1
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Bille A, Fryer K, Wallace A, Nonaka D. GTF2I mutation in micronodular thymoma with lymphoid stroma. J Clin Pathol 2024; 77:125-127. [PMID: 36600564 DOI: 10.1136/jcp-2022-208655] [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: 10/27/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022]
Abstract
AIMS Micronodular thymoma with lymphoid stroma is a rare subtype of thymoma with characteristic clinical and pathological features. Some of the features, such as indolent nature, principally spindle morphology and no significant association to myasthenia gravis, are shared with type A and AB thymoma, which is closely linked to GTF2I mutation. However, not much is known regarding the molecular genetics of this thymoma subtype. In this study, the GTF2I mutation status was investigated in 16 cases of micronodular thymoma. METHODS 16 micronodular thymomas were retrieved and the GTF2I mutation was tested by Sanger sequencing. The clinicopathological findings were documented. RESULTS GTF2I c.1271T>A p.(Leu424His) mutation within exon 15 was detected in 14 out of 16 tumours (87.5%). Two patients died of other causes while all others remained alive with no evidence of recurrence during the follow-up period ranging from 19 to 188 months (median: 100 months). CONCLUSIONS GTF2I mutation status and presence of spindle cell morphology may indicate that type A and AB thymoma, and micronodular thymoma represent a group biologically distinct from type B thymomas, which generally lack this mutation.
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Affiliation(s)
- Andrea Bille
- Department of Thoracic Surgery, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
| | - Katherine Fryer
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Andrew Wallace
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | - Daisuke Nonaka
- Department of Cellular Pathology, Guy's and St Thomas' Hospitals NHS Foundation Trust, London, UK
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2
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Taghiyev ZT, Beier LM, Moustafine V, Bechtel M, Strauch JT, Boening A. Transcaval and Intracardiac Extension of Type A Thymoma and Myxoma: A Report of Two Rare Cases. Thorac Cardiovasc Surg Rep 2024; 13:e25-e28. [PMID: 38988820 PMCID: PMC11236442 DOI: 10.1055/a-2334-7158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 05/01/2024] [Indexed: 07/12/2024] Open
Abstract
We report two cases of rare invasive tumors presenting with transvenous and intracardiac extensions. In one instance, an unusual invasive thymoma type A penetrated into the heart chamber; the other case was an extension of a myxoma into the right atrium that was associated with superior vena cava syndrome. Our interest was stimulated by the rarity of these clinicopathological observations and the unusual clinical features of diagnostic and therapeutic methods presented by these cases.
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Affiliation(s)
- Zulfugar T. Taghiyev
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen and Marburg, Giessen, Germany
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Lili-Marie Beier
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen and Marburg, Giessen, Germany
| | - Vadim Moustafine
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Matthias Bechtel
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Justus T. Strauch
- Department of Cardiothoracic Surgery, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum, Germany
| | - Andreas Boening
- Department of Adult and Pediatric Cardiovascular Surgery, University Hospital of Giessen and Marburg, Giessen, Germany
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3
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Parrack PH, Hornick JL, Sholl LM. PAX1 expression in thymic epithelial neoplasms and morphologic mimics. Hum Pathol 2023; 142:7-14. [PMID: 37776957 DOI: 10.1016/j.humpath.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 09/18/2023] [Accepted: 09/23/2023] [Indexed: 10/02/2023]
Abstract
Thymic epithelial neoplasms are morphologically diverse and can pose a diagnostic challenge that is complicated by a lack of immunohistochemistry (IHC) markers that are entirely sensitive and specific for thymic epithelium. Polyclonal PAX8 is often used in this context, but it is not a specific marker. The PAX1 transcription factor shares significant homology with PAX8 and plays an integral role in thymic development in humans and murine models. This study evaluated the role of PAX1 IHC in differentiating thymic epithelial neoplasms from morphologic mimics on whole slide tissue sections. The PAX1 antibody stained all 74 thymoma cases; however, there was wide variability in staining intensity within each subtype. The antibody was less sensitive in thymic carcinomas and thymic neuroendocrine tumors compared to thymomas and demonstrated weak staining in a subset of morphologic mimics (21 squamous cell carcinomas, 6 pulmonary neuroendocrine tumors, 1 mesothelioma, 1 lymphoblastic lymphoma, and 1 granulosa cell tumor). With a H-score positive threshold of 75, the antibody had 100% specificity, and sensitivities of 92%, 56%, and 47% in thymomas, thymic neuroendocrine tumors, and thymic carcinomas respectively. The PAX1 antibody showed frequent geographic reduction in staining consistent with compromised antigenicity from variable formalin fixation. PAX1 IHC has a moderate-to-high sensitivity for thymic epithelial neoplasms; however, the wide staining variability and fixation effects may lead to difficulty with consistent interpretation. This marker is unlikely to supplant the role of PAX8 in diagnostic practice, but it may be a useful addition to immunohistochemistry panels when evaluating for thymic primary tumors.
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Affiliation(s)
- Paige H Parrack
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA, 02115.
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA, 02115
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA, 02115
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4
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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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5
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Mallick J, Peterson JM, Pina-Oviedo S, Patel N, Venkatesan R, Stevenson HL, Qiu S, Shen Y, Lyapichev KA. Liver Metastasis of Thymoma: Case Report and Review of the Literature. Int J Surg Pathol 2022:10668969221115818. [PMID: 36259324 DOI: 10.1177/10668969221115818] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The 2021 "World Health Organization (WHO) Classification of Thoracic Tumours" classifies epithelial tumors of the thymus (thymomas) based on cytomorphology. Thymomas with benign cytomorphology are classified as type A, AB, B1, B2, and B3, while those with malignant cytomorphology are classified as thymic carcinoma. Although all thymomas have malignant potential, extra-thoracic metastasis of thymomas is exceedingly rare and the exact incidence is not known. Literature review demonstrated 39 cases of thymoma with extra-thoracic metastases reported since the publication of the 1999 WHO Classification of Thoracic Tumours. Nine of these cases presented with metastasis to the liver in the setting of concurrent metastasis to other organs, while only three cases metastasized solely to the liver. We herein report a well-documented case of type B1 thymoma with relatively limited stage (IIb) with an isolated, single liver metastasis occurring seven years after primary resection in a patient with concomitant myasthenia gravis. The following report includes a review of the literature, a discussion of thymoma classification and its relevance to prognosis, and an overview of other extra-thoracic metastatic thymoma cases.
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Affiliation(s)
- Jayati Mallick
- 441907University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Nekita Patel
- 12338University of Texas Medical Branch, Galveston, TX, USA
| | | | | | - Suimin Qiu
- 441907University of Texas Medical Branch, Galveston, TX, USA
| | - Yuan Shen
- 441907University of Texas Medical Branch, Galveston, TX, USA
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6
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Suster D, Mackinnon AC, Pihan G, Everts R, Suster S. Lymphocyte-Rich Spindle Cell Thymoma: Clinicopathologic, Immunohistochemical, Ultrastructural and Molecular Genetic Study of 80 Cases. Am J Surg Pathol 2022; 46:603-616. [PMID: 35034040 DOI: 10.1097/pas.0000000000001855] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A study of 80 cases of spindle cell thymoma in which the spindle cell component was overshadowed by massive numbers of stromal lymphocytes is presented. The patients were 38 women and 42 men, aged 8 to 81 years (mean=54 y). All tumors presented as an anterior mediastinal mass; 5 patients had myasthenia gravis and one had Good syndrome. The tumors were well-circumscribed, encapsulated, and measured 2.9 to 26.0 cm in greatest diameter (mean=7.3 cm). Using modified Masaoka staging, 66 tumors were stage I, 10 were stage IIa, 2 were stage III and 1 was stage IV. Histologically the tumors were characterized by a predominant lymphocytic population admixed with scattered small spindle epithelial cells. The neoplastic spindle cells in these tumors demonstrated 2 major growth patterns: in 33 cases, the tumors were exclusively composed of dense sheets of lymphocytes containing scattered spindle cells resembling a lymphocyte-rich thymoma (WHO type B1); in the remaining cases the tumors showed admixtures of a predominantly lymphocytic component with areas that were lymphocyte-poor and contained a pure spindle cell population similar to WHO type A. Immunohistochemical stains and electron microscopy corroborated the spindle cell morphology in both types. The GTF2I p.L424H variant was identified in 53 of 63 (84%) cases analyzed. Clinical follow-up in 27 cases showed that most of the tumors behaved in an indolent manner. Our study expands the spectrum of spindle cell thymoma by demonstrating the existence of cases that are predominantly composed of lymphocyte-rich elements and lack areas with a pure (lymphocyte poor) spindle cell morphology.
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Affiliation(s)
- David Suster
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - German Pihan
- Department of Pathology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
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7
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Wells K, Lamrca A, Papaxoinis G, Wallace A, Quinn AM, Summers Y, Nonaka D. Unique correlation between GTF2I mutation and spindle cell morphology in thymomas (type A and AB thymomas). J Clin Pathol 2022:jclinpath-2021-207837. [PMID: 35039450 DOI: 10.1136/jclinpath-2021-207837] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/04/2022] [Indexed: 12/24/2022]
Abstract
AIM Recent study has revealed frequent GTF2I mutation in thymomas, with the frequency being highest in types A and AB, followed by B1, B2, B3 and thymic carcinoma. This has led to the conclusion that GTF2I mutation correlates with more indolent histology subtype and better prognosis. In our study, the GTF2I mutation was tested in thymic epithelial tumours to investigate the relation between the mutation status and histology subtype. METHODS The GTF2I mutation was tested in 111 thymic epithelial tumours by Sanger sequencing. Correlations between GTF2I mutation status and clinicopathological parameters were evaluated. RESULTS There were 16 cases of type A, including atypical type, 37 type AB, 13 B1, 23 B2, 9 B3, 6 micronodular type, 2 metaplastic type and 5 thymic carcinomas. GTF2I mutation was seen in 78.6% of type A and 83.9% of type AB, while it was not expressed in type B, metaplastic type or thymic carcinoma (p<0.001). 75% of micronodular type also showed the mutation. Both thymoma histotype and stage were significantly associated with GTF2I mutation by univariate analysis. The presence of GTF2I mutation showed a trend towards a favourable prognosis, but this is likely due to their strong association with more indolent histologic subtypes (types A and AB). CONCLUSIONS GTF2I mutation appears unique in type A and AB thymomas, including those with atypical features and micronodular type, all of which share spindle cell morphology, indicating they represent a group biologically distinct from type B thymomas.
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Affiliation(s)
- Kirsty Wells
- Genomic Diagnostic Laboratory, Manchester Centre for Genomic Medicine, Manchester, UK.,Blueprint Genetics, Helsinki, Finland
| | - Angela Lamrca
- Medical Oncology, The Christie NHS Foundation Trust, Manchester, Manchester, UK
| | - George Papaxoinis
- Department of Medical Oncology, Agios Savvas Anticancer Hospital, Athens, Greece
| | - Andrew Wallace
- Manchester Centre for Genomic Medicine, Manchester University NHS Foundation Trust, Manchester, UK
| | | | - Yvonne Summers
- Medical Oncology, The Christie NHS Foundation Trust, Manchester, Manchester, UK
| | - Daisuke Nonaka
- Cellular Pathology, Guy's and St Thomas' Hospitals NHS Trust, London, UK
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8
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Li M, Xu L, Li L, Dai Q, Xu D. The Early Perioperative Outcomes of Subxiphoid Approach Versus Lateral Intercostal Approach Thoracoscopic Thymectomy for Thymic Tumors: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2021; 32:256-264. [PMID: 33661028 DOI: 10.1089/lap.2021.0036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Objectives: To systematically evaluate the early perioperative outcomes regarding the safety and efficacy of subxiphoid thoracoscopic thymectomy (STT) versus lateral intercostal thoracoscopic thymectomy (LITT) for patients with thymic tumors. Methods: A thorough literature search of the following online databases was performed: Web of Science, PubMed, Embase, Cochrane Library, Google Scholar, and ClinicalTrials.gov. Original research articles published before December 30, 2020, that compared STT with LITT were included. Meta-analysis was performed for early perioperative outcomes, including blood loss, pain score, duration of hospital stay, operative time, chest tube drainage time, and incidence of postoperative complications. Results: Six studies that included 604 patients were finally selected for our analysis, with 296 cases of STT and 308 cases of LITT. Our results showed that compared with LITT, STT was associated with less blood loss (standardized mean difference = -0.81, 95% confidence interval [CI] = -1.49 to -0.14, P = .02), a lower pain score (weighted mean difference [WMD] = -2.55, 95% CI = -3.52 to -1.59; P < .00001), and a shorter hospital stay (WMD = -1.37, 95% CI = -2.37 to -0.36; P = .008), whereas there were no significant differences with regard to the operative time (WMD = -10.04, 95% CI = -22.29 to 2.21, P = .11), chest tube drainage time (WMD = -0.58, 95% CI = -1.17 to 0.02, P = .06), and the incidence of postoperative complications (odds ratio = 0.75, 95% CI = 0.39 to 1.44, P = .38). Conclusions: The current analysis suggests that STT is superior to LITT with respect to the early perioperative outcomes, and STT is a safe and effective surgical method for patients with thymic tumors.
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Affiliation(s)
- Meng Li
- Department of Thoracic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Linhao Xu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Li Li
- Kangda College, Nanjing Medical University, Lianyungang, China
| | - Qin Dai
- Department of Thoracic Surgery, The Second People's Hospital of Lianyungang, Lianyungang, China
| | - Dandan Xu
- Department of Oncology, The Second People's Hospital of Lianyungang, Lianyungang, China
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9
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Kim A, Choi SJ, Kang CH, Lee S, Son H, Kim JA, Shin JY, Kim SM, Hong YH, Sung JJ. Risk factors for developing post-thymectomy myasthenia gravis in patients with thymoma. Muscle Nerve 2021; 63:531-537. [PMID: 33434360 DOI: 10.1002/mus.27169] [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: 07/28/2020] [Revised: 01/04/2021] [Accepted: 01/06/2021] [Indexed: 11/06/2022]
Abstract
BACKGROUND Thymectomy is required for the treatment of thymoma-associated myasthenia gravis (MG). However, MG may develop only after thymectomy, a condition known as post-thymectomy MG. This study aimed to investigate the risk factors for post-thymectomy MG in patients with thymoma. METHODS We retrospectively identified 235 patients with thymoma who underwent thymectomy at a single hospital from January 2008 to December 2017: 44 with preoperatively diagnosed MG were excluded, leaving 191 patients in the final analysis. Univariable survival analyses using Cox proportional hazards regression model and Kaplan-Meier estimate were conducted to identify risk factors for post-thymectomy MG. RESULTS Post-thymectomy MG developed in 4.2% (8/191) of the patients with thymoma between 18 days and 108 mo after surgery. Hazard ratios (HRs) of pre- and postoperative anti-acetylcholine receptor antibody (AChR-Ab) titers were 2.267 (P = .002) and 1.506 (P < .001), respectively. Patients with extended thymectomy had a low chance of post-thymectomy MG (HR 0.035, P = .007). Larger thymoma (HR, 1.359; P = .005) and type A or AB thymoma according to World Health Organization histological classification (HR, 11.92; P = .021) were associated with higher chances of post-thymectomy MG. Within the subgroup of preoperatively AChR-Ab seropositive patients, post-thymectomy MG developed in 22.2% (6/27). CONCLUSIONS Pre- and postoperative AChR-Ab levels should be measured in patients with thymoma. A large thymoma and partial thymectomy appear to be associated with a higher probability of post-thymectomy MG.
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Affiliation(s)
- Ahwon Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seok-Jin Choi
- Department of Neurology, Inha University School of Medicine, Incheon, Republic of Korea
| | - Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - Seonkyung Lee
- Department of Neurology, Seoul National University Bundang Hospital, Seoul, Republic of Korea
| | - Hyoshin Son
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jin-Ah Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Je-Young Shin
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Sung-Min Kim
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yoon-Ho Hong
- Department of Neurology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Jung-Joon Sung
- Department of Neurology, Seoul National University Hospital, Seoul, Republic of Korea.,Department of Neurology, Seoul National University College of Medicine, Seoul, Republic of Korea
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10
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Minami K, Jimbo N, Tanaka Y, Uchida T, Okamoto T, Shimizu N, Doi T, Hokka D, Itoh T, Maniwa Y. Fibrous bands associated with higher Masaoka stage and poor recurrence-free survival in patients with thymoma. Thorac Cancer 2020; 12:349-356. [PMID: 33236521 PMCID: PMC7862782 DOI: 10.1111/1759-7714.13755] [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: 10/04/2020] [Revised: 11/05/2020] [Accepted: 11/08/2020] [Indexed: 11/26/2022] Open
Abstract
Background Fibrous bands (FBs) are one of the histological features in tumors which can be confirmed by hematoxylin and eosin (H&E)‐stained slides. FBs have been reported to correlate with malignancy in various tumors. This study aimed to investigate whether the presence of FBs is associated with malignancy in thymoma. Methods A total of 123 consecutive patients with thymoma who underwent microscopically complete resections from January 2000 to December 2018 were enrolled into this study. H&E‐stained slides of all thymoma patients were re‐examined. Study patients were classified into two groups: with FBs (n = 36) and without FBs (n = 87). Clinicopathological characteristics, overall survival (OS), and recurrence‐free survival (RFS) were compared between the two groups. Furthermore, multivariate analyses were performed to identify whether the presence of FBs was associated with higher Masaoka stage and poor prognosis in patients with thymoma. Results The Masaoka stage was found to be higher and recurrence more likely in thymoma patients with FBs than in those without. RFS was significantly poorer in thymoma patients with FBs than in those without, although no significant difference was observed in OS between them. The presence of FBs was significantly associated with higher Masaoka stage in the multivariate analysis using logistic regression. Additionally, the presence of FBs was an independent prognostic factor for poor RFS in multivariate analysis using Cox's proportional hazards model. Conclusions The presence of FBs in patients with thymoma was associated with higher Masaoka stage, higher recurrence rate, and poorer RFS. Key points Significant findings of the study Fibrous bands (FBs) are bands of fibrosis dividing tumors into different‐sized irregular islands. The presence of FBs is associated with higher Masaoka stage and poor recurrence‐free survival in patients with thymoma. What this study adds The presence of fibrous bands might be associated with the malignant behavior of thymoma. Confirming the presence or absence of FBs may result in personalized medication for patients with thymoma.
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Affiliation(s)
- Kazuhiro Minami
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Naoe Jimbo
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yugo Tanaka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takahiro Uchida
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takeshi Okamoto
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Nahoko Shimizu
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takefumi Doi
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Daisuke Hokka
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoo Itoh
- Department of Diagnostic Pathology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Yoshimasa Maniwa
- Division of Thoracic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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11
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Van Backer JT, Cedeno-Rodriguez A, Nabagiez J. Third distant recurrence of benign thymoma in a patient with myasthenia gravis. BMJ Case Rep 2019; 12:12/4/e228529. [PMID: 30988107 DOI: 10.1136/bcr-2018-228529] [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: 11/04/2022] Open
Abstract
Myasthenia gravis (MG) is an autoimmune disease where antibodies attack the presynaptic terminals at the neuromuscular junction causing progressive weakness. Associated with thymomas, resection can improve symptoms. A 29-year-old woman with MG who underwent two previous thymectomies, at ages 11 and 15 presented 14 years later with recurrent MG symptoms and an anterior mediastinal mass. Robotic-assisted thoracoscopic excision of the mediastinal mass was performed without complications. She recovered well and had improvement of her MG symptoms. Thymectomy can significantly improve symptoms in MG even for patients who do not have a thymoma. Reports of distant benign thymoma recurrence are rare. MG patients require continued monitoring and vigilance, even after thymectomy. Benign thymomas can recur even after significant time intervals, and utilisation of the robotic platform for recurrent thymoma excision is safe, even following two sternotomies. Patient symptoms improve with redo thymectomy.
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Affiliation(s)
| | | | - John Nabagiez
- Thoracic Surgery, Albany Medical Center Hospital, Albany, New York, USA
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12
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Koçer B, Kaplan T, Günal N, Koçer BG, Akkaş Y, Yazkan R, Dural K, Kulaçoğlu S, Han S. Long-term survival after R0 resection of thymoma. Asian Cardiovasc Thorac Ann 2018; 26:461-466. [PMID: 29945456 DOI: 10.1177/0218492318778634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to evaluate the results of R0 resection of thymoma to identify prognostic factors for long-term outcomes. Methods Data of 62 patients (28 male, 34 female) with a mean age of 47.26 ± 14.42 years, who underwent R0 resection for thymoma and were followed-up between February 2004 and March 2016, were analyzed retrospectively. Results Eight patients had a video-assisted thoracoscopic thymectomy and 54 had a transsternal extended thymectomy. During a mean follow-up of 128.67 ± 7.95 months, regional recurrence of thymoma was observed in 9 (14.5%) patients. Overall 5- and 10-year survival rates were 85.36% and 78.20%, respectively. The 5- and 10-year survival rates in patients aged < 50 years were significantly better than in those aged ≥ 50 years (92% and 72% vs. 88% and 39%, p < 0.0001). The 10-year overall survival of patients in Masaoka stage I and II was better than those in stage III (88.9%, 78.4%, 69.8%, respectively, log-rank p < 0.001). The 10-year survival of patients with World Health Organization histological type A, AB, and B1 thymomas was better than those with type B2 and B3 (log-rank test p < 0.001). In multivariate analysis, age < 50 years ( p = 0.001), Masaoka stage ( p = 0.006), histological type ( p = 0.001), and recurrence ( p = 0.04) were independent prognostic factors for survival. Conclusion Our study indicates that age < 50 years, Masaoka stage, histological type, and recurrence are the determinants of survival in surgically resected cases of thymoma.
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Affiliation(s)
- Bulent Koçer
- 1 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Tevfik Kaplan
- 2 Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey
| | - Nesimi Günal
- 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey
| | - Bilge Gönenli Koçer
- 4 Department of Neurology, Dişkapi Yildirim Beyazit Teaching and Research Hospital, Ankara, Turkey
| | - Yucel Akkaş
- 1 Department of Thoracic Surgery, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Rasih Yazkan
- 5 Department of Thoracic Surgery, Suleyman Demirel University School of Medicine, Isparta, Turkey
| | - Koray Dural
- 3 Department of Thoracic Surgery, Kirikkale University School of Medicine, Kirikkale, Turkey
| | - Sezer Kulaçoğlu
- 6 Department of Pathology, Ankara Numune Teaching and Research Hospital, Ankara, Turkey
| | - Serdar Han
- 2 Department of Thoracic Surgery, Ufuk University School of Medicine, Ankara, Turkey
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Li M, Hou F, Zhao J, Zhang T, Li D, Wu W, Liu X, Xu L. Focal adhesion kinase is overexpressed in thymic epithelial tumors and may serve as an independent prognostic biomarker. Oncol Lett 2017; 15:3001-3007. [PMID: 29435030 PMCID: PMC5778861 DOI: 10.3892/ol.2017.7676] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 11/02/2017] [Indexed: 01/16/2023] Open
Abstract
Focal adhesion kinase (FAK) has long been considered to be a key regulator of growth factor receptor- and integrin-mediated signals, with pivotal roles in tumor cells through its kinase activity and scaffolding function. Increased FAK expression and activity has been observed in tumors of various origins and is often associated with a poor prognosis. However, there have been no studies on the aberrant expression of FAK in thymic epithelial tumors to date. The aim of the present study was to evaluate FAK expression in thymic epithelial tumors and to explore the prognostic significance of FAK. FAK expression was investigated in 100 formalin-fixed, paraffin-embedded human thymic epithelial tumor (TET) specimens using immunohistochemical analysis with FAK-specific monoclonal antibody 4.47, and the associations between FAK expression and clinicopathological parameters (including sex, age, tumor size, myasthenia gravis, World Health Organization classification and Masaoka-Koga stage) were analyzed. FAK was significantly overexpressed in TETs compared with in normal thymus tissues (P<0.001). Additionally, FAK overexpression was significantly associated with advanced tumor stages (stages III or IV; P<0.001) and highly aggressive TET subtypes (type B2 and B3 thymomas and thymic carcinomas; P<0.001). Furthermore, FAK overexpression was significantly associated with a worse 10-year overall survival, as determined by univariate analysis (P<0.001). Multivariate analysis revealed that FAK overexpression was an independent prognostic factor for patients with TETs (P=0.034). The results of the present study suggest that FAK serves an important role in the tumorigenesis and progression of TETs. Therefore, FAK may serve as a prognostic biomarker and is a potential therapeutic target for the treatment of TETs.
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Affiliation(s)
- Meng Li
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Feng Hou
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Jie Zhao
- Department of Pathology, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Tianqiang Zhang
- Department of Cardiothoracic Surgery, The Municipal Hospital of Zaozhuang, Zaozhuang, Shandong 277100, P.R. China
| | - Dongfei Li
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Wensi Wu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Xiaotong Liu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
| | - Linhao Xu
- Department of Thoracic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, Shandong 266003, P.R. China
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Jazi HH, Harmon DM, Tran T, Denham C. Malignant thymoma with metastasis associated with paraneoplastic myasthenia gravis. Proc (Bayl Univ Med Cent) 2017; 30:330-332. [PMID: 28670075 DOI: 10.1080/08998280.2017.11929636] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
We describe a patient who initially presented with a mixed thymic tumor and developed myasthenia gravis 8 years following thymectomy with recurrence of metastatic disease. Metastasis to the pleura, mediastinum, and cervical spine was identified with a positron emission tomography scan when this patient presented with recurring pneumonias and atrial fibrillation. The presentation and diagnosis were clouded by multiple courses of prednisone and chemotherapy for respiratory complications and metastatic disease, respectively. Classical myasthenia gravis symptoms emerged when his prednisone was tapered. The delayed presentation of paraneoplastic disease and the rare metastatic site make this case particularly unusual.
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Affiliation(s)
- Hourossadat Hashemi Jazi
- Departments of Internal Medicine (Jazi), Pathology (Tran), and Oncology (Denham), Baylor University Medical Center; and Texas A&M University College of Medicine (Harmon), Dallas, Texas
| | - David M Harmon
- Departments of Internal Medicine (Jazi), Pathology (Tran), and Oncology (Denham), Baylor University Medical Center; and Texas A&M University College of Medicine (Harmon), Dallas, Texas
| | - Tuan Tran
- Departments of Internal Medicine (Jazi), Pathology (Tran), and Oncology (Denham), Baylor University Medical Center; and Texas A&M University College of Medicine (Harmon), Dallas, Texas
| | - Claude Denham
- Departments of Internal Medicine (Jazi), Pathology (Tran), and Oncology (Denham), Baylor University Medical Center; and Texas A&M University College of Medicine (Harmon), Dallas, Texas
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Bürger T, Schaefer IM, Küffer S, Bohnenberger H, Reuter-Jessen K, Chan JKC, Emmert A, Hinterthaner M, Marx A, Ströbel P. Metastatic type A thymoma: morphological and genetic correlation. Histopathology 2016; 70:704-710. [PMID: 27926794 DOI: 10.1111/his.13138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/02/2016] [Indexed: 01/08/2023]
Abstract
AIMS The vast majority of type A thymomas are diagnosed in tumour stages 1 or 2, and metastatic cases are exceedingly rare. The histological and genetic features of such metastatic type A thymomas have not been described in detail. METHODS AND RESULTS Five metastatic type A thymomas in tumour stage Masaoka IVb that had been reviewed by a panel of expert pathologists were analysed using comparative genomic hybridization (CGH). Cases 1, 2 and 3 showed the prototypical morphology of type A thymomas with mainly solid growth patterns. These cases displayed only very subtle nuclear irregularities and slight nuclear crowding, but no other atypical features. Mitoses were absent. Cases 3 and 4, in contrast, had a distinctly atypical morphology. CGH revealed partially recurrent alterations in four cases (with and without atypical morphology), including gains on chromosome 1q (one case), 17q (two cases), chromosome 19 (three cases) and 22q (one case) and losses on chromosome 17p (two cases) and 22q (one case). CONCLUSION Rare metastatic type A thymomas, both with typical and 'atypical' histological features, show partially recurrent genomic alterations that differ from the much more frequent localized and indolent tumours. The fact that these alterations were recurring points to a link between clinical behaviour and molecular features. Our findings may have implications for the management and treatment of such tumours.
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Affiliation(s)
- Tobias Bürger
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Inga-Marie Schaefer
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Küffer
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Hanibal Bohnenberger
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Kirsten Reuter-Jessen
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | | | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
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16
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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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18
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Diffusion weighted MRI of mediastinal masses: Can measurement of ADC value help in the differentiation between benign and malignant lesions. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2016. [DOI: 10.1016/j.ejrnm.2015.12.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
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A large microRNA cluster on chromosome 19 is a transcriptional hallmark of WHO type A and AB thymomas. Br J Cancer 2016; 114:477-84. [PMID: 26766736 PMCID: PMC4815766 DOI: 10.1038/bjc.2015.425] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Revised: 11/03/2015] [Accepted: 11/10/2015] [Indexed: 12/24/2022] Open
Abstract
Background: Thymomas are one of the most rarely diagnosed malignancies. To better understand its biology and to identify therapeutic targets, we performed next-generation RNA sequencing. Methods: The RNA was sequenced from 13 thymic malignancies and 3 normal thymus glands. Validation of microRNA expression was performed on a separate set of 35 thymic malignancies. For cell-based studies, a thymoma cell line was used. Results: Hierarchical clustering revealed 100% concordance between gene expression clusters and WHO subtype. A substantial differentiator was a large microRNA cluster on chr19q13.42 that was significantly overexpressed in all A and AB tumours and whose expression was virtually absent in the other thymomas and normal tissues. Overexpression of this microRNA cluster activates the PI3K/AKT/mTOR pathway. Treatment of a thymoma AB cell line with a panel of PI3K/AKT/mTOR inhibitors resulted in marked reduction of cell viability. Conclusions: A large microRNA cluster on chr19q13.42 is a transcriptional hallmark of type A and AB thymomas. Furthermore, this cluster activates the PI3K pathway, suggesting the possible exploration of PI3K inhibitors in patients with these subtypes of tumour. This work has led to the initiation of a phase II clinical trial of PI3K inhibition in relapsed or refractory thymomas (http://clinicaltrials.gov/ct2/show/NCT02220855).
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Clinicopathologic and Prognostic Implications of Programmed Death Ligand 1 Expression in Thymoma. Ann Thorac Surg 2016; 101:1361-9. [PMID: 26794891 DOI: 10.1016/j.athoracsur.2015.10.044] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/12/2015] [Accepted: 10/13/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Programmed death ligand 1 (PD-L1) has been reported to be expressed in various malignancies and is considered to be a prognostic factor and an immunotherapeutic target. The aim of this study was to characterize PD-L1 expression in thymoma and determine statistical associations between this expression and clinical features. METHODS We reviewed formalin-fixed, paraffin-embedded tissue specimens from 82 thymoma cases accumulated at Kurume University, the majority of which achieved surgical complete resection. Expression of PD-L1 was evaluated by immunohistochemistry. Statistical associations between PD-L1 expression and clinicopathologic features were evaluated by using χ(2) test and Fisher's exact test. Disease-free survival and overall survival curves were established by the Kaplan-Meier method and compared using a log-rank test. Predictive factors for disease-free survival after complete resection were analyzed by using a Cox proportional hazards model in univariate and multivariate analysis. RESULTS Overall, 44 thymoma cases (54%) revealed high PD-L1 expression. High PD-L1 expression was statistically associated with Masaoka stage III/IV disease (p = 0.043) and World Health Organization type B2 or B3 thymoma (p = 0.044). Disease-free survival after complete resection in high PD-L1 expression was significantly worse than that in low PD-L1 expression (p = 0.021), although there was no significant difference in overall survival (p = 0.957). Multivariate analysis also revealed high PD-L1 expression as an independent risk factor for recurrence (p = 0.008). CONCLUSIONS Characterization of PD-L1 expression in thymoma should enable more effective clinical approaches, including prognostic stratification of patients and potential use of anti-PD-L1 antibody immunotherapy.
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Mneimneh WS, Gökmen-Polar Y, Kesler KA, Loehrer PJ, Badve S. Micronodular thymic neoplasms: case series and literature review with emphasis on the spectrum of differentiation. Mod Pathol 2015; 28:1415-27. [PMID: 26360499 DOI: 10.1038/modpathol.2015.104] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 07/09/2015] [Accepted: 07/10/2015] [Indexed: 11/09/2022]
Abstract
We report nine cases of micronodular thymoma with lymphoid B-cell hyperplasia and one case of micronodular thymic carcinoma with lymphoid hyperplasia from our institution. For a better understanding of these rare tumors, clinical records, and histological features of these cases were reviewed, with detailed review of additional 64 literature cases of micronodular thymic neoplasms. The joint analysis identified 64 cases of micronodular thymoma with lymphoid B-cell hyperplasia and 9 cases of micronodular thymic carcinoma with lymphoid hyperplasia. Both groups revealed slight male predilection, with male:female ratio of 1.3:1 and 5:4, and occurred at >40 years of age, with a mean of 64 (41-83) and 62 (42-78) years, respectively. Myasthenia gravis was noted in 3/64 (5%) and 1/9 (11%) patients, respectively. Other systemic, disimmune, or hematologic disorders were noted in 6/64 (9%) and 1/9 (11%) patients, respectively. Components of conventional thymoma were reported in 11/64 (17%) micronodular thymomas with lymphoid B-cell hyperplasia, with transitional morphology between the two components in most of them. Cellular morphology was predominantly spindle in micronodular thymoma with lymphoid B-cell hyperplasia when specified (30/43), and epithelioid in micronodular thymic carcinoma with lymphoid hyperplasia (6/9), and cytological atypia was more encountered in the latter. Dedifferentiation/transformation from micronodular thymoma with lymphoid B-cell hyperplasia to micronodular thymic carcinoma with lymphoid hyperplasia seems to occur in a small subset of cases. Three cases of micronodular thymomas with lymphoid B-cell hyperplasia were described with co-existent low-grade B-cell lymphomas. Follow-up data were available for 30 micronodular thymomas with lymphoid B-cell hyperplasia and 6 micronodular thymic carcinomas with lymphoid hyperplasia, with a mean of 47 (0.2-180) months and 23 (3-39) months, respectively. Patients were alive without disease, except for five micronodular thymoma with lymphoid B-cell hyperplasia patients (dead from unrelated causes), and one micronodular thymic carcinoma with lymphoid hyperplasia patient (dead of disease).
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Affiliation(s)
- Wadad S Mneimneh
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Yesim Gökmen-Polar
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Kenneth A Kesler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Patrick J Loehrer
- Department of Medicine, Indiana University Simon Cancer Center, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, USA
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22
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Huang PW, Chang KM. Solitary metastasis to the breast after complete resection of encapsulated type AB thymoma: a case report. J Med Case Rep 2015; 9:63. [PMID: 25890208 PMCID: PMC4416233 DOI: 10.1186/s13256-015-0551-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 02/20/2015] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Type AB thymoma is generally considered a benign tumor with excellent prognosis. Rare case reports of type A and AB thymomas with recurrence and metastasis have been documented, although extrathoracic metastases are extremely rare. To the best of our knowledge, this is the first reported case of type AB thymoma with solitary metastasis to the breast. CASE PRESENTATION We describe an 83-year-old Taiwanese woman with a metastatic thymoma to the breast 10 years after complete resection of noninvasive and encapsulated primary tumor, and analyze the possible factors to explain the recurrence and metastasis of the stage I thymomas. CONCLUSIONS Even a clinically benign tumor such as type AB thymoma still has a possibility of metastasizing to an unusual site. When any uncommon tumor presents in any site, a suspicion of secondary neoplasm and thorough clinical history are required.
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Affiliation(s)
- Pei-Wen Huang
- Department of Pathology, Mackay Memorial Hospital, Hsinchu, No.690, Sec. 2, Guangfu Rd, East Dist, Hsinchu City, 30071, Taiwan.
| | - Kuo-Ming Chang
- Department of Pathology, Mackay Memorial Hospital, Hsinchu, No.690, Sec. 2, Guangfu Rd, East Dist, Hsinchu City, 30071, Taiwan.
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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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Green AC, Marx A, Ströbel P, Mason M, Lim E, Jordan S, Ladas G, Dusmet M, Rice A, Nicholson AG. Type A and AB thymomas: histological features associated with increased stage. Histopathology 2014; 66:884-91. [PMID: 25382290 DOI: 10.1111/his.12512] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Accepted: 07/16/2014] [Indexed: 11/26/2022]
Abstract
AIMS The current WHO classification of thymic epithelial neoplasms describes type A and type AB thymomas as behaving 'like benign neoplasms'. However, recent published data suggest that rare cases may show more aggressive behaviour. The aim of this study was to assess the frequency of atypical cases, and to determine whether atypia is associated with more advanced disease. METHODS AND RESULTS One hundred and twenty-one thymomas (type A, n = 68; type AB, n = 53) were retrospectively reviewed for 'atypical' features (nuclear pleomorphism, mitotic activity, and necrosis). Logistic regression was used to ascertain the association with increasing Masaoka-Koga stage. Where available, follow-up data were also reviewed. There were 72 stage I, 42 stage II, five stage III and two stage IV tumours. Only the presence of necrosis showed a significant association with increased stage in univariate and multivariate analysis. Nuclear atypia and increased mitotic activity were not associated with increasing stage of disease. CONCLUSIONS Our data support the concept of there being more aggressive atypical variants of both type A and type AB thymoma, and suggest that the presence of necrosis could be used to predict aggressive behaviour.
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Affiliation(s)
- Anna C Green
- Department of Histopathology, Royal Brompton and Harefield Hospitals NHS Foundation Trust, London, UK
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Vladislav IT, Gökmen-Polar Y, Kesler KA, Loehrer PJ, Badve S. The prognostic value of architectural patterns in a study of 37 type AB thymomas. Mod Pathol 2014; 27:863-8. [PMID: 24232865 DOI: 10.1038/modpathol.2013.203] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Accepted: 10/21/2013] [Indexed: 11/09/2022]
Abstract
Spindle cell thymomas with prominent amount of lymphocytes are classified as WHO type AB tumors. However, there are architectural pattern differences in these tumors. We investigated the importance of architectural pattern in type AB thymomas in relation to prognostic value. Archival hematoxylin-eosin stained slides of 37 AB type thymomas were reviewed for the presence (type 1) or absence (type 2) of reticular growth pattern. Reticular growth pattern is defined as the presence of a network of elongated bland spindle cells separating nests of tumor cells admixed with lymphoid cells. The architectural patterns were correlated with tumor stage at diagnosis and presence or absence of recurrent disease. The analysis identified 18 cases of type 1 AB thymoma and 19 cases of type 2. Type 2 cases also had greater cytologic atypia within the spindle cells. Patients with type 1 tumors were more likely to have early stage disease. In contrast, type 2 pattern was associated with higher stage at diagnosis (P<0.001) and greater likelihood for recurrence (P<0.05) and metastases. Architectural features are prognostically relevant in classification of WHO AB type thymomas and may constitute a form of personalized medicine. Independent confirmation of the findings is necessary to confirm the association of architectural pattern with outcomes.
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Affiliation(s)
- I Tudor Vladislav
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine and Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Yesim Gökmen-Polar
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine and Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Kenneth A Kesler
- Department of Internal Medicine, Indiana University School of Medicine and Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Patrick J Loehrer
- Department of Surgery, Indiana University School of Medicine and Indiana University Simon Cancer Center, Indianapolis, IN, USA
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine and Indiana University Simon Cancer Center, Indianapolis, IN, USA
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Huang B, Belharazem D, Li L, Kneitz S, Schnabel PA, Rieker RJ, Körner D, Nix W, Schalke B, Müller-Hermelink HK, Ott G, Rosenwald A, Ströbel P, Marx A. Anti-Apoptotic Signature in Thymic Squamous Cell Carcinomas - Functional Relevance of Anti-Apoptotic BIRC3 Expression in the Thymic Carcinoma Cell Line 1889c. Front Oncol 2013; 3:316. [PMID: 24427739 PMCID: PMC3876280 DOI: 10.3389/fonc.2013.00316] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/11/2013] [Indexed: 12/24/2022] Open
Abstract
The molecular pathogenesis of thymomas and thymic carcinomas (TCs) is poorly understood and results of adjuvant therapy are unsatisfactory in case of metastatic disease and tumor recurrence. For these clinical settings, novel therapeutic strategies are urgently needed. Recently, limited sequencing efforts revealed that a broad spectrum of genes that play key roles in various common cancers are rarely affected in thymomas and TCs, suggesting that other oncogenic principles might be important. This made us re-analyze historic expression data obtained in a spectrum of thymomas and thymic squamous cell carcinomas (TSCCs) with a custom-made cDNA microarray. By cluster analysis, different anti-apoptotic signatures were detected in type B3 thymoma and TSCC, including overexpression of BIRC3 in TSCCs. This was confirmed by qRT-PCR in the original and an independent validation set of tumors. In contrast to several other cancer cell lines, the BIRC3-positive TSCC cell line, 1889c showed spontaneous apoptosis after BIRC3 knock-down. Targeting apoptosis genes is worth testing as therapeutic principle in TSCC.
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Affiliation(s)
- Bei Huang
- Pathologisches Institut der Universität Würzburg , Würzburg , Germany
| | - Djeda Belharazem
- Pathologisches Institut und Zentrum für Medizinische Forschung (ZMF), Universitätsmedizin Mannheim der Universität Heidelberg , Mannheim , Germany
| | - Li Li
- Pathologisches Institut und Zentrum für Medizinische Forschung (ZMF), Universitätsmedizin Mannheim der Universität Heidelberg , Mannheim , Germany ; Pathologisches Institut der Universitätsmedizin Göttingen , Göttingen , Germany
| | - Susanne Kneitz
- Pathologisches Institut der Universität Würzburg , Würzburg , Germany
| | | | - Ralf J Rieker
- Pathologisches Institut, Universität Heidelberg , Heidelberg , Germany
| | - Daniel Körner
- Abteilung Thoraxchirurgie, Thoraxklinik Rohrbach, Universität Heidelberg , Heidelberg , Germany
| | - Wilfred Nix
- Neurologische Universitätsklinik Mainz , Mainz , Germany
| | - Berthold Schalke
- Neurologische Universitätsklink Regensburg , Regensburg , Germany
| | | | - German Ott
- Pathologisches Institut, Robert-Bosch-Krankenhaus , Stuttgart , Germany
| | - Andreas Rosenwald
- Pathologisches Institut der Universität Würzburg , Würzburg , Germany
| | - Philipp Ströbel
- Pathologisches Institut und Zentrum für Medizinische Forschung (ZMF), Universitätsmedizin Mannheim der Universität Heidelberg , Mannheim , Germany ; Pathologisches Institut der Universitätsmedizin Göttingen , Göttingen , Germany
| | - Alexander Marx
- Pathologisches Institut und Zentrum für Medizinische Forschung (ZMF), Universitätsmedizin Mannheim der Universität Heidelberg , Mannheim , Germany
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Yamada Y, Tomaru U, Ishizu A, Kiuchi T, Kasahara M, Matsuno Y. Expression of thymoproteasome subunit β5t in type AB thymoma. J Clin Pathol 2013; 67:276-8. [DOI: 10.1136/jclinpath-2013-201930] [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]
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The role of histology in predicting recurrence of type A thymomas: a clinicopathologic correlation of 23 cases. Mod Pathol 2013; 26:1059-64. [PMID: 23579619 DOI: 10.1038/modpathol.2013.49] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 01/09/2013] [Accepted: 01/10/2013] [Indexed: 01/16/2023]
Abstract
Spindle cell thymomas (type A), as per the WHO definition, are benign tumors with an excellent prognosis. However, recent studies document aggressive behavior with local recurrences as well as extrathoracic metastases. More recently, Nonaka and Rosai have raised the question as to whether atypical features like cellular atypia, mitotic activity, necrosis, and vascular permeation could predict the adverse outcomes of these tumors. In an effort to address the 'atypia and outcome' issue of spindle cell thymomas, we analyzed our database of over 600 cases of thymic tumors to identify type A thymomas. The presence of histomorphological features like tumor size, nuclear shape and variability, mitotic rate, and presence/absence of necrosis were correlated with Masaoka stage, relapse/recurrence, and extrathoracic metastases. The study identified 23 patients of pure spindle cell thymomas (WHO type A) ranging in age from 40 to 88 years (median age, 54 years) and with male-to-female ratio of 1:0.9. Approximately 43% of the cases had recurrence or metastases during the followup period (average, 49 months). The presence of necrosis correlates with both relapse and extrathoracic metastases but not with the stage of diagnosis. However, none of the other clinical or histological features, including size, predominant nuclear shape, nuclear variability, and mitotic activity, were correlated with the outcome parameters, such as stage at diagnosis, presence or absence of relapse, and extrathoracic metastases. Histological atypia is fairly common in WHO type A thymomas. The presence of necrosis was associated with both locoregional and systemic disease. However, none of the other clinical or histological features correlated with aggressive behavior.
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Gökmen-Polar Y, Cook RW, Goswami CP, Wilkinson J, Maetzold D, Stone JF, Oelschlager KM, Vladislav IT, Shirar KL, Kesler KA, Loehrer PJ, Badve S. A gene signature to determine metastatic behavior in thymomas. PLoS One 2013; 8:e66047. [PMID: 23894276 PMCID: PMC3722217 DOI: 10.1371/journal.pone.0066047] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2013] [Accepted: 04/30/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose Thymoma represents one of the rarest of all malignancies. Stage and completeness of resection have been used to ascertain postoperative therapeutic strategies albeit with limited prognostic accuracy. A molecular classifier would be useful to improve the assessment of metastatic behaviour and optimize patient management. Methods qRT-PCR assay for 23 genes (19 test and four reference genes) was performed on multi-institutional archival primary thymomas (n = 36). Gene expression levels were used to compute a signature, classifying tumors into classes 1 and 2, corresponding to low or high likelihood for metastases. The signature was validated in an independent multi-institutional cohort of patients (n = 75). Results A nine-gene signature that can predict metastatic behavior of thymomas was developed and validated. Using radial basis machine modeling in the training set, 5-year and 10-year metastasis-free survival rates were 77% and 26% for predicted low (class 1) and high (class 2) risk of metastasis (P = 0.0047, log-rank), respectively. For the validation set, 5-year metastasis-free survival rates were 97% and 30% for predicted low- and high-risk patients (P = 0.0004, log-rank), respectively. The 5-year metastasis-free survival rates for the validation set were 49% and 41% for Masaoka stages I/II and III/IV (P = 0.0537, log-rank), respectively. In univariate and multivariate Cox models evaluating common prognostic factors for thymoma metastasis, the nine-gene signature was the only independent indicator of metastases (P = 0.036). Conclusion A nine-gene signature was established and validated which predicts the likelihood of metastasis more accurately than traditional staging. This further underscores the biologic determinants of the clinical course of thymoma and may improve patient management.
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Affiliation(s)
- Yesim Gökmen-Polar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Robert W. Cook
- Castle Biosciences Incorporated, Friendswood, Texas, United States of America
| | - Chirayu Pankaj Goswami
- Center for Computational Biology and Bioinformatics, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Jeff Wilkinson
- The DNA Diagnostics Laboratory, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | - Derek Maetzold
- Castle Biosciences Incorporated, Friendswood, Texas, United States of America
| | - John F. Stone
- The DNA Diagnostics Laboratory, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, United States of America
| | | | - Ioan Tudor Vladislav
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kristen L. Shirar
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Kenneth A. Kesler
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Patrick J. Loehrer
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
| | - Sunil Badve
- Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America
- * E-mail:
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Gökmen-Polar Y, Sanders KL, Goswami CP, Cano OD, Zaheer NA, Jain RK, Kesler KA, Nelson RP, Vance GH, Smith D, Li L, Cardoso AA, Badve S, Loehrer PJ, Sledge GW. Establishment and characterization of a novel cell line derived from human thymoma AB tumor. J Transl Med 2012; 92:1564-73. [PMID: 22926645 DOI: 10.1038/labinvest.2012.115] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Thymomas are low-grade epithelial tumors of the anterior mediastinum. The complexity of the disease and the lack of in vitro and in vivo models hamper the development of better therapeutics. In this study, we report a novel cell line, designated as IU-TAB-1, which was established from a patient with stage II thymoma (World Health Organization-type AB). The IU-TAB-1 cell line was established in vitro and characterized using histological and immunohistochemical staining, fluorescence-activated cell sorting, cytogenetic analyses and functional assays including in vitro and a NOD/SCID xenograft model. A whole-genome gene expression analysis (Illumina) was performed on the IU-TAB-1 cell line and 34 thymomas to determine the clinical relevance of the cell line. The IU-TAB-1 cell line was positive for epithelial markers (pan-cytokeratin and EpCAM/CD326) including thymic epithelial (TE) surface markers (such as CD29, CD9, CD54/ICAM-1, CD58 and CD24) and p63, and negative for B- and T-cell lineage markers. Gene expression profiling demonstrated overlapping and distinct genes between IU-TAB-1 and primary thymomas including the primary tumor (from which the cell line was derived). IU-TAB-1 cells are tumorigenic when implanted in immunodeficient mice with tumors reaching a volume of 1000 mm³ at around 130 days. The established cell line represents a biologically relevant new tool to investigate the molecular pathology of thymic malignancies and to evaluate the efficacy of novel therapeutics both in vitro and in vivo.
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Affiliation(s)
- Yesim Gökmen-Polar
- Department of Medicine, Indiana University School of Medicine, Walther Hall, 980W Walnut Street, C230, IN 46202, USA.
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Badve S, Goswami C, Gökmen-Polar Y, Nelson RP, Henley J, Miller N, Zaheer NA, Sledge GW, Li L, Kesler KA, Loehrer PJ. Molecular analysis of thymoma. PLoS One 2012; 7:e42669. [PMID: 22912720 PMCID: PMC3418289 DOI: 10.1371/journal.pone.0042669] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Accepted: 07/10/2012] [Indexed: 11/18/2022] Open
Abstract
Histologic classification of thymomas has significant limitations with respect to both subtype definitions and consistency. In order to better understand the biology of the disease processes, we performed whole genome gene expression analysis. RNA was extracted from fresh frozen tumors from 34 patients with thymomas and followup data was available. Using the Illumina BeadStudio® platform and Human Ref-8 Beadchip, gene expression data was analyzed with Partek Genomics Suite®, and Ingenuity Pathways Analysis (IPA). Unsupervised clustering of gene expression data, representing one of the largest series in literature, resulted in identification of four molecular clusters of tumors (C1–C4), which correlated with histology (P = 0.002). However, neither histology nor clusters correlated with clinical outcomes. Correlation of gene expression data with clinical data showed that a number of genes were associated with either advanced stage at diagnosis or development of recurrence or metastases. The top pathways associated with metastases were amino acid metabolisms, biosynthesis of steroids and glycosphingolipids, cell cycle checkpoint proteins and Notch signaling. The differential expression of some of the top genes related to both metastases and stage was confirmed by RT-PCR in all cases of metastases and matched nonmetastatic cases. A number of potential candidates for therapeutics were also identified.
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Affiliation(s)
- Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, Indiana, United States of America.
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32
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Is There a Spectrum of Cytologic Atypia in Type A Thymomas Analogous to That Seen in Type B Thymomas? A Pilot Study of 13 Cases. Am J Surg Pathol 2012; 36:889-94. [DOI: 10.1097/pas.0b013e31824fff50] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Vladislav T, Jain RK, Alvarez R, Mehta RJ, Gökmen-Polar Y, Kesler KA, Henley JD, Loehrer PJ, Badve S. Extrathoracic metastases of thymic origin: a review of 35 cases. Mod Pathol 2012; 25:370-7. [PMID: 22080058 DOI: 10.1038/modpathol.2011.178] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Thymic tumors are categorized as types A, AB, B1, B2, B3, and thymic carcinoma under the World Health Organization (WHO) classification. Thymomas are typically slow growing tumors that predominantly involve the surrounding structures through direct invasion, while thymic carcinomas tend to be more aggressive. A significant number of patients are asymptomatic and can present with metastases as the first presentation. The exact incidence of extrathoracic metastases from thymoma is not known. This study describes a series of 35 cases of histologically documented metastatic thymomas and thymic carcinomas at extrathoracic sites. These cases were classified according to the current World Health Organization (WHO) classification criteria, and we present their clinical data as well as discuss the differential diagnoses of these lesions. Our study shows that all types of thymic tumors, regardless of histologic type, can be associated with invasion and metastases to thoracic and extrathoracic sites.
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Affiliation(s)
- Tudor Vladislav
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine and Indiana University Simon Cancer Center, Indianapolis, IN, USA
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Keditsu KK, Karimundackal G, Jambhekar NA, Pramesh CS. Unusual clinical behaviour of thymoma with recurrent myasthenia gravis. Interact Cardiovasc Thorac Surg 2012; 14:909-11. [PMID: 22378319 DOI: 10.1093/icvts/ivs064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A 58-year old man with thymoma and myasthenia gravis (MG) had undergone thymectomy 8 years ago with histopathologically confirmed non-invasive WHO-type AB thymoma. After 5 years of complete remission, symptoms of MG resurfaced, and a recurrent anterior mediastinal mass was detected for which he received radiotherapy. He presented to us 3 years later with productive cough and exertional dyspnoea; the positron emission tomography-computed tomography scan revealed a metabolically active pulmonary nodule in the right lung as the only site of disease for which a right lower lobectomy was done. Microscopy established an intrapulmonary WHO-type B2 thymoma and the patient is currently asymptomatic on steroids, anticholinesterase and immunosuppressant therapy. We discuss the variable and unpredictable course of thymomas; the possibility of transformation into more aggressive types with each recurrence, association with recurrent MG post-thymectomy and presentation several years later with metastatic disease.
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Affiliation(s)
- Keduovinuo K Keditsu
- Department of Surgical Oncology, Division of Thoracic surgery, Tata Memorial Hospital, Mumbai, India
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