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Qu L, Xiong Y, Yao Q, Zhang B, Li T. Micronodular thymoma with lymphoid stroma: Two cases, one in a multilocular thymic cyst, and literature review. Thorac Cancer 2017; 8:734-740. [PMID: 28941195 PMCID: PMC5668509 DOI: 10.1111/1759-7714.12517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 12/28/2022] Open
Abstract
Micronodular thymoma with lymphoid stroma (MTWLS) is a rare type of thymoma that shows a similar pattern but varied morphology and immunophenotype of tumor cells. Because of the extremely limited number of cases reported, the pathology and biology of MTWLS are equivocal. Herein, we report two cases located in the anterior mediastinum: Case 1: a 58‐year‐old woman with a cystic mass measuring 5 × 3.0 × 2.5 cm in Mosaoka stage I; and Case 2: a 50‐year‐old man with a solid mass measuring 2.5 × 2.5 × 2.0 cm in stage IIb. Both patients were treated by thymectomy and are alive without recurrence or metastasis 15 and 17 months after surgery, respectively. Regardless of the spectrum of pathology and stage of MTWLS, this unique type of thymoma has a homogeneously favorable prognosis.
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Affiliation(s)
- Linlin Qu
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Yan Xiong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Qian Yao
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Bo Zhang
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Ting Li
- Department of Pathology, Peking University First Hospital, Beijing, China
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Robotic Thymectomy Is Feasible for Large Thymomas: A Propensity-Matched Comparison. Ann Thorac Surg 2017; 104:1673-1678. [PMID: 28935345 DOI: 10.1016/j.athoracsur.2017.05.074] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Revised: 05/18/2017] [Accepted: 05/22/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Robotic-assisted thymectomy (RAT) is increasingly performed for resection of thymomas. Its application for large tumors remains controversial. In this study, we evaluated the safety and feasibility of RAT for large thymomas in comparison with transsternal thymectomy (ST). METHODS A single institution database was reviewed for patients who underwent RAT for thymoma of 4 cm or larger between 2004 and 2016. Propensity scores were applied to match RAT with ST patients, based on age, sex, tumor size, and Masaoka stage. Perioperative outcomes were compared. RESULTS Twenty patients (15 women and 5 men, median age 59 years) underwent RAT for a large thymoma (median size 6.0 cm). A right-sided approach was used in 14 patients (70%). A control group of 34 ST patients (median size 6.7 cm) had similar Masaoka staging (p = 0.64). Combined resection of adjacent structures, including pericardium, lung, and phrenic nerve, were frequently performed in both groups (50% RAT versus 47% ST, p = 0.83). RAT patients had lower blood loss (25 mL versus 150 mL, p = 0.001), were more frequently managed with a single chest tube (85% versus 56%, p = 0.027), and had a shorter median length of stay (3 days versus 4 days, p = 0.034). There were no perioperative deaths and no major vascular injuries. Three RAT patients (15%) were converted to open approach. Overall complication rates were similar between RAT and ST patients (15% versus 24%, p = 0.45). No difference was seen in R0 resection rates (90% versus 85%, p = 0.62). CONCLUSIONS RAT can be performed safely and effectively in a radical fashion for large thymomas. Future studies are necessary to determine long-term oncologic outcomes.
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Ried M, Rechenmacher M, Dietl B, Marx A, Hamer OW, Schalke B, Kirzinger L, Hofmann HS. Therapie von Thymomen und Thymuskarzinomen. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s11654-017-0037-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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104
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Xue L, Wang L, Dong J, Yuan Y, Fan H, Zhang Y, Wang Q, Ding J. Risk factors of myasthenic crisis after thymectomy for thymoma patients with myasthenia gravis†. Eur J Cardiothorac Surg 2017; 52:692-697. [DOI: 10.1093/ejcts/ezx163] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 04/25/2017] [Indexed: 11/14/2022] Open
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105
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Kawakita N, Kondo K, Toba H, Yoneda A, Takizawa H, Tangoku A. A case of atypical type A thymoma with vascular invasion and lung metastasis. Gen Thorac Cardiovasc Surg 2017. [DOI: 10.1007/s11748-017-0794-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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106
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Tseng YC, Tseng YH, Kao HL, Hsieh CC, Chou TY, Goan YG, Hsu WH, Hsu HS. Long term oncological outcome of thymoma and thymic carcinoma - an analysis of 235 cases from a single institution. PLoS One 2017. [PMID: 28632791 PMCID: PMC5478134 DOI: 10.1371/journal.pone.0179527] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Thymoma has a variable long-term oncological outcome after surgical resection. Survival and tumor recurrence were analyzed to determine the predisposing factors for tumor recurrence. METHODS A total of 235 patients who underwent surgery for thymoma or thymic carcinoma from December 1997 to March 2013 were analyzed using Masaoka staging system and World Health Organization (WHO) histological classification. Surgical intervention included extended thymothymectomy via median sternotomy and thymomectomy via thoracotomy/ video-assisted thoracoscopic surgery (VATS). RESULTS The median duration of follow-up was 105 months (12-198 months). Among these 235 patients, recurrence was observed in 25 patients (10.7%). according to Masaoka stage I, IIA, IIB, III, IVA, IVB, recurrence rates were 1/65(1.5%), 8/106(7.5%), 1/32(3.1%), 6/20(30.0%), 8/10(80.0%), 1/1(100.0%), respectively. Disease or treatment-related mortality was observed in 13 patients. Overall survival rate was 94.4%. After univariate analysis, predisposing factors for tumor recurrence included Masaoka stage, WHO histologic type, tumor size, adjuvant therapy and margin status. CONCLUSIONS Due to the indolent behavior of thymoma, tumor recurrence appears to be a better assessment of oncological outcome rather than survival. Factors associated with tumor recurrence include Masaoka stage, WHO histologic type, tumor size, adjuvant therapy and margin status.
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Affiliation(s)
- Yen-Chiang Tseng
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Institute of Clinical Medicine, National Yang-Ming University, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Han Tseng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Hua-Lin Kao
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chih-Cheng Hsieh
- Institute of Clinical Medicine, National Yang-Ming University, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Teh-Ying Chou
- Institute of Clinical Medicine, National Yang-Ming University, National Yang-Ming University School of Medicine, Taipei, Taiwan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yih-Gang Goan
- Division of Thoracic Surgery, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Wen-Hu Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Han-Shui Hsu
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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Yuan ZY, Gao SG, Mu JW, Xue Q, Mao YS, Wang DL, Zhao J, Gao YS, Huang JF, He J. Long-term outcomes of 307 patients after complete thymoma resection. CHINESE JOURNAL OF CANCER 2017; 36:46. [PMID: 28506287 PMCID: PMC5433013 DOI: 10.1186/s40880-017-0213-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 01/12/2017] [Indexed: 11/22/2022]
Abstract
Background Thymoma is an uncommon tumor without a widely accepted standard care to date. We aimed to investigate the clinicopathologic variables of patients with thymoma and identify possible predictors of survival and recurrence after initial resection. Methods We retrospectively selected 307 patients with thymoma who underwent complete resection at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College (Beijing, China) between January 2003 and December 2014. The associations of patients’ clinical characteristics with prognosis were estimated using Cox regression and Kaplan–Meier survival analyses. Results During follow-up (median, 86 months; range, 24–160 months), the 5- and 10-year disease-free survival (DFS) rates were 84.0% and 73.0%, respectively, and the 5- and 10-year overall survival (OS) rates were 91.0% and 74.0%, respectively. Masaoka stage (P < 0.001), World Health Organization (WHO) histological classification (P < 0.001), and postoperative radiotherapy after initial resection (P = 0.006) were associated with recurrence (52/307, 16.9%). Multivariate analysis revealed that, after initial resection, WHO histological classification and Masaoka stage were independent predictors of DFS and OS. The pleura (25/52, 48.0%) were the most common site of recurrence, and locoregional recurrence (41/52, 79.0%) was the most common recurrence pattern. The recurrence pattern was an independent predictor of post-recurrence survival. Patients with recurrent thymoma who underwent repeated resection had increased post-recurrence survival rates compared with those who underwent therapies other than surgery (P = 0.017). Conclusions Masaoka stage and WHO histological classification were independent prognostic factors of thymoma after initial complete resection. The recurrence pattern was an independent predictor of post-recurrence survival. Locoregional recurrence and repeated resection of the recurrent tumor were associated with favorable prognosis.
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Affiliation(s)
- Zu-Yang Yuan
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - Shu-Geng Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - Ju-Wei Mu
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - Qi Xue
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - You-Sheng Mao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - Da-Li Wang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - Jun Zhao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - Yu-Shun Gao
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - Jin-Feng Huang
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China
| | - Jie He
- Department of Thoracic Surgery, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100021, P. R. China.
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Bellissimo T, Ganci F, Gallo E, Sacconi A, Tito C, De Angelis L, Pulito C, Masciarelli S, Diso D, Anile M, Petrozza V, Giangaspero F, Pescarmona E, Facciolo F, Venuta F, Marino M, Blandino G, Fazi F. Thymic Epithelial Tumors phenotype relies on miR-145-5p epigenetic regulation. Mol Cancer 2017; 16:88. [PMID: 28486946 PMCID: PMC5424390 DOI: 10.1186/s12943-017-0655-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 04/24/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Thymoma and thymic carcinoma are the most frequent subtypes of thymic epithelial tumors (TETs). A relevant advance in TET management could derive from a deeper molecular characterization of these neoplasms. We previously identified a set of microRNA (miRNAs) differentially expressed in TETs and normal thymic tissues and among the most significantly deregulated we described the down-regulation of miR-145-5p in TET. Here we describe the mRNAs diversely regulated in TETs and analyze the correlation between these and the miRNAs previously identified, focusing in particular on miR-145-5p. Then, we examine the functional role of miR-145-5p in TETs and its epigenetic transcriptional regulation. METHODS mRNAs expression profiling of a cohort of fresh frozen TETs and normal tissues was performed by microarray analysis. MiR-145-5p role in TETs was evaluated in vitro, modulating its expression in a Thymic Carcinoma (TC1889) cell line. Epigenetic transcriptional regulation of miR-145-5p was examined by treating the TC1889 cell line with the HDAC inhibitor Valproic Acid (VPA). RESULTS Starting from the identification of a 69-gene signature of miR-145-5p putative target mRNAs, whose expression was inversely correlated to that of miR-145-5p, we followed the expression of some of them in vitro upon overexpression of miR-145-5p; we observed that this resulted in the down-regulation of the target genes, impacting on TETs cancerous phenotype. We also found that VPA treatment of TC1889 cells led to miR-145-5p up-regulation and concomitant down-regulation of miR-145-5p target genes and exhibited antitumor effects, as indicated by the induction of cell cycle arrest and by the reduction of cell viability, colony forming ability and migration capability. The importance of miR-145-5p up-regulation mediated by VPA is evidenced by the fact that hampering miR-145-5p activity by a LNA inhibitor reduced the impact of VPA treatment on cell viability and colony forming ability of TET cells. Finally, we observed that VPA was also able to enhance the response of TET cells to cisplatin and erlotinib. CONCLUSIONS Altogether our results suggest that the epigenetic regulation of miR-145-5p expression, as well as the modulation of its functional targets, could be relevant players in tumor progression and treatment response in TETs.
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Affiliation(s)
- Teresa Bellissimo
- Deptartment of Anatomical, Histological, Forensic & Orthopaedic Sciences, Section of Histology & Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Federica Ganci
- Oncogenomic and Epigenetic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Enzo Gallo
- Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Andrea Sacconi
- Oncogenomic and Epigenetic Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Claudia Tito
- Deptartment of Anatomical, Histological, Forensic & Orthopaedic Sciences, Section of Histology & Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Luciana De Angelis
- Deptartment of Anatomical, Histological, Forensic & Orthopaedic Sciences, Section of Histology & Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Claudio Pulito
- Molecular Chemoprevention Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Silvia Masciarelli
- Deptartment of Anatomical, Histological, Forensic & Orthopaedic Sciences, Section of Histology & Medical Embryology, Sapienza University of Rome, Rome, Italy
| | - Daniele Diso
- Department of Thoracic Surgery, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy
| | - Marco Anile
- Department of Thoracic Surgery, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy
| | - Vincenzo Petrozza
- Pathology Unit, ICOT, Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Latina, Italy
| | - Felice Giangaspero
- Department of Radiological, Oncological, and Anatomo-pathological Science, Sapienza University of Rome, Rome, Italy and IRCCS Neuromed, Pozzilli, Italy
| | - Edoardo Pescarmona
- Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Francesco Facciolo
- Thoracic Surgery Unit, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Federico Venuta
- Department of Thoracic Surgery, Azienda Policlinico Umberto I, Sapienza University of Rome, Rome, Italy.,Fondazione Eleonora Lorillard Spencer Cenci, Rome, Italy
| | - Mirella Marino
- Department of Pathology, "Regina Elena" National Cancer Institute, Rome, Italy
| | - Giovanni Blandino
- Oncogenomic and Epigenetic Unit, "Regina Elena" National Cancer Institute, Rome, Italy.
| | - Francesco Fazi
- Deptartment of Anatomical, Histological, Forensic & Orthopaedic Sciences, Section of Histology & Medical Embryology, Sapienza University of Rome, Rome, Italy.
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Nakada T, Akiba T, Yabe M, Tanaka K, Nakano M, Suzuki M, Morikawa T. Clinicopathological Features of Thymoma with Ring Calcification: Case Reports. Ann Thorac Cardiovasc Surg 2017; 23:256-261. [PMID: 28458302 DOI: 10.5761/atcs.cr.16-00247] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Thymomas with ring calcifications are very rare and quaint style. Herein, we presented our three cases of thymomas with ring calcifications and reviewed totally 10 cases including 7 cases of previous English literatures. The median age was 53 years. Myasthenia gravis was a complication in 40%. The median maximal diameter was 50 mm. They were diagnosed as pathological type B or had type B component. Based on World Health Organization (WHO) classification, 20%, 60%, and 20% cases were stage I, stage II, and stage III, respectively. Seven ring calcifications were within tumors (inner type) and two cases were outside tumors (outer type). The other had a thymoma arising in the calcic wall of a calcified thymic cyst (miscellaneous type). Four other anterior mediastinal tumors with ring calcification had been reported. We need pathological examinations for a definitive diagnosis. Surgeons should plan surgery because of the possibility of invasive thymomas, or other malignant tumors.
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Affiliation(s)
- Takeo Nakada
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Tadashi Akiba
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Mitsuo Yabe
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Keiichiro Tanaka
- Department of Surgery, Jikei University Kashiwa Hospital, Kashiwa, Chiba, Japan
| | - Masataka Nakano
- Department of Pathology, Jikei University Kashiwa Hospital, Chiba, Japan
| | - Masafumi Suzuki
- Department of Pathology, Jikei University Kashiwa Hospital, Chiba, Japan
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Choe J, Lee SM, Lim S, Choi SH, Kim N, Do KH, Seo JB. Doubling time of thymic epithelial tumours on CT: correlation with histological subtype. Eur Radiol 2017; 27:4030-4036. [PMID: 28332015 DOI: 10.1007/s00330-017-4795-y] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2016] [Revised: 01/27/2017] [Accepted: 03/07/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES We retrospectively evaluated the doubling time (DT) of thymic epithelial tumours (TET) according to the histological subtype on CT. METHODS From January 2005 to June 2016, we enrolled 53 patients who had pathologically confirmed TET and at least two CT scans. Tumour size was measured using a two-dimensional method, and the DT was calculated. DTs were compared among histological subtypes, and factors associated with rapid tumour growth (DT <180 days) were assessed. RESULTS In 42 of the 53 patients (79.2%) the tumours showed interval growth (>2 mm) during follow-up. The median DT for all tumours was 400 days (range 48-1,964 days). There were no significant differences in DT in relation to histological subtype (p = 0.177). When TETs were recategorized into three groups, i.e. low-risk thymomas (types A, AB, B1), high-risk thymomas (types B2, B3), and thymic carcinoma, DT was significantly different among the groups (median DT 436, 381 and 189 days, respectively; p = 0.031). Histological subtype (type B3 and thymic carcinoma) was the single independent predictor of rapid tumour growth. CONCLUSIONS The majority of TETs grew during follow-up with variable and relatively slow growth rates. Histological features of aggressive behaviour significantly correlated with a decreased DT and rapid growth. KEY POINTS • The majority of thymic epithelial tumours grew during follow-up (79.2%, 42/53). • Doubling times of thymic epithelial tumours were highly variable (median 400 days). • Histological features of aggressive behaviour significantly correlated with a decreased doubling time.
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Affiliation(s)
- Jooae Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea
| | - Sang Min Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea.
| | - Soyeoun Lim
- Department of Radiology, University of Ulsan College of Medicine, Ulsan University Hospital, Ulsan, Korea
| | - Se Hoon Choi
- Department of Thoracic and Cardiovascular Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Namkug Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea
| | - Kyung-Hyun Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea
| | - Joon Beom Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43 Gil, Songpa-gu, Seoul, 138-736, Korea
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111
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Roden AC. Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby. Arch Pathol Lab Med 2017; 141:232-246. [PMID: 28134578 DOI: 10.5858/arpa.2016-0057-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Numerous histomorphologic and staging classifications of thymic epithelial tumors (TETs) have been proposed during the last century, suggesting that the classification of these tumors is challenging and controversial. Difficulties of classifying TETs include various combinations of epithelial cells and lymphocytes and the paucity of these tumors. The prognostic significance, specifically of the histomorphologic classifications, has been debated. Early classifications were also challenged by the uncertainty of the neoplastic component(s) of the tumor. OBJECTIVE -To discuss the evolution of the histomorphologic classification and the staging system of TET. Controversies and problems of some classifications and their importance for therapeutic management and prognosis will be reviewed. Classifications that incorporated new concepts and approaches at the time or outcome studies will be highlighted. Current classifications will be discussed and the staging system that was recently proposed for the upcoming eighth American Joint Committee on Cancer staging will be described. DATA SOURCES -Search of literature database (PubMed) and current (2015) World Health Organization classification. CONCLUSIONS -Histomorphologic and staging classifications of TET have evolved during the last century and especially during the era of Thomas V. Colby, MD. Evidence supports that the staging system has prognostic implications independent of and superior to the histomorphologic classification. Histomorphology appears to be important for biologic features of TET.
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Kitami A, Sano F, Ohashi S, Suzuki K, Uematsu S, Suzuki T, Kadokura M. The Usefulness of Positron-Emission Tomography Findings in the Management of Anterior Mediastinal Tumors. Ann Thorac Cardiovasc Surg 2017; 23:26-30. [PMID: 28123154 PMCID: PMC5347484 DOI: 10.5761/atcs.oa.16-00205] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 11/07/2016] [Indexed: 11/16/2022] Open
Abstract
PURPOSE We performed a retrospective analysis to evaluate the usefulness of positron-emission tomography/computed tomography (PET/CT) findings in the classification and management of anterior mediastinal tumors. METHODS Between 2006 and 2015, 105 patients with anterior mediastinal tumor received PET/CT. 18F-fluorodeoxyglucose (18F-FDG)-PET images were obtained 60 minutes after the injection of 18F-FDG. RESULTS The histological classifications were as follows: thymoma (n = 49), thymic carcinoma (TC) (n = 19), malignant lymphoma (ML) (n = 8), teratoma (n = 7), thymic cyst (n = 14), and others (n = 8). Upon visual inspection (SUV max: >2.0), all of the malignant tumors showed 18F-FDG accumulation (with the exception of one type A thymoma). Two of the 14 thymic cysts and three of the seven teratomas showed slight 18F-FDG accumulation. The SUV max values of the low-grade thymomas, high-grade thymomas, TCs and MLs were 3.14 ± 0.73, 4.34 ± 1.49, 8.59 ± 3.05, and 10.08 ± 2.53, respectively, with significant differences between the low- and high-grade thymomas, and between TCs and MLs. The sensitivity, specificity and accuracy of 18F-FDG in the detection of low-grade thymomas and thymomas with a maximum diameter of ≤50 mm and an SUV max of ≤3.4 were 85%, 48%, and 60%, respectively. CONCLUSION FDG-PET/CT is an objective and useful modality in the differential diagnosis and management of anterior mediastinal tumors.
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Affiliation(s)
- Akihiko Kitami
- Respiratory Disease Center, Showa University Northern Yokohama Hospital, Yokohama, Kanagawa, Japan
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Pfister F, Hussain H, Belharazem D, Busch S, Simon-Keller K, Becker D, Pfister E, Rieker R, Ströbel P, Marx A. Vascular architecture as a diagnostic marker for differentiation of World Health Organization thymoma subtypes and thymic carcinoma. Histopathology 2017; 70:693-703. [DOI: 10.1111/his.13114] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 10/26/2016] [Indexed: 01/27/2023]
Affiliation(s)
- Frederick Pfister
- Department of Nephropathology; Institute of Pathology; Universitätsklinikum Erlangen; Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
- Institute of Pathology; University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
| | - Hussam Hussain
- Institute of Pathology; University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
| | - Djeda Belharazem
- Institute of Pathology; University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
| | - Svenja Busch
- Institute of Pathology; University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
| | - Katja Simon-Keller
- Institute of Pathology; University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
| | - Dominic Becker
- Institute of Pathology; University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
| | - Eva Pfister
- Department of Nephropathology; Institute of Pathology; Universitätsklinikum Erlangen; Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
- Institute of Pathology; University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
| | - Ralf Rieker
- Institute of Pathology; Universitätsklinikum Erlangen; Friedrich-Alexander-University Erlangen-Nürnberg; Erlangen Germany
| | - Philipp Ströbel
- Institute of Pathology; University Medicine Göttingen; Göttingen Germany
| | - Alexander Marx
- Institute of Pathology; University Medical Centre Mannheim; University of Heidelberg; Mannheim Germany
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Kirzinger L, Boy S, Marienhagen J, Schuierer G, Neu R, Ried M, Hofmann HS, Wiebe K, Ströbel P, May C, Kleylein-Sohn J, Baierlein C, Bogdahn U, Marx A, Schalke B. Octreotide LAR and Prednisone as Neoadjuvant Treatment in Patients with Primary or Locally Recurrent Unresectable Thymic Tumors: A Phase II Study. PLoS One 2016; 11:e0168215. [PMID: 27992479 PMCID: PMC5161359 DOI: 10.1371/journal.pone.0168215] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Accepted: 11/23/2016] [Indexed: 12/17/2022] Open
Abstract
Therapeutic options to cure advanced, recurrent, and unresectable thymomas are limited. The most important factor for long-term survival of thymoma patients is complete resection (R0) of the tumor. We therefore evaluated the response to and the induction of resectability of primarily or locally recurrent unresectable thymomas and thymic carcinomas by octreotide Long-Acting Release (LAR) plus prednisone therapy in patients with positive octreotide scans. In this open label, single-arm phase II study, 17 patients with thymomas considered unresectable or locally recurrent thymoma (n = 15) and thymic carcinoma (n = 2) at Masaoka stage III were enrolled. Octreotide LAR (30 mg once every 2 weeks) was administered in combination with prednisone (0.6 mg/kg per day) for a maximum of 24 weeks (study design according to Fleming´s one sample multiple testing procedure for phase II clinical trials). Tumor size was evaluated by volumetric CT measurements, and a decrease in tumor volume of at least 20% at week 12 compared to baseline was considered as a response. We found that octreotide LAR plus prednisone elicited response in 15 of 17 patients (88%). Median reduction of tumor volume after 12 weeks of treatment was 51% (range 20%-86%). Subsequently, complete surgical resection was achieved in five (29%) and four patients (23%) after 12 and 24 weeks, respectively. Octreotide LAR plus prednisone treatment was discontinued in two patients before week 12 due to unsatisfactory therapeutic effects or adverse events. The most frequent adverse events were gastrointestinal (71%), infectious (65%), and hematological (41%) complications. In conclusion, octreotide LAR plus prednisone is efficacious in patients with primary or recurrent unresectable thymoma with respect to tumor regression. Octreotide LAR plus prednisone was well tolerated and adverse events were in line with the known safety profile of both agents.
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Affiliation(s)
- Lukas Kirzinger
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Sandra Boy
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Jörg Marienhagen
- Department of Nuclear Medicine, University of Regensburg, Regensburg, Germany
| | | | - Reiner Neu
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Michael Ried
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Hans-Stefan Hofmann
- Department of Thoracic Surgery, University of Regensburg, Regensburg, Germany
| | - Karsten Wiebe
- Department of Cardiac and Thoracic Surgery, University of Muenster, Muenster, Germany
| | - Philipp Ströbel
- Institute of Pathology, University of Goettingen, Goettingen, Germany
| | | | | | | | - Ulrich Bogdahn
- Department of Neurology, University of Regensburg, Regensburg, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Berthold Schalke
- Department of Neurology, University of Regensburg, Regensburg, Germany
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115
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Bürger T, Schaefer IM, Küffer S, Bohnenberger H, Reuter-Jessen K, Chan JKC, Emmert A, Hinterthaner M, Marx A, Ströbel P. Metastatic type A thymoma: morphological and genetic correlation. Histopathology 2016; 70:704-710. [PMID: 27926794 DOI: 10.1111/his.13138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/02/2016] [Indexed: 01/08/2023]
Abstract
AIMS The vast majority of type A thymomas are diagnosed in tumour stages 1 or 2, and metastatic cases are exceedingly rare. The histological and genetic features of such metastatic type A thymomas have not been described in detail. METHODS AND RESULTS Five metastatic type A thymomas in tumour stage Masaoka IVb that had been reviewed by a panel of expert pathologists were analysed using comparative genomic hybridization (CGH). Cases 1, 2 and 3 showed the prototypical morphology of type A thymomas with mainly solid growth patterns. These cases displayed only very subtle nuclear irregularities and slight nuclear crowding, but no other atypical features. Mitoses were absent. Cases 3 and 4, in contrast, had a distinctly atypical morphology. CGH revealed partially recurrent alterations in four cases (with and without atypical morphology), including gains on chromosome 1q (one case), 17q (two cases), chromosome 19 (three cases) and 22q (one case) and losses on chromosome 17p (two cases) and 22q (one case). CONCLUSION Rare metastatic type A thymomas, both with typical and 'atypical' histological features, show partially recurrent genomic alterations that differ from the much more frequent localized and indolent tumours. The fact that these alterations were recurring points to a link between clinical behaviour and molecular features. Our findings may have implications for the management and treatment of such tumours.
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Affiliation(s)
- Tobias Bürger
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Inga-Marie Schaefer
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Küffer
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Hanibal Bohnenberger
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Kirsten Reuter-Jessen
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | | | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
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116
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Predictors of Pleural Implants in Patients With Thymic Tumors. Ann Thorac Surg 2016; 102:1647-1652. [DOI: 10.1016/j.athoracsur.2016.04.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 04/04/2016] [Accepted: 04/11/2016] [Indexed: 02/04/2023]
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117
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The 2015 World Health Organization Classification of Tumors of the Thymus: Continuity and Changes. J Thorac Oncol 2016; 10:1383-95. [PMID: 26295375 DOI: 10.1097/jto.0000000000000654] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This overview of the 4th edition of the World Health Organization (WHO) Classification of thymic tumors has two aims. First, to comprehensively list the established and new tumor entities and variants that are described in the new WHO Classification of thymic epithelial tumors, germ cell tumors, lymphomas, dendritic cell and myeloid neoplasms, and soft-tissue tumors of the thymus and mediastinum; second, to highlight major differences in the new WHO Classification that result from the progress that has been made since the 3rd edition in 2004 at immunohistochemical, genetic and conceptual levels. Refined diagnostic criteria for type A, AB, B1-B3 thymomas and thymic squamous cell carcinoma are given, and it is hoped that these criteria will improve the reproducibility of the classification and its clinical relevance. The clinical perspective of the classification has been strengthened by involving experts from radiology, thoracic surgery, and oncology; by incorporating state-of-the-art positron emission tomography/computed tomography images; and by depicting prototypic cytological specimens. This makes the thymus section of the new WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart a valuable tool for pathologists, cytologists, and clinicians alike. The impact of the new WHO Classification on therapeutic decisions is exemplified in this overview for thymic epithelial tumors and mediastinal lymphomas, and future perspectives and challenges are discussed.
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118
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Affiliation(s)
- Frank Detterbeck
- Section of Thoracic Surgery, Yale Thoracic Oncology Program, Yale University School of Medicine, New Haven, CT, USA
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119
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Marx A, Ströbel P. [Mediastinum]. DER PATHOLOGE 2016; 37:397-399. [PMID: 27553532 DOI: 10.1007/s00292-016-0225-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Affiliation(s)
- A Marx
- Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - P Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Robert-Koch-Straße 40, 37075, Göttingen, Deutschland.
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120
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Abstract
Thymomas are rare tumors but are one of the most common mediastinal neoplasms in adults and exhibit an enormous variability in histological, biological and genetic features. The morphological spectrum within a given entity is enormous and some tumors with histological patterns of more than one entity are more common than pure histological subtypes. Due to a lack of subtype-specific markers classification of thymomas often requires complex diagnostic algorithms. The refined presentation including the definition of obligatory and optional features and of diagnostic immunohistochemical profiles, is the focus of the new World Health Organization (WHO) classification of thymomas, aiming at improving diagnostic reproducibility. This review highlights novel aspects of the WHO classification of thymomas and addresses typical differential diagnostic challenges with a focus on diagnostic pitfalls.
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Affiliation(s)
- A Marx
- Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland.
| | - C-A Weis
- Pathologisches Institut, Universitätsmedizin Mannheim, Universität Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Deutschland
| | - P Ströbel
- Institut für Pathologie, Universitätsmedizin Göttingen, Göttingen, Deutschland
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121
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Burt BM, Yao X, Shrager J, Antonicelli A, Padda S, Reiss J, Wakelee H, Su S, Huang J, Scott W. Determinants of Complete Resection of Thymoma by Minimally Invasive and Open Thymectomy: Analysis of an International Registry. J Thorac Oncol 2016; 12:129-136. [PMID: 27566187 DOI: 10.1016/j.jtho.2016.08.131] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 07/06/2016] [Accepted: 08/15/2016] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Minimally invasive thymectomy (MIT) is a surgical approach to thymectomy that has more favorable short-term outcomes for myasthenia gravis than open thymectomy (OT). The oncologic outcomes of MIT performed for thymoma have not been rigorously evaluated. We analyzed determinants of complete (R0) resection among patients undergoing MIT and OT in a large international database. METHODS The retrospective database of the International Thymic Malignancy Interest Group was queried. Chi-square and Wilcoxon rank sum tests, multivariate logistic regression models, and propensity matching were performed. RESULTS A total of 2514 patients underwent thymectomy for thymoma between 1997 and 2012; 2053 of them (82%) underwent OT and 461 (18%) underwent MIT, with the use of MIT increasing significantly in recent years. The rate of R0 resection among patients undergoing OT was 86%, and among those undergoing MIT it was 94% (p < 0.0001). In propensity-matched MIT and OT groups (n = 266 in each group); however, the rate of R0 resection did not differ significantly (96% in both the MIT and OT groups, p = 0.7). Multivariate analyses were performed to identify determinants of R0 resection. Factors independently associated with R0 resection were geographical region, later time period, less advanced Masaoka stage, total thymectomy, and the absence of radiotherapy. Surgical approach, whether minimally invasive or open, was not associated with completeness of resection. CONCLUSIONS The use of MIT for resection of thymoma has been increasing substantially over time, and MIT can achieve rates of R0 resection for thymoma similar to those achieved with OT.
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Affiliation(s)
| | | | - Joseph Shrager
- Stanford University School of Medicine, Stanford, California
| | | | - Sukhmani Padda
- Stanford University School of Medicine, Stanford, California
| | - Jonathan Reiss
- University of California Davis Medical Center, Sacramento, California
| | - Heather Wakelee
- Stanford University School of Medicine, Stanford, California
| | - Stacey Su
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
| | - James Huang
- Memorial Sloan-Kettering Cancer Center, New York, New York
| | - Walter Scott
- Fox Chase Cancer Center, Philadelphia, Pennsylvania
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122
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Abstract
Thymic carcinomas (TC) are approximately 10 times less prevalent than thymomas but of high clinical relevance because they are more aggressive, less frequently resectable than thymomas and usually refractory to classical and targeted long-term treatment approaches. Furthermore, in children and adolescents TC are more frequent than thymomas and particularly in this age group, germ cell tumors need to be a differential diagnostic consideration. In diagnostic terms pathologists face two challenges: a), the distinction between thymic carcinomas and thymomas with a similar appearance and b), the distinction between TC and histologically similar metastases and tumor extensions from other primary tumors. Overcoming these diagnostic challenges is the focus of the new WHO classification of thymic epithelial tumors. The objectives of this review are to highlight novel aspects of the WHO classification of thymic carcinomas and to address therapeutically relevant diagnostic pitfalls.
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123
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Marino M, Salvitti T, Pescarmona E, Palmieri G. Thymic epithelial tumors in a worldwide perspective: lessons from observational studies. J Thorac Dis 2016; 8:1851-5. [PMID: 27621842 PMCID: PMC4999657 DOI: 10.21037/jtd.2016.06.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 05/17/2016] [Indexed: 11/06/2022]
Affiliation(s)
- Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Tommaso Salvitti
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Edoardo Pescarmona
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Giovannella Palmieri
- Rare Tumors Reference Center, Department of Clinical Medicine and Surgery, University Federico II, Naples, Italy
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Do YW, Lee HJ, Narm KS, Jung HS, Lee JG, Kim DJ, Chung KY, Lee CY. Tumor perimeter and lobulation as predictors of pleural recurrence in patients with resected thymoma. Lung Cancer 2016; 98:79-83. [DOI: 10.1016/j.lungcan.2016.05.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2016] [Revised: 04/13/2016] [Accepted: 05/24/2016] [Indexed: 10/21/2022]
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125
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Moving Immune Checkpoint Blockade in Thoracic Tumors beyond NSCLC. J Thorac Oncol 2016; 11:1819-1836. [PMID: 27288978 DOI: 10.1016/j.jtho.2016.05.027] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 05/24/2016] [Accepted: 05/28/2016] [Indexed: 02/07/2023]
Abstract
SCLC and malignant pleural mesothelioma (MPM) are historically characterized by a disappointing lack of significant therapeutic breakthroughs for novel agents, and both malignancies represent true unmet medical needs. Given the promising results of anti-cytotoxic T-lymphocyte associated protein-4 and anti-programmed cell death-1/programmed death ligand-1 antibodies in the treatment of advanced NSCLCs, these immune checkpoint inhibitors are now also under investigation in SCLC and MPM, as well as in thymic epithelial tumors (TETs). Here, we review the biological and clinical rationale for immune checkpoint inhibition in SCLC, MPM, and TETs and present preliminary clinical results with available antibodies. Immunotherapeutic perspectives for these malignancies in terms of novel agents currently under evaluation or anticipated in the near future are also discussed. Current immune checkpoint blockers targeting cytotoxic T-lymphocyte associated protein-4 and the programmed cell death-1/programmed death ligand-1 axis, administered alone or in combination and as multimodality treatment, are likely to be a valuable addition to the therapeutic array for managing SCLC and MPM; studies in TETs, which are currently in their infancy, are merited. Close attention to potential toxicities will be important to the success of such strategies in these settings.
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126
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Khandelwal A, Sholl LM, Araki T, Ramaiya NH, Hatabu H, Nishino M. Patterns of metastasis and recurrence in thymic epithelial tumours: longitudinal imaging review in correlation with histological subtypes. Clin Radiol 2016; 71:1010-1017. [PMID: 27267746 DOI: 10.1016/j.crad.2016.05.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 04/26/2016] [Accepted: 05/09/2016] [Indexed: 02/05/2023]
Abstract
AIM To determine the patterns of metastasis and recurrence in thymic epithelial tumours based on longitudinal imaging studies, and to correlate the patterns with World Health Organization (WHO) histological classifications. MATERIALS AND METHODS Seventy-seven patients with histopathologically confirmed thymomas (n=62) and thymic carcinomas (n=15) who were followed with cross-sectional follow-up imaging after surgery were retrospectively studied. All cross-sectional imaging studies during the disease course were reviewed to identify metastasis or recurrence. The sites of involvement and the time of involvement measured from surgery were recorded. RESULTS Metastasis or recurrence was noted in 24 (31%) of the 77 patients. Patients with metastasis or recurrence were significantly younger than those without (median age: 46 versus 60, respectively; p=0.0005), and more commonly had thymic carcinomas than thymomas (p=0.002). The most common site of involvement was the pleura (17/24), followed by the lung (9/24), and thoracic nodes (9/24). Abdominopelvic involvement was noted in 12 patients, most frequently in the liver (n=8). Lung metastasis was more common in thymic carcinomas than thymomas (p=0.0005). Time from surgery to the development of metastasis or recurrence was shortest in thymic carcinoma, followed by high-risk thymomas, and was longest in low-risk thymoma (median time in months: 25.1, 68.8, and not reached, respectively; p=0.0015). CONCLUSIONS The patterns of metastasis and recurrence of thymic epithelial tumours differ significantly across histological subgroups, with thymic carcinomas more commonly having metastasis with shorter length of time after surgery. The knowledge of different patterns of tumour spread may contribute to further understanding of the biological and clinical behaviours of these tumours.
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Affiliation(s)
- A Khandelwal
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - L M Sholl
- Department of Pathology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - T Araki
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - N H Ramaiya
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - H Hatabu
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA
| | - M Nishino
- Department of Radiology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, 450 Brookline Ave., Boston, MA 02215, USA.
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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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Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2015; 26 Suppl 5:v40-55. [PMID: 26314779 DOI: 10.1093/annonc/mdv277] [Citation(s) in RCA: 279] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- N Girard
- Department of Respiratory Medicine, Expert Centre for Thymic Malignancies, Reference Centre for Orphan Pulmonary Diseases, Hôpital Louis Pradel, Hospices Civils de Lyon, Lyon, France
| | - E Ruffini
- Department of Thoracic Surgery, University of Torino, Turin, Italy
| | - A Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - C Faivre-Finn
- Institute of Cancer Sciences, The University of Manchester, Manchester Academic Health Science Centre, The Christie NHS Foundation Trust, Manchester, UK
| | - S Peters
- Department of Medical Oncology, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne, Switzerland
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131
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Detterbeck F, Korst R. The International Thymic Malignancy Interest Group thymic initiative: a state-of-the-art study of thymic malignancies. Semin Thorac Cardiovasc Surg 2015; 26:317-22. [PMID: 25837546 DOI: 10.1053/j.semtcvs.2015.02.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2015] [Indexed: 11/11/2022]
Abstract
Thymic malignancies are relatively rare tumors. A general lack of knowledge, misconceptions about benignancy, confusion about the definition of terms, and variability in reporting of outcomes have further hampered progress in these diseases. The International Thymic Malignancy Interest Group has emerged to counter these challenges and has brought together a worldwide multidisciplinary community determined to improve outcomes for these patients. Although the organization is young (initiated in 2010), major early accomplishments have created a foundation and infrastructure for scientific research. These include consensus definitions of terms, an unprecedented global database, development of practical clinical resources and, together with the International Association for the Study of Lung Cancer, development of proposals for the first formal stage classification of these malignant tumors. Many articles have been published or are under way, and a second phase of projects building on the early success is proceeding. The greatest accomplishment of the International Thymic Malignancy Interest Group lies in the establishment of an open culture of collaboration and the engagement of a broad group of individuals united by a common mission. It is a testament to what can be achieved, despite ongoing and inherent challenges, by determination and a collective effort.
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Affiliation(s)
- Frank Detterbeck
- Department of Thoracic Surgery, Yale School of Medicine, New Haven, Connecticut.
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