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Abdel Jalil R, Abdallah FA, Obeid Z, Harb AK, Abou Chaar MK, Shannies TB, El-Edwan A, Haddad H, Ghraibeh A, Abu-Shanab A. Locally advanced thymoma; does neoadjuvant chemotherapy make a difference? J Cardiothorac Surg 2023; 18:245. [PMID: 37592291 PMCID: PMC10436628 DOI: 10.1186/s13019-023-02357-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/13/2023] [Indexed: 08/19/2023] Open
Abstract
BACKGROUND Regardless of its rare occurrence, Thymoma remains the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment modality. In locally advanced and borderline resectable tumors, neoadjuvant chemotherapy (NACT) may be utilized to increase the chance of R0 resection, raising the question of its efficacy and safety. METHODS Demographic and clinical data from patients who presented to a tertiary cancer center between January 2015-October 2021 with a diagnosis of thymoma and underwent curative surgical resection was collected. Computed tomography scan was used to delineate clinical staging, tumor size and to detect post-therapeutic variations in tumor burden. The response evaluation criteria in solid tumors (RECIST) was used to classify the effect of NACT on tumor burden. The pathological response was determined by measuring the percentage of necrotic tissue. RESULTS A total of 23 patients were diagnosed with thymoma. Most patients were male with a mean age 46 (± 15) years at diagnosis. The most common clinical stage was stage II with 5 patients (22%). A total of 12 patients had NACT as compared to 11 patients who had upfront surgery. The mean change in tumor volume was 165 cm3 (p = 0.079) and the change in and maximum diameter was 1.53 ± 1.49 cm (p < 0.01). The effect of NACT on tumor burden based on RECIST criteria was minimal as 8 patients had stable disease. Based on pathological findings, the average necrotic portion of the tumor was 39.5% (p = 0.152). The overall survival rate is 95.65%, mean survival was 115 months (4-125). Recurrence occurred in 5 patients. The NACT group had a higher risk for recurrence (4; 33.3%) with a mean survival of 43.8 months compared to 59.6 months in those who did not receive induction therapy. CONCLUSIONS The exact role of induction chemotherapy in locally advanced thymoma patients remains controversial. NACT effect after utilizing radiological and pathological assessment tools was not found to significantly improve oncological outcomes compared to upfront surgery in locally advanced disease, with minimal radiologic and pathologic effect. To further demonstrate the impact of induction chemotherapy, we recommend multicentric collaborative studies.
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Affiliation(s)
- Riad Abdel Jalil
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan.
| | - Farah A Abdallah
- Department of Research, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Zeinab Obeid
- Department of Research, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Ahmad Khaled Harb
- Department of Research, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Mohamad K Abou Chaar
- Department of Surgery, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Tariq Bassem Shannies
- Department of Research, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Ahed El-Edwan
- Department of Anesthesia, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Hussam Haddad
- Department of Pathology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Azza Ghraibeh
- Department of Radiology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
| | - Ahmad Abu-Shanab
- Department of Thoracic Oncology, King Hussein Cancer Center, Queen Rania Al Abdullah Street, P.O. Box 1269, Amman, 11941, Jordan
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2
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Fan Y, Cui T, Wei S, Gao X. Prognostic value of preoperative chemotherapy for thymic epithelial tumors: A propensity-matched analysis based on the SEER database. Front Surg 2023; 10:1108699. [PMID: 37009618 PMCID: PMC10063892 DOI: 10.3389/fsurg.2023.1108699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2022] [Accepted: 02/27/2023] [Indexed: 03/19/2023] Open
Abstract
BackgroundThe aim of this study was to assess the impact of preoperative chemotherapy on long-term survival (≥1 month) in patients with thymic epithelial tumors (TETs) and conditions suitable for chemotherapy using data from surveillance, epidemiology, and end-result databases.MethodsThis retrospective study controlled for confounding factors by propensity score matching (PSM), analyzed overall survival (OS) and cancer-specific survival (CSS) by Kaplan-Meier methods, and analyzed factors affecting the prognosis of patients undergoing surgery for thymic epithelial tumors by univariate and multifactorial Cox regression.ResultsA total of 2,451 patients who underwent surgery for TETs were identified from the Surveillance, Epidemiology, and End Results database. Preoperative chemotherapy significantly improved OS and CSS in patients with stage III/IV TETs compared to patients without preoperative chemotherapy. Subgroup analysis showed that patients younger than 60 years of age with TETs, patients with thymic carcinoma, and patients with TETs with multiple cancers were more likely to benefit from preoperative chemotherapy.ConclusionThis study found that preoperative chemotherapy is a viable option for advanced thymoma with favorable overall and cancer-specific survival rates, but patient history and physical condition should be fully considered in conjunction with diagnostic imaging findings to assess patient tolerance to chemotherapy.
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Affiliation(s)
- Yan Fan
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Tianjiao Cui
- Department of Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuai Wei
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Xingcai Gao
- Department of Thoracic Surgery, The Fifth Affiliated Hospital of Zhengzhou University, Zhengzhou, China
- Correspondence: Xingcai Gao
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3
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Li H, Ren B, Yu S, Gao H, Sun PL. The clinicopathological significance of thymic epithelial markers expression in thymoma and thymic carcinoma. BMC Cancer 2023; 23:161. [PMID: 36797681 PMCID: PMC9936685 DOI: 10.1186/s12885-023-10619-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 02/06/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND The classification of thymomas is based on the morphology of epithelial tumor cells and the proportion of lymphocytes. Type A thymomas are composed of the spindle or oval tumor epithelial cells. Tumor cells of B thymomas are epithelioid-shaped with increasing atypia. Type AB thymomas have the features of epithelial tumor cells of A and B thymomas. The diagnosis can be difficult because of the complex morphology. Some novel thymic epithelial markers have been reported in several preclinical studies, but they have not been applied to clinical practice. Here, we investigated the expression of 3 cortical and 3 medullary markers, which are thymoproteasome-specific subunit β5t (β5t), thymus-specific serine protease 16 (PRSS16), cathepsin V, autoimmune regulator (AIRE), CD40 and claudin-4. METHODS Immunohistochemistry was used to analyze 53 cases of thymomas and thymic squamous cell carcinomas (TSCC), aiming to explore the expression of cortical and medullary epithelial markers and their correlation with histological classification, Masaoka-Koga stage, and prognosis. RESULTS Our results found that for cortical epithelial markers the expression of β5t, PRSS16, and cathepsin V was higher in type AB and B thymomas than in micronodular thymoma with lymphoid stroma (MNT), and we observed a dramatic increase of β5t and PRSS16 expression in type AB compared to type A thymomas. In medullary epithelial markers, the expression of AIRE was higher in type A than in B3 thymomas. CD40 and β5t expression were associated with the Masaoka-Koga stage. High cathepsin V expression was related to a good prognosis and a longer progression-free survival. CONCLUSION This is the first comprehensive analysis of the role of thymic cortical and medullary epithelial markers as biomarkers for differential diagnosis and prognosis in thymic tumors. Thymic medullary epithelial immunophenotype was found to exhibit in type A, MNT, and TSCC. Type B thymomas primarily exhibited a cortical epithelial immunophenotype. Type AB thymomas showed cortical, medullary, or mixed corticomedullary epithelial immunophenotype. Our results demonstrated that thymic cortical and medullary epithelial markers including β5t, PRSS16, cathepsin V, and AIRE could be used as ancillary markers in the diagnosis and prognosis of thymic epithelial tumors.
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Affiliation(s)
- Huiyang Li
- grid.452829.00000000417660726Department of Pathology, The Second Hospital of Jilin University, 218 Ziqiang Road, 130041 Changchun, Jilin China
| | - Bo Ren
- grid.452829.00000000417660726Department of Pathology, The Second Hospital of Jilin University, 218 Ziqiang Road, 130041 Changchun, Jilin China
| | - Shili Yu
- grid.452829.00000000417660726Department of Pathology, The Second Hospital of Jilin University, 218 Ziqiang Road, 130041 Changchun, Jilin China
| | - Hongwen Gao
- grid.452829.00000000417660726Department of Pathology, The Second Hospital of Jilin University, 218 Ziqiang Road, 130041 Changchun, Jilin China
| | - Ping-Li Sun
- Department of Pathology, The Second Hospital of Jilin University, 218 Ziqiang Road, 130041, Changchun, Jilin, China.
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4
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Tian W, Li X, Sun Y, Wang J, Jiang G, Tong H. Myasthenia gravis affects overall survival in patients with thymoma: an analysis of multicentre database using propensity score matching. Interact Cardiovasc Thorac Surg 2021; 33:250-257. [PMID: 34151968 DOI: 10.1093/icvts/ivab074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 02/09/2021] [Accepted: 02/18/2021] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES About one-third of patients with thymoma have myasthenia gravis (MG). It remains controversial whether MG affects the prognosis of patients with thymoma. The aim of this study was to evaluate the effect of MG on the prognosis of patients with thymoma in a multicentre database. METHODS Patients with thymoma who underwent thymectomy were identified from 2 prospectively collected databases in 2 medical centres from 2010 to 2018. Kaplan-Meier curves and the log-rank test were used to assess overall survival and recurrence-free survival, and a Cox proportional hazards model was used to determine significant contributors to survival. Propensity score matching was performed to eliminate selection bias. RESULTS A total of 514 patients with thymoma were included in this study, of whom 320 patients were MG-free and 194 had MG. Patients with MG were younger (median age 50 vs 54 years, P = 0.001) and had smaller tumours (4.4 ± 2.0 vs 4.9 ± 2.3 cm, P = 0.020). Pathological analysis showed that type B tumours especially B2-B3 (B2 + B3 + mix B tumours, 55.2%) are more common in patients with MG, while type AB (37.2%) was the most common in patients without MG. A larger proportion of Masaoka III-IV stage tumour (25.7% vs 11.0%, P < 0.001) was seen in patients with thymoma and MG. Multivariable Cox regression analysis demonstrated that MG (hazard ratio [HR] = 3.729, 95% confidence interval [CI]: 1.398-9.947, P = 0.009), incomplete resection (HR = 5.441, 95% CI: 1.500-19.731, P = 0.010) and Masaoka stage III + IV (HR = 3.390, 95% CI: 1.196-9.612, P = 0.022) were negative prognostic factors of overall survival. Meanwhile, MG (HR =3.489, 95% CI: 1.403-8.680, P = 0.007) and Masaoka stage III + IV (HR = 6.582, 95% CI: 2.575-16.828, P < 0.001) were negative prognostic factors of recurrence-free survival. Propensity-matched analysis compared 148 patient pairs. K-M survival analysis demonstrated that MG was associated with worse overall survival and recurrence-free survival in propensity score-matched patients (log-rank, P = 0.034 and 0.017, respectively). CONCLUSIONS Thymoma patients with MG have smaller tumours and a higher percentage of late-stage tumours, which are mainly of WHO B types, especially B2-B3 types. In addition, MG is significantly associated with worse overall survival and recurrence-free survival in thymoma.
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Affiliation(s)
- Wenxin Tian
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.,Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Xiao Li
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Yaoguang Sun
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.,Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
| | - Jun Wang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Guanchao Jiang
- Department of Thoracic Surgery, Peking University People's Hospital, Beijing, China
| | - Hongfeng Tong
- Department of Thoracic Surgery, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing 100730, China.,Department of Thoracic Surgery, Peking University People's Hospital, Beijing 100044, China
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5
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Al-Bulushi A, Al Salmi I, Al Rahbi F, Farsi AA, Hannawi S. The role of thymectomy in myasthenia gravis: A programmatic approach to thymectomy and perioperative management of myasthenia gravis. Asian J Surg 2021; 44:819-828. [PMID: 33579606 DOI: 10.1016/j.asjsur.2020.12.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 11/18/2020] [Accepted: 12/23/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Myasthenia gravis is a rare autoimmune disease caused by antibodies that probably originate from the thymus glands. This study examined the epidemiology of patients with MG, who underwent thymectomy over the last three decades. METHODS The objectives of this observational study were to investigate the clinicopathological features, treatment modalities, and prognostic factors for patients with thymic masses, over three decades at the Royal Hospital, Muscat, Oman. RESULTS There were 100 patients who underwent thymectomy with a mean (SD) age of 32.0 (8.6) years, of which 20% were men and 80% were women. Their follow up period, cardiac and neurology clinics, ranged from 1.5 to 12.0 years with a mean (SD) of 6.0 (3.0) years. Small percentage of MG patients had diabetes and hypertension and 10% of patients have positive family history of MG. Symptoms at the onset of the disease were ophthalmoplegia in 75%, limb weakness in 39%, bulbar symptoms in 57% and respiratory symptoms in 39% of patients. The Osserman grading was Grade I - 5%, Grade IIA - 39%, Grade IIB - 34%, and Grade III - 22%. Post thymectomy, 21% of patients had complete clinical remission, 76% of patients had significant clinical improvement and 3% had no apparent improvement in their clinical status. Histologically, hyperplasia was found in 57% and involuted thymus in 18% of patients. CONCLUSION Thymectomy can reduce patient's need for medication and reduce the severity of MG regardless of age, sex, severity, or length of sickness, or thymic masses. The early-onset, sever M.G, female, thymic hyperplasia benefit the most. Patients classified as Osserman Class IIA and IIB benefit most from this procedure.
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Affiliation(s)
- Ahmed Al-Bulushi
- Cardio-Thoracic Department, National Heart Centre, The Royal Hospital, Sultanate of Oman, Muscat, Oman.
| | - Issa Al Salmi
- Medicine Department, The Royal Hospital, 23 July Street, P O Box 1331, code 111, Muscat, Oman; Medicine Department, Oman Medical Board, Muscat, Oman.
| | - Fatma Al Rahbi
- Medicine Department, The Royal Hospital, 23 July Street, P O Box 1331, code 111, Muscat, Oman.
| | | | - Suad Hannawi
- Medicine Department, MOHAP, Dubai, United Arab Emirates.
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6
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Derderian SC, Potter DD, Bansal S, Rowse PG, Partrick DA. Open versus thoracoscopic thymectomy for juvenile myasthenia gravis. J Pediatr Surg 2020; 55:1850-1853. [PMID: 31826816 DOI: 10.1016/j.jpedsurg.2019.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 11/01/2019] [Accepted: 11/19/2019] [Indexed: 12/17/2022]
Abstract
BACKGROUND Juvenile myasthenia gravis (JMG) is an antibody mediated autoimmune disorder that manifests as progressive voluntary muscle weakness and fatigue. In medically refractory cases, thymectomy has been shown to abrogate symptoms and reduce glucocorticoid dependence. While transcervical or transsternal incisions have been the traditional approach, adult trends now favor thoracoscopic thymectomy. Little data exist to support this approach in children. METHODS A retrospective review of all patients younger than 20 years of age who underwent a thymectomy for JMG at two pediatric institutions between 2001 and 2018 was performed. Children were divided into either an open (transcervical or transsternal) or thoracoscopic group and baseline characteristics, perioperative, and postoperative outcomes were compared. RESULTS Thirty-four thymectomies were performed during the 18-year study period; 18 via an open and 16 via a thoracoscopic approach. The operative time was shorter for open procedures compared thoracoscopic ones (108 ± 49 and 145 ± 43 min, respectively, p = 0.025). Thoracoscopic thymectomy was associated with less intraoperative blood loss (5.5 ± 6.0 vs 55 ± 67 ml, p = 0.007), decreased duration of postoperative intravenous narcotic use (5.0 ± 1.5 vs 20 ± 23 h, p = 0.018), and a shorter length of hospitalization (1.7 ± 1.0 vs 2.7 ± 1.1 days, p = 0.009). No perioperative complication occurred in either group. Clinical improvement was reported in 94% of children in both groups. CONCLUSIONS Thoracoscopic thymectomy in children is a safe and effective surgical technique for the treatment of JMG. Increased acceptance of this minimally invasive approach by children, families, and referring neurologists may enable earlier surgical intervention. TYPE OF STUDY Clinical research paper. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - D Dean Potter
- Division of Pediatric Surgery, Mayo Clinic, Rochester, MN
| | - Samiksha Bansal
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO
| | - Phillip G Rowse
- Department of Cardiothoracic Surgery, Mayo Clinic, Rochester, MN
| | - David A Partrick
- Department of Pediatric Surgery, Children's Hospital Colorado, Aurora, CO.
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7
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Maruyama N, Sasaki T, Arasaki A, Matsuzaki A, Nakasone T, Teruya T, Matayoshi A, Maruyama T, Karube K, Fujita J, Yoshimi N, Kuniyoshi Y, Nishihara K. Thymoma appearing 9 years after the resection of squamous cell carcinoma of the lip: A case report of triple primary tumors and literature review. Oncol Lett 2019; 18:2777-2788. [PMID: 31452756 PMCID: PMC6704295 DOI: 10.3892/ol.2019.10675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 04/09/2019] [Indexed: 11/06/2022] Open
Abstract
The occurrence of second primary tumor (SPT)following malignancy treatment is common. In patients with head and neck (H&N) cancer, SPTs principally occur in the H&N region, lungs or esophagus. Therefore, patient follow-up after cancer treatment is important in order to detect recurrence, metastasis and new primary tumors. However, no standard guidelines on lifelong follow-up imaging are available. Herein, we report a patient who presented with three metachronous primary tumors-squamous cell carcinoma (SCC) of the tongue, SCC of the lip and type A thymoma. The third tumor was incidentally detected during follow-up using contrast-enhanced computed tomography (CT) 9 years following resection of the second tumor. To the best of our knowledge, this specific combination of metachronous tumors has not yet been reported. Based on the literature review, we observed that thymoma occurs following H&N cancer treatment. Therefore, to ensure that the presence of subsequent thymomas is not overlooked, we suggest regular lifelong follow-up using contrast-enhanced CT in patients who had previously been diagnosed with H&N cancer. The literature review revealed that thymomas occur in patients with H&N cancer and should be detected at the earliest convenience.
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Affiliation(s)
- Nobuyuki Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takanobu Sasaki
- Department of Thoracic and Cardiovascular Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Thoracic Surgery, Tohoku Medical and Pharmaceutical University Hospital, Sendai, Miyagi 983-8512, Japan
| | - Akira Arasaki
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akiko Matsuzaki
- Department of Pathology, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Takao Teruya
- Department of Thoracic and Cardiovascular Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Tessho Maruyama
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Molecular Microbiology Group, Tropical Biosphere Research Center, University of the Ryukyus, Nishihara, Okinawa 903-0213, Japan
| | - Kennosuke Karube
- Department of Pathology and Cell Biology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Jiro Fujita
- Department of Infectious Diseases, Respiratory, and Digestive Medicine (The First Department of Internal Medicine), University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Naoki Yoshimi
- Department of Pathology, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Pathology and Oncology, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Yukio Kuniyoshi
- Department of Thoracic and Cardiovascular Surgery, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
- Department of Oral and Maxillofacial Surgery, University Hospital of the Ryukyus, Nishihara, Okinawa 903-0215, Japan
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8
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Kanzaki R, Kanou T, Ose N, Funaki S, Shintani Y, Minami M, Kida H, Ogawa K, Kumanogoh A, Okumura M. Long-term outcomes of advanced thymoma in patients undergoing preoperative chemotherapy or chemoradiotherapy followed by surgery: a 20-year experience. Interact Cardiovasc Thorac Surg 2019; 28:360-367. [PMID: 30256943 DOI: 10.1093/icvts/ivy276] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 07/25/2018] [Accepted: 08/15/2018] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES The results of preoperative chemotherapy or chemoradiotherapy followed by surgery for locally advanced thymoma were analysed. METHODS Between 1997 and 2016, 29 patients with a thymoma underwent preoperative chemotherapy or chemoradiotherapy followed by surgery. These cases were retrospectively reviewed. RESULTS The study population included 9 men and 20 women, with a mean age of 48.8 years (range 31-68 years). The preoperative Masaoka stage was III in 12, IVa in 13 and IVb in 4 patients, whereas histological type was B3 in 11, B2 in 9 and others in 5 patients. The mean tumour size was 8.0 ± 2.5 cm (3.4-15.0 cm). The site of infiltration shown in preoperative radiological examinations was the aorta in 6 patients, the superior vena cava in 14 patients and the pulmonary artery trunk in 3 patients, with pleural dissemination detected in 14. Three patients underwent chemoradiotherapy. Chemotherapy regimens given were cisplatin + doxorubicin + vincristine + cyclophosphamide in 9 patients, carboplatin + paclitaxel in 6 patients, cisplatin + doxorubicin + methylprednisolone in 5 patients and others in 9 patients, with partial response obtained in 11 patients and stable disease noted in 18 patients. Complete resection was achieved in 24 (83%) cases. There were no perioperative mortalities, whereas 6 (21%) patients developed postoperative complications. The 5- and 10-year overall survival rates were 100% and 87%, respectively, and 5- and 10-year disease-free survival rates were 50% and 50%, respectively. CONCLUSIONS Preoperative chemotherapy or chemoradiotherapy followed by surgery for locally advanced thymoma can be performed with an acceptable degree of surgical risk. Such a strategy should be proactively considered, as it can lead to favourable long-term results.
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Affiliation(s)
- Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
| | - Hiroshi Kida
- Respiratory Center, Osaka University Hospital, Osaka, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Kazuhiko Ogawa
- Respiratory Center, Osaka University Hospital, Osaka, Japan.,Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Atsushi Kumanogoh
- Respiratory Center, Osaka University Hospital, Osaka, Japan.,Department of Respiratory Medicine and Clinical Immunology, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan.,Respiratory Center, Osaka University Hospital, Osaka, Japan
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9
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Fujiwara A, Funaki S, Ose N, Kanou T, Kanzaki R, Minami M, Shintani Y. Surgical resection for advanced thymic malignancy with pulmonary hilar invasion using hemi-clamshell approach. J Thorac Dis 2018; 10:6475-6481. [PMID: 30746191 DOI: 10.21037/jtd.2018.11.73] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background The hemi-clamshell (HCS) approach provides a wide anterior view of the mediastinum as well as outstanding exposure of the pulmonary hilum. Here, we evaluated the utility and outcomes of this approach in cases of advanced thymic malignancy with hilar invasion. Methods We performed a retrospective analysis of 14 patients with thymic epithelial malignancy surgically resected with an HCS approach. All required lung resection because of suspected pulmonary hilar vessel invasion. Results Histological findings showed that 8 patients had a thymoma and 6 a thymic carcinoma. Thirteen patients underwent lung resection, a lobectomy or bilobectomy in 8 and wedge resection in 5, while 1 had an exploratory thoracotomy. Seven patients with a thymoma underwent resection of disseminated lesions and 8 of 10 who underwent phrenic nerve resection received diaphragmatic plication through an HCS procedure. There were no postoperative mortalities. Macroscopic complete surgical resection was achieved in 13 cases. Conclusions An HCS approach was helpful for lung resection performed for advanced thymic malignancy with hilar invasion by providing multiple access paths to the tumor and hilum, allowing for a sufficient surgical margin. Furthermore, it was useful for resection of disseminated lesions and diaphragmatic plication.
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Affiliation(s)
- Ayako Fujiwara
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Soichiro Funaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Naoko Ose
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Takashi Kanou
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Ryu Kanzaki
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Masato Minami
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yasushi Shintani
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Sato Y, Yanagawa M, Hata A, Enchi Y, Kikuchi N, Honda O, Nakanishi K, Tomiyama N. Volumetric analysis of the thymic epithelial tumors: correlation of tumor volume with the WHO classification and Masaoka staging. J Thorac Dis 2018; 10:5822-5832. [PMID: 30505490 PMCID: PMC6236181 DOI: 10.21037/jtd.2018.09.133] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 05/20/2018] [Indexed: 11/06/2022]
Abstract
BACKGROUND The purpose of our study was to investigate the correlation between tumor volume (TV) and each subtype of thymic epithelial tumors (TETs) based on the World Health Organization (WHO) classification and Masaoka staging. METHODS Sixty-one consecutive patients (45 thymomas and 16 thymic carcinomas) were studied. All were classified according to Masaoka staging: 31 non-invasive TETs (stage I) and 30 invasive TETs (8 stage II, 11 stage III, 3 stage IVa, and 8 stage IVb). TV on computed tomography (CT) were semi-automatically calculated using our software. The correlation of TV with each WHO subtype and Masaoka staging was analyzed using Mann-Whitney U and Scheffe's F test. RESULTS Thymic carcinoma (mean ± SD, 117.5±143.6 cm3) was significantly larger than thymoma (53.4±78.4 cm3) (P=0.0016). Stage IVb tumor (190.8±156.8 cm3) was significantly larger than stage I (33.1±42.6 cm3) (P<0.05). Invasive TETs were significantly larger than non-invasive TETs (P=0.0016). TV >54.3 cm3 indicated invasive TETs. CONCLUSIONS TV of invasive TETs may be larger at the time of initial presentation. TV >54.3 cm3 indicates invasive TETs.
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Affiliation(s)
- Yukihisa Sato
- Department of Diagnostic Radiology, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Masahiro Yanagawa
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Akinori Hata
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Yukihiro Enchi
- Division of Radiology, Department of Medical Technology, Osaka University Hospital, Suita, Osaka, Japan
| | - Noriko Kikuchi
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Osamu Honda
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
| | - Katsuyuki Nakanishi
- Department of Diagnostic Radiology, Osaka International Cancer Institute, Chuo-ku, Osaka, Japan
| | - Noriyuki Tomiyama
- Department of Radiology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
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Shen J, Tie H, Xu A, Chen D, Ma D, Zhang B, Zhu C, Wu Q. Inter-relationship among myasthenia gravis, WHO histology, and Masaoka clinical stage and effect on surgical methods in patients with thymoma: a retrospective cohort study. J Thorac Dis 2018; 10:2981-2990. [PMID: 29997965 DOI: 10.21037/jtd.2018.05.30] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background The aim of study is to analyze the inter-relationship among WHO histology, myasthenia gravis (MG) and Masaoka stage and to assess the feasibility of thoracoscopic surgery in thymoma patients. Methods Data from 142 consecutive thymoma patients from January 2009 to March 2016 were retrospectively reviewed in our institution. Histological classification and clinical staging were assessed by WHO histology criteria and Masaoka stage. We investigated the clinical characteristics, inter-relationship among WHO histology, MG and Masaoka stage, and compared the feasibility and safety of thoracoscopic thymectomy by comparison of open thymectomy. Results Among 142 patients, the incidence of MG was 29.6%. Compared with A and AB-type thymomas, a higher prevalence of advance clinical stage was in B1 to C-type thymomas (37/63 vs. 9/43, P<0.001), and there was an increased trend of Masaoka stage from A to C-type thymomas (P<0.001). The incidence of MG was significantly higher in AB, B1 and B2-type thymomas than other type thymomas (23/63 vs. 6/44, P=0.009) and in early Masaoka clinical stage than advanced Masaoka clinical stage (29/80 vs. 12/59, P=0.042). Thoracoscopic surgery could significantly decrease blood loss in patients with (104.06±137.36 vs. 350.91±560.79 mL, P=0.001) or without MG (91.90±77.70 vs. 266.32±292.60 mL, P=0.02), with comparable complications. Additionally, thoracoscopic surgery could achieve an equal effect on the remission of MG with open surgery (7/11 vs. 10/14, P=1.000), and Masaoka stage was significantly associated with the remission of MG after thymectomy. Conclusions Our study suggests that WHO histology, MG, and Masaoka stage interrelate with one another, and Masaoka stage is an important prognostic factor in remission of MG after thymectomy in thymoma patients. Thoracoscopic thymectomy could achieve an equal efficacy to open thymectomy and should be recommended as a routine surgery for patients with early Masaoka stage.
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Affiliation(s)
- Jianfei Shen
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Hongtao Tie
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Anyi Xu
- Department of Emergency Medicine, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Dan Chen
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
| | - Dehua Ma
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Bo Zhang
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Chengchu Zhu
- Department of Thoracic Surgery, Taizhou Hospital of Zhejiang Province, Wenzhou Medical University, Linhai 317000, China
| | - Qingchen Wu
- Department of Cardiothoracic Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400042, China
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Sarıhan S, Bayram AS, Gebitekin C, Yerci O, Sıgırlı D. Thymic tumors and results of radiotherapy. Rep Pract Oncol Radiother 2018; 23:97-104. [PMID: 29681772 DOI: 10.1016/j.rpor.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2017] [Revised: 10/04/2017] [Accepted: 12/11/2017] [Indexed: 12/25/2022] Open
Abstract
Aim The aim of this study was to evaluate thymic epithelial tumors (TETs) for treatment outcomes and prognostic factors on survival. Background TETs are very rare neoplasms and multidisciplinary approach is recommended according to prognostic factors. Materials and methods Between 1995 and 2013, 31 patients were treated with median 5400 cGy (range: 1620-6596 cGy) radiotherapy (RT). Eleven patients received adjuvant or concurrent chemotherapy. There were 25 thymomas, 4 thymic carcinomas and 2 thymic neuroendocrin carcinomas. According to Masaoka, staging and WHO classification, cases were divided to good (n: 10), moderate (n: 9) and poor (n: 12) prognostic risk groups. Survival was calculated from diagnosis. Results In January 2016, 22 cases were alive with median 51.5 months (range: 2-170.5) follow-up. Recurrences were observed in 29% of patients in median 29.5 months (range: 6.5-105). Local control, mean overall (OS) and disease-free survival (DFS) rates were 86%, 119 and 116 months, respectively. There was a significant difference for R0 vs. R+ resection (81% vs. 43%, p = 0.06, and 69% vs. 46%, p = 0.05), Masaoka stage I-II vs. III-IV (75% vs. 52%, p = 0.001, and 75% vs. 37%, p < 0.001), and also prognostic risk groups (100% vs. 89% vs. 48%, p = 0.003, and 100% vs. 87% vs. 27%, p = 0.004) in terms of 5-year OS and DFS, respectively. Conclusion In our study, prognostic risk stratification was shown to be a significant predictor of survival. There is a need to investigate subgroups that may or may not benefit from adjuvant RT.
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Key Words
- 3D-CRT/IMRT, three-dimensional conformal RT/intensity modulated RT
- 4D-CT, four-dimensional computed tomography
- CHE, chemotherapy
- CT, computed tomography
- DFS, disease-free survival
- LC, local control
- MG, Myasthenia Gravis
- NEC, thymic neuroendocrin carcinoma
- OS, overall survival
- PET/CT, positron emission tomography
- PF, prognostic factor
- R+, incomplete resection
- R0, complete resection
- R1, microscopic residual disease
- R2, macroscopic residual disease
- RT, radiotherapy
- TC, thymic carcinoma
- TET, thymic epitelial tumor
- WHO, World Health Organization
- cm, centimeter
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Affiliation(s)
- Sureyya Sarıhan
- Department of Radiation Oncology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Ahmet Sami Bayram
- Department of Thoracic Surgery, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Cengiz Gebitekin
- Department of Thoracic Surgery, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Omer Yerci
- Department of Pathology, Uludag University, Faculty of Medicine, Bursa, Turkey
| | - Deniz Sıgırlı
- Department of Biostatistics, Uludag University, Faculty of Medicine, Bursa, Turkey
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Fukuhara M, Higuchi M, Owada Y, Inoue T, Watanabe Y, Yamaura T, Muto S, Hasegawa T, Suzuki H. Clinical and pathological aspects of microscopic thymoma with myasthenia gravis and review of published reports. J Thorac Dis 2017; 9:1592-1597. [PMID: 28740673 DOI: 10.21037/jtd.2017.05.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Microscopic thymomas, defined as epithelial proliferations smaller than 1 mm in diameter, characteristically occur in patients with myasthenia gravis without macroscopic thymic epithelial tumors. However, some clinical and pathological aspects of this entity are still unclear. METHODS This retrospective study includes five consecutive patients who had undergone extended thymectomy for myasthenia gravis at our institution from April 2007 to March 2016 and in whom microscopic thymomas were diagnosed by histopathological examination of the resected specimens. During the same period, we performed 32 extended transsternal thymothymectomies/thymectomies in patients with myasthenia gravis, including the above five cases. We here review 18 cases of microscopic thymoma, including our five cases and 13 previously reported cases. RESULTS The incidence of previously undiagnosed microscopic thymoma in patients undergoing thymectomy for myasthenia gravis in our institution is 15.2%. Serum preoperative anti-acetylcholine receptor antibody (anti-AchR Ab) titers were abnormally high in all of our five cases h (74.4±53.3 nmol/L) and decreased significantly after surgery (11.7±13.5 nmol/L, P=0.037). We divided our cases into the following three groups: microscopic thymoma group (Group M), thymoma group (Group T) and non-thymic tumor group (Group N). The mean preoperative anti-AchR Ab titers of these groups were 74.4, 26.5, and 368 nmol/L, respectively. All these values decreased postoperatively. The mean anti-AchR Ab titer was significantly higher in Group M than in Group T (P=0.034). All five cases in Group M were found by post-operative pathological examination to have multifocal type A thymomas. CONCLUSIONS Microscopic thymomas tend to be multifocal type A thymomas. Anti-AchR Ab titers decreased significantly in all groups. It is very important to both perform complete extended thymectomies in patients with myasthenia gravis and pathological examination of thin slices of thymic tissue to maximize detection of microscopic thymomas.
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Affiliation(s)
- Mitsuro Fukuhara
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsunori Higuchi
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Owada
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuya Inoue
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuzuru Watanabe
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takumi Yamaura
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoshi Muto
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takeo Hasegawa
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
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Ohata K, Yoshimura T, Matsubara Y, Yasuhara Y, Terada Y. Invasive Thymoma Protruding into the Superior Vena Cava through the Thymic Vein. Ann Thorac Cardiovasc Surg 2015; 22:122-4. [PMID: 26299398 DOI: 10.5761/atcs.cr.15-00149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
We report a rare case of protrusion of an invasive thymoma with intraluminal growth through the thymic vein into the superior vena cava (SVC) without direct invasion of the vessel walls. The tumor and left brachiocephalic vein were resected, and the tumor in the SVC was removed with temporal bypass of the right brachiocephalic vein and right auricle. Histopathological finding showed that the thymoma had protruded via a thymic vein. During resection of a thymoma, a detailed examination of thymic vein is necessary to ensure that no tumor tissue remains in the vessels.
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Affiliation(s)
- Keiji Ohata
- Department of Thoracic Surgery, Respiratory Disease Center, Kyoto Katsura Hospital, Kyoto, Kyoto, Japan
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Filosso PL, Evangelista A, Ruffini E, Rendina EA, Margaritora S, Novellis P, Rena O, Casadio C, Andreetti C, Guerrera F, Lausi PO, Diso D, Mussi A, Venuta F, Oliaro A, Lucchi M. Does myasthenia gravis influence overall survival and cumulative incidence of recurrence in thymoma patients? A Retrospective clinicopathological multicentre analysis on 797 patients. Lung Cancer 2015; 88:338-43. [DOI: 10.1016/j.lungcan.2015.03.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Revised: 02/23/2015] [Accepted: 03/08/2015] [Indexed: 10/23/2022]
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Rod J, Orbach D, Verité C, Coze C, Stephan JL, Varlet F, Thomas-de-Montpreville V, Reguerre Y, Besse B, Sarnacki S. Surgical management of thymic epithelial tumors in children: lessons from the French Society of Pediatric Oncology and review of the literature. Pediatr Blood Cancer 2014; 61:1910-5. [PMID: 25130986 DOI: 10.1002/pbc.25159] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 05/28/2014] [Indexed: 12/24/2022]
Abstract
PURPOSE We report the results of a French multicenter retrospective study based on a period of more than 30 years and a review of the literature in order to more clearly define the surgical approach and specific pediatric risk factors. METHODS Clinical data of children comprising all histologic subtypes of thymic epithelial tumors (TET) treated between 1979 and 2009 in French pediatric oncology centers were retrospectively analyzed and discussed in the light of a review of all pediatric cases reported in the literature. RESULTS Nine cases were identified, corresponding to five females and four males with a median age of 13 years (range: 7.5-17). Histologic subtypes were type AB (n = 1), type B (n = 5) and type C (n = 3). Treatment consisted of tumor resection (4 R0, 4 R1, 1 R2) via right anterior thoracotomy, posterolateral thoracotomy, left thoracoscopy, sternotomy and cervicosternotomy, and/or chemotherapy, mainly cyclophosphamide-doxorubicin-cisplatin (CAP; n = 5), and/or radiotherapy (n = 4). Two patients with TET type C died. All other patients are alive with a median follow-up of 4 years (range: 1.5-20). Review of a total of 93 pediatric cases reported in the literature showed statistically significant associations between less favorable histologic subtypes and male gender (P = 0.012), advanced Masaoka stage (P < 0.001) and quality of resection (P < 0.001) respectively. CONCLUSIONS A review of the literature and our series identified several risk factors to take into account in the therapeutically decision. Complete resection through a sternotomy is highly recommended.
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Affiliation(s)
- J Rod
- Department of Pediatric Surgery, University of Caen Hospital, France
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Beydoun SR, Gong H, Ashikian N, Rison RA. Myasthenia gravis associated with invasive malignant thymoma: two case reports and a review of the literature. J Med Case Rep 2014; 8:340. [PMID: 25312448 PMCID: PMC4205965 DOI: 10.1186/1752-1947-8-340] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2014] [Accepted: 08/20/2014] [Indexed: 11/26/2022] Open
Abstract
Introduction Approximately ten to fifteen percent of patients with myasthenia gravis are found to have a thymoma, and twenty to twenty-five percent of patients with thymoma have myasthenia gravis. Thymomatous myasthenia gravis tends to have a difficult clinical course and poor prognosis. Case presentation We report two cases (one patient of Asian ethnicity and the other of Caucasian ethnicity) of atypical presentations of myasthenia gravis associated with invasive malignant thymoma. Both patients were diagnosed at a young age, in their 20s. They presented with a turbulent course of myasthenia gravis and recurrent thymoma, but obtained good outcome after aggressive treatment involving multiple different specialists. Conclusions Although thymomatous myasthenia gravis tends to have a difficult clinical course and poor prognosis, early and aggressive treatment along with multidisciplinary management may improve the outcome of these patients.
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Affiliation(s)
| | | | | | - Richard Alan Rison
- Department of Neurology, University of Southern California, Keck School of Medicine, Los Angeles County Medical Center, 1520 San Pablo Street, Los Angeles, CA 90033, USA.
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Filosso PL, Venuta F, Oliaro A, Ruffini E, Rendina EA, Margaritora S, Casadio C, Terzi A, Rena O, Lococo F, Guerrera F. Thymoma and inter-relationships between clinical variables: a multicentre study in 537 patients. Eur J Cardiothorac Surg 2014; 45:1020-7. [DOI: 10.1093/ejcts/ezt567] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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19
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Prélaud AR, Lee AJD, Mueller RS, Zeeland YRA, Bettenay S, Majzoub M, Zenker I, Hein J. Presumptive paraneoplastic exfoliative dermatitis in four domestic rabbits. VETERINARY RECORD CASE REPORTS 2013. [DOI: 10.1136/vetreccr.101226rep] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - A. Jassies‐van der Lee
- Department of Clinical Sciences of Companion AnimalsFaculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - R. S. Mueller
- Centre for Clinical Veterinary MedicineLudwig‐Maximilians‐UniversityGermany
| | - Y. R. A. Zeeland
- Department of Clinical Sciences of Companion AnimalsFaculty of Veterinary MedicineUtrecht UniversityUtrechtThe Netherlands
| | - S. Bettenay
- Tierdermatologie DeisenhofenDeisenhofenGermany
| | - M. Majzoub
- Institute for Veterinary PathologyLudwig‐Maximilians‐UniversityMunichGermany
| | - I. Zenker
- Tierärztliche Klinik für Kleintiere in DüsseldorfGermany
| | - J. Hein
- Centre for Clinical Veterinary MedicineLudwig‐Maximilians‐UniversityGermany
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[Thymoma-associated myasthenia gravis: Clinical features and surgical results]. Rev Neurol (Paris) 2013; 169:879-83. [PMID: 23639728 DOI: 10.1016/j.neurol.2013.01.625] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2012] [Revised: 12/21/2012] [Accepted: 01/21/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The aim of this study was to compare the characteristics of myasthenic patients with and without thymoma, and the results of thymectomy in both types of patients. MATERIAL AND METHODS A retrospective study was conducted among 66 patients who underwent thymectomy for myasthenia gravis in our department over a 10-year period (2000-2010). The surgical approach was sternotomy or anterolateral thoracotomy. Patients were divided into two groups according to the presence of thymoma: with (T-MG) and without (NT-MG) thymoma. Complete stable remission (CSR) was the primary endpoint. RESULTS Median age was 35.09±9.89 years. The NT-MG group had 38 patients (57.57%) and the T-MG group 28 patients (42.43%). There was no difference between the two groups regarding the surgical approach (P=0.52). T-MG patients were older (40.54±15.16 vs. 31.37±9.46) (P=0.008) and predominantly male. There were more generalized forms (P=0.01) and more bulbar involvement (P=0.02) in the T-MG group. The rate of CSR at 5 years was 7% and 17% in the T-MG and NT-MG patients respectively (P=0.70). At 10 years, it was 36% and 94.73% respectively (P=0.03). CONCLUSION Thymomatous myasthenia gravis is characterized by the severity of its clinical features. Remission rate at 10 years was significantly lower in the myasthenia with thymoma group.
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Prélaud AR, der Lee AJV, Mueller RS, van Zeeland YRA, Bettenay S, Majzoub M, Zenker I, Hein J. Presumptive paraneoplastic exfoliative dermatitis in four domestic rabbits. Vet Rec 2013; 172:155. [DOI: 10.1136/vr.101226] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
| | - A. Jassies-van der Lee
- Department of Clinical Sciences of Companion Animals; Faculty of Veterinary Medicine; Utrecht University; Utrecht The Netherlands
| | - R. S. Mueller
- Centre for Clinical Veterinary Medicine; Ludwig-Maximilians-University Germany
| | - Y. R. A. van Zeeland
- Department of Clinical Sciences of Companion Animals; Faculty of Veterinary Medicine; Utrecht University; Utrecht The Netherlands
| | - S. Bettenay
- Tierdermatologie Deisenhofen; Deisenhofen Germany
| | - M. Majzoub
- Institute for Veterinary Pathology; Ludwig-Maximilians-University Munich Germany
| | - I. Zenker
- Tierärztliche Klinik für Kleintiere in Düsseldorf; Germany
| | - J. Hein
- Centre for Clinical Veterinary Medicine; Ludwig-Maximilians-University Germany
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Preoperative CT findings of thymoma are correlated with postoperative Masaoka clinical stage. Acad Radiol 2013; 20:66-72. [PMID: 22981603 DOI: 10.1016/j.acra.2012.08.002] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2012] [Revised: 07/30/2012] [Accepted: 08/01/2012] [Indexed: 11/22/2022]
Abstract
RATIONALE AND OBJECTIVES Both preoperative computed tomography (CT) staging and postoperative surgical Masaoka clinical staging are of great clinical importance for diagnosing thymomas. Our study aimed to investigate the relationships between these two staging systems. MATERIALS AND METHODS This was a retrospective review of 129 patients who had undergone thymoma surgery. Helical CT and 16-slice CT were performed preoperatively. Surgical findings were evaluated according to the Masaoka clinical staging system. RESULTS A significant association was shown between Masaoka clinical staging and CT staging, especially of features including tumor size (P = .004), tumor shape (P < .001), tumor density (P < .001), capsule completeness (P < .001), and involvement of surrounding tissues (P < .001). Based on the CT findings, there were 35.09% of Masaoka stage I patients who had a tumor size <5 cm as compared to 14.81% of stage IV patients. Only 8.77% of Masaoka stage I patients had a tumor size ≥10 cm as compared to 40.74% of stage IV patients. In stages III and IV, most tumors were irregularly shaped with an uneven density and incomplete capsule. Invasive tumors were more frequently found in stages III (81.48%) and IV (88.89%) than in stages I (0%) and II (38.89%). The incidence of myasthenia gravis was comparable in different stages. Consistency between CT and Masaoka clinical stages was higher in stage I (37.98%) than other stages (approximately 10%). CONCLUSION This study documented a close relationship between preoperative CT thymoma staging and postoperative Masaoka clinical staging. Thus, preoperative CT findings can be beneficial for determining the proper management and prognosis of thymoma patients.
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Thongprayoon C, Tantrachoti P, Phatharacharukul P, Buranapraditkun S, Klaewsongkram J. Associated Immunological Disorders and Cellular Immune Dysfunction in Thymoma: A Study of 87 Cases from Thailand. Arch Immunol Ther Exp (Warsz) 2012; 61:85-93. [DOI: 10.1007/s00005-012-0207-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2012] [Accepted: 09/21/2012] [Indexed: 02/07/2023]
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Liu GB, Qu YJ, Liao MY, Hu HJ, Yang GF, Zhou SJ. Relationship Between Computed Tomography Manifestations of Thymic Epithelial Tumors and the WHO Pathological Classification. Asian Pac J Cancer Prev 2012; 13:5581-5. [DOI: 10.7314/apjcp.2012.13.11.5581] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Nikolic DM, Nikolic AV, Lavrnic DV, Medjo BP, Ivanovski PI. Childhood-onset myasthenia gravis with thymoma. Pediatr Neurol 2012; 46:329-31. [PMID: 22520357 DOI: 10.1016/j.pediatrneurol.2012.02.025] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2011] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
Juvenile myasthenia gravis is an acquired, autoimmune disease occurring before age 16 years. Thymoma is exceedingly rare in children, especially in association with juvenile myasthenia gravis. We describe a 14-year-old boy with juvenile myasthenia gravis and thymoma. He presented with difficulties chewing and swallowing, nasal speech, and fluctuating weakness of the leg muscles. Neurologic examination revealed masticatory and bulbar muscle weakness with nasal speech, proximal muscle weakness, fatigability of the arms and legs, and distal muscle weakness of the legs. A diagnosis of juvenile myasthenia gravis was confirmed by a positive neostigmine test, a decremental response on repetitive nerve stimulation, and increased titers of serum anti-acetylcholine receptor antibodies. The patient received anticholinesterases, corticosteroids, azathioprine, and thymectomy. A pathohistologic analysis of the thymus gland indicated thymoma, Masaoka grade II. After 2 years of an unstable disease course, remission was achieved. Because only 10 cases of thymoma-associated myasthenia gravis are described in the pediatric population, this report offers an important contribution to a better understanding of this rare association.
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Cavalcante P, Le Panse R, Berrih-aknin S, Maggi L, Antozzi C, Baggi F, Bernasconi P, Mantegazza R. The thymus in myasthenia gravis: Site of “innate autoimmunity”? Muscle Nerve 2011; 44:467-84. [DOI: 10.1002/mus.22103] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Schwartz JA, Solomon JA, Henkelman K, Leininger JR, Iverson WO. Spontaneous Thymoma in a Juvenile Cynomolgus Macaque (Macaca fascicularis). Toxicol Pathol 2011; 39:706-10. [DOI: 10.1177/0192623311407345] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A single, solid, yellow-white thymic mass was found at necropsy of a two-year-old female cynomolgus macaque from a four-week, repeat-dose toxicity and immunogenicity study. Microscopically, the mass was multilobular and well encapsulated, surrounded by a thick connective tissue capsule, and composed of dense sheets of elongate or spindle-shaped cells and large cystic cavities separated by thick connective tissue stroma. Normal thymus was adjacent to the mass, but it was compressed. Within the mass were abundant interspersed Hassall’s corpuscles; individual and small clusters of mature, small lymphocytes; scattered eosinophils; large areas of necrosis; focal mineralization; and cholesterol clefts. An interesting feature was the presence of large multinucleated giant cells, which varied widely in size and nuclear number. Immunohistochemical staining for two lymphocyte markers and two structural proteins confirmed the identity of the neoplastic spindle cells and other cellular components. There was no evidence of vascular invasion or metastasis. Features of the thymoma indicated it was a pre-existing condition and not treatment related.
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Affiliation(s)
| | - J. A. Solomon
- Charles River, Preclinical Services, Reno, Nevada, USA
| | - K. Henkelman
- Charles River, Preclinical Services, Reno, Nevada, USA
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Thymoma-associated myasthenia gravis without acetylcholine receptor antibodies. J Neurol Sci 2011; 302:112-3. [DOI: 10.1016/j.jns.2010.12.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 12/11/2010] [Accepted: 12/15/2010] [Indexed: 11/19/2022]
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Abstract
Thymic epithelial tumors, such as thymomas and thymic carcinomas, are the most common primary neoplasms of the mediastinum. In 1999, the World Health Organization (WHO) proposed a consensus classification of thymic epithelial tumors based on the morphology of the epithelial cells and the ratio of lymphocytes to epithelial cells, which was revised in 2004. The latest classification system stratifies thymic epithelial tumors into six categories: types A, AB, B1, B2, B3, and thymic carcinoma. This article describes the prediction of thymoma histology and stage on the basis of radiographic criteria by reviewing the following: the WHO histologic classification of thymic epithelial tumors, the clinical staging of thymomas based on prognosis, and the radiographic appearance of thymomas according to the WHO histologic classification.
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Immunohistochemistry of Thymic Epithelial Tumors as a Tool in Translational Research. Thorac Surg Clin 2011; 21:33-46, vi. [DOI: 10.1016/j.thorsurg.2010.08.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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31
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Forquer JA. Thymic neoplasms. Curr Probl Cancer 2010; 34:328-66. [PMID: 21112444 DOI: 10.1016/j.currproblcancer.2010.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Jeffrey A Forquer
- Department of Radiation Oncology, The University of Toledo Medical Center, Toledo, Ohio, USA
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De Montpréville VT. [Thymomas and thymic carcinomas]. Rev Mal Respir 2010; 27:1281-7. [PMID: 21163404 DOI: 10.1016/j.rmr.2010.08.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/06/2010] [Indexed: 12/12/2022]
Affiliation(s)
- V Thomas De Montpréville
- Service d'Anatomie Pathologique, Centre Chirurgical Marie-Lannelongue, 133 Avenue de la Résistance, 92350 Le-Plessis-Robinson, France.
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Marx A, Willcox N, Leite MI, Chuang WY, Schalke B, Nix W, Ströbel P. Thymoma and paraneoplastic myasthenia gravis. Autoimmunity 2010; 43:413-27. [PMID: 20380583 DOI: 10.3109/08916930903555935] [Citation(s) in RCA: 133] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Paraneoplastic autoimmune diseases associate occasionally with small cell lung cancers and gynecologic tumors. However, myasthenia gravis (MG) occurs in at least 30% of all patients with thymomas (usually present at MG diagnosis). These epithelial neoplasms almost always have numerous admixed maturing polyclonal T cells (thymocytes). This thymopoiesis-and export of mature CD4(+)T cells-particularly associates with MG, though there are rare/puzzling exceptions in apparently pure epithelial WHO type A thymomas. Other features potentially leading to inefficient self-tolerance induction include defective epithelial expression of the autoimmune regulator (AIRE) gene and/or of major histocompatibility complex class II molecules in thymomas, absence of myoid cells, failure to generate FOXP3(+) regulatory T cells, and genetic polymorphisms affecting T-cell signaling. However, the strong focus on MG/neuromuscular targets remains unexplained and suggests some biased autoantigen expression, T-cell selection, or autoimmunization within thymomas. There must be further clues in the intriguing serological and cellular parallels in some patients with late-onset MG but without thymomas-and in others with AIRE mutations-and in the contrasts with early-onset MG, as discussed here.
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Affiliation(s)
- A Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, D-68135 Mannheim, Germany.
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Zhou ZY, Sun RC, Yang GY, Yang SD, Yu MH, Liang JB. Giant-cell anaplastic carcinoma with osteoclastic giant cells of the chest cavity: a distinctive form of thymic carcinoma? Int J Surg Pathol 2010; 18:363-8. [PMID: 20667924 DOI: 10.1177/1066896910375954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Here, the authors describe a case of giant-cell anaplastic carcinoma with osteoclastic giant cells of the chest cavity-which could be a distinctive form of thymic carcinoma-which expressed CD5 and CD45. To the authors' knowledge, there has been no previous report on this subject. A 62-year-old woman presented with continuous pain in the left back associated with coughing and shortness of breath for more than 2 months prior to referral to the hospital. Palliative resection of a mediastinal tumor was performed. During the operation, it was found that the mass occupied most of the chest invading the chest wall, aorta, vena cava, and lung tissue. The patient soon died from diabetic complications in spite of anti-infection treatment. The tumor was composed of large areas of necrosis and anaplastic neoplastic giant cells with high mitotic activity, and osteoclast-like cells; there was marked inflammatory cell infiltration. The anaplastic neoplastic giant cells were immunoreactive for CKpan, CD5, CD45, VIM, and p53. Approximately 50% to 60% of the tumor cells showed immunoreactivity for Ki-67. In situ hybridization for Epstein-Barr virus-encoded RNA was negative for tumor cells and nonneoplastic osteoclastic giant cells. Because this tumor is very rare, extensive clinical, radiological, and morphological examinations as well as immunohistochemical studies are essential to make the diagnosis.
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Affiliation(s)
- Zhi-yi Zhou
- Department of Pathology, Wuxi People's Hospital Affiliated to Nanjing Medical University, Wuxi, Jiangsu, People's Republic of China.
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Kim JY, Kim HO, Kim JS, Moon DH, Kim YH, Kim DK, Park SI, Park YS, Ryu JS. (18)F-FDG PET/CT is Useful for Pretreatment Assessment of the Histopathologic Type of Thymic Epithelial Tumors. Nucl Med Mol Imaging 2010; 44:177-84. [PMID: 24899947 DOI: 10.1007/s13139-010-0036-x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2010] [Revised: 05/10/2010] [Accepted: 05/14/2010] [Indexed: 01/08/2023] Open
Abstract
PURPOSE This study was performed to assess the usefulness of (18)F-fluorodeoxyglucose ((18)F-FDG) positron emission tomography (PET) or PET/computed tomography (CT) for distinguishing thymic epithelial tumors according to World Health Organization (WHO) classifications. METHODS We analyzed a total of 45 patients (range, 29-75 years of age; mean, 55 years) with pathologically confirmed thymic epithelial tumors who underwent pretreatment (18)F-FDG PET or PET/CT between November 2003 and October 2009. The size, visual grading of uptake value, peak standardized uptake value (SUVpeak), uptake pattern, and contour of each tumor, and associated findings on PET or PET/CT, were analyzed relative to the three simplified WHO subgroups: less-invasive thymomas (types A and AB), more-invasive thymomas (types B1, B2, and B3) and thymic carcinomas. We statistically assessed the relationship of (18)F-FDG PET or PET/CT findings with these simplified subgroups. RESULTS Of the 45 patients, ten had less-invasive thymomas, 23 had more-invasive thymomas, and 12 had thymic carcinomas. The SUVpeak of the less- and more-invasive thymomas were significantly lower than those of thymic carcinomas (p < 0.000), but there was no difference in SUVpeak between less- and more-invasive thymomas. The visual grading scale (p < 0.000), uptake pattern (p = 0.001), and contour (p < 0.000) of the tumors differed significantly among the three simplified subgroups. CONCLUSION The image findings of (18)F-FDG PET or PET/CT differed significantly by histologic subgroups. Pre-treatment evaluation with (18)F-FDG PET or PET/CT might be helpful in differentiating subgroups of thymic epithelial tumors.
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Affiliation(s)
- Ji Young Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeonwon-gil, Pungnap-dong, Songpa-gu, Seoul, 138-736 Korea
| | - Hye Ok Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeonwon-gil, Pungnap-dong, Songpa-gu, Seoul, 138-736 Korea
| | - Jae Seung Kim
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeonwon-gil, Pungnap-dong, Songpa-gu, Seoul, 138-736 Korea
| | - Dae Hyuk Moon
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeonwon-gil, Pungnap-dong, Songpa-gu, Seoul, 138-736 Korea
| | - Yong Hee Kim
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong Kwan Kim
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung-Ii Park
- Department of Thoracic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Soo Park
- Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jin-Sook Ryu
- Department of Nuclear Medicine, Asan Medical Center, University of Ulsan College of Medicine, 86 Asanbyeonwon-gil, Pungnap-dong, Songpa-gu, Seoul, 138-736 Korea
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Banerjee D. Reinventing diagnostics for personalized therapy in oncology. Cancers (Basel) 2010; 2:1066-91. [PMID: 24281107 PMCID: PMC3835119 DOI: 10.3390/cancers2021066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2010] [Revised: 05/15/2010] [Accepted: 05/28/2010] [Indexed: 11/16/2022] Open
Abstract
Human cancers are still diagnosed and classified using the light microscope. The criteria are based upon morphologic observations by pathologists and tend to be subject to interobserver variation. In preoperative biopsies of non-small cell lung cancers, the diagnostic concordance, even amongst experienced pulmonary pathologists, is no better than a coin-toss. Only 25% of cancer patients, on average, benefit from therapy as most therapies do not account for individual factors that influence response or outcome. Unsuccessful first line therapy costs Canada CAN$1.2 billion for the top 14 cancer types, and this extrapolates to $90 billion globally. The availability of accurate drug selection for personalized therapy could better allocate these precious resources to the right therapies. This wasteful situation is beginning to change with the completion of the human genome sequencing project and with the increasing availability of targeted therapies. Both factors are giving rise to attempts to correlate tumor characteristics and response to specific adjuvant and neoadjuvant therapies. Static cancer classification and grading systems need to be replaced by functional classification systems that not only account for intra- and inter- tumor heterogeneity, but which also allow for the selection of the correct chemotherapeutic compounds for the individual patient. In this review, the examples of lung and breast cancer are used to illustrate the issues to be addressed in the coming years, as well as the emerging technologies that have great promise in enabling personalized therapy.
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Affiliation(s)
- Diponkar Banerjee
- Centre for Translational and Applied Genomics (CTAG), Provincial Health Services Authority (PHSA) Laboratories, Vancouver, British Columbia, Canada.
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A follicular dendritic cell sarcoma of the mediastinum with immature T cells and association with myasthenia gravis. Am J Surg Pathol 2010; 34:742-5. [PMID: 20305533 DOI: 10.1097/pas.0b013e3181d7a2ee] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Follicular dendritic cell (FDC) sarcoma is a very rare neoplasm showing morphologic and phenotypic features of FDCs. It occurs primarily in lymph nodes but also in extranodal sites. So far, there have been no reports on FDC sarcoma associated with myasthenia gravis. In the following we will present a case of an FDC tumor of the mediastinum associated with paraneoplastic myasthenia gravis in a 39-year-old man. The tumor contained a major proportion of immature T cells, which may be connected to this patient's very unusual clinical presentation with autoimmune phenomena. Extranodal FDC sarcomas still seem hardly noticed, and their clinical and pathologic characteristics remain to be better defined.
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Honglin Yin, Jun Du, Zhenfeng Lu, Xia Jiao, Jiandong Wang, Xiaojun Zhou. The Correlation of the World Health Organization Histologic Classification of Thymic Epithelial Tumors and Its Prognosis: A Clinicopathologic Study of 108 Patients From China. Int J Surg Pathol 2009; 17:255-61. [PMID: 19443889 DOI: 10.1177/1066896909334126] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study retrospectively reviewed the clinicopathological features of thymic epithelial tumors in 108 patients, and evaluated World Health Organization (WHO) histologic classification of thymic tumors. Other prognostic factors, including age, gender, clinical stage, and completeness of tumor resection were also analyzed. Seven type A tumors, 19 type AB, 23 type B1, 19 type B2, 27 type B3, and 13 thymic carcinomas were studied. The 5-year and 10-year survival rates were 100% after resection of tumor types A and AB; 93% and 81% for B1; 83% and 70% for B2; and 43% and 33% for B3. The overall 5-year and 10-year survival rates were 72.0% and 63.0%, respectively. Tumor classification was highly significant in predicting survival ( P .001) and also reflected the clinical behavior of tumors. The Masaoka stage was the most important independent prognostic index in thymomas. The WHO histologic subtype and completeness of resection were also important prognostic factors.
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Affiliation(s)
- Honglin Yin
- Department of Pathology, Jinling Hospital Nanjing, Medical School, Nanjing University, China, yinhl1978@ yahoo.com.cn
| | - Jun Du
- Department of Pathology, Jinling Hospital Nanjing, Medical School, Nanjing University, China
| | - Zhenfeng Lu
- Department of Pathology, Jinling Hospital Nanjing, Medical School, Nanjing University, China
| | - Xia Jiao
- Department of Pathology, Jinling Hospital Nanjing, Medical School, Nanjing University, China
| | - Jiandong Wang
- Department of Pathology, Jinling Hospital Nanjing, Medical School, Nanjing University, China
| | - Xiaojun Zhou
- Department of Pathology, Jinling Hospital Nanjing, Medical School, Nanjing University, China
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Wu M, Sun K, Gil J, Gan L, Burstein DE. Immunohistochemical detection of p63 and XIAP in thymic hyperplasia and thymomas. Am J Clin Pathol 2009; 131:689-93. [PMID: 19369629 DOI: 10.1309/ajcpvtz06dhkcogp] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We subjected 23 formalin-fixed, paraffin-embedded tissue blocks (11 cases of thymic hyperplasia and 12 thymomas [3 encapsulated, 8 with capsular invasion, and 1 atypical]) to incubation with monoclonal anti-X-linked inhibitor of apoptosis protein (XIAP) (BD Biosciences, San Jose, CA) and monoclonal anti-p63 (4A4, Santa Cruz, Santa Cruz, CA). Granular or heterogeneous cytoplasmic XIAP staining and nuclear p63 staining were considered positive. We compared thymic hyperplasia with thymoma and capsulated thymoma with thymoma with capsular invasion or atypia. p63 was positive in virtually all thymic epithelial cells in hyperplasia and thymoma. XIAP was negative in all hyperplasia cases except one. Of 12 thymomas, 9 were XIAP+ with focal/weak to diffuse/strong positivity: 2 of 3 encapsulated and 7 of 8 thymomas with capsular invasion were XIAP+. One atypical thymoma was XIAP-. XIAP expression differed significantly between hyperplasia and thymoma (P = .0007) but not between capsulated and invasive thymomas (P = .3797). p63 is consistently positive in nonneoplastic and neoplastic thymic epithelium. XIAP expression in thymoma suggests a possible role in the pathogenesis of thymoma and may be helpful in differentiating thymic hyperplasia from thymoma, especially in small biopsy specimens. However, the level of expression does not correlate with capsular invasion or atypia.
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Gu Z, Mitsui H, Inomata K, Honda M, Endo C, Sakurada A, Sato M, Okada Y, Kondo T, Horii A. The methylation status of FBXW7 beta-form correlates with histological subtype in human thymoma. Biochem Biophys Res Commun 2008; 377:685-688. [PMID: 18938137 DOI: 10.1016/j.bbrc.2008.10.047] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2008] [Accepted: 10/09/2008] [Indexed: 11/15/2022]
Abstract
FBXW7 is reported to be a tumor suppressor gene, and the functional inactivation of FBXW7 has been reported in various human tumors. In this study, we investigated the FBXW7 gene in human thymoma; although no mutations were evident, a significantly high frequency of methylation in the FBXW7 beta-form promoter was observed in types B1 or higher (P=0.014). We propose a novel mechanism for the pathogenesis of thymoma by FBXW7 beta-form and hypothesize that expressional suppression plays an important role in the malignant potential of thymoma.
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Affiliation(s)
- Zhaodi Gu
- Department of Molecular Pathology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Hidetoshi Mitsui
- Department of Molecular Pathology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Kenichi Inomata
- Department of Molecular Pathology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan
| | - Masako Honda
- Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Chiaki Endo
- Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Akira Sakurada
- Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Masami Sato
- Division of Thoracic Surgery, Miyagi Cancer Center Hospital, 47-1 Medeshima-Shiote-aza Nodayama, Natori, 981-1293, Japan
| | - Yoshinori Okada
- Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Takashi Kondo
- Department of Thoracic Surgery, Institute of Development, Aging, and Cancer, Tohoku University, 4-1 Seiryo-machi, Aoba-ku, Sendai, 980-8575, Japan
| | - Akira Horii
- Department of Molecular Pathology, Tohoku University School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai, Miyagi 980-8575, Japan.
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Li XF, Chen Q, Huang WX, Ye YB. Response to sorafenib in cisplatin-resistant thymic carcinoma: a case report. Med Oncol 2008; 26:157-60. [PMID: 18846437 DOI: 10.1007/s12032-008-9100-0] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2008] [Accepted: 09/25/2008] [Indexed: 10/21/2022]
Abstract
Platinum-based chemotherapy regimens are often recommended for patients with unresectable thymic carcinoma. In more than 60 cases, however, the systemic chemotherapy provides little benefit. In this report, we described a case of advanced KIT- and VEGF-positive thymic carcinoma with liver and lung metastasis. The patient, a 46-year-old man, exhibited a resistance to cisplatin-based chemotherapy, but responded to the treatment with sorafenib, a molecular target-based therapy. After 4 months of sorafenib therapy, his lung and liver metastases as well as the mediastinal tumor shrank dramatically. Moreover, the tumors showed stable disease for at least 9 months. To the best of our knowledge, it is the first report about a response of advanced thymic carcinoma to sorafenib. The preliminary study suggested that molecular target-based therapy could be an alternative treatment to those chemotherapy-refractory patients.
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Affiliation(s)
- Xiao-Feng Li
- Department of Oncology, Quanzhou Hospital of Traditional Chinese Medicine, 215 South Wenling Road, Quanzhou, 362000, People's Republic of China.
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Thymoma-associated myasthenia gravis: Outcome, clinical and pathological correlations in 197 patients on a 20-year experience. J Neuroimmunol 2008; 201-202:237-44. [DOI: 10.1016/j.jneuroim.2008.07.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 07/17/2008] [Accepted: 07/17/2008] [Indexed: 11/17/2022]
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