative Onc

48、ology Group, Southwest Oncology Group, and Southeastern Cancer Study Group. J Clicol 1994;12:11641168.2Kim ES, Putnam JB, Komaki R, et al. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidationchemotherapy for

49、unresectable malignant thymomas: final report.g Cancer 2004;44:369379.3Fornasiero A, Daniele O, Ghiotto C, et al. Chemotherapy for invasive thymoma. A 13-year experience. Cancer 1991;68:3033.4Giaccone G, Ardizzoni A, Kirkpatrick A, et al. Cisplatin and etoide combination chemotherapy for locally adv

50、anced or metasic thymoma. A phase II study of theEuropeananization for Research and Treatment of Cancerg Cancer Cooperative Group. J Clicol 1996;14:814820.5LoehrJ Sr, Jiroutek M, Aisner S, et al. Combined etoide, ifosfamide, and cisplatinhe treatment of patients widvanced thymoma and thymic carcinom

51、a: anergroup trial. Cancer 2001;91:20102015.6Lemma GL, Lee JW, Aisner SC, et al. Phase II study of carboplatin and paaxel in advanced thymoma and thymic carcinoma. J Clicol 2011;29:20602065.7Thomas A, Rajan A, Berman A, et al. Sunitinib in patients with chemotherapy-refractory thymoma and thymic car

52、cinoma: an open-label phase 2 trial. Lancet Oncol 2015;16:177-186.8LoehrJ, Yiannoutsos CT, Dropcho S, et al. A phase II trial of pemetrexed in patients with recurrent thymoma or thymic carcinoma abstract. J Cli 2006;24(Suppl 18):Abstract 7079.9Zucali PA, De Pas TM, Palmieri G, et al. Phase II study

53、of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-basedcolchemotherapy abstract. J Clicol 2014;32(suppl 5): Abstract 7527.10Umemura S, Segawa Y, Fujiwara K, et al. A case of recurrent metas ic thymoma showing a marked response to pa2002;32:262265.axel mono

54、therapy. Jpn J Clicol11Yamamoto N, Tsurutani J, Yoshimura N, et al. Phase II study ofkly paaxel for relapsed and refractory small cellg cancer.ancer Res 2006;26:777781.12LoehrJ Sr, Wang W, Johnson DH, et al. Octreotide alone or with prednisone in patients widvanced thymoma and thymic carcinoma: an E

55、astern CooperativeOncology Group Phase II Trial. J Clicol 2004;22:293299.13Palmieri G, Merola G, Federico P, et al. Preliminary results of phase II study of ccitabine and gemcitabine (CAP-GEM) in patients with metasic pretreated thymicthelialtumors (TETs). Ancol 2010;21:1168-1172.14Stewart DJ, Dahro

56、uge S, Soltys KM, Evans WK. A phase II study of 5-fluorouracil plus high-dose folinic acidhe treatment of recurrent small cellg cancer. Am J Clicol1995;18:130132.15Andr T, Louvet C, Maindrault-Goebel F, et al. CPT-11 (irinotecan) addition to bimonthly, high-dose leucovorin and bolus and continuous-i

57、nfu pretreated metas ic colorectal cancer. GERCOR. Eur J Cancer 1999;35:13431347.5-fluorouracil(FOLFIRI) for16Highley MS, Underhill CR, Parnis FX, et al. Treatment of invasive thymoma with single-agent ifosfamide. J Clicol 1999;17:27372744. THYM-CVer3.2016, 07/13/16 National Comprehensive Cancer Net

58、work, Inc. 2016,s. TheEvidence BlocksTM,Guidelines and this illustration may not be reproduced in any form without the express written permisofAllmendations are category 2A unless otherwise indicated.Clinical Trials:be vest the best management of any patient with cancer is in a clinical trial. Parti

59、cipation in clinical trials is espelly encouraged.Pred by Maria Che7/18/2016 2:30:41 AM. Foral use only. Not approved for distribution. Copyright 2016 National Comprehensive Cancer Network, Inc.,s.National Comprehensive Cancer Network Guidelines Index Table of ContentsDiscus世界卫生组织组织分型 1类型描述A型肿瘤组织中可见

60、大量肿瘤性胸腺上皮细胞，呈纺锤形或椭圆形，缺少核异质性，伴有很少或不伴有肿瘤非肿瘤相关的淋巴细胞。AB型肿瘤组织有典型的局灶性 A 型胸腺瘤特征，但还有局灶性的富含淋巴细胞的混分。B1型与正常的胸腺组织非常相似，具有大片与正常胸腺皮质几乎无法区分外观的胸腺髓质区。B2型肿瘤上皮成分中富含大量淋巴细胞，散在分布具有泡状核的圆形细胞，且核仁明显。周围间隙常见，有时非常显著。周围的肿瘤细胞成栅栏状排列。B3型胸腺瘤主要由圆形或多边形的上皮细胞状生长，表现为无或轻度异型性，其中混合中等量的淋巴细胞，肿瘤上皮细胞成片C）肿瘤上皮成分有显著的异型性，其细胞结构特点与胸腺不同，反而类似于其他的癌细胞。C 型