101
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Chen D, Meng X, Zhao Y, Wu S. Isolated splenic metastasis from a thymic carcinoma: A case report. Cancer Biol Ther 2016; 17:911-4. [PMID: 27413995 DOI: 10.1080/15384047.2016.1210738] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Thymic carcinomas are rare tumors that arise in the anterior mediastinum. Most of these malignancies develop local metastases limited in the thorax. Splenic metastases from thymic carcinomas are extremely rare. Here we report a case of isolated splenic metastasis from a 38-year-old female patient with Stage IV thymic carcinoma, who was treated with chemoradiotherapy. At twenty-2 months follow-up, the patient was found to have an isolated spleen metastasis, which was treated by Cyberknife with a reduced size of the metastasis, representing a partial response. Although splenic metastasis is a rare phenomenon, physicians need to be aware of the possibility of such metastases.
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Affiliation(s)
- Dongmei Chen
- a Department of Radiation Oncology , Hospital of PLA, Clinical College, Anhui Medical University , Beijing , P.R. China.,b Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , P.R. China
| | - Xiangying Meng
- b Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , P.R. China
| | - Yaowei Zhao
- b Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , P.R. China
| | - Shikai Wu
- a Department of Radiation Oncology , Hospital of PLA, Clinical College, Anhui Medical University , Beijing , P.R. China.,b Department of Radiation Oncology , Affiliated Hospital of Academy of Military Medical Sciences , Beijing , P.R. China
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102
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Janik S, Schiefer AI, Bekos C, Hacker P, Haider T, Moser J, Klepetko W, Müllauer L, Ankersmit HJ, Moser B. HSP27 and 70 expression in thymic epithelial tumors and benign thymic alterations: diagnostic, prognostic and physiologic implications. Sci Rep 2016; 6:24267. [PMID: 27097982 PMCID: PMC4838882 DOI: 10.1038/srep24267] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 03/21/2016] [Indexed: 01/23/2023] Open
Abstract
Thymic Epithelial Tumors (TETs), the most common tumors in the anterior mediastinum in adults, show a unique association with autoimmune Myasthenia Gravis (MG) and represent a multidisciplinary diagnostic and therapeutic challenge. Neither risk factors nor established biomarkers for TETs exist. Predictive and diagnostic markers are urgently needed. Heat shock proteins (HSPs) are upregulated in several malignancies promoting tumor cell survival and metastases. We performed immunohistochemical staining of HSP27 and 70 in patients with TETs (n = 101) and patients with benign thymic alterations (n = 24). Further, serum HSP27 and 70 concentrations were determined in patients with TETs (n = 46), patients with benign thymic alterations (n = 33) and volunteers (n = 49) by using ELISA. HSPs were differentially expressed in histologic types and pathological tumor stages of TETs. Weak HSP tumor expression correlated with worse freedom from recurrence. Serum HSP concentrations were elevated in TETs and MG, correlated with clinical tumor stage and histologic subtype and decreased significantly after complete tumor resection. To conclude, we found HSP expression in the vast majority of TETs, in physiologic thymus and staining intensities in patients with TETs have been associated with prognosis. However, although interesting and promising the role of HSPs in TETs as diagnostic and prognostic or even therapeutic markers need to be further evaluated.
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Affiliation(s)
- S Janik
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Austria.,Christian Doppler Laboratory for the Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Austria
| | - A I Schiefer
- Clinical Institute of Pathology, Medical University Vienna, Austria
| | - C Bekos
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Austria.,Christian Doppler Laboratory for the Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Austria
| | - P Hacker
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Austria.,Christian Doppler Laboratory for the Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Austria
| | - T Haider
- Christian Doppler Laboratory for the Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Austria.,University Clinic for Trauma Surgery, Medical University Vienna, Austria
| | - J Moser
- Departments of Dermatology and Venereology and Karl Landsteiner Institute of Dermatological Research, Karl Landsteiner University of Health Sciences, St. Pölten, Austria
| | - W Klepetko
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Austria
| | - L Müllauer
- Clinical Institute of Pathology, Medical University Vienna, Austria
| | - H J Ankersmit
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Austria.,Christian Doppler Laboratory for the Diagnosis and Regeneration of Cardiac and Thoracic Diseases, Medical University Vienna, Austria
| | - B Moser
- Department of Thoracic Surgery, Division of Surgery, Medical University Vienna, Austria
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103
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Detterbeck FC. The creation of the international thymic malignancies interest group as a model for rare diseases. Am Soc Clin Oncol Educ Book 2016:471-4. [PMID: 24451782 DOI: 10.14694/edbook_am.2012.32.23] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Similar to other orphan diseases, little progress has been made in the past decades in thymic malignancies. A determination to make a difference, despite the challenges facing a rare disease, led to the formation of the International Thymic Malignancies Interest Group (ITMIG) in 2010. This organization has brought together the majority of those focused on the management of thymic malignancies and has built a foundation for scientific collaboration, including consistent use of terms, an international database, and multidisciplinary engagement of clinicians and researchers from around the world. ITMIG has embarked on the development of novel approaches to research particularly suited to a rare condition. ITMIG has gained substantial recognition for the rapid progress that has been made and serves as a model for the advancement of knowledge in a rare disease.
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Affiliation(s)
- Frank C Detterbeck
- From the Yale University School of Medicine, Thoracic Surgery, New Haven, CT
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104
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Matsuoka K, Murata Y, Ueda M, Miyamoto Y. Ectopic thymic carcinoma presenting as an intrathoracic mass. Asian Cardiovasc Thorac Ann 2016; 24:480-3. [PMID: 27072863 DOI: 10.1177/0218492316643842] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
An asymptomatic 83-year-old man was found to have a right intrathoracic tumor. Computed tomography demonstrated a soft-tissue density mass measuring 55 × 25 × 22 mm adjacent to the right anterior chest wall. At surgery, the tumor was found to adhere to the diaphragm and right lung, contiguous with the mediastinal fat tissue. Histology of the resected specimen demonstrated proliferation of spindle and sarcomatous cells with multinucleated giant cells. Thus the tumor was diagnosed as undifferentiated thymic carcinoma and was considered to have arisen from ectopic thymic tissue. At 2 years postoperatively, the patient had no evidence of recurrence.
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Affiliation(s)
- Katsunari Matsuoka
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Hyogo, Japan
| | - Yoshitake Murata
- Department of Thoracic Surgery, National Hospital Organization Nagara Medical Center, Gifu City, Gifu, Japan
| | - Mitsuhiro Ueda
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Hyogo, Japan
| | - Yoshihiro Miyamoto
- Department of Thoracic Surgery, National Hospital Organization Himeji Medical Center, Himeji City, Hyogo, Japan
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105
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Mlika M, Boudaya S, Braham E, Chermiti F, Sayi A, Marghli A, El Mezni F. About thymic carcinomas: challenges in diagnosis and management. Asian Cardiovasc Thorac Ann 2016; 24:350-4. [PMID: 27002097 DOI: 10.1177/0218492316640129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Thymic carcinomas are rare tumors with a challenging diagnosis. Our aim was to report our 17-year experience of these tumors and to highlight the challenges encountered and the main differential diagnoses ruled out. METHODS We studied 12 (92%) men and 1 (7.7%) woman with a mean age of 37 years (range 15-60 years). All patients were symptomatic, with chest pain representing the most frequent symptom. Radiology revealed anterior mediastinal masses in all cases, with either infiltration of the adjacent organs or pulmonary parenchymal metastases. RESULTS The diagnosis was made on surgical biopsies in 12 cases and a lymph node biopsy in one. Microscopic examination revealed squamous carcinoma in 3 cases, synovial sarcoma in 1, mucinous adenocarcinoma in 1, undifferentiated carcinoma in 2, clear cell carcinoma in 1, lymphoepithelioma-like carcinoma in 2, atypical carcinoid tumor in 2, and sarcomatoid carcinoma in 1. Total surgical resection was possible in one patient after neoadjuvant chemotherapy and radiotherapy. Follow-up was possible in only 6 patients, and the mean survival reached 13 months. CONCLUSION In spite of the lack of follow-up information, this study demonstrates the poor outcome associated with these tumors and the need for standardized treatment.
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Affiliation(s)
- Mouna Mlika
- Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Sadok Boudaya
- Department of Thoracic Surgery, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Emna Braham
- Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Fatma Chermiti
- Department of Pulmonology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Ahmed Sayi
- Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia
| | - Adel Marghli
- Department of Thoracic Surgery, Faculty of Medicine, University of Tunis El Manar, Tunis, Tunisia
| | - Faouzi El Mezni
- Department of Pathology, Abderrahman Mami Hospital, Ariana, Tunisia
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106
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Wang W, Liu D, Yang L, Li Y, Xu H, Wang F, Zhao J, Zhang L. CXCR4 overexpression correlates with poor prognosis in myasthenia gravis–associated thymoma. Hum Pathol 2016; 49:49-53. [DOI: 10.1016/j.humpath.2015.10.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/05/2015] [Accepted: 10/08/2015] [Indexed: 10/22/2022]
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107
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Induction therapy followed by surgical resection in Stage-III thimic epithelial tumors: Long-term results from a multicentre analysis of 108 cases. Lung Cancer 2016; 93:88-94. [DOI: 10.1016/j.lungcan.2016.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 01/07/2016] [Accepted: 01/15/2016] [Indexed: 11/21/2022]
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108
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Simonelli M, Zucali PA, Suter MB, Lorenzi E, Rubino L, Fatuzzo G, Alloisio M, Santoro A. Targeted therapy for thymic epithelial tumors: a new horizon? Review of the literature and two cases reports. Future Oncol 2016; 11:1223-32. [PMID: 25832879 DOI: 10.2217/fon.14.318] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Surgical resection remains the cornerstone of therapy for early-stage thymic epithelial tumors (TETs), while in advanced or recurrent forms, a multimodality approach incorporating radiation and chemotherapy is required. Given the absence of effective treatment options for metastatic/refractory TETs and the poor related prognosis, there is a compelling need to identify promising 'drugable' molecular targets. Initial reports of activity from targeted agents in TETs derived from anecdotal cases have been often associated with specific activating mutations. Only in recent years, several agents have been formally investigated into prospective clinical trials, with varying success rates. We reviewed the literature on targeted therapy in TETs along with two cases of thymoma achieving striking responses to sorafenib in combination with lapatinib.
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Affiliation(s)
- Matteo Simonelli
- Humanitas Cancer Center, Oncology & Hematology Unit, Istituto Clinico Humanitas IRCCS, 20089 Rozzano MI, Italy
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109
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DU Y, Wang Y, Tang J, Ge J, Qin Q, Jiang LI, Liu X, Zhu X, Wang Y. Pancreatic metastasis resulting from thymic neuroendocrine carcinoma: A case report. Oncol Lett 2016; 11:1907-1910. [PMID: 26998098 DOI: 10.3892/ol.2016.4112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
Thymic neuroendocrine carcinoma (NEC) is a rare type of cancer. Unlike other thymic epithelial tumors and carcinoids originating in other locations, thymic NEC possesses a more aggressive biological behavior, including invasion to proximal structures, local recurrence and distant hematogenous metastasis. Distant metastasis is often observed in the bones, lungs, spleen, liver and adrenal glands. However, pancreatic metastasis resulting from thymic NEC is extremely uncommon, and only a few cases of patients with this disease have been reported. The current study presents the case of a patient with pancreatic metastasis resulting from thymic NEC. The patient was admitted to hospital with an anterior mediastinal neoplasm, which was identified using chest enhanced computed tomography. The patient underwent a monobloc excision of the tumor with resection of involved structures. Subsequently, a pathological diagnosis of atypical thymic carcinoid was provided, according to the morphological characteristics observed and the expression of neuroendocrine markers, as identified by immunohistochemistry. Following surgery, the patient received adjuvant chemotherapy and radiotherapy. However, ~2 years after surgery, metastasis at the pancreatic head was identified. The patient underwent a total pancreatectomy and splenectomy, and did not receive any post-operative therapies; however, the patient succumbed to the disease 9 months following surgery. Overall, the results from the present study demonstrate the clinical features of thymic NEC, which may aid with the diagnosis of this rare disease in other patients.
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Affiliation(s)
- Yang DU
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Ying Wang
- Department of East Ward Oncology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, Sichuan 610072, P.R. China
| | - Jie Tang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Jun Ge
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Qing Qin
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - L I Jiang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xiaoke Liu
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xianglan Zhu
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yongsheng Wang
- Department of Medical Oncology, Cancer Center, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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110
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Lopez-Marco A, Al-Zuhir N, Kornaszewska M. Ectopic intrapleural thymoma: a rare location in the thoracic cavity. J Surg Case Rep 2016; 2016:rjv166. [PMID: 26738510 PMCID: PMC4702014 DOI: 10.1093/jscr/rjv166] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We present a patient with a large thymoma on the right thoracic cavity developing from the visceral pleura. This is a rare location for this tumour, and only a few had been reported to date in the literature.
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Affiliation(s)
- Ana Lopez-Marco
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
| | - Naail Al-Zuhir
- Department of Cardiothoracic Surgery, University Hospital of Wales, Cardiff, UK
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111
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Leuzzi G, Rocco G, Ruffini E, Sperduti I, Detterbeck F, Weder W, Venuta F, Van Raemdonck D, Thomas P, Facciolo F. Multimodality therapy for locally advanced thymomas: A propensity score–matched cohort study from the European Society of Thoracic Surgeons Database. J Thorac Cardiovasc Surg 2016; 151:47-57.e1. [DOI: 10.1016/j.jtcvs.2015.08.034] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2015] [Revised: 06/17/2015] [Accepted: 08/10/2015] [Indexed: 11/27/2022]
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112
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Kumar R. Myasthenia gravis and thymic neoplasms: A brief review. World J Clin Cases 2015; 3:980-983. [PMID: 26677446 PMCID: PMC4677085 DOI: 10.12998/wjcc.v3.i12.980] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Revised: 07/09/2015] [Accepted: 10/13/2015] [Indexed: 02/05/2023] Open
Abstract
Thymoma is the most common mediastinal tumor. They have varied presentation ranging from asymptomatic incidental mediastinal masses to locally extensive tumor with compressive symptoms and distant metastases. They have frequent association with various paraneoplastic syndromes (PNS). The most common PNS associated with thymoma is myasthenia gravis (MG). Patients of thymoma with MG have a favourable outcome due to early disclosure of the disease. Histologically they are classified into five subtypes and Masaoka-Koga staging system is used for staging. Surgery, chemotherapy and radiotherapy play an important role along with anti-myasthenia drugs. This review would like to highlight the association of thymoma with MG and associated clinical and therapeutic issues.
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113
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Ried M, Marx A, Götz A, Hamer O, Schalke B, Hofmann HS. State of the art: diagnostic tools and innovative therapies for treatment of advanced thymoma and thymic carcinoma. Eur J Cardiothorac Surg 2015; 49:1545-52. [PMID: 26670806 DOI: 10.1093/ejcts/ezv426] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 11/09/2015] [Indexed: 12/30/2022] Open
Abstract
In this review article, state-of-the-art diagnostic tools and innovative treatments of thymoma and thymic carcinoma (TC) are described with special respect to advanced tumour stages. Complete surgical resection (R0) remains the standard therapeutic approach for almost all a priori resectable mediastinal tumours as defined by preoperative standard computed tomography (CT). If lymphoma or germ-cell tumours are differential diagnostic considerations, biopsy may be indicated. Resection status is the most important prognostic factor in thymoma and TC, followed by tumour stage. Advanced (Masaoka-Koga stage III and IVa) tumours require interdisciplinary therapy decisions based on distinctive findings of preoperative CT scan and ancillary investigations [magnetic resonance imaging (MRI)] to select cases for primary surgery or neoadjuvant strategies with optional secondary resection. In neoadjuvant settings, octreotide scans and histological evaluation of pretherapeutic needle biopsies may help to choose between somatostatin agonist/prednisolone regimens and neoadjuvant chemotherapy as first-line treatment. Finally, a multimodality treatment regime is recommended for advanced and unresectable thymic tumours. In conclusion, advanced stage thymoma and TC should preferably be treated in experienced centres in order to provide all modern diagnostic tools (imaging, histology) and innovative therapy techniques. Systemic and local (hyperthermic intrathoracic chemotherapy) medical treatments together with extended surgical resections have increased the therapeutic options in patients with advanced or recurrent thymoma and TC.
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Affiliation(s)
- Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
| | - Alexander Marx
- Institute for Pathology, University Medical Centre Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Andrea Götz
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Okka Hamer
- Department of Radiology, University Medical Center Regensburg, Regensburg, Germany
| | - Berthold Schalke
- Department of Neurology, University Regensburg at the District Medical Center, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Regensburg, Germany
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114
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Tseng YL, Chang JM, Lai WW, Chang KC, Lee SC, Lin SH, Yen YT. Behind and Beyond the Masaoka Staging: A 25-Year Follow-up Study of Tumor Recurrence in Completely Resected Thymic Epithelial Tumors in a Single Institution. Medicine (Baltimore) 2015; 94:e2278. [PMID: 26717364 PMCID: PMC5291605 DOI: 10.1097/md.0000000000002278] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
We analyzed prognosticators for recurrence and post-recurrence survival in completely resected thymic epithelial tumors for the past 25 years in a single institution.Between June 1988 and December 2013, 238 patients undergoing intent-to-treat surgery for thymic epithelial tumors were reviewed. Sex, age, myasthenia gravis (MG), tumor histology, Masaoka staging, characteristic of locoregional invasion and recurrence, and the treatment for recurrence were collected. Comparison between groups was conducted using the Student t test and χ test. Survival analysis was performed using the Kaplan-Meier method and log-rank test. The Cox proportional hazards model was used for univariate and multivariate analyses of prognostic factors.One hundred sixteen of 135 patients with completely resected thymoma and 35 of 56 patients with thymic carcinoma remained free of recurrence. In patients with completely resected thymoma, Masaoka staging, MG, tumor invasion into the lung, pericardium, and innominate vein or superior vena cava (SVC) invasion were associated with recurrence-free survival in univariate analysis (P = 0.004, 0.003, 0.001, 0.007, and 0.039, respectively). In multivariate analysis, MG was the positive independent prognosticator (P = 0.039). In patients with completely resected thymic carcinoma, Masaoka staging and innominate vein or SVC invasion were associated with recurrence-free survival in univariate analysis (P = 0.045 and 0.005, respectively), whereas innominate vein or SVC invasion was the negative independent prognosticator (P = 0.012). In patients with recurrent thymoma, those treated with surgery followed by chemotherapy had a significantly better post-recurrence survival than those undergoing chemoradiotherapy (P = 0.029) and those without treatment (P = 0.007). Patients with recurrent thymic carcinoma undergoing surgery followed by chemotherapy had a significantly better post-recurrence survival than those without treatment (P = 0.004), but not significantly better than those undergoing chemoradiotherapy (P = 0.252).In patients with completely resected thymoma, MG was the positive independent prognosticators of recurrence-free survival. Surgery should be attempted for recurrent disease for better post-recurrence survival. In patients with completely resected thymic carcinoma, innominate vein or SVC invasion was the negative independent prognosticator. Surgery for recurrence could be considered since it provided benefit for post-recurrence survival as chemoradiotherapy did.
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Affiliation(s)
- Yau-Lin Tseng
- From the Division of Thoracic Surgery (Y-LT, W-WL, Y-TY), Department of Surgery, National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University, Tainan; Division of Thoracic Surgery (J-MC), Department of Surgery, Chia-Yi Christian Hospital, Chia-Yi; Department of Pathology (K-CC), National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University; Biostatistics Consulting Center (S-CL), National Cheng Kung University Hospital, College of Medical College, National Cheng Kung University; and Institute of Clinical Medicine (S-HL, Y-TY), National Cheng Kung University, Tainan, Taiwan
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115
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Ried M, Neu R, Schalke B, von Süßkind-Schwendi M, Sziklavari Z, Hofmann HS. Radical surgical resection of advanced thymoma and thymic carcinoma infiltrating the heart or great vessels with cardiopulmonary bypass support. J Cardiothorac Surg 2015; 10:137. [PMID: 26515387 PMCID: PMC4627626 DOI: 10.1186/s13019-015-0346-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/27/2015] [Indexed: 01/29/2023] Open
Abstract
Background Radical surgical resection of advanced thymic tumors invading either the heart or great vessels facing towards the heart is uncommonly performed because of the potential morbidity and mortality. To achieve a complete tumor resection, the use of cardiolpulmonary bypass (CPB) support might be necessary. Methods Retrospective analysis of the results in six patients, who underwent radical tumor resection with CBP support. Results Mean age was 46 years (27 to 66 years) and five patients were male. Tumor infiltration of the heart or the great vessels was evident in all patients. Five patients underwent induction therapy. Two patients were operated in complete cardioplegic arrest (antegrade cerebral perfusion: n = 1). Arterial cannulation of the ascending aorta (n = 5) or the femoral artery (n = 1) and venous cannulation of the right atrium (n = 4) or the femoral vein (n = 2) were performed. Resection of the left brachiocephalic vein (n = 6), resection of the superior caval vein (n = 2), the ascending aorta (n = 1) and the complete aortic arch with outgoing branches (n = 1) were performed. A macroscopic complete resection (R0/R1) was achieved in five patients, whereas one patient was resected incompletely (R2). In-hospital mortality was 0 %. Three (50 %) patients needed operative revision (hematothorax: n = 2, chylothorax: n = 1). All patients had a complicated postoperative course and developed respiratory insufficiency. Conclusions Locally advanced thymoma/thymic carcinoma invading the heart or great vessels can be treated with radical surgical resection alongside with increased perioperative morbidity. The usage of CBP improves the chance of complete tumor resection in selected patients and might lead to a prolonged survival.
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Affiliation(s)
- Michael Ried
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany.
| | - Reiner Neu
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany.
| | - Berthold Schalke
- Department of Neurology, University Regensburg at the District Medical Center, Regensburg, Germany.
| | - Marietta von Süßkind-Schwendi
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany.
| | - Zsolt Sziklavari
- Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University Medical Center Regensburg, Franz-Josef-Strauß-Allee 11, D-93053, Regensburg, Germany. .,Department of Thoracic Surgery, Hospital Barmherzige Brüder Regensburg, Regensburg, Germany.
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116
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Lindenmann J, Fink-Neuboeck N, Pichler M, Anegg U, Maier A, Smolle J, Smolle-Juettner FM. Stage-based treatment for thymoma in due consideration of thymectomy: a single-center experience and comparison with the literature. World J Surg Oncol 2015; 13:303. [PMID: 26474756 PMCID: PMC4609052 DOI: 10.1186/s12957-015-0718-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 10/05/2015] [Indexed: 12/17/2022] Open
Abstract
Background Thymomas represent an uncommon and heterogeneous group of intrathoracic malignancies which require different treatments corresponding to their individual tumor stage. The objective of this study was to review the efficacy of our applied stage-based treatment for thymoma in due consideration of thymectomy. Methods This is a single-center, institutional review board-approved retrospective study of 50 consecutive patients with thymoma treated at our division within 10 years. Results There were 29 women (58 %) and 21 men (42 %), mean age 58.3 years. Twenty nine (58 %) had clinical symptoms and 14 (28 %) had myasthenia gravis. Forty-five patients (90 %) underwent thymectomy and complete resection was done in 42 cases (93.3 %). Histologic results were 6 subtype A, 5 AB, 8 B1, 12 B2, 12 B3, and 7 C. The Masaoka staging system revealed 20 stage I, 18 stage II, 6 stage III, and 6 stage IV. Two patients had neoadjuvant therapy and 25 received postoperative treatment. Five (11.1 %) had tumor recurrence, treated with re-resection. The 5-year disease-free survival was 91.5 %. Two patients died of tumor progression and three died of other causes (10 %). The 5-year overall survival was 82.3 % and the median survival time was 92.1 months. The 5-year survival rate after thymectomy was 87.2 % and the median survival was 92.1 months. Conclusions Complete resection still remains the mainstay in the treatment of non-metastatic thymoma and should be performed whenever feasible. Close multidisciplinary teamwork is mandatory to optimize the neurologic outcome and to prolong postoperative survival.
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Affiliation(s)
- Joerg Lindenmann
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
| | - Nicole Fink-Neuboeck
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Martin Pichler
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Udo Anegg
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Alfred Maier
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Josef Smolle
- Institute of Medical Informatics, Statistics and Documentation, Medical University Graz, Graz, Austria
| | - Freyja Maria Smolle-Juettner
- Division of Thoracic and Hyperbaric Surgery, Department of Surgery, Medical University Graz, Auenbruggerplatz 29, 8036, Graz, Austria
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Outcomes of Thymoma Treated with Multimodality Approach: A Tertiary Cancer Center Experience of 71 Patients. TUMORI JOURNAL 2015; 103:572-576. [DOI: 10.5301/tj.5000429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/20/2022]
Abstract
Aims To explore the demographics and clinical outcome of patients with thymoma treated with a multimodality approach at our institute. Methods A total of 71 patients with thymoma (Masaoka stage II-IV and WHO subtype AB-B3) treated from 1999-2013 were included in this retrospective analysis. Age, stage, WHO subtypes, details of surgery, radiotherapy, and chemotherapy were noted. Progression-free survival (PFS) was estimated using Kaplan-Meier method and SPSS (version 21.0) was used for statistical analysis. Results Male:female ratio was 56:15 with median age at presentation of 41 years. Stage-wise distribution was 6:46:19 for stage II, stage III, and stage IV, respectively. A total of 31 patients (44%) had associated myasthenia gravis and 3 had pure red cell aplasia. A total of 57 patients (80%) underwent radical thymectomy and all of these patients received adjuvant radiotherapy. A total of 15 patients and 7 patients received adjuvant chemotherapy and neoadjuvant chemotherapy, respectively. At median follow-up of 19.3 months (range 7.9-72.3 months), 2-year and 3-year PFS rate for the entire cohort was 78.3% and 57.1%, respectively. On univariate analysis, surgery (hazard ratio [HR] 3.881; 95% confidence interval [CI] 1.784-19.220; p = 0.006) and stage (HR 5.457; 95% CI 1.567-18.996; p = 0.0001) were significant prognostic factors and association with myasthenia gravis (HR 0.404; 95% CI 0.151-1.078; p = 0.078) trended towards better PFS. Stage retained its prognostic significance (HR 5.501; 95% CI 2.076-14.573; p = 0.0006) on multivariate analysis. Conclusions Multimodality management of locally advanced thymoma yields decent survival outcomes. Masaoka stage is an independent prognostic factor for survival and radical surgery should be contemplated in all cases of locoregionally limited thymoma.
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Successful Pregnancies after the Treatment of a Thymic Carcinoid. Case Rep Obstet Gynecol 2015; 2015:802713. [PMID: 26294990 PMCID: PMC4532952 DOI: 10.1155/2015/802713] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Accepted: 05/19/2015] [Indexed: 11/20/2022] Open
Abstract
The present report describes the case of a woman diagnosed with an adrenocorticotropic hormone- (ACTH-) secreting thymic carcinoid associated with Cushing's syndrome. Treatment consisted of tumour resection and 131-I-meta-iodobenzylguanidine (MIBG) therapy. In spite of her iatrogenic menopausal state she twice became pregnant and delivered two healthy babies but developed recurrences during both pregnancies. The last recurrence presented as a primary breast cancer. Despite poor prognosis our patient survived for eleven years. To our knowledge this is the first report of successful pregnancy and delivery in a patient with a thymic carcinoid.
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Xu C, Feng QF, Fan CC, Zhai YR, Chen YD, Zhang HX, Xiao ZF, Liang J, Chen DF, Zhou ZM, Wang LH, He J. Patterns and predictors of recurrence after radical resection of thymoma. Radiother Oncol 2015; 115:30-4. [PMID: 25794972 DOI: 10.1016/j.radonc.2015.03.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Revised: 03/02/2015] [Accepted: 03/02/2015] [Indexed: 01/10/2023]
Abstract
BACKGROUND Recurrence of thymomas even after complete resection is common, but the relapse patterns remain controversial. This study aimed to define the patterns and predictors of relapse after complete resection of thymoma. METHODS A single-institution retrospective study was performed with 331 patients who underwent radical resection of thymoma between 1991 and 2012. RESULTS After a median follow-up of 59 months, the recurrence rate was 6.9% (23/331). Relapse occurred in 23 patients with the pleura (14) and tumor bed (6) as the most common sites of recurrence. According to the definitions of the International Thymic Malignancy Interest Group, 10 (43.5%) patients had local relapse, 15 (65.2%) had regional relapse, 10 (43.5%) had distant relapse. The difference in survival following relapse between lung and regional relapse was statistically significant (P=0.027) but that between lung and distant relapse was not (P=0.808). The recurrence rates correlated with the initial Masaoka stage. Further, recurrence also correlated with World Health Organization (WHO) tumor type. The recurrence-free survival rates in patients with tumor size ⩾8 cm were worse than those of patients with tumor size <8 cm (P=0.007). Tumor size was also correlated with stage (r=0.110). As tumor becomes larger, the stage is more advanced (P=0.023). Multivariate analysis showed that Masaoka stage (P=0.005), tumor size (P=0.033), and WHO histological type (P=0.046) were predictive factors of relapse. CONCLUSION Regional recurrence is the most common relapse pattern but local and distant relapse are also common. Advanced Masaoka stage, larger tumor size, and type B3 are risk factors of recurrence. Lung relapse should be considered distant relapse. Further, tumor size was correlated with Masaoka stage and therefore should be considered in the staging system.
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Affiliation(s)
- Cai Xu
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Qin-Fu Feng
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
| | - Cheng-Cheng Fan
- Department of Radiation Oncology, Cancer Hospital, Zhengzhou University, China
| | - Yi-Rui Zhai
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Dong Chen
- Department of Radiation Oncology, Beijing Shijitan Hospital, China
| | - Hong-Xing Zhang
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ze-Fen Xiao
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jun Liang
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong-Fu Chen
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zong-Mei Zhou
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lu-Hua Wang
- Department of Radiation Oncology, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jie He
- Department of Thorax Surgery, Cancer Hospital/Institute, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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CAO YONGCHENG, ZHU MING, MAO RUIQI, CAO RUIXUE, YU GUOLI, NIU AIJUN. Oncocytic carcinoma of the salivary gland with thymoma: A case report and review of the literature. Oncol Lett 2015; 9:681-684. [PMID: 25624895 PMCID: PMC4301545 DOI: 10.3892/ol.2014.2707] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2014] [Accepted: 10/15/2014] [Indexed: 11/23/2022] Open
Abstract
Oncocytic carcinoma (OC) arising in the salivary gland is a very rare tumor with only 32 previously reported cases. In this report, we describe a novel case of oncocytic carcinoma with associated thymoma, which arose in the left parotid gland of a 66-year-old male with a history of a painless left parotid mass for 1 year. Oncocytes are large, polygonal cells that are characterized by marked cellular atypia, frequent mitoses, wide eosinophilic granular cytoplasm, a central nucleus and a prominent nucleolus. The follow-up data showed no evidence of recurrence and the patient is in a good health 20 months after the surgery. In the current case, the patient had not only OC but also thymoma, which is exceedingly rare and may represent the first documented case in the literature.
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Affiliation(s)
- YONGCHENG CAO
- Department of Pathology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - MING ZHU
- Department of Radiology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - RUIQI MAO
- Department of Pathology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - RUIXUE CAO
- Department of Pathology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - GUOLI YU
- Department of Pathology, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
| | - AIJUN NIU
- Department of Laboratory Medicine, General Hospital of Jinan Military Command, Jinan, Shandong 250031, P.R. China
- Correspondence to: Dr Aijun Niu, Department of Laboratory Medicine, General Hospital of Jinan Military Command, 25 Shifan Road, Jinan, Shandong 250031, P.R. China, E-mail:
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Omasa M, Date H, Sozu T, Sato T, Nagai K, Yokoi K, Okamoto T, Ikeda N, Tanaka F, Maniwa Y. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage II and III thymic epithelial tumors: the Japanese Association for Research on the Thymus Database Study. Cancer 2015; 121:1008-16. [PMID: 25565590 DOI: 10.1002/cncr.29166] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2014] [Revised: 08/07/2014] [Accepted: 08/08/2014] [Indexed: 11/11/2022]
Abstract
BACKGROUND The efficacy of postoperative radiotherapy (PORT) for thymic epithelial tumors is still controversial. Using the Japanese Association for Research on the Thymus (JART) database, this study was aimed at clarifying the efficacy of PORT for Masaoka stage II and III thymic carcinoma and thymoma. METHODS The JART database registered the records of 2835 patients collected from 32 Japanese institutions from 1991 to 2010. Thymic carcinoma and thymoma at stage II or III were extracted. The efficacy of PORT with respect to relapse-free survival (RFS) and overall survival (OS) was evaluated with the Kaplan-Meier method and Cox regression analysis. RESULTS There were 1265 patients in all: 155 thymic carcinoma cases (12.3%) and 1110 thymoma cases (87.7%). Eight hundred ninety-five (70.8%) were at stage II, and 370 (29.2%) were at stage III. Four hundred three cases (31.9%) underwent PORT. PORT for stage II and III thymic carcinoma was associated with increasing RFS (hazard ratio, 0.48; 95% confidence interval, 0.30-0.78; P = .003) but was not associated with OS (hazard ratio, 0.94; 95% confidence interval, 0.51-1.75; P = .536). PORT for stage II and III thymoma was not associated with RFS or OS (P = .350). A subgroup analysis of stage III thymoma showed no factor associated with the efficacy of PORT. CONCLUSIONS In this study, PORT did not increase RFS or OS for stage II or III thymoma but increased RFS for stage II and III thymic carcinoma.
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Affiliation(s)
- Mitsugu Omasa
- Department of Thoracic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Park SH, Kim JH, Lee JY, Shin SK, Hong YK, Kie JH, Kang DY, Lee CH. A Case of Thymic Carcinoma with Behcet's Disease Combined with Immunoglobulin A Nephropathy. JOURNAL OF RHEUMATIC DISEASES 2015. [DOI: 10.4078/jrd.2015.22.2.118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Se Hee Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Ho Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Jung Yoen Lee
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sug Kyun Shin
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Yong Kook Hong
- Department of Radiology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Jeong Hae Kie
- Department of Pathology, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Du Yong Kang
- Department of Thoracic and Cardiovascular Surgery, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | - Chan Hee Lee
- Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
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Van Raemdonck D. What comes out of Pandora's box? J Thorac Cardiovasc Surg 2014; 149:110-1. [PMID: 25524681 DOI: 10.1016/j.jtcvs.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 11/03/2014] [Indexed: 11/29/2022]
Affiliation(s)
- Dirk Van Raemdonck
- Department of Thoracic Surgery, University Hospitals Leuven, Leuven, Belgium.
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Zhao Y, Chen H, Shi J, Fan L, Hu D, Zhao H. The correlation of morphological features of chest computed tomographic scans with clinical characteristics of thymoma. Eur J Cardiothorac Surg 2014; 48:698-704. [PMID: 25527169 DOI: 10.1093/ejcts/ezu475] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2014] [Accepted: 11/18/2014] [Indexed: 02/04/2023] Open
Abstract
OBJECTIVES Chest computed tomography (CT) scanning has been widely utilized in thymoma identification and staging as well as in follow-up monitoring for recurrence. However, the relationship between some CT imaging features and pathological types, clinical stage, completeness of resection, or prognosis in thymoma has not been well explored. METHODS We retrospectively reviewed preoperative CT imaging for 238 thymoma patients, who had undergone thymectomy from October 2007 to December 2011. All CT parameters were assessed in each case based on clinical and pathological data. Survival analysis was performed by using the Kaplan-Meier and log-rank tests. RESULTS Tumour contours (P = 0.008), homogeneity (P = 0.009), degree of enhancement (P = 0.013), fat plane obliteration with adjacent structures (P < 0.001), the presence of mediastinal lymphadenopathy (P = 0.010), irregular infiltration into the lung (P = 0.012) and tumour shape (P = 0.007) were associated with the World Health Organization (WHO) histological classification. Lobulated or irregular tumour contours (P < 0.001), presence of calcifications (P = 0.002), infiltration of surrounding fat (P < 0.001), irregular infiltration into the lung (P < 0.001), irregular infiltration into vascular (P < 0.001), more abutment of vessels (P < 0.001) and pulmonary changes adjacent to the tumour (P < 0.001) were associated with the more advanced Masaoka-Koga clinical stage. Tumour contours (P < 0.001), infiltration of surrounding fat (P = 0.008), irregular infiltration into the lung (P < 0.001) and degree of abutment of vessel circumference (P = 0.001) were associated with completeness of resection. With multivariate analysis, no CT image features could reliably predict on the overall or disease-free survival rate. CONCLUSIONS CT imaging does have some features, which are significantly correlated with the WHO classification, the Masaoka-Koga clinical staging and the completeness of resection, although it has no definite role to evaluate preoperatively the survival rate of thymoma patients.
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Affiliation(s)
- Yang Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China
| | - Haiquan Chen
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China
| | - Jianxin Shi
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China
| | - Limin Fan
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China
| | - Dingzhong Hu
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China
| | - Heng Zhao
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiaotong University, Shanghai, PR China
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Koning MV, Struijs A. Adrenal insufficiency presenting as bilateral rigid auricles: a case report. J Med Case Rep 2014; 8:302. [PMID: 25209544 PMCID: PMC4168984 DOI: 10.1186/1752-1947-8-302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Accepted: 07/30/2014] [Indexed: 11/10/2022] Open
Abstract
Introduction Stiff ears appear to be a warning sign for adrenal insufficiency. This remarkable and rare sign has not been described to present in adrenal insufficiency in the setting of critical care. Case presentation We present the case of a 68-year-old Caucasian male who underwent a thymoma resection and suffered from preoperative weight loss and lack of strength. The perioperative phase was characterised by hypotension and sputum stasis due to muscle weakness, which caused two readmissions to the intensive care unit. His physical examination showed two fully rigid auricles. In retrospect, our patient suffered from secondary adrenal insufficiency and hypogonadism. Conclusions The bilateral rigid auricles appeared to be a warning sign for adrenal insufficiency. This remarkable sign is easily checked, and should prompt a higher index of suspicion towards adrenal insufficiency and other hormonal deficiencies.
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Affiliation(s)
- Mark Vincent Koning
- Department of Anaesthesiology, Erasmus University Medical Center, Postbus 2040, 3000, CA Rotterdam, The Netherlands.
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Ruffini E, Venuta F. Management of thymic tumors: a European perspective. J Thorac Dis 2014; 6 Suppl 2:S228-37. [PMID: 24868441 DOI: 10.3978/j.issn.2072-1439.2014.04.19] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2014] [Accepted: 04/15/2014] [Indexed: 12/13/2022]
Abstract
Thymic tumors are rare mediastinal tumors, which are considered as orphan diseases due to their low prevalence. The most recent histologic classification divides thymic tumors into thymomas, thymic carcinomas (TC) and neuroendocrine thymic tumors (NETT). Until recently, clinical research on thymic tumors has been primarily represented by single-institution experiences usually scattered over a long time period in order to accumulate a sufficient number of patients for clinical analysis. Europe has played a pivotal role in the advancement of the clinical research on thymus in the past years. In the last decade, there has been an increased interest in thymic malignancies in the scientific community. The European Society of Thoracic Surgeons (ESTS), the most representative society of general thoracic surgeons in the world, established a dedicated thymic working group in 2010 with the intent to provide a platform among ESTS members with a specific interest in thymic malignancies. The present review is intended to provide, through the description of the activity of the ESTS thymic working group and its published results, an overview of the European contribution to the thymic research. A brief overview of the state-of-the-art of clinical presentation, diagnosis, staging and histologic classification of thymic tumors is also provided, along with the most recent therapeutic advancements.
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Affiliation(s)
- Enrico Ruffini
- 1 Section of Thoracic Surgery, Department of Surgery, University of Torino, Torino, Italy ; 2 Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy
| | - Federico Venuta
- 1 Section of Thoracic Surgery, Department of Surgery, University of Torino, Torino, Italy ; 2 Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Fondazione Eleonora Lorilard Spencer Cenci, Rome, Italy
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Abstract
Thymoma is the most common tumor of the anterior mediastinum. This tumor is associated with unique paraneoplastic syndromes. The rarity of this tumor has somewhat obscured the optimal treatment for this disease. The World Health Organization classification system, which published in 1999, appears to be an advance in our understanding of thymoma. The Masaoka classification is now the most widely accepted and is an excellent predictor of the prognosis of thymoma. Now the International Thymic Malignancy Interest Group is currently engaged in the development of a validated formal TNM classification system for thymic malignancies. The optimal treatment of thymoma is performed according to its clinical stage. Surgery remains the mainstay of treatment for thymic epithelial tumors. Minimally invasive surgery including thoracoscopic surgery and robotic surgery for stage I and II thymomas is increasing now. The value of postoperative radiotherapy in completely resected stage II or III tumors is questionable. As thymomas have a moderate response rate to chemotherapy or radiotherapy, multimodality therapy involving surgery, chemotherapy and radiotherapy appears to increase the rate of complete resection and survival in the advanced (stage III and IV) thymomas.
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Affiliation(s)
- Kazuya Kondo
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, 18-15 Kuramoto-cho 3, Tokushima, 770-8509, Japan,
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Okuma Y, Hosomi Y, Watanabe K, Yamada Y, Horio H, Maeda Y, Okamura T, Hishima T. Clinicopathological analysis of thymic malignancies with a consistent retrospective database in a single institution: from Tokyo Metropolitan Cancer Center. BMC Cancer 2014; 14:349. [PMID: 24885581 PMCID: PMC4039543 DOI: 10.1186/1471-2407-14-349] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs), which comprise thymoma and thymic carcinoma, are rare cancers with specific morphological and clinical features. Their clinical characteristics and outcomes have gradually been clarified by assessing large-scale, retrospective data obtained with international cooperation. METHODS The study is a retrospective review of 187 Japanese patients with TETs who attended our institution from 1976 to 2012. Relevant clinical features of patients with TETs and their tumors, including histology, staging, treatment strategies, and overall survival, were investigated. Differences in survival were assessed by the Kaplan-Meier method and uni- and multi-variate Cox proportional hazards regression analyses. RESULTS The 187 patients included 52 patients with stage I, 37 with stage II, 22 with stage III, and 76 with stage IVa/IVb tumors according to the Masaoka-Koga Staging System. As to histological type, five patients had type A, 33 type AB, 19 type B1, 39 type B2, and 15 type B3 thymomas, whereas 68 patients had thymic carcinoma, including 11 with neuroendocrine carcinomas according to the 2004 WHO classification. Either insufficient data were available to classify the tumors of the remaining eight patients or they had rare types. Immunological abnormalities were present in 26 patients, most of whom had thymomas (21.8% of the thymoma group). Most of the patients who presented with symptoms had myasthenia gravis or extensive thymic carcinoma. Secondary cancers were present in 25 patients (13.3%). The overall 5- and 10-year survival rates for thymoma were 85.4 and 71.5%, respectively, and those for thymic carcinoma were 33.8 and 2.3%, respectively. OS differed significantly between stage IVa thymomas and thymic carcinomas. The stage and whether the tumors were thymomas or thymic carcinomas were significant determinants of survival according to multivariate analysis. CONCLUSION The efficacy of treatments for thymoma and thymic carcinoma should be investigated separately because these tumors differ in their clinical features and prognosis.
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Affiliation(s)
- Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo 113-8677, Japan
- Division of Oncology, Research Center for Medical Science, The Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo 113-8677, Japan
| | - Kageaki Watanabe
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo 113-8677, Japan
| | - Yuko Yamada
- Departments of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan
| | - Hirotoshi Horio
- Departments of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan
| | - Yoshiharu Maeda
- Department of Chemotherapy, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan
| | - Tatsuru Okamura
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo 113-8677, Japan
| | - Tsunekazu Hishima
- Departments of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan
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Thymoma patients treated in a phase I clinic at MD Anderson Cancer Center: responses to mTOR inhibitors and molecular analyses. Oncotarget 2014; 4:890-8. [PMID: 23765114 PMCID: PMC3757246 DOI: 10.18632/oncotarget.1015] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Thymomas and thymic carcinoma are rare tumors with no approved therapies. Our purpose was to analyze the molecular features and outcomes of patients referred to the Clinical Center for Targeted Therapy (Phase I Clinic). METHODS We retrospectively reviewed the medical records of consecutive referred patients with advanced/metastatic thymoma or thymic carcinoma RESULTS Twenty-one patients were identified (median age 52 years; 10 women; median number of prior systemic therapies = 2). Six of 10 patients (60%) treated with mTOR inhibitor combination regimens achieved stable disease (SD) ≥12 months or a partial response (PR). For patients treated on mTOR inhibitor regimens (N = 10), median time to treatment failure (TTF) was 11.6 months versus 2.3 months on last conventional regimen prior to referral (p=0.024). Molecular analyses (performed by next generation sequencing in seven patients and single polymerase chain reaction (PCR)-based assays in an additional six patients) showed diverse actionable mutations: PIK3CA (1 of 12 tested; 8%); EGFR (1 of 13; 8%); RET (1 of 7; 14%); and AKT1 (1 of 7; 14%). Of two patients with PIK3CA or AKT1 mutations, one was treated with an mTOR inhibitor-based regimen and achieved 26% regression with a TTF of 17 months. CONCLUSION Patients with advanced/metastatic thymoma or thymic carcinoma demonstrated prolonged TTF on mTOR inhibitor-based therapy as compared to prior conventional treatment. Heterogeneity in actionable molecular aberrations was observed, suggesting that multi-assay molecular profiling and individualizing treatment merits investigation.
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131
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Yen YT, Lai WW, Chang KW, Chang KC, Lee SC, Lin SH, Wu MH, Tseng YL. Factors Predicting Recurrence and Postrecurrence Survival in Completely Resected Thymic Carcinoma. Ann Thorac Surg 2014; 97:1169-75. [DOI: 10.1016/j.athoracsur.2013.12.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 12/02/2013] [Accepted: 12/18/2013] [Indexed: 10/25/2022]
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132
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Bae MK, Lee SK, Kim HY, Park SY, Park IK, Kim DJ, Chung KY. Recurrence after thymoma resection according to the extent of the resection. J Cardiothorac Surg 2014; 9:51. [PMID: 24646138 PMCID: PMC3994658 DOI: 10.1186/1749-8090-9-51] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2013] [Accepted: 03/11/2014] [Indexed: 11/21/2022] Open
Abstract
Background Complete resection of the thymus is considered appropriate for a thymoma resection because any remaining thymic tissue can lead to local recurrence. However, there are few studies concerning the extent of thymus resection. Therefore, we conducted a retrospective study to investigate whether recurrence following thymoma resection correlated to the extent of resection. Methods Between 1986 and 2011, a total of 491 patients underwent resection of thymic epithelial tumors with curative intent. Of those, we excluded patients with an undetermined World Health Organization (WHO) histologic type, patients with type C thymoma, and patients who underwent incomplete resection (n = 21). The remaining 342 patients were reviewed retrospectively and compared recurrence according to the extent of resection. Results Extended thymectomy was performed in 239 patients (69.9%) and limited thymectomy was performed 103 patients (30.1%). In the extended thymectomy group, 29 recurrences occurred, and in the limited thymectomy group, 10 recurrences occurred. Comparing rates of freedom from recurrence between two groups, there was no significant statistical difference in total recurrence (p =0.472) or local recurrence (p =0.798). After matching patients by stage and tumor size, there was no significant difference in freedom from recurrence between the two groups (p = 0.162). Additionally, after adjusting for histologic type and MG, there was also no significant difference (p = 0.125) between groups. Conclusions No difference in the rate of recurrence was observed in patients following limited thymectomy compared with extended thymectomy.
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Affiliation(s)
| | | | | | | | | | | | - Kyung Young Chung
- Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea.
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133
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Manoly I, Whistance RN, Sreekumar R, Khawaja S, Horton JM, Khan AZ, Casali G, Thorpe JA, Amer K, Woo E. Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma. Eur J Cardiothorac Surg 2014; 45:e187-93. [DOI: 10.1093/ejcts/ezu077] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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134
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Huang J, Detterbeck FC, Wang Z, Loehrer PJ. [Standard outcome measures for thymic malignancies]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:122-9. [PMID: 24581163 PMCID: PMC6131238 DOI: 10.3779/j.issn.1009-3419.2014.02.10] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James Huang
- Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine and Department of Biostatistics, School of Epidemiology and Public Health, Yale University, New Haven, Connecticut
| | - Frank C Detterbeck
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Zuoheng Wang
- Thoracic Service, Memorial Sloan-Kettering Cancer Center, New York City, New York
| | - Patrick J Loehrer
- HH Gregg Professor of Oncology, Division of Medical Oncology, Department of Internal Medicine, Indiana Universitychool of Medicine, Indianapolis, Indiana
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135
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Gönen M. [Bias, biostatistics, and prognostic factors]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:137-41. [PMID: 24581165 PMCID: PMC6131235 DOI: 10.3779/j.issn.1009-3419.2014.02.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Mithat Gönen
- Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York
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136
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Filosso PL, Guerrera F, Rendina AE, Bora G, Ruffini E, Novero D, Ruco L, Vitolo D, Anile M, Ibrahim M, Casadio C, Rena O, Terzi A, Lyberis P, Oliaro A, Venuta F. Outcome of surgically resected thymic carcinoma: A multicenter experience. Lung Cancer 2014; 83:205-10. [DOI: 10.1016/j.lungcan.2013.11.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2013] [Revised: 10/19/2013] [Accepted: 11/18/2013] [Indexed: 10/26/2022]
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137
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Filosso PL, Ruffini E, Lausi PO, Lucchi M, Oliaro A, Detterbeck F. Historical perspectives: The evolution of the thymic epithelial tumors staging system. Lung Cancer 2014; 83:126-32. [DOI: 10.1016/j.lungcan.2013.09.013] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Revised: 09/16/2013] [Accepted: 09/23/2013] [Indexed: 10/26/2022]
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138
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Granato F, Blackhall V, Alessandra R, Spina D, Luca V, Piero P, Mohiyaddin S, Asif M, Kirk AJB, Giuseppe G. Outcome in excised thymomas: role of prognostic factors and impact of additional malignancies on survival. Scott Med J 2014; 59:22-9. [DOI: 10.1177/0036933013518147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background and aims: Although the management of thymomas has been extensively evaluated, the value of prognostic factors in the outcome of these patients remains unclear. Methods and results: The medical records of all patients who underwent resection of thymoma between January 1985 and September 2010 at a single thoracic unit were reviewed. Patients were followed up with reference to disease recurrence and development of additional malignancies (AM). Total thymectomy was performed in all 68 cases. Mean follow-up time was four years. Mean survival was 63.9 months. Mean disease-free interval was 13 months. Factors affecting prognosis were Masaoka staging and WHO histological sub-type. Patients with thymomas had a higher risk of developing AM when compared with a control population of individuals with other tumours ( p = 0.0002). Among thymomas, the cortical subtype was associated with a higher risk of AM ( p = 0.047) and mortality ( p = 0.001). Conclusions: This data confirms that Masaoka staging and WHO histologic sub-type are the most important prognostic factors in patients with thymoma. Moreover, thymomas predominantly arising from the thymic cortex are associated with a higher risk of developing other malignancies and with poorer survival. The cortical origin of thymoma could therefore be considered as a significant prognostic factor.
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Affiliation(s)
- F Granato
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
- Professor of Genetics, Doctorate School of Oncology and Genetic, University Hospital of Siena, Italy
| | - V Blackhall
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
| | - R Alessandra
- Professor of Genetics, Doctorate School of Oncology and Genetic, University Hospital of Siena, Italy
| | - D Spina
- Consultant Pathologist, Department of Pathology, University Hospital of Siena, Italy
| | - V Luca
- Professor of Thoracic Surgery, Department of Thoracic Surgery, University Hospital of Siena, Italy
| | - P Piero
- Professor of Thoracic Surgery, Department of Thoracic Surgery, University Hospital of Siena, Italy
| | - S Mohiyaddin
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
| | - M Asif
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
| | - A JB Kirk
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
| | - Gotti Giuseppe
- Professor of Thoracic Surgery, Department of Thoracic Surgery, University Hospital of Siena, Italy
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139
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Filosso PL, Venuta F, Oliaro A, Ruffini E, Rendina EA, Margaritora S, Casadio C, Terzi A, Rena O, Lococo F, Guerrera F. Thymoma and inter-relationships between clinical variables: a multicentre study in 537 patients. Eur J Cardiothorac Surg 2014; 45:1020-7. [DOI: 10.1093/ejcts/ezt567] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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140
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Rajan A, Carter CA, Berman A, Cao L, Kelly RJ, Thomas A, Khozin S, Chavez AL, Bergagnini I, Scepura B, Szabo E, Lee MJ, Trepel JB, Browne SK, Rosen LB, Yu Y, Steinberg SM, Chen HX, Riely GJ, Giaccone G. Cixutumumab for patients with recurrent or refractory advanced thymic epithelial tumours: a multicentre, open-label, phase 2 trial. Lancet Oncol 2014; 15:191-200. [PMID: 24439931 DOI: 10.1016/s1470-2045(13)70596-5] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND No standard treatment exists for refractory or relapsed advanced thymic epithelial tumours. We investigated the efficacy of cixutumumab, a fully human IgG1 monoclonal antibody targeting the insulin-like growth factor 1 receptor in thymic epithelial tumours after failure of previous chemotherapy. METHODS Between Aug 25, 2009, and March 27, 2012, we did a multicentre, open-label, phase 2 trial in patients aged 18 years or older with histologically confirmed recurrent or refractory thymic epithelial tumours. We enrolled individuals who had progressed after at least one previous regimen of platinum-containing chemotherapy, had an Eastern Cooperative Oncology Group performance status of 0 or 1, and had measurable disease and adequate organ function. Eligible patients received intravenous cixutumumab (20 mg/kg) every 3 weeks until disease progression or development of intolerable toxic effects. The primary endpoint was the frequency of response, analysed on an intention-to-treat basis. We also did pharmacodynamic studies. This trial is registered with ClinicalTrials.gov, number NCT00965250. FINDINGS 49 patients were enrolled (37 with thymomas and 12 with thymic carcinomas) who received a median of eight cycles of cixutumumab (range 1-46). At the final actuarial analysis when follow-up data were updated (Nov 30, 2012), median potential follow-up (from on-study date to most current follow-up date) was 24·0 months (IQR 17·3-36·9). In the thymoma cohort, five (14%) of 37 patients (95% CI 5-29) achieved a partial response, 28 had stable disease, and four had progressive disease. In the thymic carcinoma cohort, none of 12 patients (95% CI 0-26) had a partial response, five had stable disease, and seven had progressive disease. The most common grade 3-4 adverse events in both cohorts combined were hyperglycaemia (five [10%]), lipase elevation (three [6%]), and weight loss, tumour pain, and hyperuricaemia (two each [4%]). Nine (24%) of 37 patients with thymoma developed autoimmune conditions during treatment (five were new-onset disorders), the most common of which was pure red-cell aplasia. Two (4%) patients died; one was attributed to disease progression and the other to disease-related complications (respiratory failure, myositis, and an acute coronary event), which could have been precipitated by treatment with cixutumumab. INTERPRETATION Cixutumumab monotherapy is well-tolerated and active in relapsed thymoma. Development of autoimmunity during treatment needs further investigation. FUNDING Division of Cancer Treatment and Diagnosis at the National Cancer Institute (National Institutes of Health), ImClone Systems.
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Affiliation(s)
- Arun Rajan
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Corey A Carter
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Arlene Berman
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Liang Cao
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ronan J Kelly
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Anish Thomas
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sean Khozin
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Ariel Lopez Chavez
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Barbara Scepura
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Eva Szabo
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Min-Jung Lee
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Jane B Trepel
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Sarah K Browne
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Lindsey B Rosen
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | - Yunkai Yu
- Genetics Branch, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Seth M Steinberg
- Biostatistics and Data Management Section, Office of the Clinical Director, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Helen X Chen
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | | | - Giuseppe Giaccone
- Medical Oncology Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.
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141
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Komaki R, Gomez DR. Radiotherapy for thymic carcinoma: adjuvant, inductive, and definitive. Front Oncol 2014; 3:330. [PMID: 24455488 PMCID: PMC3887269 DOI: 10.3389/fonc.2013.00330] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2013] [Accepted: 12/25/2013] [Indexed: 12/25/2022] Open
Abstract
Although historically thymoma and thymic carcinoma have been treated surgically, radiation therapy also has an important role, either as postoperative therapy to reduce the risk of mediastinal recurrence or as part of definitive treatment for patients who cannot undergo surgery. Induction chemotherapy and molecular targeted agents may also be appropriate for thymic carcinoma, the behavior of which resembles non-small-cell lung carcinoma more than that of thymoma or invasive thymoma and is increasingly being treated like lung cancer. We present here a review of current therapies for thymic malignancies and briefly discuss the potential benefits from novel technologies for such treatment.
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Affiliation(s)
- Ritsuko Komaki
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston, TX , USA
| | - Daniel R Gomez
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center , Houston, TX , USA
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142
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Kent MS, Wang T, Gangadharan SP, Whyte RI. What is the Prevalence of a “Nontherapeutic” Thymectomy? Ann Thorac Surg 2014; 97:276-82; discussion 82. [DOI: 10.1016/j.athoracsur.2013.07.121] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2013] [Revised: 07/25/2013] [Accepted: 07/29/2013] [Indexed: 10/26/2022]
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143
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Korst RJ, Bezjak A, Blackmon S, Choi N, Fidias P, Liu G, Marx A, Wright C, Mock S, Rutledge JR, Keshavjee S. Neoadjuvant chemoradiotherapy for locally advanced thymic tumors: A phase II, multi-institutional clinical trial. J Thorac Cardiovasc Surg 2014; 147:36-44, 46.e1. [DOI: 10.1016/j.jtcvs.2013.08.061] [Citation(s) in RCA: 82] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 08/15/2013] [Accepted: 08/21/2013] [Indexed: 11/29/2022]
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144
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Mokhtar M, Kondo K, Namura T, Ali AHK, Fujita Y, Takai C, Takizawa H, Nakagawa Y, Toba H, Kajiura K, Yoshida M, Kawakami G, Sakiyama S, Tangoku A. Methylation and expression profiles of MGMT gene in thymic epithelial tumors. Lung Cancer 2013; 83:279-87. [PMID: 24388682 DOI: 10.1016/j.lungcan.2013.12.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2013] [Revised: 12/05/2013] [Accepted: 12/11/2013] [Indexed: 12/31/2022]
Abstract
OBJECTIVES A key challenge in diagnosis and treatment of thymic epithelial tumors (TET) is in improving our understanding of the genetic and epigenetic changes of these relatively rare tumors. METHODS Methylation specific PCR (MSP) and immunohistochemistry were applied to 66 TET to profile the methylation status of DNA repair gene O6-methylguanine DNA methyltransferase (MGMT) and its protein expression in TET to clarify the association between MGMT status and clinicopathological features, response to chemotherapy and overall survival. RESULTS MGMT methylation was significantly more frequent in thymic carcinoma than in thymoma (17/23, 74% versus 13/44, 29%; P<0.001). Loss of expression of MGMT protein was significantly more frequent in thymic carcinoma than in thymoma (20/23, 87% versus 10/44, 23%; P<0.0001). There is a significant correlation between of MGMT methylation and loss of its protein expression (P<0.0003). MGMT methylation and loss of expression were significantly more frequent in advanced thymic epithelial tumors (III/IV) than in early tumors (I/II). CONCLUSION MGMT methylation plays a soul role in development of TET, especially in thymic carcinoma. Therefore, translation of our results from basic molecular research to clinical practice may have important implication for considering MGMT methylation as a marker and a target of future therapies in TET.
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Affiliation(s)
- Mohamed Mokhtar
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan; Department of Oncological Surgery, Minia Oncology Institute, Minia, Egypt
| | - Kazuya Kondo
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan.
| | - Toshiaki Namura
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Abdellah H K Ali
- Department of Respiratory Medicine, Sohag Faculty of Medicine, Sohag University, Sohag, Egypt
| | - Yui Fujita
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Chikako Takai
- Department of Oncological Medical Services, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Hiromitsu Takizawa
- Department of Thoracic, Endocrine and Oncological Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Yasushi Nakagawa
- Department of Thoracic, Endocrine and Oncological Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Hiroaki Toba
- Department of Thoracic, Endocrine and Oncological Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Koichiro Kajiura
- Department of Thoracic, Endocrine and Oncological Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Mitsuteru Yoshida
- Department of Thoracic, Endocrine and Oncological Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Gyokei Kawakami
- Department of Thoracic, Endocrine and Oncological Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Shoji Sakiyama
- Department of Thoracic, Endocrine and Oncological Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
| | - Akira Tangoku
- Department of Thoracic, Endocrine and Oncological Surgery, Institute of Health Biosciences, The University of Tokushima Graduate School, Tokushima, Japan
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Berardi R, De Lisa M, Pagliaretta S, Onofri A, Morgese F, Savini A, Ballatore Z, Caramanti M, Santoni M, Mazzanti P, Cascinu S. Thymic neoplasms: an update on the use of chemotherapy and new targeted therapies. A literature review. Cancer Treat Rev 2013; 40:495-506. [PMID: 24355362 DOI: 10.1016/j.ctrv.2013.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2013] [Revised: 11/10/2013] [Accepted: 11/12/2013] [Indexed: 12/14/2022]
Abstract
Thymic malignancies represent a wide range of clinical, histological and molecular entities, with probably considerable heterogeneity even among tumors of the same histotype. Systemic chemotherapy with cisplatin-based regimens continues to represent the standard of care in metastatic or inoperable refractory/recurrent diseases and ADOC regimen (including cisplatin, doxorubicin, vincristine and cyclophosphamide) demonstrated the longer overall response rate and median survival in the first line setting, although no randomized trial is available; and there is still a lack of standard treatment after first-line failure. To date research efforts are focused on translational studies on molecular pathways involved in thymic tumors carcinogenesis, aimed to better understand and predict the efficacy of chemotherapy and targeted therapy. Recent molecular characterization includes identification of a number of oncogenes, tumor suppressor genes, chromosomal aberrations, angiogenic factors, and tumor invasion factors involved in cellular survival and proliferation and in tumor growth. The use of biologic drugs is currently not recommended in a routine practice because there are limited data on their therapeutic role in thymic epitelial tumors. Because of the lack of data from adequate-sized, prospective trials are required for validation and the enrolment of patients with advanced disease into available clinical trials has to be encouraged.
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Affiliation(s)
- Rossana Berardi
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy.
| | - Mariagrazia De Lisa
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Silvia Pagliaretta
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Azzurra Onofri
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Francesca Morgese
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Agnese Savini
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Zelmira Ballatore
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Miriam Caramanti
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Matteo Santoni
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Paola Mazzanti
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
| | - Stefano Cascinu
- Medical Oncology, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I, GM Lancisi, G Salesi, Ancona, Italy
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146
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Imai H, Kaira K, Yoshino R, Sato K, Shimizu K, Kawashima O, Tanaka S, Mori M. Clinical features of patients with invasive thymoma: A retrospective analysis of 61 cases. SURGICAL PRACTICE 2013. [DOI: 10.1111/1744-1633.12026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
| | - Kyoichi Kaira
- Department of Medicine and Molecular Science; Gunma University Graduate School of Medicine; Maebashi; Gunma
| | - Reiko Yoshino
- Department of Respiratory Medicine; National Hospital Organization Nishigunma Hospital; Shibukawa; Gunma
| | - Koji Sato
- Department of Respiratory Medicine; Gunma Cancer Center; Ohta; Gunma
| | - Kimihiro Shimizu
- Department of Thoracic and Visceral Organ Surgery; Gunma University Graduate School of Medicine; Maebashi; Gunma
| | - Osamu Kawashima
- Department of Respiratory Surgery; National Hospital Organization Nishigunma Hospital; Shibukawa; Gunma
| | - Shigebumi Tanaka
- Department of Surgery; Isesaki Municipal Hospital; Isesaki; Gunma
| | - Masatomo Mori
- Department of Medicine and Molecular Science; Gunma University Graduate School of Medicine; Maebashi; Gunma
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Zhang Z, Wu B, Niu L, Mu F, Chen J, Li J, Zuo J, Xu K. Combination percutaneous cryotherapy and iodine-125 seed implantation for unresectable malignant thymoma: Experience in 19 patients. Cryobiology 2013; 67:170-4. [DOI: 10.1016/j.cryobiol.2013.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Revised: 06/29/2013] [Accepted: 06/29/2013] [Indexed: 02/07/2023]
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Park IK, Kim YT, Jeon JH, Kim HS, Hwang Y, Seong YW, Kang CH, Kim JH. Importance of Lymph Node Dissection in Thymic Carcinoma. Ann Thorac Surg 2013; 96:1025-32; discussion 1032. [DOI: 10.1016/j.athoracsur.2013.04.057] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 04/10/2013] [Accepted: 04/15/2013] [Indexed: 11/30/2022]
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149
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Lee KH, Kim KT, Son HS, Jung JS, Cho JH. Porcine dermal collagen (permacol) for sternal reconstruction. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2013; 46:312-5. [PMID: 24003418 PMCID: PMC3756168 DOI: 10.5090/kjtcs.2013.46.4.312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/20/2012] [Revised: 02/07/2013] [Accepted: 03/07/2013] [Indexed: 11/24/2022]
Abstract
In chest wall reconstruction after wide chest wall resection, the use of a musculocutaneous flap or prosthetic materials is inevitable for maintaining thoracic movement and a closed pleural cavity. We report a case of a 63-year-old male with a large invasive thymic carcinoma in the anterior mediastinum. The mass measured 6.8 cm and involved the sternum, left side of the parasternal area, ribs, and intercostal muscles. The patient underwent subtotal sternectomy, radical thymectomy, and reconstruction with biological mesh (Permacol). Successful chest wall reconstruction without any other complications was achieved, demonstrating the effectiveness of Permacol.
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Affiliation(s)
- Kwang Hyoung Lee
- Department of Thoracic and Cardiovascular Surgery, Korea University College of Medicine, Korea
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