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Tanaka T, Goto Y, Masuda K, Shinno Y, Matsumoto Y, Okuma Y, Yoshida T, Horinouchi H, Yamamoto N, Ohe Y. The remarkable antitumor efficacy of corticosteroid treatment in patients with refractory thymomas. Respir Investig 2024; 62:766-772. [PMID: 38964045 DOI: 10.1016/j.resinv.2024.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Revised: 06/25/2024] [Accepted: 06/26/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Some case reports have found that corticosteroid treatments shrunk thymoma lesions remarkably after the failure of chemotherapy or surgery. However, few studies have comprehensibly evaluated the antitumor effects of corticosteroids in patients with invasive thymomas. METHODS We reviewed the medical records of 13 consecutively enrolled patients with locally advanced or metastatic thymomas treated via corticosteroid monotherapies from January 2010 to March 2021 in our institute. A Cox's proportional hazard model and the Kaplan-Meier method were used to identify factors associated with survival. RESULTS The median follow-up time was 26 months (range, 13-115 months). The median initial dose of corticosteroid was 0.90 mg/kg/day prednisolone equivalent (range, 0.4-1.1 mg/kg/day). Of the 13 cases, 7 (53.8%, 95% CI: 0.25-0.81) exhibited a partial response and 5 (38.5%, 95% CI: 0.14-0.68) stable disease. The median progression-free survival was 5.7 months [95% confidence interval (CI): 1.5-9.6 months]. The median overall survival was 25.3 months (95% CI: 7.1-not attained). The median duration of corticosteroid use was 3 months (range, 1-64 months). Patients with WHO subtype B thymomas exhibited a better overall response rate to corticosteroids than did patients with other disease subtypes (75%, 95% CI: 0.19-0.99). Adverse events of Grade 3 or more were not observed. CONCLUSIONS Corticosteroids are clinically valuable for patients with thymomas.
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Affiliation(s)
- Tomohiro Tanaka
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan; Department of Respiratory Medicine and Infectious Diseases, Niigata University Medical & Dental Hospital, 1-757 Asahimachi-dori, Chuo Ward, Niigata City, 951-8510, Japan.
| | - Yasushi Goto
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
| | - Ken Masuda
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuki Shinno
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuji Matsumoto
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yusuke Okuma
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tatsuya Yoshida
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Hidehito Horinouchi
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Noboru Yamamoto
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Yuichiro Ohe
- Department of Thoracic Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
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Lipowicz JM, Malińska A, Nowicki M, Rawłuszko-Wieczorek AA. Genes Co-Expressed with ESR2 Influence Clinical Outcomes in Cancer Patients: TCGA Data Analysis. Int J Mol Sci 2024; 25:8707. [PMID: 39201394 PMCID: PMC11354723 DOI: 10.3390/ijms25168707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2024] [Revised: 08/02/2024] [Accepted: 08/07/2024] [Indexed: 09/02/2024] Open
Abstract
ERβ has been assigned a tumor suppressor role in many cancer types. However, as conflicting findings emerge, ERβ's tissue-specific expression and functional role have remained elusive. There remains a notable gap in compact and comprehensive analyses of ESR2 mRNA expression levels across diverse tumor types coupled with an exploration of its potential gene network. In this study, we aim to address these gaps by presenting a comprehensive analysis of ESR2 transcriptomic data. We distinguished cancer types with significant changes in ESR2 expression levels compared to corresponding healthy tissue and concluded that ESR2 influences patient survival. Gene Set Enrichment Analysis (GSEA) distinguished molecular pathways affected by ESR2, including oxidative phosphorylation and epithelial-mesenchymal transition. Finally, we investigated genes displaying similar expression patterns as ESR2 in tumor tissues, identifying potential co-expressed genes that may exert a synergistic effect on clinical outcomes, with significant results, including the expression of ACIN1, SYNE2, TNFRSF13C, and MDM4. Collectively, our results highlight the significant influence of ESR2 mRNA expression on the transcriptomic landscape and the overall metabolism of cancerous cells across various tumor types.
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Affiliation(s)
- Julia Maria Lipowicz
- Department of Histology and Embryology, Doctoral School, Poznan University of Medical Sciences, Święcickiego 6 Street, 60-781 Poznań, Poland;
| | - Agnieszka Malińska
- Department of Histology and Embryology, Poznan University of Medical Sciences, Święcickiego 6 Street, 60-781 Poznań, Poland
| | - Michał Nowicki
- Department of Histology and Embryology, Poznan University of Medical Sciences, Święcickiego 6 Street, 60-781 Poznań, Poland
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Fujiwara M, Watanabe H, Takigawa Y, Goda M, Shiraha K, Inoue T, Matsuoka S, Kudo K, Sato A, Sato K, Fujiwara K, Shibayama T. Successful treatment of type B2 thymoma with steroid and radiotherapy. Respirol Case Rep 2024; 12:e70006. [PMID: 39139612 PMCID: PMC11319843 DOI: 10.1002/rcr2.70006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2024] [Accepted: 08/07/2024] [Indexed: 08/15/2024] Open
Abstract
An 86-year-old woman with leg edema and dyspnea on exertion was admitted to our hospital. Chest computed tomography (CT) revealed a mass in the anterior mediastinum with pericardial invasion. Histological examination with endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) led to the diagnosis of Masaoka stage IVa type B2 thymoma. For palliation, radiotherapy (32 Gy/16 fractions) and prednisolone (30 mg/day) were administered and tapered. After treatment, both the pericardial effusion and tumour size decreased. Combination therapy with steroids and radiotherapy may be effective for treating thymomas.
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Affiliation(s)
- Miho Fujiwara
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Hiromi Watanabe
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Yuki Takigawa
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Mayu Goda
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Keisuke Shiraha
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Tomoyoshi Inoue
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Suzuka Matsuoka
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Kenichiro Kudo
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Akiko Sato
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Ken Sato
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Keiichi Fujiwara
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
| | - Takuo Shibayama
- Department of Respiratory MedicineNHO Okayama Medical CenterOkayamaJapan
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4
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Berg J, Tonev GT, Grimnes JO, Suhrke P, Hammarström C, Vu HPN. Thymoma with pleural metastases. TIDSSKRIFT FOR DEN NORSKE LEGEFORENING 2023; 143:22-0670. [PMID: 37341399 DOI: 10.4045/tidsskr.22.0670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023] Open
Abstract
Metastatic thymoma is a rare and serious condition that is treated with cytostatics according to the guidelines. Cytostatics have limited efficacy and are toxic. This case report illustrates how glucocorticoid treatment can have a significant effect.
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Affiliation(s)
- Janna Berg
- Medisinsk avdeling, Sykehuset i Vestfold, Tønsberg
| | | | | | - Pål Suhrke
- Patologiavdelingen, Sykehuset i Vestfold, Tønsberg
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Disappearance of recurrent thymic epithelial tumor following corticosteroid and cyclosporine treatment: A case report. Respir Investig 2021; 60:322-325. [PMID: 34799281 DOI: 10.1016/j.resinv.2021.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 10/03/2021] [Accepted: 10/21/2021] [Indexed: 11/23/2022]
Abstract
Thymic epithelial tumors (TETs) are considered orphan neoplasms, and treatment options for recurrent or metastatic stages are limited. Here, we have reported a case of recurrent TET that showed complete remission after receiving high-dose corticosteroids followed by low-dose corticosteroids and cyclosporine. No recurrence was observed for the next 2 years. The effects of corticosteroids on the TET and the associated pure red cell aplasia led to adjustment of the diagnosis from thymic carcinoma to thymoma. Low-dose corticosteroids and cyclosporine might be the reason for remission maintenance.
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Hanibuchi M, Saijo A, Mitsuhashi A, Kajimoto T, Kitagawa T. A rare case of invasive thymoma presented a dramatic response to low-dose prednisolone as a single-drug therapy. THE JOURNAL OF MEDICAL INVESTIGATION 2021; 68:396-399. [PMID: 34759168 DOI: 10.2152/jmi.68.396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
A 76-year-old woman with a history of angina pectoris, hypertension and dyslipidemia was pointed out an abnormal opacity in the right hilar region on routine chest X-ray. Chest computed tomography showed masses in the anterior mediastinum with the invasion of the adjacent ascending aorta, right brachiocephalic vein and right pleura. Histologic examination led to a diagnosis of Masaoka stage IVa thymoma. Three courses of chemotherapy were given, but further tumor progression was seen. Thereafter, the patient was followed without aggressive treatments. One year after the initial diagnosis, she presented with dyspnea and right chest pain. Chest CT revealed right massive pleural effusion with pleural dissemination and much further progression of existing tumors. For the purpose of symptom palliation, a low dose (5 mg / day) of prednisolone was commenced, which unexpectedly led to marked alleviation of patient's symptoms and dramatic decrease of pleural effusion. To the best of our knowledge, this is the first report of an invasive thymoma responded to low-dose corticosteroid. The present case suggests that corticosteroids, even at low doses, might be potentially effective for invasive thymoma after failure of surgery, chemotherapy and radiotherapy. J. Med. Invest. 68 : 396-399, August, 2021.
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Affiliation(s)
- Masaki Hanibuchi
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikoku-Chuo, Japan
| | - Atsuro Saijo
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikoku-Chuo, Japan
| | - Atsushi Mitsuhashi
- Department of Respiratory Medicine and Rheumatology, Graduate School of Biomedical Sciences, Tokushima University, Tokushima, Japan
| | - Tatsuya Kajimoto
- Department of Respiratory Medicine, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikoku-Chuo, Japan
| | - Tetsuya Kitagawa
- Department of Cardiovascular Surgery, Shikoku Central Hospital of the Mutual aid Association of Public School teachers, Shikoku-Chuo, Japan
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Prognostic Significance of Glucocorticoid Receptor Expression in Cancer: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13071649. [PMID: 33916028 PMCID: PMC8037088 DOI: 10.3390/cancers13071649] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/17/2021] [Accepted: 03/24/2021] [Indexed: 01/30/2023] Open
Abstract
Simple Summary In solid tumours, emerging evidence indicates that signalling through the glucocorticoid receptor (GR) can encourage the growth and spread of tumours and so drugs targeting this receptor are in development for use in cancer treatment. For these reasons, GR may be useful in anticipating a patient’s outcome upon their cancer diagnosis or to predict their tumours response to drugs targeting this receptor. In this review we aim to ascertain whether GR expression in tumours affects cancer patient survival. Overall, GR expression did not affect patient survival when assessing all cancer types. However, we found that in certain cancer subtypes such as gynaecological cancers (endometrial and ovarian) and early stage, untreated triple negative breast cancers, high GR expression is linked with cancer progression and therefore a poorer patient prognosis. Further studies are needed to uncover the exact role of GR in specific tumour (sub)types in order to provide the correct patients with GR targeting therapies. Abstract In solid malignancies, the glucocorticoid receptor (GR) signalling axis is associated with tumour progression and GR antagonists are in clinical development. Therefore, GR expression may be a useful potential prognostic or predictive biomarker for GR antagonist therapy in cancer. The aim of this review is to investigate if GR expression in tumours is predictive of overall survival or progression free survival. Twenty-five studies were identified through systematic searches of three databases and a meta-analysis conducted using a random effects model, quantifying statistical heterogeneity. Subgroup analysis was conducted for cancer types and publication bias was assessed via funnel plots. There was high heterogeneity in meta-analysis of the studies in all cancer types, which found no association between high GR expression with overall survival (pooled unadjusted HR 1.16, 95% CI (0.89–1.50), n = 2814; pooled adjusted HR 1.02, 95% CI (0.77–1.37), n = 2355) or progression-free survival (pooled unadjusted HR 1.12, 95% CI (0.88–1.42), n = 3365; pooled adjusted HR 1.04, 95% CI (0.6–1.81), n = 582) across all cancer types. However, subgroup meta-analyses showed that high GR expression in gynaecological cancers (endometrial and ovarian) (unadjusted HR 1.83, 95% CI (1.31–2.56), n = 664) and early stage, untreated triple negative breast cancers (TNBCs) (unadjusted HR 1.73, 95% CI (1.35–2.23), n = 687) is associated with disease progression. GR expression in late stage, chemotherapy treated TNBC was not prognostic (unadjusted HR 0.76, 95% CI (0.44, 1.32), n = 287). In conclusion, high GR expression is associated with an increased risk of disease progression in gynaecological and early stage, untreated TNBC. Additional studies are required to elucidate the tumour specific function of the GR receptor in order to ensure GR antagonists target the correct patient groups.
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Pinton G, Manzotti B, Balzano C, Moro L. Expression and clinical implications of estrogen receptors in thoracic malignancies: a narrative review. J Thorac Dis 2021; 13:1851-1863. [PMID: 33841973 PMCID: PMC8024832 DOI: 10.21037/jtd-20-2277] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Thoracic malignancies represent a significant global health burden with incidence and mortality increasing year by year. Thoracic cancer prognosis and treatment options depend on several factors, including the type and size of the tumor, its location, and the overall health status of patients. Gender represents an important prognostic variable in thoracic malignancies. One of the greatest biological differences between women and men is the presence of female sex hormones, and an increasing number of studies suggest that estrogens may play either a causative or a protective role in thoracic malignancies. Over the past 60 years since the discovery of the first nuclear estrogen receptor (ER) isoform α and the almost 20 years since the discovery of the second estrogen receptor, ERβ, different mechanisms governing estrogen action have been identified and characterized. This literature review reports the published data regarding the expression and function of ERs in different thoracic malignancies and discuss sex disparity in clinical outcomes. From this analysis emerges that further efforts are warranted to better elucidate the role of sex hormones in thoracic malignancies, and to reduce disparities in care between genders. Understanding the mechanisms by which gender-related differences can affect and interfere with the onset and evolution of thoracic malignancies and impact on response to therapies could help to improve the knowledge needed to develop increasingly personalized and targeted treatments.
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Affiliation(s)
- Giulia Pinton
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Beatrice Manzotti
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Cecilia Balzano
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100 Novara, Italy
| | - Laura Moro
- Department of Pharmaceutical Sciences, University of Piemonte Orientale, 28100 Novara, Italy
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9
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Jeong JH, Pyo JS, Kim NY, Kang DW. Diagnostic Roles of Immunohistochemistry in Thymic Tumors: Differentiation between Thymic Carcinoma and Thymoma. Diagnostics (Basel) 2020; 10:E460. [PMID: 32640732 PMCID: PMC7399973 DOI: 10.3390/diagnostics10070460] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 06/27/2020] [Accepted: 07/02/2020] [Indexed: 11/23/2022] Open
Abstract
Background: The present study aims to evaluate the diagnostic roles of various immunohistochemical (IHC) markers in thymic tumors, including thymic carcinoma (TC) and thymoma (TM). Methods: Eligible studies were obtained by searching the PubMed databases and screening the searched articles. Thirty-eight articles were used in the present meta-analysis and included 636 TCs and 1861 TMs. Besides, for IHC markers with statistical significance, a diagnostic test accuracy review was performed. Results: The comparison of various IHC expressions between TC and TM was performed for 32 IHC markers. Among these IHC markers, there were significant differences between TC and TM for beta-5t, B-cell lymphoma 2 (Bcl-2), calretinin, CD1a, CD5, carcinoembryonic antigen (CEA), cytokeratin19 (CK19), CD117, glucose transporter 1 (Glut-1), insulin-like growth factor 1 receptor (IGF-1R), mesothelin, MOC31, mucin1 (MUC1), p21, and terminal deoxynucleotidyl transferase (TdT). Markers with higher expressions in TCs were Bcl-2, calretinin, CD5, CEA, CD117, Glut-1, IGF-1R, mesothelin, MOC31, MUC1, and p21. Among these markers, there were no significant differences between TC and TM type B3 in immunohistochemistries for Bcl-2 and CK19. On the other hand, β-catenin and CD205 showed a considerable difference in IHC expressions between TC and TM type B3, but not between TC and overall TM. In diagnostic test accuracy review, MUC1 and beta-5t were the most useful markers for TC and TM, respectively. Conclusions: Taken together, our results showed that the expression rates for various IHC markers significantly differed between TC and TM. The IHC panel can be useful for differentiation from limited biopsied specimens in daily practice.
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Affiliation(s)
- Jae-Han Jeong
- Department of Thoracic and Cardiovascular Surgery, Chosun University Hospital, Chosun University School of Medicine, Gwangju 61453, Korea;
| | - Jung-Soo Pyo
- Department of Pathology, Daejeon Eulji University Hospial, Eulji University School of Medicine, Daejeon 35233, Korea;
| | - Nae-Yu Kim
- Department of Internal Medicine, Daejeon Eulji University Hospital, Eulji University School of Medicine, Daejeon 35233, Korea;
| | - Dong-Wook Kang
- Department of Pathology, Chungnam National University Sejong Hospital, 20 Bodeum 7-ro, Sejong 30099, Korea
- Department of Pathology, Chungnam National University School of Medicine, 266 Munhwa Street, Daejeon 35015, Korea
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Onuki T, Ueda S, Otsu S, Yanagihara T, Kawakami N, Yamaoka M, Inagaki M. Thymectomy during Myasthenic Crisis under Artificial Respiration. Ann Thorac Cardiovasc Surg 2019; 25:215-218. [PMID: 29515082 PMCID: PMC6698714 DOI: 10.5761/atcs.cr.17-00176] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 12/28/2017] [Indexed: 11/20/2022] Open
Abstract
A 34-year-old man was diagnosed with thymoma, which was evaluated preoperatively as stage II or III, with myasthenia gravis (MG). The size of the tumor was 70 × 44 × 80 mm. No invasion to neighboring organs was observed. Prednisolone was prescribed for stabilization of MG. However, a myasthenic crisis (MC) occurred, and intensive care, including emergent endobronchial intubation followed by artificial ventilation, pulse steroid therapy, high-dose intravenous immunoglobulin, and tacrolimus hydrate, was initiated. A chest computed tomography on day 6 revealed tumor reduction to 50 × 30 × 60 mm. An extended total thymectomy by median sternotomy was performed, and artificial ventilation was continued after that. Scheduled artificial ventilation and steroid therapy together can, therefore, enable complete resection of thymoma in patients undergoing treatment for MC. While ventilation helps avert a respiratory failure, the steroid therapy temporarily reduces the tumor size, making resection easier.
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Affiliation(s)
- Takuya Onuki
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Sho Ueda
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Shinichi Otsu
- Department of Neurology, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Takahiro Yanagihara
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Naoki Kawakami
- Department of Respiratory Medicine, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Masatoshi Yamaoka
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
| | - Masaharu Inagaki
- Department of General Thoracic Surgery, Tsuchiura Kyodo General Hospital, Tsuchiura, Ibaraki, Japan
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Potentially actionable FGFR2 high-level amplification in thymic sebaceous carcinoma. Virchows Arch 2019; 476:323-327. [PMID: 31401665 DOI: 10.1007/s00428-019-02644-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2019] [Revised: 07/30/2019] [Accepted: 08/02/2019] [Indexed: 10/26/2022]
Abstract
Our aim was to investigate sebaceous differentiation in thymus tumours and to identify new actionable genomic alterations. To this end we screened 35 normal and 23 hyperplastic thymuses, 127 thymomas and 41 thymic carcinomas for the presence of sebaceous differentiation as defined by morphology and expression of adipophilin and androgen receptor (AR). One primary thymic carcinoma showed morphology of sebaceous carcinomas (keratinizing and foam cells, calcifications, giant cells), a strong expression of adipophilin and AR together with squamous markers. NGS revealed high-level amplification of fibroblast growth factor receptor 2 (FGFR2). In thymuses and thymomas, no cells with sebaceous morphology were present. Occasionally, macrophages or epithelial cells showed adipophilin-positivity, however, without co-expression of AR. Thymic sebaceous carcinoma should be considered if a thymic carcinoma shows clear or foamy features. Testing for FGFR2 amplification might be warranted when searching for actionable genomic alterations in sebaceous carcinomas in the mediastinum and in other locations.
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Merveilleux du Vignaux C, Dansin E, Mhanna L, Greillier L, Pichon E, Kerjouan M, Clément-Duchêne C, Mennecier B, Westeel V, Robert M, Quantin X, Zalcman G, Thiberville L, Lena H, Molina T, Calcagno F, Fournel P, Mazières J, Besse B, Girard N. Systemic Therapy in Advanced Thymic Epithelial Tumors: Insights from the RYTHMIC Prospective Cohort. J Thorac Oncol 2018; 13:1762-1770. [PMID: 30138763 DOI: 10.1016/j.jtho.2018.08.005] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 08/02/2018] [Accepted: 08/13/2018] [Indexed: 12/19/2022]
Abstract
INTRODUCTION Thymic epithelial tumors (TETs) are rare malignancies that may be aggressive and difficult to treat. In the advanced setting, systemic treatments may be delivered as primary therapy before surgery or definitive radiotherapy, as exclusive treatment when no focal treatment is feasible, or in the setting of recurrences. Réseau tumeurs THYMIques et Cancer (RYTHMIC) is the nationwide network for TETs in France. The objective of the study was to describe the modalities and analyze the efficacy of systemic treatments for patients with advanced TETs included in the RYTHMIC prospective database hosted by the French Thoracic Cancer Intergroup. METHODS All consecutive patients for whom systemic treatment was discussed at the RYTHMIC multidisciplinary tumor board from 2012 to 2015 and who received at least one cycle of treatment were included. The main end points were objective response and progression-free survival (PFS). RESULTS A total of 236 patients were included in this analysis. Of those 236 patients, 91 received primary chemotherapy, leading to response rates of 83% for thymomas and 75% for thymic carcinomas and a median PFS of 23.2 months. A strong predictor of longer PFS was histologic type of thymoma (p < 0.001). Exclusive chemotherapy was delivered to 54 patients. The response rates were 31% for thymomas and 37% for thymic carcinomas. The median PFS was 6.2 months, and it was correlated to response rate (p = 0.001). Systemic therapy for a first, second, third, and fourth recurrence was delivered to 114, 81, 51, and 27 patients, respectively. The response rates ranged between 15% and 39% for thymomas and 4% to 21% for thymic carcinomas. The median PFS times were 7.7, 6.2, 5.9, and 6.5 months, respectively. CONCLUSION Patients with advanced thymic malignancies may receive multiple lines of systemic therapy, with an opportunity for clinically relevant PFS rates for which objective response may be a surrogate. Our real-life study provides landmark efficacy data that are needed when designing clinical trials to assess innovative agents.
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Affiliation(s)
- Claire Merveilleux du Vignaux
- Respiratory Medicine Department, Hospices Civils de Lyon, Lyon, France; University of Lyon, University Claude Bernard Lyon 1, Lyon, France
| | - Eric Dansin
- Medical Oncology Department, Centre Oscar Lambret, Lille, France
| | - Laurent Mhanna
- Respiratory Medicine Department, University Hospital, Toulouse, France
| | - Laurent Greillier
- Respiratory Medicine Department, Assistance Publique Hôpitaux de Marseille, Marseille, France
| | - Eric Pichon
- Respiratory Medicine Department, University Hospital, Tours, France
| | - Mallorie Kerjouan
- Respiratory Medicine Department, University Hospital, Rennes, France
| | | | - Bertrand Mennecier
- Respiratory Medicine Department, University Hospital, Strasbourg, France
| | - Virginie Westeel
- Respiratory Medicine Department, University Hospital, Besançon, France
| | - Marie Robert
- Medical Oncology Department, Institut de Cancérologie de l'Ouest, Nantes, France
| | - Xavier Quantin
- Respiratory Medicine Department, University Hospital, Montpellier, France
| | - Gérard Zalcman
- Respiratory Medicine Department, Bichat Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Luc Thiberville
- Respiratory Medicine Department, University Hospital, Rouen, France
| | - Hervé Lena
- Respiratory Medicine Department, University Hospital, Rennes, France
| | - Thierry Molina
- Pathology Department, Necker Hospital, Assistance Publique Hôpitaux de Paris, Paris, France
| | - Fabien Calcagno
- Respiratory Medicine Department, University Hospital, Besançon, France
| | - Pierre Fournel
- Medical Oncology Department, Institut de Cancérologie de la Loire, Saint-Etienne, France
| | - Julien Mazières
- Respiratory Medicine Department, University Hospital, Toulouse, France
| | - Benjamin Besse
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Nicolas Girard
- University of Lyon, University Claude Bernard Lyon 1, Lyon, France; Thorax Institute Curie-Montsouris, Curie Institute, Paris, France.
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13
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Qi G, Liu P, Dong H, Gu S, Yang H, Xue Y. Metastatic Thymoma-Associated Myasthenia Gravis: Favorable Response to Steroid Pulse Therapy Plus Immunosuppressive Agent. Med Sci Monit 2017; 23:1217-1223. [PMID: 28278141 PMCID: PMC5356615 DOI: 10.12659/msm.902442] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Our study retrospectively reviewed the therapeutic effect of steroid pulse therapy in combination with an immunosuppressive agent in myasthenia gravis (MG) patients with metastatic thymoma. MATERIAL AND METHODS MG patients with metastatic thymoma that underwent methylprednisolone pulse therapy plus cyclophosphamide were retrospectively analyzed. Patients initially received methylprednisolone pulse therapy followed by oral methylprednisolone. Cyclophosphamide was prescribed simultaneously at the beginning of treatment. Clinical outcomes, including therapeutic efficacy and adverse effects of MG and thymoma, were assessed. RESULTS Twelve patients were recruited. According to histological classification, 4 cases were type B2 thymoma, 3 were type B3, 2 were type B1, and 1 was type AB. After combined treatment for 15 days, both the thymoma and MG responded dramatically to high-dose methylprednisolone plus cyclophosphamide. The symptoms of MG were improved in all patients, with marked improvement in 6 patients and basic remission in 4. Interestingly, complete remission of thymoma was achieved in 5 patients and partial remission in 7 patients. Myasthenic crisis was observed in 1 patient and was relieved after intubation and ventilation. Adverse reactions were observed in 7 patients (58.3%), most commonly infections, and all were resolved without discontinuation of therapy. During the follow-up, all patients were stabilized except for 1 with pleural metastasis who received further treatment and another 1 who died from myasthenic crisis. CONCLUSIONS The present study in a series of MG patients with metastatic thymoma indicated that steroid pulse therapy in combination with immunosuppressive agents was an effective and well-tolerated for treatment of both metastatic thymoma and MG. Glucocorticoid pulse therapy plus immunosuppressive agents should therefore be considered in MG patients with metastatic thymoma.
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Affiliation(s)
- Guoyan Qi
- Myasthenia Gravis Treatment Center of Hebei Province, 1st Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Peng Liu
- Myasthenia Gravis Treatment Center of Hebei Province, 1st Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Huimin Dong
- Myasthenia Gravis Treatment Center of Hebei Province, 1st Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Shanshan Gu
- Myasthenia Gravis Treatment Center of Hebei Province, 1st Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Hongxia Yang
- Myasthenia Gravis Treatment Center of Hebei Province, 1st Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
| | - Yinping Xue
- Myasthenia Gravis Treatment Center of Hebei Province, 1st Hospital of Shijiazhuang, Shijiazhuang, Hebei, China (mainland)
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14
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Expression of estrogen and progesterone receptors across human malignancies: new therapeutic opportunities. Cancer Metastasis Rev 2016; 34:547-61. [PMID: 25543191 DOI: 10.1007/s10555-014-9543-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Estrogen and progesterone receptors (ERs and PRs) are known for their prognostic as well as treatment predictive value in breast cancer. Although these receptors are differentially expressed in some other malignancies, and likely participate in the biology of those cancer types, the relevance to outcome and therapy is not well established. The use of ER as a highly effective therapeutic target in oncology was pioneered in breast cancer, and the lessons learned from its success could potentially benefit patients with several other malignancies in which hormone receptors are highly expressed. Indeed, there are several potent drugs available that target hormone receptors. These agents show incontrovertible evidence of benefit in patients with hormone receptor-positive breast cancer. It is conceivable that these drugs may have salutary effects in a variety of cancers other than those originating in the breast, based on the overexpression of hormone receptors in some patients, and the preclinical and clinical reports showing responses to these drugs in diverse cancers, albeit in small series or anecdotally. We therefore undertook a literature review in order to summarize the current data regarding the biologic and clinical implications of expression of estrogen and progesterone receptors in various malignancies and the possibilities for deployment of hormone manipulation beyond breast cancer.
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15
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Li SY, Wang YX, Wang L, Qian ZB, Ji ML. Cytoplasm estrogen receptor β5 as an improved prognostic factor in thymoma and thymic carcinoma progression. Oncol Lett 2015; 10:2341-2346. [PMID: 26622848 DOI: 10.3892/ol.2015.3555] [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] [Received: 05/24/2014] [Accepted: 07/23/2015] [Indexed: 02/02/2023] Open
Abstract
A number of previous studies have reported that sex steroid hormones, including estrogens, are involved in the regulation of the thymic function. The aim of the present study was to investigate the expression of estrogen receptor β5 (ERβ5) in thymic tumors and the correlation between ERβ5 expression and thymoma biological characteristics. The expression levels of ERβ5 in thymic epithelial tumors was evaluated in 103 patents using immunohistochemical staining and reverse transcription-quantitative polymerase chain reaction. In addition, an indirect immunofluorescence assay was performed to evaluate the ERβ5 expression levels in the TC1889 and T1682 cell lines. The survival outcome was estimated using Kaplan-Meier plots. The results indicated that ERβ5 expression was mainly located in the thymic tumor cell cytoplasm (87.37%; 90/103 cases) and overexpression was observed in thymic tumors compared with normal thymic tissues (P=0.001). Using the Kruskal-Wallis test, a statistically significant association was observed between cytoplasmic ERβ5 (cERβ5) expression and thymic tumor subtypes (P=0.024) and stages (P=0.003 and R=-0.376). The Kaplan-Meier plots revealed that cERβ5 expression was significantly associated with improved overall and progression-free survival (P=0.008 and P=0.004, respectively). The present study suggested that overexpression of cERβ5 may indicate an improved prognosis and may be involved in the underlying mechanism through which estrogen inhibits thymoma and thymic carcinoma development.
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Affiliation(s)
- Sheng-Ying Li
- Department of Physiology, Basic Medical College of Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Yu-Xia Wang
- Department of Physiology, Basic Medical College of Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Lei Wang
- Department of Physiology, Basic Medical College of Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Zhi-Bing Qian
- Department of Physiology, Basic Medical College of Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
| | - Ming-Li Ji
- Department of Physiology, Basic Medical College of Xinxiang Medical University, Xinxiang, Henan 453003, P.R. China
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16
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Katsuya Y, Fujita Y, Horinouchi H, Ohe Y, Watanabe SI, Tsuta K. Immunohistochemical status of PD-L1 in thymoma and thymic carcinoma. Lung Cancer 2015; 88:154-9. [DOI: 10.1016/j.lungcan.2015.03.003] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2014] [Revised: 02/14/2015] [Accepted: 03/04/2015] [Indexed: 01/21/2023]
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17
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Hattori Y, Yoshida A, Yoshida M, Takahashi M, Tsuta K. Evaluation of androgen receptor and GATA binding protein 3 as immunohistochemical markers in the diagnosis of metastatic breast carcinoma to the lung. Pathol Int 2015; 65:286-92. [DOI: 10.1111/pin.12278] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 02/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Yukinori Hattori
- Department of Pathology and Clinical Laboratories; National Cancer Center Hospital; Tokyo Japan
- Department of Pathology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Akihiko Yoshida
- Department of Pathology and Clinical Laboratories; National Cancer Center Hospital; Tokyo Japan
| | - Masayuki Yoshida
- Department of Pathology and Clinical Laboratories; National Cancer Center Hospital; Tokyo Japan
| | - Masahide Takahashi
- Department of Pathology; Nagoya University Graduate School of Medicine; Nagoya Japan
| | - Koji Tsuta
- Department of Pathology and Clinical Laboratories; National Cancer Center Hospital; Tokyo Japan
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18
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Mimae T, Tsuta K, Kondo T, Nitta H, Grogan TM, Okada M, Asamura H, Tsuda H. Protein expression and gene copy number changes of receptor tyrosine kinase in thymomas and thymic carcinomas. Ann Oncol 2012; 23:3129-3137. [PMID: 22700994 DOI: 10.1093/annonc/mds147] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Insulin-like growth factor-1 receptor (IGF-1R), epidermal growth factor receptor (EGFR), human epidermal growth factor receptor-type 2 (HER2), and c-Met are members of the receptor tyrosine kinases (RTKs). The associations between the RTK status [protein expression and gene copy number (GCN)] and patient characteristics and between the RTK status and prognosis remain undetermined. MATERIALS AND METHODS The study included 140 patients who underwent surgery for thymic tumors. Protein expression was evaluated by immunohistochemistry (IHC) and GCN was evaluated by bright-field in situ hybridization (BISH). The correlations between the RTK status and clinicopathological findings were examined. RESULTS IGF-1R protein was frequently detected in thymic carcinoma (83.8%) and EGFR in thymic tumors (91.4%). Thirty-six and 39 tumors were BISH high for IGF-1R and EGFR, respectively: 28 and 25 exhibited high polysomy; 8 and 14 exhibited gene amplification. No tumor was positive for HER2 or c-Met by IHC and BISH. Multivariate analysis revealed that IGF-1R gene amplification (P = 0.027), thymic carcinoma histology, and higher tumor stage were significantly correlated with an adverse prognosis. CONCLUSIONS Thymic epithelial tumors frequently express IGF-1R and/or EGFR proteins. IGF-1R gene amplification is suggested to define an unfavorable subset for thymic epithelial tumors.
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Affiliation(s)
- T Mimae
- Divisions of Pathology and Clinical Laboratories, Japan; Divisions of Pharmaco-Proteomics, Japan; Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - K Tsuta
- Divisions of Pathology and Clinical Laboratories, Japan.
| | - T Kondo
- Divisions of Pharmaco-Proteomics, Japan
| | - H Nitta
- Department of Medical Innovation, Ventana Medical Systems, Inc., Tucson, USA
| | - T M Grogan
- Department of Medical Innovation, Ventana Medical Systems, Inc., Tucson, USA
| | - M Okada
- Department of Surgical Oncology, Research Institute for Radiation Biology and Medicine, Graduate School of Biomedical Sciences, Hiroshima University, Hiroshima, Japan
| | - H Asamura
- Divisions of Thoracic Surgery, National Cancer Center Hospital, Tokyo, Japan
| | - H Tsuda
- Divisions of Pathology and Clinical Laboratories, Japan
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