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Suster D, Suster S. On the Histologic Classification of Thymoma. Adv Anat Pathol 2024; 31:22-33. [PMID: 37702296 DOI: 10.1097/pap.0000000000000412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023]
Abstract
The classification of thymoma continues to be a source of controversy in pathology. The difficulties in histologic classification are evident from the number of proposals that have been offered over the years, as well as for the continuous changes and modifications introduced by the World Health Organization to their classification system over the past 20 years. We analyze here some of the issues involved in the classification of these tumors and the difficulties encountered for practicing pathologists in deciphering the "letters and numbers" system devised by the World Health Organization. We would like to propose an alternate approach to thymoma histologic classification that capitalizes on the basic observation of their cytologic features and incorporates the pattern of growth resulting from the interplay of the tumor cells with other cellular constituents as a secondary characteristic. The proposed histologic classification provides a simplified, reproducible means of histologically categorizing these tumors and can be easily understood by most practicing pathologists in simple and clear morphologic terms.
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Affiliation(s)
- David Suster
- Department of Pathology, Rutgers University Hospital, Newark, NJ
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
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Weissferdt A, Moran CA. Atypical thymoma (epithelial-rich thymoma, well-differentiated thymic carcinoma, WHO type B3 thymoma): A conundrum. Pathol Res Pract 2023; 245:154459. [PMID: 37043966 DOI: 10.1016/j.prp.2023.154459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 04/07/2023] [Indexed: 04/14/2023]
Abstract
Thymomas composed predominantly of epithelioid tumor cells with scattered lymphocytes have been well recognized in the literature. This subtype of thymoma has been variously termed epithelial-rich thymoma, well-differentiated thymic carcinoma, atypical thymoma, or World Health Organization (WHO) type B3 thymoma. Regardless of the designation however, these tumors are known to show a spectrum of histopathological growth patterns that may pose challenges in interpretation and diagnosis, particularly when dealing with small mediastinoscopic biopsies. Just like any other type of thymoma, those composed predominantly of epithelioid cells may present as encapsulated or invasive tumors. Nevertheless, compared to other subtypes of thymoma, they are uncommon neoplasms. Therefore, it becomes very important to sufficiently sample thymomas before making a diagnosis of a particular subtype, especially when the tumor is rich in epithelioid cells and only has a scant lymphocytic component. Because of the unusual occurrence of these tumors, there are only few large series of cases that attempt to highlight not only the more salient histopathological features but also the most important immunohistochemical and molecular characteristics.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
| | - Cesar A Moran
- Department of Pathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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3
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Altshuler E, Mathavan A, Mathavan A, Krekora U, Mathavan M, Hones K, Daily K. Clinical characteristics, prognostic factors, and long-term outcomes associated with epithelial malignancies of the thymus: A 20-year single-institution experience. Cancer Rep (Hoboken) 2023; 6:e1750. [PMID: 36369906 PMCID: PMC10026295 DOI: 10.1002/cnr2.1750] [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: 07/07/2022] [Revised: 09/17/2022] [Accepted: 10/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Thymic epithelial tumors are rare and include thymomas and thymic carcinomas. There is scarce literature characterizing prognostic factors and long-term outcomes in these tumors. AIMS This review aims to describe disease features of thymomas and thymic carcinomas and to report clinical differences among thymoma histological subtypes. METHODS AND RESULTS A retrospective chart review was performed at the University of Florida Shands Hospital, a tertiary care academic medical center in Gainesville, Florida, USA. The review included clinical data of adults with thymic epithelial tumors diagnosed between 2001 and 2021. Significant associations among demographics, histology, stage, and outcomes were investigated. Thymoma subgroup analysis was performed using histological subtype and sex. Forty patients with thymoma and seven patients with thymic carcinoma were included in the final analysis. Among those with thymomas, patients with subtype B1, B2, or B3 tumors were younger, had larger tumors, and presented with higher stage disease when compared to those with subtypes A or AB. Tumor recurrence was most common in subtype B2 and B3 tumors (50.0% and 16.7% vs. 0%; p < .01). However, there was no significant difference in overall survival between histologic subtypes. Compared to females, males with thymomas had superior overall survival (103.0 vs. 62.9 months; p = .021) despite presenting with larger tumors (9.8 vs. 5.8 cm; p = .041). Concomitant myasthenia gravis was associated with increased recurrence but not worsened mortality. Compared to thymomas, patients with thymic carcinoma presented with higher-stage disease and had poorer 5-year survival (50.0% vs. 93.1%; p < .01). CONCLUSION This study affirmed pathologic stage and resectability as prognostic factors for thymic epithelial tumors. New findings include inferior overall survival in female patients and higher recurrence rates in those with thymomas and concomitant myasthenia gravis.
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Affiliation(s)
- Ellery Altshuler
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
| | - Akash Mathavan
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Akshay Mathavan
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Urszula Krekora
- College of Medicine, University of Central Florida, Orlando, Florida, USA
| | - Mohit Mathavan
- Department of Internal Medicine, St George's University School of Medicine, Great River, New York, USA
| | - Keegan Hones
- College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Karen Daily
- Department of Internal Medicine, University of Florida, Gainesville, Florida, USA
- Division of Hematology and Oncology, University of Florida, Gainesville, Florida, USA
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Shao Y, Tang M, Fang L, Wei S, Gao X, Liu W. Prognostic value of tumor size in thymic epithelial tumors: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e31741. [PMID: 36401408 PMCID: PMC9678511 DOI: 10.1097/md.0000000000031741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Whether the size of thymic epithelial tumors (TETs) has an impact on prognosis has long been a controversial issue. Our study was designed to investigate the value of tumor size in the prognosis (overall survival (OS) and relapse-free survival) of patients with TETs. METHODS We searched the databases such as PubMed, EMBASE, Web of Science, and clinical trials registration system for articles illustrating the impact of tumor size on survival data in TETs patients. We did a meta-analysis for OS and relapse-free survival. RESULTS We recruited 9 studies in our meta-analysis. Our study illustrates that TETs patients with small tumor size had better relapse-free survival (hazard ratio = 1.66, 95% confidence interval 1.18-2.35, P = .004) and OS (hazard ratio = 1.93, 95% confidence interval 1.30-2.80, P = .001) in comparison to patients with large tumor size. CONCLUSIONS In conclusion, the results of our meta-analysis showed that TET size was significantly associated with overall and relapse-free survival of patients, with relatively small tumors tending to have a better prognosis.
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Affiliation(s)
- Yifeng Shao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Mingbo Tang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Linan Fang
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Shixiong Wei
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Xinliang Gao
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
| | - Wei Liu
- Department of Thoracic Surgery, The First Hospital of Jilin University, Changchun, Jilin, China
- * Correspondence: Wei Liu, Department of Thoracic Surgery, The First Hospital of Jilin University, 71 Xinmin Street, Changchun, Jilin Province 130021, P.R. China (e-mail: )
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Li J, Liu Y, Zhang X, Zheng X, Qi G. Prognostic factors for overall survival after surgical resection in patients with thymic epithelial tumors: A systematic review and meta-analysis. Medicine (Baltimore) 2022; 101:e30867. [PMID: 36181069 PMCID: PMC9524934 DOI: 10.1097/md.0000000000030867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs) originate in the thymic epithelial cell, including thymoma and thymic carcinoma. Surgical resection is the first choice for most patients. However, some studies have shown that the factors affecting the prognosis of these patients are not consistent. To evaluate prognostic factors in patients with surgically resected thymic epithelial tumors, we performed a meta-analysis. METHODS We searched the Chinese biomedical literature database, Pubmed, Embase, Cochrane Library and other electronic databases. Studies including postoperative overall survival (OS) and predictors of TETs were included. We made a comprehensive analysis the hazard ratios (HRs) through a single proportional combination. HRs were combined using single proportion combinations. RESULTS The meta-analysis included 11,695 patients from 26 studies. The pooled OS was 84% at 5 years and 73% at 10 years after TETs operation. The age as continuous-year (HR 1.04, 95% confidence interval (CI) 1.02-1.04), incomplete resection (HR 4.41, 95% CI 3.32-5.85), WHO histologic classification (B2/B3 vs A/AB/B1 HR 2.76, 95% CI 1.25-6.21), Masaoka Stage (stage III/IV vs I/II HR 2.74, 95% CI 2.12-3.55,) were the poor prognostic factors. CONCLUSIONS For patients with TETs after surgical resection, advanced age, incomplete resection, WHO classification B2/B3, and higher Masaoka stage are risk factors for poor prognosis.
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Affiliation(s)
- Jiaduo Li
- People’s Hospital of Shijiazhuang affiliated to Hebei Medical University - Center of Treatment of Myasthenia Gravis, Shijiazhuang, Hebei, China
| | - Yaling Liu
- People’s Hospital of Shijiazhuang affiliated to Hebei Medical University - Center of Treatment of Myasthenia Gravis, Shijiazhuang, Hebei, China
| | - Xiaohe Zhang
- People’s Hospital of Shijiazhuang affiliated to Hebei Medical University - Center of Treatment of Myasthenia Gravis, Shijiazhuang, Hebei, China
| | - Xuguang Zheng
- People’s Hospital of Shijiazhuang affiliated to Hebei Medical University - Center of Treatment of Myasthenia Gravis, Shijiazhuang, Hebei, China
| | - Guoyan Qi
- People’s Hospital of Shijiazhuang affiliated to Hebei Medical University - Center of Treatment of Myasthenia Gravis, Shijiazhuang, Hebei, China
- *Correspondence: Guoyan Qi, People’s Hospital of Shijiazhuang affiliated to Hebei Medical University, Center of Treatment of Myasthenia Gravis, Shijiazhuang, Hebei, 050011, China (e-mail: )
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Angirekula M, Chang SY, Jenkins SM, Greipp PT, Sukov WR, Marks RS, Olivier KR, Cassivi SD, Roden AC. CD117, BAP1, MTAP, and TdT Is a Useful Immunohistochemical Panel to Distinguish Thymoma from Thymic Carcinoma. Cancers (Basel) 2022; 14:cancers14092299. [PMID: 35565429 PMCID: PMC9100150 DOI: 10.3390/cancers14092299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The morphologic distinction between thymic carcinomas and thymomas, specifically types B3, A, and occasionally micronodular thymomas with lymphoid stroma (MNTLS) can be challenging, as has also been shown in interobserver reproducibility studies. Since thymic carcinomas have a worse prognosis than thymomas, the diagnosis is important for patient management and treatment. This study aimed to identify a panel of immunohistochemical (IHC) markers that aid in the distinction between thymomas and thymic carcinomas in routine practice. Materials and Method: Thymic carcinomas, type A and B3 thymomas, and MNTLS were identified in an institutional database of thymic epithelial tumors (TET) (1963–2021). IHC was performed using antibodies against TdT, Glut-1, CD5, CD117, BAP1, and mTAP. Percent tumor cell staining was recorded (Glut-1, CD5, CD117); loss of expression (BAP1, mTAP) was considered if essentially all tumor cells were negative; TdT was recorded as thymocytes present or absent (including rare thymocytes). Results: 81 specimens included 44 thymomas (25 type A, 11 type B3, 8 MNTLS) and 37 thymic carcinomas (including 24 squamous cell carcinomas). Using BAP1, mTAP, CD117 (cut-off, 10%), and TdT, 88.9% of thymic carcinomas (95.7% of squamous cell carcinomas) and 77.8% of thymomas could be predicted. Glut-1 expression was not found to be useful in that distinction. All tumors that expressed CD5 in ≥50% of tumor cells also expressed CD117 in ≥10% of tumor cells. In four carcinomas with homozygous deletion of CDKN2A, mTAP expression was lost in two squamous cell carcinomas and in a subset of tumor cells of an adenocarcinoma and was preserved in a lymphoepithelial carcinoma. Conclusion: A panel of immunostains including BAP1, mTAP, CD117 (using a cut-off of 10% tumor cell expression), and TdT can be useful in the distinction between thymomas and thymic carcinomas, with only a minority of cases being inconclusive.
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Affiliation(s)
- Mounika Angirekula
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
| | - Sindy Y Chang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
| | - Sarah M. Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, USA;
| | - Patricia T. Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
| | - William R. Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
| | - Randolph S. Marks
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN 55902, USA;
| | - Kenneth R. Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55902, USA;
| | - Stephen D. Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55902, USA;
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
- Correspondence:
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Georgiev A, Hilendarov A, Tsvetkova S, Vasilska A. Thymoma type B2 progression, due to fear of contamination, in association with hydrocephalus: A case report of avoidant behavior during COVID-19 pandemic. Radiol Case Rep 2022; 17:680-684. [PMID: 34976266 PMCID: PMC8712279 DOI: 10.1016/j.radcr.2021.12.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 12/04/2021] [Accepted: 12/13/2021] [Indexed: 11/08/2022] Open
Abstract
The novel coronavirus pandemic outbreak caused extreme public fear, health concerns, and psychological distress, especially in oncology patients. The presented rare case is of a 40-year-old female with thymoma type B, with rapid progression, due to fear from the COVID-19 pandemic. Biopsy and histological verification of the tumor show a B-type thymoma with a high proliferative index. The fear of infection is causing avoidant behavior and leads to suboptimal therapy in some oncology patients that will have severe consequences. We can conclude that adequate, personalized, and most importantly, active psychological care is necessary and should be implemented for cancer patients. To be prepared for a future lockdown, it may be helpful to urge patients to seek alternative forms of social contact, such as online and mobile communications, to combat depression lockdown effects.
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Yale AD, Priestnall SL, Pittaway R, Taylor AJ. Thymic epithelial tumours in 51 dogs: Histopathologic and clinicopathologic findings. Vet Comp Oncol 2021; 20:50-58. [PMID: 34036722 DOI: 10.1111/vco.12705] [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] [Received: 01/02/2021] [Revised: 05/07/2021] [Accepted: 05/09/2021] [Indexed: 11/27/2022]
Abstract
Canine thymic epithelial tumours (TET) are uncommon and little is known about their behaviour. Previous attempts at histologic classification have varied, and as such reliable prognostic information is unavailable. The aim of this retrospective multi-institutional study was to evaluate cases of canine TETs, irrespective of subtype, in order to identify useful histopathologic and clinicopathologic prognostic factors. Cases were included if the tumour arose from the cranial mediastinum and a diagnosis of TET was made on the basis of histopathology. Fifty-one dogs were included. In addition to clinicopathologic data, histology samples were reviewed for the following features: mitotic count, percentage of necrosis, presence of Hassall's corpuscles, lymphocytic infiltrate, cellular pleomorphism and vascular or capsular invasion. The median survival time for all dogs was 449 days. The 1- and 2-year survival rate was 52.6% and 26.3% respectively. On multivariable analysis surgical excision of the thymic tumour was associated with significantly prolonged survival; the presence of metastasis, myasthenia gravis and moderate or marked cellular pleomorphism were associated with significantly reduced survival. Additional studies are needed to further evaluate prognostic factors to aid treatment recommendations.
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Menon D, Katzberg H, Barnett C, Pal P, Bezjak A, Keshavjee S, Bril V. Thymoma pathology and myasthenia gravis outcomes. Muscle Nerve 2021; 63:868-873. [PMID: 33675078 DOI: 10.1002/mus.27220] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 02/24/2021] [Accepted: 02/27/2021] [Indexed: 11/05/2022]
Abstract
INTRODUCTION There is limited evidence regarding the impact of World Health Organization (WHO) subtype of thymoma on post-thymectomy outcome of thymoma-associated myasthenia gravis (TAMG). The objective was to determine if the pathological subtypes of thymoma were associated with post-thymectomy outcomes of myasthenia gravis (MG), in patients with TAMG. METHODS We performed a retrospective study of consecutive patients with TAMG who attended the neuromuscular clinic between January 2018 and December 2019 with a minimum follow-up of 1 y after thymectomy. Outcome measures were MG Impairment Index (MGII), single-simple question (SSQ), Myasthenia Gravis Foundation of America post-intervention status (MGFA PIS) and non-responder MG status at last assessment. RESULTS Ninety-five patients were included; mean age at onset was 48.1 ± 12.1 y; 54(56.8%) were females. Thirteen patients developed MG post-thymectomy. The most common thymoma was WHO type B2 in 39 (41.1%). Most patients (40, 42.1%) had Masaoka stage II thymoma. There was no association of thymoma subtypes or Masaoka stage of disease with age, gender, MG phenotype, serology, post-thymectomy onset, interval from onset to thymectomy, MGII, SSQ, MGFA PIS, or non-responder status. Associations were found between positive serology and lower MGII (11.1 ± 14.2 vs 23 ± 12.9, P = .050), thymic follicular hyperplasia (TFH) and higher SSQ (89.3 ± 11.7 vs 80.1 ± 20.2, P-.043), and lack of recurrence and higher SSQ (84.1 ± 18 vs 72.5 ± 20, P = .037). DISCUSSION The WHO pathological subtype of thymoma did not correlate with MG outcomes. However, positive acetylcholine antibody serology, presence of TFH, and non-recurrence of thymoma predict a favorable outcome.
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Affiliation(s)
- Deepak Menon
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Hans Katzberg
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Carolina Barnett
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Prodipto Pal
- Department of Laboratory Medicine and Pathology, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrea Bezjak
- Department of Radiation Oncology, University Health Network, Princess Margaret Cancer Centre, University of Toronto, Toronto, Ontario, Canada
| | - Shaf Keshavjee
- Department of Surgery, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Vera Bril
- Ellen and Martin Prosserman Centre for Neuromuscular Diseases, University Health Network, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada
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Wong-Chong J, Bernadach M, Ginzac A, Veyssière H, Durando X. Pembrolizumab as a novel therapeutic option for patients with refractory thymic epithelial tumor: A case report. World J Clin Cases 2021; 9:1139-1147. [PMID: 33644178 PMCID: PMC7896660 DOI: 10.12998/wjcc.v9.i5.1139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/12/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thymic epithelial carcinomas are rare and have a poor prognosis. Treatment of thymic epithelial carcinoma is multimodal and includes surgery, post-operative radiation therapy, adjuvant and neoadjuvant chemotherapy, or exclusive chemotherapy based on disease resectability. However, there is currently no standard treatment regimen for metastatic and recurrent thymic carcinoma.
CASE SUMMARY A 45-year-old Caucasian male, with no past medical history, presented with hepatalgia and a cervical mass. A computed tomography (CT) scan showed multiple suspect lesions in the lungs, liver, and anterior mediastinum associated with mediastinal and cervical adenopathy. CT-guided percutaneous biopsies of the liver lesions and anterior mediastinal mass were performed, confirming the histopathology of thymic epithelial carcinoma. Management consisted of several chemotherapy regimens and radiation therapy, administered between April 2016 and December 2018. The patient achieved complete metabolic response. Fluorodeoxyglucose positron emission tomography/CT performed in June 2019 showed disease relapse, with reappearance of a large hypermetabolic hepatic mass and involvement of mediastinal and axillary lymph nodes. Intravenous pembrolizumab (200 mg, every 3 wk) was administered after two prior systemic therapies. The patient’s response to treatment was last documented on March 5, 2020.
CONCLUSION Pembrolizumab was successful in treatment of a patient with programmed death-ligand 1-negative metastatic thymic carcinoma, pretreated with chemotherapy.
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Affiliation(s)
- Jonathan Wong-Chong
- Département d’Oncologie Médicale, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- UFR Médecine, Université Clermont Auvergne, Clermont-Ferrand 63011, France
| | - Maureen Bernadach
- Département d’Oncologie Médicale, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand 63011, France
- Centre d’Investigation Clinique, UMR501, Clermont-Ferrand 63011, France
| | - Angeline Ginzac
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand 63011, France
| | - Hugo Veyssière
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand 63011, France
| | - Xavier Durando
- Département d’Oncologie Médicale, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- UFR Médecine, Université Clermont Auvergne, Clermont-Ferrand 63011, France
- Division de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand 63011, France
- INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, Clermont-Ferrand 63011, France
- Centre d’Investigation Clinique, UMR501, Clermont-Ferrand 63011, France
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Benveniste MFK, Betancourt Cuellar SL, Carter BW, Strange CD, Marom EM. Thymic Epithelial Neoplasms: Tumor-Node-Metastasis Staging. Radiol Clin North Am 2021; 59:183-192. [PMID: 33551080 DOI: 10.1016/j.rcl.2020.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Thymic epithelial neoplasms are a group of malignant tumors that includes thymoma, thymic carcinoma, and thymic neuroendocrine tumors. Although several staging systems have been developed over the years for use with these cancers, they have been interpreted and implemented in a nonuniform manner. Recently, the International Association for the study of Lung Cancer and the International Thymic Malignancy Interest Group developed a tumor-node-metastasis staging system that has been universally accepted and correlates with patient survival and outcomes. Although pathologic staging is determined by histologic examination of the resected tumor, imaging plays an important role in clinical staging and is important for informing therapeutic decisions.
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Affiliation(s)
- Marcelo F K Benveniste
- Division of Diagnostic Imaging, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA.
| | - Sonia L Betancourt Cuellar
- Division of Diagnostic Imaging, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Brett W Carter
- Department of Thoracic Imaging, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Chad D Strange
- Division of Diagnostic Imaging, MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030, USA
| | - Edith M Marom
- Department of Diagnostic Radiology, The Chaim Sheba Medical Center, Affiliated with the Tel Aviv University, Tel Aviv, 2 Derech Sheba, Ramat Gan 5265601, Israel
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Correlation of Computed Tomography Parameters with Histology, Stage and Prognosis in Surgically Treated Thymomas. ACTA ACUST UNITED AC 2020; 57:medicina57010010. [PMID: 33374432 PMCID: PMC7824084 DOI: 10.3390/medicina57010010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Revised: 12/17/2020] [Accepted: 12/18/2020] [Indexed: 11/16/2022]
Abstract
Background and objectives: The histological classification and staging of thymic tumors remains a matter of debate. The correlation of computed tomography (CT) parameters with tumor histology and stage also still has to be completely assessed. The aim of this study was therefore to analyze the correlation of radiological parameters with histological and staging classifications of thymomas evaluating their prognostic role. Methods: Data of 50 patients with thymoma submitted to a complete surgical treatment between 2005 and 2015 were retrospectively analyzed. Tumors were classified according to the WHO and Suster and Moran (S&M) histological classifications and to the Masaoka-Koga and tumor, node and metastases (TNM) staging systems. The correlation of CT features with histology and stage and the prognostic role of histopathological and radiological features were assessed. Results: Five-year overall (OS) and disease-free survival (DFS) were 90.3% and 81.1%, respectively. A significant correlation of DFS with the Masaoka-Koga (p = 0.001) and TNM staging systems (p = 0.002) and with the S&M (p = 0.02) and WHO histological classifications (p = 0.04) was observed. CT scan features correlated with tumor stage, histology and prognosis. Moderately differentiated tumors (WHO B3) had a significantly higher incidence of irregular shape and contours (p = 0.002 and p = 0.001, respectively) and pericardial contact (p = 0.036). A larger tumor volume (p = 0.03) and a greater length of pleural contact (p = 0.04) adversely influenced DFS. The presence of pleural (p < 0.001) or lung invasion (p = 0.02) and of pleural effusion (p = 0.004) was associated with a significantly worse OS. Conclusions: Pre-operative CT scan parameters correlate with stage and histology, and have a prognostic role in surgically treated thymomas.
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Rioja P, Ruiz R, Galvez-Nino M, Lozano S, Valdiviezo N, Olivera M, Cabero O, Guillen ME, De La Guerra A, Amorin E, Barrionuevo C, Mas L. Epidemiology of thymic epithelial tumors: 22-years experience from a single-institution. Thorac Cancer 2020; 12:420-425. [PMID: 33356008 PMCID: PMC7882391 DOI: 10.1111/1759-7714.13760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 11/30/2022] Open
Abstract
Background To assess the correlation of WHO histological classification and Masaoka–Koga staging system of thymic epithelial tumors (TETs) with prognosis. Methods We retrospectively analyzed 83 patients with TETs in the Instituto Nacional de Enfermedades Neoplasicas between 1996 to 2018. We analyzed the clinical stages, histological types and treatment modalities and attempted to determine the impact on overall survival. The data was retrieved from clinical files and reviewed by a pathologist who reclassificated according to the 2004 WHO classification system. The staging was performed with the Masaoka–Koga staging system. Survival curves were constructed with Kaplan‐Meir method. Results There was a total of 83 patients with a median age of 55 years old included in the study. The histological type corresponded to thymoma (T) in 63.8% (n = 53) and to thymic carcinoma (TC) in 36.1%. T were type A, AB, B1, B2 and B3 in 14.4%, 18%, 12%, 3.6%, 7.4% of cases, respectively. The proportion of advanced disease (Masaoka stage III–IV) was high (65%). With a median follow‐up of 88.4 months, median overall survival (OS) was 81.6 months for T and 12.3 months for TC (P = 0.01). Univariate analysis showed that sex, histological type, clinical stage and surgery (P = 0.01) were significant independent prognostic factors. On multivariate analysis, histology type and Masaoka–Koga staging had an effect on survival. Conclusions The results indicates a clear association between the WHO histological classification and Masaoka–Koga staging system with survival. We found a higher proportion of TETs with advanced disease at diagnosis. Further research are required and collaboration is important to foster knowledge focused on classification and treatment. Key points Significant findings of the study The WHO histological classification, the Masaoka–Koga system and surgery treatment were associated with overall survival. What this study adds To determine prognosis factors in TETs.
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Affiliation(s)
| | - Rossana Ruiz
- National Institute of Neoplastic Diseases, Lima, Peru.,Peruvian Group of Clinical Studies in Oncology, Lima, Peru
| | | | - Sophia Lozano
- National Institute of Neoplastic Diseases, Lima, Peru
| | | | | | | | | | | | - Edgar Amorin
- National Institute of Neoplastic Diseases, Lima, Peru
| | | | - Luis Mas
- National Institute of Neoplastic Diseases, Lima, Peru.,Peruvian Group of Clinical Studies in Oncology, Lima, Peru
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14
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Pudert T, Weyrich A, Geburek F, Herden C, Röcken M. Atypical thymoma in a horse: Diagnostic approach and application of an alternative histological classification system. EQUINE VET EDUC 2020. [DOI: 10.1111/eve.13419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- T. Pudert
- Clinic for Horses Department of Surgery and Orthopaedics Faculty of Veterinary Medicine Justus‐Liebig‐University GiessenGermany
| | - A. Weyrich
- Institute of Veterinary Pathology Faculty of Veterinary Medicine Justus‐Liebig‐University GiessenGermany
| | - F. Geburek
- Equine Clinic University of Veterinary Medicine Hannover Foundation Hannover Germany
| | - C. Herden
- Institute of Veterinary Pathology Faculty of Veterinary Medicine Justus‐Liebig‐University GiessenGermany
| | - M. Röcken
- Clinic for Horses Department of Surgery and Orthopaedics Faculty of Veterinary Medicine Justus‐Liebig‐University GiessenGermany
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15
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Wolf JL, van Nederveen F, Blaauwgeers H, Marx A, Nicholson AG, Roden AC, Ströbel P, Timens W, Weissferdt A, von der Thüsen J, den Bakker MA. Interobserver variation in the classification of thymic lesions including biopsies and resection specimens in an international digital microscopy panel. Histopathology 2020; 77:734-741. [PMID: 32506527 PMCID: PMC7702114 DOI: 10.1111/his.14167] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 05/22/2020] [Accepted: 05/31/2020] [Indexed: 11/30/2022]
Abstract
Aims Thymic tumours are rare in routine pathology practice. Although the World Health Organization (WHO) classification describes a number of well‐defined categories, the classification remains challenging. The aim of this study was to investigate the reproducibility of the WHO classification among a large group of international pathologists with expertise in thymic pathology and by using whole slide imaging to facilitate rapid diagnostic turnover. Methods and results Three hundred and five tumours, consisting of 90 biopsies and 215 resection specimens, were reviewed with a panel‐based virtual microscopy approach by a group of 13 pathologists with expertise in thymic tumours over a period of 6 years. The specimens were classified according to the WHO 2015 classification. The data were subjected to statistical analysis, and interobserver concordance (Fleiss kappa) was calculated. All cases were diagnosed within a time frame of 2 weeks. The overall level of agreement was substantial (κ = 0.6762), and differed slightly between resection specimens (κ = 0.7281) and biopsies (κ = 0.5955). When analysis was limited to thymomas only, and they were grouped according to the European Society for Medical Oncology Clinical Practice Guidelines into B2, B3 versus A, AB, B1 and B3 versus A, AB, B1, B2, the level of agreement decreased slightly (κ = 0.5506 and κ = 0.4929, respectively). Difficulties arose in distinguishing thymoma from thymic carcinoma. Within the thymoma subgroup, difficulties in distinction were seen within the B group. Conclusions Agreement in diagnosing thymic lesions is substantial when they are assessed by pathologists with experience of these rare tumours. Digital pathology decreases the turnaround time and facilitates access to what is essentially a multinational resource. This platform provides a template for dealing with rare tumours for which expertise is sparse.
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Affiliation(s)
- Janina L Wolf
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands
| | | | - Hans Blaauwgeers
- Department of Pathology, OLVG Lab BV, Amsterdam, The Netherlands
| | - Alexander Marx
- Universitätsklinikum Mannheim, Heidelberg University, Heidelberg, Germany
| | - Andrew G Nicholson
- National Heart and Lung Institute, Imperial College London, London, UK.,Department of Histopathology, Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | | | - Wim Timens
- University Medical Centre Groningen, Groningen, The Netherlands
| | | | | | - Michael A den Bakker
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands.,Maasstad Ziekenhuis, Rotterdam, The Netherlands
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16
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Yun JK, Kim HR, Kim DK, Shim YM, Kim YT, Chung KY. Tumor size as a prognostic factor in limited-stage thymic epithelial tumors: A multicenter analysis. J Thorac Cardiovasc Surg 2020; 162:309-317.e9. [PMID: 32736865 DOI: 10.1016/j.jtcvs.2020.05.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 04/28/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The prognostic significance of tumor size in thymic epithelial tumors (TETs) has not been fully evaluated. We aimed to clarify the prognostic value of tumor size in limited-stage and advanced-stage TETs. METHODS Clinical records of patients with completely resected TETs were retrospectively collected from 4 tertiary centers between January 2000 and February 2013. Information on the Masaoka-Koga stage was available for 1215 patients (M-K group), and 433 patients were classified according to the eighth edition of the Tumor-Node-Metastasis staging system (TNM group). Limited-stage and advanced-stage TETs were defined according to whether they were confined within the surrounding fatty tissues without invasion. The optimal cutoff value was selected using a maximally selected log-rank statistic. RESULTS The median tumor size was 6.0 ± 2.8 cm in the M-K group and 6.5 ± 3.0 cm in the TNM group. In the multivariable analysis, tumor size had a significant effect on both overall survival (P = .003) and recurrence-free survival (P < .001) for limited-stage tumors (M-K stage I or II or TNM stage I), but not for advanced-stage tumors (M-K stage III or IV or TNM stage II-IV; P = .349 for overall survival and P = .439 for recurrence-free survival). The optimal cutoff value for tumor size was >5.5 cm for both overall survival and recurrence-free survival in limited-stage TETs. CONCLUSIONS Tumor size is an independent prognostic factor in patients with completely resected limited-stage TETs and a cutoff value >5.5 cm might help clinicians enact proper treatment strategies and surveillance.
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Affiliation(s)
- Jae Kwang Yun
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Hyeong Ryul Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea.
| | - Dong Kwan Kim
- Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Ulsan University College of Medicine, Seoul, Republic of Korea
| | - Young Mog Shim
- Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Young Tae Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Kyung Young Chung
- Department of Thoracic and Cardiovascular Surgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
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17
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Guleria P, Parshad R, Malik PS, Ray R, Pandey RM, Jain D. Histotyping of Indian thymomas: A clinicopathologic study from north India. Indian J Med Res 2020; 150:153-160. [PMID: 31670270 PMCID: PMC6829775 DOI: 10.4103/ijmr.ijmr_530_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background & objectives: Thymomas are rare, but most common anterior mediastinal lesions. The histomorphologic spectrum of thymic epithelial tumours (TETs) in Indian population has not been explored in depth. This study was aimed to assess the histomorphology of TETs in the Indian patients and correlate clinical parameters with pathological features. Methods: It was a retrospective study conducted in a tertiary referral hospital in north India. All morphologically confirmed cases of TETs since 2009 were included. Clinical details and histology slides were reviewed using the Modified Masaoka-Koga staging system and WHO 2015 classification. Clinicopathological correlation and survival analysis were done. A comparative review from other published Indian studies was performed. Results: A total of 219 cases of TETs (138 resections and 81 biopsies) were identified. The most common histomorphologic type was B2, and the most frequent stage was I. Types A/AB were common in older age (P<0.01). Clinically, higher stage tumours were found mostly in men (P<0.01), and these were Type B thymomas (P<0.01). Myasthenia gravis was more common in women (P<0.02) and in lower stages (P<0.05). Survival analysis revealed significant association between recurrence and tumour stage. Although thymic carcinoma was diagnosed on biopsy, no resectable case was identified. Interpretation & conclusions: Our findings showed that the thymomas in Indian patients were most commonly Stage I tumours of B2 and AB histotypes. Resected thymic carcinomas were conspicuously absent in our study. More studies need to be done to establish the frequency and biology of TETs from India.
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Affiliation(s)
- Prerna Guleria
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Parshad
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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18
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Agrawal M, Uppin MS, Uppin SG, Challa S, Agrawal S, Dharmrakshak AK. Thymoma diagnosis and categorization in the current scenario: Morphological analysis based on interobserver variability. Ann Thorac Med 2020; 15:90-94. [PMID: 32489444 PMCID: PMC7259390 DOI: 10.4103/atm.atm_350_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Accepted: 01/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND: Thymomas are not so common tumors that are encountered in day-to-day pathology reporting. The WHO system was proposed in 2015. Although, through its detailed reporting, the WHO elaborates all subtypes and morphological clinches to diagnosis, it was important to ascertain its reproducibility in our day-to-day reporting. AIMS: The aims of the study were (1) to study the interobserver agreement, concordance rates, and variability in the classification of a large number of thymomas received in our department as per the WHO 2015, (2) to correlate the WHO subtype with Masaoka–Koga stage, and (3) to study the variations in demography of thymomas in Indian patients as compared to those reported in the literature. SETTING AND DESIGN: This retrospective study was done at a tertiary care teaching hospital with huge surgical oncology patient load, also pertaining to the cardiothoracic surgeries. It is predominantly an interobserver agreement design to study the reproducibility of the WHO 2015 classification on thymic epithelial tumors. METHODS: Four pathologists have independently reviewed histopathology slides of 65 cases of thymomas and classified them into predefined categories. Kappa statistics was applied to the observations. RESULTS: There was a substantial interobserver agreement in overall classification of thymomas with a Cohen's kappa score of 0.66. A better score was achieved for the classification of Group B thymomas. The WHO subtypes correlate well with the Masaoka–Koga staging system, and this finding is statistically significant. This article also presents the clinical details of a large number of thymoma cases. CONCLUSION: The new WHO classification has good reproducibility among pathologists in thymoma reporting.
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Affiliation(s)
- Meetu Agrawal
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Megha S Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Shantveer G Uppin
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sundaram Challa
- Department of Pathology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - Sumeet Agrawal
- Department of Rheumatology, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
| | - A K Dharmrakshak
- Department of Cardiothoracic and Vascular Surgery, Nizam's Institute of Medical Sciences, Hyderabad, Telangana, India
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19
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Alothaimeen HS, Memon MA. Treatment Outcome and Prognostic Factors of Malignant Thymoma - A Single Institution Experience. Asian Pac J Cancer Prev 2020; 21:653-661. [PMID: 32212790 PMCID: PMC7437341 DOI: 10.31557/apjcp.2020.21.3.653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: Our objectives are to investigate the clinicopathological features, treatment modalities, and prognostic and prognostic factors in order to estimate long-term outcomes for patients with thymoma and thymic carcinoma at our institution. Methods: We reviewed all patients diagnosed with thymic malignancies malignancies over a period of 38 years (from 1976 to 2014). Patients were identified using a single institution database at King Faisal Specialist Hospital and Research Center (KFSH and RC), Riyadh. Demographic data, clinical staging, histopathology classification, treatment approaches, and survival data were collected. Data Analysis was performed using both the Kaplan–Meier method and Cox proportional hazards modeling. Results: The fifty-six identified patients consists of 30 females (53.6%) and 26 males (46.4%). The median age at diagnosis was 39 years. About 37% of the patients were diagnosed with myasthenia gravis (MG). There was a significant association between the WHO histologic classification and the Masaoka stage (p= 0.018). The estimated 5-year overall survival rate was 88.6% for patients with thymic malignancies. The median survival time of thymoma and thymic carcinoma was 61 and 14 months, respectively. The univariate analysis suggested that histology (thymoma versus thymic carcinoma, p= 0.044) and Masaoka stage (II-III versus IV, p= 0.048) were independent prognostic factors affecting overall survival. Histology (p = 0.044) was found to be an independent predictor of overall survival. Conclusion: The findings of this study indicates that late Masaoka-Koga staging and histology types are significantly associated with extended overall survival. Similarly, surgical resection and multimodality treatments play a significant role in thymic malignancies neoplasms therapy strategies to prolong survival rates.
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Affiliation(s)
- Haya S Alothaimeen
- Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - Muhammad A Memon
- Oncology Center, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia.,Cancer Institute, Geisinger Health System, Pennsylvania, USA
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20
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Di Nunno N, Patanè FG, Amico F, Asmundo A, Pomara C. The Role of a Good Quality Autopsy in Pediatric Malpractice Claim: A Case Report of an Unexpected Death in an Undiagnosed Thymoma. Front Pediatr 2020; 8:31. [PMID: 32117836 PMCID: PMC7026673 DOI: 10.3389/fped.2020.00031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 01/21/2020] [Indexed: 11/13/2022] Open
Abstract
Thymomas are extremely rare in the first 20 years of life, with different clinical presentations: from asymptomatic mediastinal masses to compressive and paraneoplastic syndromes. In pediatric population, the respiratory disorders have a higher incidence. The overall thymoma mortality rate is described as 40% and metastasized tumors are more aggressive. This case report describes a compressive syndrome caused by a thymoma in which symptoms were exacerbated by a concurrent pulmonary infection, thus leading an affected infant to sudden death despite medical treatment. In this case, patient's death occurred just before the differential diagnostic process got completed. Malpractice claim was based on the missing diagnosis as well as the suspect of inadequate provided care. Consequently, autopsy played a crucial post-mortem role to find out the cause of death, and to exclude any professional liability. Despite modern diagnostic techniques, autopsies are still the best available forensic tool. It is useful to remember that death is a fact of life, therefore not always preventable.
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Affiliation(s)
- Nunzio Di Nunno
- Department of History Society and Human Studies, University of Salento, Lecce, Italy
| | - Federico Giuseppe Patanè
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Francesco Amico
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
| | - Alessio Asmundo
- Departmental section of Legal Medicine "G. Martino", University of Messina, Messina, Italy
| | - Cristoforo Pomara
- Department of Medical, Surgical Sciences and Advanced Technologies G.F. Ingrassia, University of Catania, Catania, Italy
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21
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Reeve EJ, Mapletoft EK, Schiborra F, Maddox TW, Lamb CR, Warren-Smith CMR. Mediastinal lymphoma in dogs is homogeneous compared to thymic epithelial neoplasia and is more likely to envelop the cranial vena cava in CT images. Vet Radiol Ultrasound 2019; 61:25-32. [PMID: 31574584 DOI: 10.1111/vru.12812] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 11/28/2022] Open
Abstract
In order to identify CT signs that could be used to distinguish cranial mediastinal lymphoma and thymic epithelial neoplasia, a retrospective case-control study was done. Associations between CT signs and diagnosis were tested using binary logistic regression and results expressed as odds ratio and 95% confidence interval. Sixty-two dogs that had thoracic CT and confirmed diagnosis of lymphoma (n = 33) or thymic neoplasia (n = 29) were sampled. Thymic neoplasms included 24 thymomas and five thymic carcinomas. Dogs with thymic epithelial neoplasia were significantly older than dogs with lymphoma (median age 8.6 years versus 6.0 years, P = .007), but there were no significant differences in prevalence of clinical signs. Diagnosis of thymic epithelial neoplasia was associated with heterogeneous attenuation in pre- (odds ratio 23.3, 95% confidence interval, 4.5-121.1) and post-contrast (odds ratio 30.7, 95% confidence interval, 3.6-265.0) images. Conversely, envelopment of the cranial vena cava by the mass was less likely with thymic epithelial neoplasia than lymphoma (odds ratio 0.07, 95% confidence interval, 0.007-0.66). Greater standard deviation of Hounsfield unit values in post-contrast images was associated with thymic epithelial neoplasia (P = .005). Based on ROC analysis, SD > 17HU of the mass in post-contrast images had a sensitivity of 72% and specificity of 79% for thymic epithelial neoplasia. There were no significant differences in morphology, prevalence of calcification, mediastinal lymphadenopathy, cranial vena cava invasion, collateral vessels, or pleural fluid associated with these tumors. Thymic epithelial neoplasms tended to occur in older dogs and were heterogeneous in CT images, whereas mediastinal lymphoma was more homogeneous and more likely to envelop the cranial vena cava.
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Affiliation(s)
| | - Emma K Mapletoft
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, London, UK
| | | | - Thomas W Maddox
- Institute of Veterinary Science, University of Liverpool, Liverpool, UK
| | - Christopher R Lamb
- Department of Clinical Sciences and Services, The Royal Veterinary College, University of London, London, UK
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22
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Oselin K, Girard N, Lepik K, Adamson-Raieste A, Vanakesa T, Almre I, Leismann T, Chalabreysse L. Pathological discrepancies in the diagnosis of thymic epithelial tumors: the Tallinn-Lyon experience. J Thorac Dis 2019; 11:456-464. [PMID: 30962989 DOI: 10.21037/jtd.2018.12.123] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Thymic epithelial tumors are rare thoracic tumors for which pathological diagnosis is challenging due to the definition of multiple subtypes, tumor heterogeneity, and variations in interobserver reproducibility. In this study, we aimed at analyzing the quality of pathological reporting in line with the consistency between initial diagnosis and final diagnosis after expert review through a collaboration between the largest thoracic oncology center in Estonia, and one expert center in France. Methods Hospital electronic database and pathology databases from the Tallinn North Estonia Medical Centre were searched for thymic and mediastinal tumors from 2010 to 2017. Pathology specimens were referred to the Pathology Department of the Lyon University hospital. Overall, 55 tissue specimens from 49 patients were included. Results From pathology reports, tumor size, diagnosis, and invasion had been mentioned in ≥80% of cases, while resection status and staging were assessed in only 48% and 17% of cases, respectively. The initial diagnosis was consistent with that of the review in 60% of cases. Diagnostic concordance for thymoma subtypes was low (Cohen's kappa 0.34, 95% CI: 0.16-0.52). Overall, a major change in the management of 8 (16%) patients had to be made after pathological review: 3 patients had a normal thymus according to the reference centre, while thymoma B1 or B2 had been diagnosed locally; 5 additional patients had a final diagnosis of non-thymic tumor. Conclusions Implementing structured pathology reports may help to decrease discrepancies in the diagnosis of thymic epithelial tumors. The development of expert networks is an opportunity to improve diagnosis and patient care, particularly in regard to rare cancers.
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Affiliation(s)
- Kersti Oselin
- Department of Chemotherapy, North Estonia Medical Centre, Tallinn 13419, Estonia
| | - Nicolas Girard
- Université Lyon 1, Université de Lyon, Hospices Civils de Lyon, Lyon (Bron) 69677, France.,Institut Curie, Institut du Thorax Curie-Montsouris, Paris 75005, France
| | - Katrin Lepik
- Department of Pathology, North Estonia Medical Centre, Tallinn 13419, Estonia
| | - Aidi Adamson-Raieste
- Department of Radiotherapy, North Estonia Medical Centre, Tallinn 13419, Estonia
| | - Tõnu Vanakesa
- Department of Thoracic Surgery, North Estonia Medical Centre, Tallinn 13419, Estonia
| | - Ingemar Almre
- Department of Thoracic Surgery, North Estonia Medical Centre, Tallinn 13419, Estonia
| | - Tiina Leismann
- Department of Pathology, North Estonia Medical Centre, Tallinn 13419, Estonia
| | - Lara Chalabreysse
- Université Lyon 1, Université de Lyon, Hospices Civils de Lyon, Lyon (Bron) 69677, France.,Centre Expert National Associé du Réseau RYTHMIC Tumeurs Thymiques et Cancer, Lyon, France
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23
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Abstract
Thymic epithelial neoplasms are malignant lesions that originate from the thymus and include thymoma, thymic carcinoma, and thymic neuroendocrine tumors. Although computed tomography (CT) is typically considered the imaging modality of choice for identifying thymic tumors, characterizing the primary neoplasm, and staging of disease, the role of magnetic resonance (MR) imaging continues to expand. MR imaging is effective in distinguishing thymic epithelial neoplasms and other malignant tumors from benign lesions in the prevascular mediastinum, can be used to characterize and stage thymic tumors in those patients with contraindications to contrast-enhanced CT, and can reveal morphologic features of thymic tumors. At least 15 different stage classifications have been proposed for thymic epithelial neoplasms and used to varying degrees in clinical practice. Recently, an official, consistent tumor node metastasis (TNM) staging system has been recognized by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC), based on an analysis of a retrospective database performed by the International Association for the Study of Lung Cancer (IASLC) and the International Thymic Malignancy Interest Group (ITMIG). In this article, we discuss the appropriate utilization of MR imaging in the evaluation of patients with thymic epithelial neoplasms, key imaging features of the tumors, and the impact of imaging findings on overall staging.
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Affiliation(s)
- Brett W Carter
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - John P Lichtenberger
- Department of Radiology and Radiological Sciences, Uniformed Services University of the Health Sciences, Bethesda, MD
| | - Marcelo F Benveniste
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Santoni G, Amantini C, Morelli MB, Tomassoni D, Santoni M, Marinelli O, Nabissi M, Cardinali C, Paolucci V, Torniai M, Rinaldi S, Morgese F, Bernardini G, Berardi R. High CTLA-4 expression correlates with poor prognosis in thymoma patients. Oncotarget 2018; 9:16665-16677. [PMID: 29682176 PMCID: PMC5908277 DOI: 10.18632/oncotarget.24645] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Accepted: 02/21/2018] [Indexed: 02/06/2023] Open
Abstract
Thymomas, tumors that arise from epithelial cells of the thymus gland, are the most common neoplasms of the anterior mediastinum, with an incidence rate of approximately 2.5 per million/year. Cytotoxic T Lymphocyte Antigen 4 (CTLA-4 or CD152) exerts inhibitory activity on T cells, and since its oncogenic role in the progression of different types of tumors, it has emerged as a potential therapeutic target in cancer patients. In this study, we assessed the expression of CTLA-4 both at mRNA and protein levels in paraffin embedded-tissues from patients with thymomas. Furthermore, we evaluated the relationship between CTLA-4 expression and the clinical-pathologic characteristics and prognosis in patients with thymomas. Sixty-eight patients with median age corresponding to 62 years were included in this analysis. Thymomas were classified accordingly to the WHO and Masaoka-Koga for histochemical analysis and for prognostic significance. A statistical difference was found between CTLA-4 mRNA levels in human normal thymus compared with thymoma specimens. CTLA-4 expression was statistically found to progressively increase in A, B1, B2, AB and it was maximal in B3 thymomas. According to Masaoka-Koga pathological classification, CTLA-4 expression was lower in I, IIA and IIB, and higher in invasive III and IV stages. By confocal microscopy analysis we identified the expression of CTLA-4 both in tumor cells and in CD45+ tumor-infiltrating leukocytes, mainly in B3 and AB thymomas. Finally, CTLA-4 overexpression significantly correlates with reduced overall survival in thymoma patients and in atypical thymoma subgroup, suggesting that it represents a negative prognostic factor.
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Affiliation(s)
| | - Consuelo Amantini
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Maria Beatrice Morelli
- School of Pharmacy, University of Camerino, Camerino, Italy.,Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Daniele Tomassoni
- School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | - Matteo Santoni
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-Lancisi, Salesi di Ancona, Italy
| | - Oliviero Marinelli
- School of Pharmacy, University of Camerino, Camerino, Italy.,School of Biosciences and Veterinary Medicine, University of Camerino, Camerino, Italy
| | | | - Claudio Cardinali
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Vittorio Paolucci
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-Lancisi, Salesi di Ancona, Italy
| | - Mariangela Torniai
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-Lancisi, Salesi di Ancona, Italy
| | - Silvia Rinaldi
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-Lancisi, Salesi di Ancona, Italy
| | - Francesca Morgese
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-Lancisi, Salesi di Ancona, Italy
| | - Giovanni Bernardini
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy.,I.N.M. Neuromed, Pozzilli, Isernia (IS), Italy
| | - Rossana Berardi
- Medical Oncology Unit, Università Politecnica delle Marche, Azienda Ospedaliero-Universitaria Ospedali Riuniti Umberto I-Lancisi, Salesi di Ancona, Italy
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Thymoma: a clinicopathological correlation of 1470 cases. Hum Pathol 2018; 73:7-15. [DOI: 10.1016/j.humpath.2017.08.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/02/2017] [Accepted: 08/18/2017] [Indexed: 02/07/2023]
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Carter BW, Benveniste MF, Madan R, Godoy MC, Groot PMD, Truong MT, Rosado-de-Christenson ML, Marom EM. IASLC/ITMIG Staging System and Lymph Node Map for Thymic Epithelial Neoplasms. Radiographics 2017; 37:758-776. [PMID: 28493800 DOI: 10.1148/rg.2017160096] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Thymic epithelial neoplasms are rare malignancies that arise from the thymus and include thymoma, thymic carcinoma, and thymic neuroendocrine tumors. At least 15 different stage classifications have been proposed for thymic epithelial neoplasms and used to varying degrees in clinical practice, many of which have been constructed from small groups of patients. Traditionally, the Masaoka and Masaoka-Koga staging systems have been the schemes most commonly employed, and the latter has been recommended for use by the International Thymic Malignancy Interest Group (ITMIG). An official, consistent stage classification system has recently been recognized by the American Joint Committee on Cancer (AJCC) and the Union for International Cancer Control (UICC), which are responsible for defining stage classifications for neoplasms. To establish this stage classification system, the International Association for the Study of Lung Cancer (IASLC) and ITMIG amassed a large retrospective database and evaluated this group of cases to develop proposals for the eighth edition of the stage classification manuals. For this endeavor, IASLC provided funding and statistical analysis and ITMIG provided the involvement of the clinicians and researchers actively participating in the study of thymic epithelial neoplasms. To accomplish this, a Thymic Domain of the Staging and Prognostic Factors Committee (TD-SPFC) was established to formulate the rationale, methodology, and definitions of this tumor-node-metastasis (TNM) staging system, which is presented in this article. © RSNA, 2017.
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Affiliation(s)
- Brett W Carter
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Marcelo F Benveniste
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Rachna Madan
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Myrna C Godoy
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Patricia M de Groot
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Mylene T Truong
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Melissa L Rosado-de-Christenson
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
| | - Edith M Marom
- From the Department of Diagnostic Radiology, University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Unit 1478, Houston, TX 77030 (B.W.C., M.F.B., M.C.G., P.M.d.G., M.T.T.); Department of Radiology, Brigham and Women's Hospital, Boston, Mass (R.M.); Department of Radiology, Saint Luke's Hospital of Kansas City, University of Missouri-Kansas City School of Medicine, Kansas City, Mo (M.L.R.d.C.); and Department of Radiology, Chaim Sheba Medical Center, Tel Aviv, Israel (E.M.M.)
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Assessment of the ITMIG Statement on the WHO Histological Classification and of the Eighth TNM Staging of Thymic Epithelial Tumors of a Series of 188 Thymic Epithelial Tumors. J Thorac Oncol 2017; 12:1571-1581. [DOI: 10.1016/j.jtho.2017.06.072] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2016] [Revised: 06/18/2017] [Accepted: 06/29/2017] [Indexed: 11/21/2022]
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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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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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Postoperative Radiotherapy in Locally Invasive Malignancies of the Thymus: Patterns of Care and Survival. J Thorac Oncol 2016; 11:2218-2226. [PMID: 27544056 DOI: 10.1016/j.jtho.2016.07.032] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 07/28/2016] [Accepted: 07/31/2016] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Our purpose was to determine the overall survival (OS) benefit of postoperative radiotherapy (PORT) in patients with advanced thymic malignancies and the associated predictors of PORT receipt. METHODS We queried the National Cancer Data Base for all stage II to III thymic malignancies. Trends in PORT use over time were analyzed using least squares linear regression. Factors predictive of PORT and OS were identified by using multivariate logistic and Cox regression analysis, respectively. RESULTS We identified 1156 patients between 2004 and 2012 who met the inclusion criteria. The utilization of PORT was found to increase over the study period by 41% (37% to 52% [p = 0.01]). On multivariate analysis, the factors found to be the most predictive of receipt of PORT were positive surgical margins (adjusted OR = 1.98 [p < 0.01]) and treatment at a nonacademic facility (adjusted OR = 1.44 [p = 0.01]). The 5-year OS was superior for patients receiving PORT compared with for those who did not (83% versus 79%, p = 0.03). Receipt of PORT was associated with a trend toward decreased risk for death on multivariate analysis (hazard ratio = 0.75 [p = 0.09]). In addition, a positive macroscopic margin was the most important predictor of survival (hazard ratio = 3.48 [p < 0.01]). On subgroup analysis, patients with thymic carcinoma and WHO histologic types A and AB were associated with an OS benefit with PORT, whereas types B1, B2, and B3 were not. Patients with positive margins were not associated with an OS benefit with PORT. CONCLUSIONS The use of PORT in patients with advanced thymic malignancies is increasing over time and is determined by both clinical and demographic factors. Receipt of PORT was associated with improved OS. The OS benefit with PORT was dependent on the WHO histologic type.
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Lee G, I H, Kim SJ, Pak K, Cho JS, Jeong YJ, Lee CH, Chang S. Initial Experience of 18F-FDG PET/MRI in Thymic Epithelial Tumors: Morphologic, Functional, and Metabolic Biomarkers. Clin Nucl Med 2016; 41:8-14. [PMID: 26284773 DOI: 10.1097/rlu.0000000000000946] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to investigate the value of morphologic, functional, and metabolic biomarkers acquired concurrently at PET/MRI in patients with thymic epithelial tumors. PATIENTS AND METHODS During 1 year, 9 patients with suspected thymic epithelial tumors at contrast-enhanced chest CT were prospectively enrolled and underwent preoperative 18F-FDG PET/MRI. Two chest radiologists prospectively reviewed the CT and MRI scans of PET/MRI in consensus, and 2 nuclear physicians reviewed the PET images. Visual assessment of the tumor morphology, functional biomarkers such as apparent diffusion coefficient from diffusion-weighted images, and metabolic biomarkers (including SUVmax, metabolic tumor volume, total lesion glycolysis, and heterogeneity index) were recorded. All patients underwent operation, and their pathologic reports served as the reference standard. RESULTS Thymic epithelial tumors were demonstrated in all 9 patients at pathologic examination. Tumor contour (P = 0.012) and shape (P = 0.033) had an association with the World Health Organization subtype, and the presence of septum (P = 0.048) on MRI scans had an association with the Masaoka stage. In terms of functional and metabolic biomarkers, SUVmax (ρ = 0.683, P = 0.042) and SUV/apparent diffusion coefficient (ρ = 0.703, P = 0.035) correlated with the Masaoka stage. Metabolic tumor volume (P = 0.024), heterogeneity index (P = 0.024), and total lesion glycolysis (P = 0.048) were useful for classification between low- and high-risk thymic epithelial tumors. CONCLUSIONS Although limited by the small number of patients enrolled, morphologic, functional, and metabolic biomarkers derived from PET/MRI scans were useful for the stratification of thymic epithelial tumors.
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Affiliation(s)
- Geewon Lee
- From the *Department of Radiology, †Biomedical Research Institute, Departments of ‡Thoracic and Cardiovascular Surgery, §Nuclear Medicine, and ∥Pathology, Pusan National University Hospital, Busan, South Korea; and ¶Department of Radiology, University of Colorado School of Medicine, Aurora, CO
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Zhu L, Zhang J, Marx A, Weiss C, Fang WT. Clinicopathological analysis of 241 thymic epithelial tumors-experience in the Shanghai Chest Hospital from 1997-2004. J Thorac Dis 2016; 8:718-26. [PMID: 27114840 DOI: 10.21037/jtd.2016.03.24] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND To assess the correlation of WHO histological classification of thymomas and thymic carcinomas (TCs) with prognosis in recently treated patient cohort compared to a historical one from a single institution. METHODS Retrospective review of clinical charts and histological sections of 241 patients treated during 1997-2004. Univariate and multivariate analysis of associations between risk factors including gender, age, tumor size, myasthenia gravis, WHO histological subtype, Masaoka stage, resection status, (neo-)adjuvant therapies, and survival. RESULTS The 5-year overall survival (OS) of A, AB, B1, B2, B3 thymomas and TCs patients was 100%, 100%, 94%, 80%, 94% and 45%. Five-year progression-free survival (PFS) was 100%, 96%, 78%, 80%, 78% and 39%, respectively. The 5-year OS of patients with Masaoka stage I, II, III and IV thymomas and TCs was 96%, 89%, 59% and 50%. (Neo-)adjuvant therapies were administered more often than in the historical cohort. Tumor-related death mainly occurred in patients with stage III, IV and B2, B3 thymomas and TCs. By univariate analysis, gender, tumor size, myasthenia gravis (MG) status, histotype, Masaoka stage, resection status and treatment were associated with OS. By multivariate analysis, histological subtype, Masaoka stage, and (neo-)adjuvant therapy were revealed as independent prognostic indicators. CONCLUSIONS WHO histological subtype, Masaoka stage and (neo-)adjuvant treatment have remained independent determinants of OS in patients with thymomas and TCs. Compared with the historical cohort during 1969-1996, prognosis of patients with B2, B3 thymomas has improved, which may be partly due to the increased use of adjuvant therapies. Prognosis of patients with TCs remained unsatisfactory, suggesting that neoadjuvant treatment should be tested to improve survival.
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Affiliation(s)
- Lei Zhu
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Jie Zhang
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Alexander Marx
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Christel Weiss
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
| | - Wen-Tao Fang
- 1 Department of Pathology, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China ; 2 Institute of Pathology, 3 Department of Medical Statistics and Biomathematics, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany ; 4 Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai 200032, China
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Wu J, Fang W, Chen G. The enlightenments from ITMIG Consensus on WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Dis 2016; 8:738-43. [PMID: 27114842 DOI: 10.21037/jtd.2016.01.84] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
The World Health Organization (WHO) histological classification of the thymoma and thymic carcinoma (TC) has been criticized for poor interobserver reproducibility or inconsistencies in the routine pathological diagnosis. The International Thymic Malignancy Interest Group (ITMIG) panel achieved an agreement to maintain the widely accepted WHO framework but to refine historic definitions and histological criteria, and further introduce some new terms with the aim to improve interobserver reproducibility. This review addresses the enlightenments we can get from the ITMIG consensus on the WHO histological classification of the thymoma and TC, which may be helpful for most pathologists.
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Affiliation(s)
- Jie Wu
- 1 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Wentao Fang
- 1 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
| | - Gang Chen
- 1 Department of Pathology, Zhongshan Hospital, Fudan University, Shanghai 200032, China ; 2 Department of Thoracic Surgery, Shanghai Chest Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200030, China
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Abstract
Thymoma is the most common primary malignancy of the anterior mediastinum and the most common thymic epithelial neoplasm, but it is a rare tumor that constitutes less than 1% of adult malignancies. Computed tomography (CT) is currently the imaging modality of choice for distinguishing thymoma from other anterior mediastinal masses, characterizing the primary tumor, and staging the disease. However, magnetic resonance imaging is also effective in evaluating and characterizing anterior mediastinal masses and staging thymoma in patients with contraindications to contrast-material-enhanced CT such as contrast allergy and/or renal failure.
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Affiliation(s)
- Brett W Carter
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030-4008, USA.
| | - Marcelo F K Benveniste
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030-4008, USA
| | - Mylene T Truong
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030-4008, USA
| | - Edith M Marom
- Section of Thoracic Imaging, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1478, Houston, TX 77030-4008, USA
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Modified Masaoka stage and size are independent prognostic predictors in thymoma and modified Masaoka stage is superior to histopathologic classifications. J Thorac Oncol 2015; 10:691-700. [PMID: 25629638 DOI: 10.1097/jto.0000000000000482] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION The prognostic value of histopathologic classifications of thymoma is debated. Problematic reproducibility might cause this controversy. We studied the prognostic significance of three histopathologic classifications of thymomas after three thoracic pathologists agreed upon thymoma subtype and invasion. We also compared the outcome to established prognostic parameters. METHODS Patients, surgically treated for thymic epithelial neoplasm at Mayo Clinic (1942-2008), were staged according to the modified Masaoka staging and the recently proposed staging by Moran. Three thoracic pathologists independently classified all cases according to the World Health Organization, Bernatz, and proposed Suster and Moran classification. Only thymoma that all three pathologists diagnosed as the same histopathologic subtype and extent of invasion were included in outcome analysis. RESULTS In 214 (proposed Suster and Moran classification), 145 (World Health Organization classification), and 120 cases (Bernatz classification), reviewers agreed upon subtype of thymoma and invasion and follow-up was available. Median follow-up time was 7.5-7.7 years (range between classifications). All histopathologic classifications were associated with overall survival (OS) and disease-free survival (p ≤ 0.0001 to p = 0.048); only Bernatz classification was independent of modified Masaoka staging associated with OS (p = 0.04). Modified Masaoka stage predicted outcome independent of all histopathologic classifications and resection status and strongly correlated with the proposed Moran stage (correlation coefficient, 0.95). Thymoma size and age were prognostic parameters for OS independent of any histopathologic classification. CONCLUSIONS Histopathologic classifications of thymomas are associated with prognosis but are in general not independent predictors of outcome. Modified Masaoka stage and proposed Moran staging are independent prognostic parameters for thymoma and superior to histopathologic classifications.
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Diffusion-weighted magnetic resonance imaging of thymoma: ability of the Apparent Diffusion Coefficient in predicting the World Health Organization (WHO) classification and the Masaoka-Koga staging system and its prognostic significance on disease-free survival. Eur Radiol 2015; 26:2126-38. [DOI: 10.1007/s00330-015-4031-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2015] [Accepted: 09/15/2015] [Indexed: 01/22/2023]
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Zhao Y, Shi J, Fan L, Hu D, Yang J, Zhao H. Surgical treatment of thymoma: an 11-year experience with 761 patients. Eur J Cardiothorac Surg 2015; 49:1144-9. [DOI: 10.1093/ejcts/ezv288] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2015] [Accepted: 07/20/2015] [Indexed: 11/14/2022] Open
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Shen Q, Hu W, Feng Z. Perplexing histologic classification of thymic epithelial tumor. Radiology 2015; 275:929-30. [PMID: 25997137 DOI: 10.1148/radiol.2015142437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Qijun Shen
- Department of Radiology, Hangzhou First People's Hospital, Hangzhou, Zhejiang, China *
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Reproducibility of 3 Histologic Classifications and 3 Staging Systems for Thymic Epithelial Neoplasms and Its Effect on Prognosis. Am J Surg Pathol 2015; 39:427-41. [DOI: 10.1097/pas.0000000000000391] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
INTRODUCTION The aim of the study was to identify preoperative computed tomography (CT) imaging characteristics that correlated with surgical resectability. METHODS We retrospectively reviewed the CT scans of 133 patients who underwent surgical resection for thymoma at our institution between July 21, 1997, and September 22, 2010. Imaging characteristics recorded included tumor size, attenuation, contact of mediastinal vessels, tumor morphology, infiltration of surrounding fat, changes in the adjacent lung parenchyma, lymphadenopathy, and pleural involvement. RESULTS The study group included 66 men and 67 women, aged 23-88 years (mean 58.8 years). Eighty patients (60.2%) were Masaoka stage I or II and 53 (39.8%) were Masaoka stage III or IV. Twenty-three patients (17.3%) had an incomplete surgical resection. Of these, 15 patients had microscopic residual disease (11.2%) and eight had gross residual disease (6.0%). The preoperative CT characteristics that correlated with an incomplete surgical resection included a lobulated tumor contour (p = 0.016), greater than or equal 50% abutment of the circumference of an adjacent vessel (p < 0.001), thoracic lymphadenopathy (p = 0.029), adjacent lung changes (p = 0.005) and pleural nodularity (p = 0.001). Tumor size was larger in the incompletely versus completely resected groups, with mean values of 9.7 and 6.9 cm (p value 0.013). On multivariate analysis, only degree of abutment of adjacent vessels and pleural nodularity were independent predictors of incomplete resection. CONCLUSIONS Preoperative CT findings can predict the likelihood of successful surgical resection and could help to identify patients who might benefit from neoadjuvant chemotherapy.
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Weis CA, Yao X, Deng Y, Detterbeck FC, Marino M, Nicholson AG, Huang J, Ströbel P, Antonicelli A, Marx A. The impact of thymoma histotype on prognosis in a worldwide database. J Thorac Oncol 2015; 10:367-72. [PMID: 25616178 PMCID: PMC4318643 DOI: 10.1097/jto.0000000000000393] [Citation(s) in RCA: 132] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
INTRODUCTION The rarity of thymomas and lack of multi-institutional studies have hampered therapeutic progress for decades. To overcome this, the members of the International Thymic Malignancy Interest Group created a worldwide retrospective database. This database was analyzed regarding the demographic and geographic distribution of thymomas and the impact of different variables on survival and recurrence. METHODS This study analyzed 4221 thymomas diagnosed between 1983 and 2012 with World Health Organization histotype information from the International Thymic Malignancy Interest Group database. Associations to survival and recurrence were studied by univariate and multivariate analyses. RESULTS Type B2 thymoma is the most common (28%) and type A the least common (12%) histotypes. They are significantly more frequent in Europe and the United States than Asia. Type A and AB occur at significantly higher age than other thymomas (64 and 57 years, respectively). There are no differences in gender distribution. Stage is lower in type A (90% in stages I-II) and AB than B1 to B3 thymomas (38% of type B3 in stage III). In univariate analysis, recurrence is significantly less frequent among stage I/II tumors, in type A and AB (recurrence rates, 1-2%) than B1 to B3 thymomas (2-7%). Multivariate analysis reveals an impact of age, stage, and resection status on survival and recurrence, whereas for histology there is only a significant impact on recurrence. CONCLUSION New findings are (1) geographic differences such as a lower incidence of type A and B2 thymoma in Asia; and (2) impact of stage and histology, the latter partially limited to early stage disease, on recurrence.
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Affiliation(s)
- Cleo-Aron Weis
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Xiaopan Yao
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Yanhong Deng
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Frank C. Detterbeck
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Mirella Marino
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Andrew G. Nicholson
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - James Huang
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Alberto Antonicelli
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; Section of Medical Oncology, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Division of Thoracic Surgery, Department of Surgery, Yale University School of Medicine, New Haven, Connecticut; Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; Department of Histopathology, Royal Brompton Hospital, and National Heart and Lung Institute, Imperial College London, London, United Kingdom; Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; and Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
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ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol 2015; 9:596-611. [PMID: 24722150 DOI: 10.1097/jto.0000000000000154] [Citation(s) in RCA: 194] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION The 2004 version of the World Health Organization classification subdivides thymic epithelial tumors into A, AB, B1, B2, and B3 (and rare other) thymomas and thymic carcinomas (TC). Due to a morphological continuum between some thymoma subtypes and some morphological overlap between thymomas and TC, a variable proportion of cases may pose problems in classification, contributing to the poor interobserver reproducibility in some studies. METHODS To overcome this problem, hematoxylin-eosin-stained and immunohistochemically processed sections of prototypic, "borderland," and "combined" thymomas and TC (n = 72) were studied by 18 pathologists at an international consensus slide workshop supported by the International Thymic Malignancy Interest Group. RESULTS Consensus was achieved on refined criteria for decision making at the A/AB borderland, the distinction between B1, B2, and B3 thymomas and the separation of B3 thymomas from TCs. "Atypical type A thymoma" is tentatively proposed as a new type A thymoma variant. New reporting strategies for tumors with more than one histological pattern are proposed. CONCLUSION These guidelines can set the stage for reproducibility studies and the design of a clinically meaningful grading system for thymic epithelial tumors.
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Garneau MS, Price LL, Withrow SJ, Boston SE, Ewing PJ, McClaran JK, Liptak JM, Berg J. Perioperative Mortality and Long-Term Survival in 80 Dogs and 32 Cats Undergoing Excision of Thymic Epithelial Tumors. Vet Surg 2014; 44:557-64. [PMID: 25367336 DOI: 10.1111/j.1532-950x.2014.12304.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 07/01/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine perioperative mortality, long-term survival, causes of death, and prognostic factors for dogs and cats undergoing surgical excision of thymic epithelial tumors (TETs). STUDY DESIGN Multi-institutional case series. ANIMALS Eighty dogs and 32 cats. METHODS Follow-up information was obtained for dogs and cats that underwent surgical excision of a TET between 2001 and 2012. RESULTS Perioperative mortality was 20% in dogs and 22% in cats. No independent risk factors for perioperative mortality were identified. The estimated median survival time for all dogs was 1.69 years (95% CI 0.56-4.32) and the 1- and 4-year survival rates were 55% (95% CI 44-67) and 44% (95% CI 32-56). The estimated median survival time for all cats was 3.71 years (95% CI 0.56-unestimatable) and the 1- and 4-year survival rates were 70% (95% CI 53-87) and 47% (95% CI 0-100). Of animals that survived to discharge, 42% of dogs and 20% of cats eventually died of TET-related causes. The presence of paraneoplastic syndromes (hazard ratio [HR] 5.78, 95% CI 1.64-20.45, P = .007) or incomplete histologic margins (HR 6.09, 95% CI 1.50-24.72, P = .01) were independently associated with decreased survival in dogs. No significant predictors of survival were identified in cats. Conclusions regarding the effect of chemotherapy or radiation therapy could not be made. CONCLUSIONS While there is substantial risk of perioperative death in dogs and cats undergoing surgery for TETs, many animals that survive to discharge have prolonged survival. Survival is significantly decreased in dogs with paraneoplastic syndromes or incomplete histologic margins.
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Affiliation(s)
- Mark S Garneau
- Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
| | | | - Stephen J Withrow
- Colorado State University Veterinary Teaching Hospital, Fort Collins, Colorado
| | | | | | | | | | - John Berg
- Tufts Cummings School of Veterinary Medicine, North Grafton, Massachusetts
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Roden AC, Yi ES, Jenkins SM, Donovan JL, Cassivi SD, Garces YI, Marks RS, Aubry MC. Diagnostic significance of cell kinetic parameters in World Health Organization type A and B3 thymomas and thymic carcinomas. Hum Pathol 2014; 46:17-25. [PMID: 25455993 DOI: 10.1016/j.humpath.2014.10.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Revised: 10/01/2014] [Accepted: 10/03/2014] [Indexed: 01/25/2023]
Abstract
The prognostic importance of histologic classifications of thymic epithelial neoplasms is controversial. Evidence suggests that difficulties in reproducibility affect prognostic studies. Two thoracic pathologists independently classified 80 cases of type A or B3 thymoma and thymic carcinoma according to World Health Organization (WHO) classification. Ki-67 labeling index (LI) was used to identify cutoff points between WHO types. Recursive partitioning (Rpart) and ad hoc methods separated the data points. The pathologists agreed on type A (n = 31), type B3 (n = 21), and thymic carcinoma (n = 14). Ki-67 LI differed between types A and B3 (P < .001) and between thymic carcinoma and type A (P < .001) or type B3 (P = .001). Mitotic activity differed between thymic carcinoma and type A (P < .001) or type B3 (P < .001). Rpart revealed Ki-67 LI greater than 14.0% only in thymic carcinoma; cases with Ki-67 LI less than 5.1% did not represent thymic carcinoma. Ad hoc analysis showed Ki-67 LI greater than or equal to 13.5% represents thymic carcinoma; only type A had Ki-67 LI less than 2%. The pathologists disagreed on histologic type in 14 cases. In 11 of 14 cases with available Ki-67, the Rpart method predicted the WHO type; in 7 of 14 cases, the ad hoc method predicted the WHO type. In conclusion, Ki-67 LI is helpful in differentiating thymic epithelial neoplasms, with Ki-67 LI less than 2% and greater than or equal to 13.5% distinguishing type A thymoma and thymic carcinoma, respectively.
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Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, MN, 55905, USA.
| | - Eunhee S Yi
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, MN, 55905, USA
| | - Sarah M Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic Rochester, MN, 55905, USA
| | - Janis L Donovan
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, MN, 55905, USA
| | - Stephen D Cassivi
- Division of General Thoracic Surgery, Mayo Clinic Rochester, MN, 55905, USA
| | - Yolanda I Garces
- Department of Radiation-Oncology, Mayo Clinic Rochester, MN, 55905, USA
| | - Randolph S Marks
- Division of Medical Oncology, Mayo Clinic Rochester, MN, 55905, USA
| | - Marie-Christine Aubry
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, MN, 55905, USA
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Does the World Health Organization histological classification predict outcomes after thymomectomy? Results of a multicentre study on 750 patients. Eur J Cardiothorac Surg 2014; 48:48-54. [DOI: 10.1093/ejcts/ezu368] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Accepted: 08/18/2014] [Indexed: 01/14/2023] Open
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Song Z, Jin X, Zhang Y. Treatment and prognosis of type B2 thymoma. World J Surg Oncol 2014; 12:291. [PMID: 25240293 PMCID: PMC4247722 DOI: 10.1186/1477-7819-12-291] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Accepted: 09/02/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because of the rarity of thymoma, no randomized trials have prospectively detected the prognosis and optimal treatment for type B2 thymoma. The aim of this study is to investigate the treatment and prognosis for patients with type B2 thymoma. METHODS We retrospectively evaluated the outcome of 42 patients with type B2 thymoma who were treated between 1995 and 2010 in Zhejiang Cancer Hospital. Survival curves were plotted using the Kaplan-Meier method. The Cox proportional hazard model was used for multivariate analysis. RESULTS The current study included 42 patients. The 5-year disease-free survival and overall survival rates were 62.8% and 84.9%, respectively. There were significant differences in disease-free survival and overall survival among different Masaoka stages (both P<0.001). Univariate and multivariate analysis revealed that Masaoka stage was associated with disease-free survival and overall survival (P=0.00 and 0.001, respectively). CONCLUSIONS Our results indicate that Masaoka stage affects disease-free survival and overall survival of patients with type B2 thymoma.
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Affiliation(s)
| | | | - Yiping Zhang
- Department of Chemotherapy, Zhejiang Cancer Hospital, 38 Guangji Road, Hangzhou 310022, China.
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47
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Detterbeck F, Youssef S, Ruffini E, Okumura M. [A review of prognostic factors in thymic malignancies]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:130-6. [PMID: 24581164 PMCID: PMC6131240 DOI: 10.3779/j.issn.1009-3419.2014.02.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Samuel Youssef
- Yale University School of Medicine, New Haven, Connecticut
| | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Okuma Y, Hosomi Y, Watanabe K, Yamada Y, Horio H, Maeda Y, Okamura T, Hishima T. Clinicopathological analysis of thymic malignancies with a consistent retrospective database in a single institution: from Tokyo Metropolitan Cancer Center. BMC Cancer 2014; 14:349. [PMID: 24885581 PMCID: PMC4039543 DOI: 10.1186/1471-2407-14-349] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2013] [Accepted: 05/16/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs), which comprise thymoma and thymic carcinoma, are rare cancers with specific morphological and clinical features. Their clinical characteristics and outcomes have gradually been clarified by assessing large-scale, retrospective data obtained with international cooperation. METHODS The study is a retrospective review of 187 Japanese patients with TETs who attended our institution from 1976 to 2012. Relevant clinical features of patients with TETs and their tumors, including histology, staging, treatment strategies, and overall survival, were investigated. Differences in survival were assessed by the Kaplan-Meier method and uni- and multi-variate Cox proportional hazards regression analyses. RESULTS The 187 patients included 52 patients with stage I, 37 with stage II, 22 with stage III, and 76 with stage IVa/IVb tumors according to the Masaoka-Koga Staging System. As to histological type, five patients had type A, 33 type AB, 19 type B1, 39 type B2, and 15 type B3 thymomas, whereas 68 patients had thymic carcinoma, including 11 with neuroendocrine carcinomas according to the 2004 WHO classification. Either insufficient data were available to classify the tumors of the remaining eight patients or they had rare types. Immunological abnormalities were present in 26 patients, most of whom had thymomas (21.8% of the thymoma group). Most of the patients who presented with symptoms had myasthenia gravis or extensive thymic carcinoma. Secondary cancers were present in 25 patients (13.3%). The overall 5- and 10-year survival rates for thymoma were 85.4 and 71.5%, respectively, and those for thymic carcinoma were 33.8 and 2.3%, respectively. OS differed significantly between stage IVa thymomas and thymic carcinomas. The stage and whether the tumors were thymomas or thymic carcinomas were significant determinants of survival according to multivariate analysis. CONCLUSION The efficacy of treatments for thymoma and thymic carcinoma should be investigated separately because these tumors differ in their clinical features and prognosis.
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Affiliation(s)
- Yusuke Okuma
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo 113-8677, Japan
- Division of Oncology, Research Center for Medical Science, The Jikei University School of Medicine, Minato, Tokyo, Japan
| | - Yukio Hosomi
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo 113-8677, Japan
| | - Kageaki Watanabe
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo 113-8677, Japan
| | - Yuko Yamada
- Departments of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan
| | - Hirotoshi Horio
- Departments of Thoracic Surgery, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan
| | - Yoshiharu Maeda
- Department of Chemotherapy, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan
| | - Tatsuru Okamura
- Department of Thoracic Oncology and Respiratory Medicine, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo, Tokyo 113-8677, Japan
| | - Tsunekazu Hishima
- Departments of Pathology, Tokyo Metropolitan Cancer and Infectious diseases Center Komagome Hospital, Bunkyo, Tokyo, Japan
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Wang H, Sima CS, Beasley MB, Illei P, Saqi A, Nonaka D, Geisinger KR, Huang J, Moreira AL. Classification of Thymic Epithelial Neoplasms Is Still a Challenge to Thoracic Pathologists: A Reproducibility Study Using Digital Microscopy. Arch Pathol Lab Med 2014; 138:658-63. [DOI: 10.5858/arpa.2013-0028-oa] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Granato F, Blackhall V, Alessandra R, Spina D, Luca V, Piero P, Mohiyaddin S, Asif M, Kirk AJB, Giuseppe G. Outcome in excised thymomas: role of prognostic factors and impact of additional malignancies on survival. Scott Med J 2014; 59:22-9. [DOI: 10.1177/0036933013518147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Background and aims: Although the management of thymomas has been extensively evaluated, the value of prognostic factors in the outcome of these patients remains unclear. Methods and results: The medical records of all patients who underwent resection of thymoma between January 1985 and September 2010 at a single thoracic unit were reviewed. Patients were followed up with reference to disease recurrence and development of additional malignancies (AM). Total thymectomy was performed in all 68 cases. Mean follow-up time was four years. Mean survival was 63.9 months. Mean disease-free interval was 13 months. Factors affecting prognosis were Masaoka staging and WHO histological sub-type. Patients with thymomas had a higher risk of developing AM when compared with a control population of individuals with other tumours ( p = 0.0002). Among thymomas, the cortical subtype was associated with a higher risk of AM ( p = 0.047) and mortality ( p = 0.001). Conclusions: This data confirms that Masaoka staging and WHO histologic sub-type are the most important prognostic factors in patients with thymoma. Moreover, thymomas predominantly arising from the thymic cortex are associated with a higher risk of developing other malignancies and with poorer survival. The cortical origin of thymoma could therefore be considered as a significant prognostic factor.
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Affiliation(s)
- F Granato
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
- Professor of Genetics, Doctorate School of Oncology and Genetic, University Hospital of Siena, Italy
| | - V Blackhall
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
| | - R Alessandra
- Professor of Genetics, Doctorate School of Oncology and Genetic, University Hospital of Siena, Italy
| | - D Spina
- Consultant Pathologist, Department of Pathology, University Hospital of Siena, Italy
| | - V Luca
- Professor of Thoracic Surgery, Department of Thoracic Surgery, University Hospital of Siena, Italy
| | - P Piero
- Professor of Thoracic Surgery, Department of Thoracic Surgery, University Hospital of Siena, Italy
| | - S Mohiyaddin
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
| | - M Asif
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
| | - A JB Kirk
- Professor of Genetics, Department of Cardio-Thoracic Surgery, Golden Jubilee National Hospital, Scotland
| | - Gotti Giuseppe
- Professor of Thoracic Surgery, Department of Thoracic Surgery, University Hospital of Siena, Italy
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