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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von der Thüsen J. Thymic epithelial tumours: histopathological classification and differential diagnosis. Histopathology 2024; 84:196-215. [PMID: 37994555 DOI: 10.1111/his.15097] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2023]
Abstract
The epithelial and lymphoid compartments of the thymus can give rise to a wide variety of tumours, including thymomas, thymic carcinomas, lymphoreticular proliferations, germ cell tumours, and sarcomas. While some of these have close similarity to their counterparts in other organs, both in terms of histology and immunohistochemistry, as well as molecular features, others are unique to the thymus. The epithelial tumours, which can develop in the thymus, will be discussed in this review, with a particular emphasis on resolving differential diagnosis by means of morphology, immunohistochemical profiles, and molecular diagnostics.
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Affiliation(s)
- Jan von der Thüsen
- Department of Pathology and Clinical Bioinformatics, Erasmus MC, Rotterdam, The Netherlands
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3
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Weissferdt A, Moran CA. Basaloid Squamous Cell Carcinomas of the Thymus With Prominent B-Cell Lymphoid Hyperplasia: A Clinicopathologic and Immunohistochemical Study of 10 Cases. Am J Surg Pathol 2023; 47:1039-1044. [PMID: 37341090 DOI: 10.1097/pas.0000000000002083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/22/2023]
Abstract
Ten cases of basaloid squamous cell carcinomas of the thymus are presented. The patients are 6 women and 4 men ranging in ages between 51 and 72 years (average: 61.5 y), who presented with nonspecific symptoms of cough, dyspnea, and chest pain with no history of malignancy, myasthenia gravis, or other autoimmune disease. Surgical resection of the mediastinal masses via thoracotomy or sternotomy was performed in all patients. Grossly, the tumors varied in size from 2 to 8 cm, were light tan in color, solid and slightly hemorrhagic, and had infiltrative borders. Histologically, scanning magnification showed elongated interanastomosing ribbons of tumors cells embedded in a lymphoid stroma containing germinal centers. At higher magnification, the tumors cells were round to oval with moderate amounts of lightly eosinophilic cytoplasm, oval nuclei, moderate cellular atypia, and mitotic activity ranging from 3 to 5 mitotic figures per 10 HPFs. In 8 cases, the tumor invaded perithymic adipose tissue, in 1 case the tumor infiltrated pericardium, and in 1 case, the tumor involved the pleura. Immunohistochemical stains showed positive staining in the epithelial component for pancytokeratin, p63, keratin 5/6, and p40, while CD20 and CD79a characterized the lymphoid component. Clinical follow-up was obtained in 7 patients. Two patients died within 24 months and 5 patients remained alive between 12 and 60 months. The current cases highlight the unusual feature of B-cell lymphoid hyperplasia in these tumors and their potential aggressive behavior.
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Affiliation(s)
- Annikka Weissferdt
- Department of Pathology at the University of Texas, MD Anderson Cancer Center, Houston, TX
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4
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Yamada Y. Histogenetic and disease-relevant phenotypes in thymic epithelial tumors (TETs): The potential significance for future TET classification. Pathol Int 2023; 73:265-280. [PMID: 37278579 DOI: 10.1111/pin.13343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 05/18/2023] [Indexed: 06/07/2023]
Abstract
Thymic epithelial tumors (TETs) encompass morphologically various subtypes. Thus, it would be meaningful to explore the expression phenotypes that delineate each TET subtype or overarching multiple subtypes. If these profiles are related to thymic physiology, they will improve our biological understanding of TETs and may contribute to the establishment of a more rational TET classification. Against this background, pathologists have attempted to identify histogenetic features in TETs for a long time. As part of this work, our group has reported several TET expression profiles that are histotype-dependent and related to the nature of thymic epithelial cells (TECs). For example, we found that beta5t, a constituent of thymoproteasome unique to cortical TECs, is expressed mainly in type B thymomas, for which the nomenclature of cortical thymoma was once considered. Another example is the discovery that most thymic carcinomas, especially thymic squamous cell carcinomas, exhibit expression profiles similar to tuft cells, a recently discovered special type of medullary TEC. This review outlines the currently reported histogenetic phenotypes of TETs, including those related to thymoma-associated myasthenia gravis, summarizes their genetic signatures, and provides a perspective for the future direction of TET classification.
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Affiliation(s)
- Yosuke Yamada
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
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5
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Alqaidy D, Moran CA. The Co-Existence of Micronodular Thymoma and Lymphoma: A Clinicopathological and Immunohistochemical Study of Two Cases. Int J Surg Pathol 2023; 31:152-156. [PMID: 35469460 DOI: 10.1177/10668969221095180] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Two cases with the co-existence of micronodular thymoma and lymphoma are presented. The patients are two female patients 54 and 60 years of age who presented with symptoms of chest pain, general malaise, cough, and dyspnea. Diagnostic imaging demonstrated the presence of an anterior mediastinal mass. Initial biopsy was interpreted as an epithelial neoplasm compatible with thymoma. Surgical resection took place demonstrating the presence of micronodular thymoma in both cases. In addition, in both cases the lymphoid proliferation infiltrated surrounding adipose tissue. However, in one case the lymphoid proliferation was composed of atypical lymphocytes with irregular nuclei and increase mitotic activity positive for CD3 and TDT, while in the second case, the lymphoid proliferation was composed of more mature lymphocytes with a monocytoid appearance and positive for CD20. Both of these cases represent an unusual association and one that must be kept in the differential diagnosis especially in cases of micronodular thymoma.
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Affiliation(s)
- Doaa Alqaidy
- Departments of Pathology and Laboratory Medicine, 8785University of California San Francisco, California, USA
| | - Cesar A Moran
- The University of Texas, M D Anderson Cancer Center, Houston, TX, USA
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6
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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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7
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Hsieh MS, Kao HL, Huang WC, Wang SY, Lin SY, Chu PY, Pan CC, Chou TY, Ho HL, Yeh YC. Constant p.L424H Mutation in GTF2I in Micronodular Thymomas With Lymphoid Stroma: Evidence Supporting Close Relationship With Type A and AB Thymomas. Mod Pathol 2023; 36:100008. [PMID: 36853782 DOI: 10.1016/j.modpat.2022.100008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/22/2022] [Accepted: 09/19/2022] [Indexed: 01/11/2023]
Abstract
Micronodular thymoma with lymphoid stroma is a rare thymic neoplasm characterized by discrete nodules of epithelial tumor cells separated by abundant lymphoid stroma. The genetic features of micronodular thymoma with lymphoid stroma remain largely unexplored. Owing to the interference of abundant intratumoral, nonneoplastic lymphoid cells, a highly sensitive approach is necessary to study genetic changes in these tumors. In this study, we used a highly sensitive next-generation sequencing assay using the molecular barcoding Ion AmpliSeq HD technology to study the most commonly mutated genes in thymomas, including GTF2I, HRAS, NRAS, KRAS, and TP53. A total of 12 cases of micronodular thymomas with lymphoid stroma were tested, and 2 cases also had areas of type A thymoma in their tumor bed. Two micronodular thymic carcinomas with lymphoid stroma, a histological mimic of micronodular thymoma, were also included for comparison. Recurrent p.L424H mutations in GTF2I were found in all the cases of micronodular thymoma with lymphoid stroma but not in the cases of micronodular thymic carcinomas. In addition, 3 cases of micronodular thymoma with lymphoid stroma also had concomitant HRAS and/or KRAS mutations. Our study showed that p.L424H mutations in GTF2I is a constant genetic feature of micronodular thymoma with lymphoid stroma. This finding strongly suggests that micronodular thymoma with lymphoid stroma is closely related to type A and AB thymomas because they all share p.L424H mutations in GTF2I.
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Affiliation(s)
- Min-Shu Hsieh
- Graduate Institute of Pathology, National Taiwan University College of Medicine, Taipei, Taiwan; Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Hua-Lin Kao
- Department of Pathology and Laboratory Medicine, Taipei Medical University Hospital, Taipei City, Taiwan
| | - Wen-Chang Huang
- Department of Pathology, Taipei Medical University-Wan Fang Hospital, Taipei, Taiwan
| | - Shu-Ying Wang
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shin-Ying Lin
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ping-Yuan Chu
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chin-Chen Pan
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Teh-Ying Chou
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiang-Ling Ho
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; Department of Biotechnology and Laboratory Science in Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
| | - Yi-Chen Yeh
- Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, Taipei, Taiwan; School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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8
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Zaitsu K, Nishida H, Kondo Y, Kawamura K, Kusaba T, Oyama Y, Daa T. Micronodular Thymic Carcinoma with Lymphoid Stroma: A Case Report. Int J Surg Pathol 2022:10668969221133357. [PMID: 36314459 DOI: 10.1177/10668969221133357] [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: 06/16/2023]
Abstract
Background. Micronodular thymic carcinoma (MTC) with lymphoid hyperplasia is believed to be the malignant counterpart of micronodular thymoma (MT) with lymphoid hyperplasia. Since MT and MTC share a similar morphology, MTC is considered a malignant form of MT; there have been a few malignant transformations from MT to MTC. We report a case of MTC with lymphoid hyperplasia. Case presentation. A 53-year-old woman presented with an incidental tumor on a chest X-ray. The resected tumor consisted of nodular epithelial nests and lymphoid tissue within a surrounding germinal center. Some epithelial nests showed apparent malignant morphology. Atypical epithelial cells with large vesicular nuclei formed nests, some of which showed comedo necrosis. These cells showed transition continuously to low-grade type B thymoma-like cells, demonstrating cord-like arrangements. Carcinomatous elements, expressed GLUT1, CD5, KIT, and BCL2; conversely, low-grade nests displayed attenuated expression of these markers. GTF2I point mutation and Langerhans/dendritic cells, which are indicators of favorable thymoma prognosis, were not detected. Due to pleural metastasis, the patient was treated with lenvatinib 27 months postoperatively. Conclusions. This is the first report of a partially low-grade, GTF2I-negative MTC. Histological and genetic findings might be predictive of tumor prognosis.
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Affiliation(s)
- Koki Zaitsu
- Department of Diagnostic Pathology, Faculty of Medicine, 12995Oita University, Yufu, Japan
| | - Haruto Nishida
- Department of Diagnostic Pathology, Faculty of Medicine, 12995Oita University, Yufu, Japan
| | - Yoshihiko Kondo
- Department of Diagnostic Pathology, Faculty of Medicine, 12995Oita University, Yufu, Japan
| | - Kazuhiro Kawamura
- Department of Diagnostic Pathology, Faculty of Medicine, 12995Oita University, Yufu, Japan
| | - Takahiro Kusaba
- Department of Diagnostic Pathology, Faculty of Medicine, 12995Oita University, Yufu, Japan
| | - Yuzo Oyama
- Department of Diagnostic Pathology, Faculty of Medicine, 12995Oita University, Yufu, Japan
| | - Tsutomu Daa
- Department of Diagnostic Pathology, Faculty of Medicine, 12995Oita University, Yufu, Japan
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9
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Miao L, Yang L, Zhang JX, Sun XJ, Zhang HH, Qi LL, Li M. Micronodular thymoma with lymphoid stroma: Contrast-enhanced CT features with histopathological correlation in 10 patients. Front Oncol 2022; 12:964882. [PMID: 36110950 PMCID: PMC9468748 DOI: 10.3389/fonc.2022.964882] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/09/2022] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aimed to evaluate and summarize the contrast-enhanced computed tomography (CECT) imaging features of micronodular thymoma with lymphoid stroma (MTWLS) based on all MTWLS patients at our institution and was the first imaging study of MTWLS worldwide. Methods This retrospective study included 10 MTWLS patients who underwent CECT between April 2012 and November 2021. We collected and analyzed the CECT imaging features, including the location, size, shape, tumor density, classification, and CT value of the solid component. Descriptive statistical analysis was performed using the SPSS software (version 26.0; IBM). Results Ten patients (five males [50%], five females [50%]; median age, 61.4 years; range, 54-72 years) underwent CECT. Of the 10 cases, one case was purely cystic, seven cases were cystic-solid, and two cases were purely solid. Six cases were round/oval in shape, and four cases were irregularly shaped. Excluding a purely cystic tumor with an unmeasurable degree of enhancement, two cases showed moderate enhancement, and seven cases showed significant enhancement. Among the solid or cystic-solid cases, the mean CT value of the measurable solid component on the enhanced scan was 93.9 HU. Nine masses were located adjacent to the mediastinal pleura, pericardium, or large vessels. Additionally, there were no malignant tumor signs in any patient, including penetration of the mediastinal pleura or involvement of the pericardium, pleural effusion, elevation of the diaphragm, or direct vascular invasion. Conclusion MTWLS demonstrates certain features on CECT, such as a high rate of cystic change, significant solid component enhancement, and no malignant, invasive imaging features. These CECT features are helpful for diagnosing MTWLS.
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Affiliation(s)
- Lei Miao
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin Yang
- Departments of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jia-Xing Zhang
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xu-Jie Sun
- Departments of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huan-Huan Zhang
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lin-Lin Qi
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Meng Li
- Departments of Radiology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Meng Li,
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10
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Angirekula M, Chang SY, Jenkins SM, Greipp PT, Sukov WR, Marks RS, Olivier KR, Cassivi SD, Roden AC. CD117, BAP1, MTAP, and TdT Is a Useful Immunohistochemical Panel to Distinguish Thymoma from Thymic Carcinoma. Cancers (Basel) 2022; 14:cancers14092299. [PMID: 35565429 PMCID: PMC9100150 DOI: 10.3390/cancers14092299] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
Abstract
Background: The morphologic distinction between thymic carcinomas and thymomas, specifically types B3, A, and occasionally micronodular thymomas with lymphoid stroma (MNTLS) can be challenging, as has also been shown in interobserver reproducibility studies. Since thymic carcinomas have a worse prognosis than thymomas, the diagnosis is important for patient management and treatment. This study aimed to identify a panel of immunohistochemical (IHC) markers that aid in the distinction between thymomas and thymic carcinomas in routine practice. Materials and Method: Thymic carcinomas, type A and B3 thymomas, and MNTLS were identified in an institutional database of thymic epithelial tumors (TET) (1963–2021). IHC was performed using antibodies against TdT, Glut-1, CD5, CD117, BAP1, and mTAP. Percent tumor cell staining was recorded (Glut-1, CD5, CD117); loss of expression (BAP1, mTAP) was considered if essentially all tumor cells were negative; TdT was recorded as thymocytes present or absent (including rare thymocytes). Results: 81 specimens included 44 thymomas (25 type A, 11 type B3, 8 MNTLS) and 37 thymic carcinomas (including 24 squamous cell carcinomas). Using BAP1, mTAP, CD117 (cut-off, 10%), and TdT, 88.9% of thymic carcinomas (95.7% of squamous cell carcinomas) and 77.8% of thymomas could be predicted. Glut-1 expression was not found to be useful in that distinction. All tumors that expressed CD5 in ≥50% of tumor cells also expressed CD117 in ≥10% of tumor cells. In four carcinomas with homozygous deletion of CDKN2A, mTAP expression was lost in two squamous cell carcinomas and in a subset of tumor cells of an adenocarcinoma and was preserved in a lymphoepithelial carcinoma. Conclusion: A panel of immunostains including BAP1, mTAP, CD117 (using a cut-off of 10% tumor cell expression), and TdT can be useful in the distinction between thymomas and thymic carcinomas, with only a minority of cases being inconclusive.
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Affiliation(s)
- Mounika Angirekula
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
| | - Sindy Y Chang
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
| | - Sarah M. Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN 55902, USA;
| | - Patricia T. Greipp
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
| | - William R. Sukov
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
| | - Randolph S. Marks
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN 55902, USA;
| | - Kenneth R. Olivier
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN 55902, USA;
| | - Stephen D. Cassivi
- Division of General Thoracic Surgery, Mayo Clinic, Rochester, MN 55902, USA;
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55902, USA; (M.A.); (S.Y.C.); (P.T.G.); (W.R.S.)
- Correspondence:
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11
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Han L, Wang EH, Wang L. Undifferentiated Large Cell Carcinoma of the Thymus Associated with Plasma-Cell Type Castleman Disease-Like Reaction: A Case Series. Onco Targets Ther 2022; 15:237-242. [PMID: 35299998 PMCID: PMC8922448 DOI: 10.2147/ott.s356043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Accepted: 03/04/2022] [Indexed: 11/29/2022] Open
Abstract
Undifferentiated large cell carcinoma of the thymus with a Castleman disease (CD)-like reaction is a thymic carcinoma accompanied by an inflammatory reaction closely resembling the morphological features of CD. This disease is extremely rare and distinctive, only five cases have been documented in a single report, and all five cases were associated with a reaction like the hyaline vascular type CD. For the first time, we report two cases of undifferentiated large cell carcinoma of the thymus with a plasma cell type CD-like reaction. The two cases presented similar histological findings and immunoprofiles. Undifferentiated large cells were arranged in nests and cords within hyperplastic follicles, mimicking pseudogerminal centers. Abundant plasma cells were distributed in the interfollicular areas. The tumor cells were positive for CK-pan and BRG1 staining but negative for CD5, CD117, CK5/6, p63, p40, and EBER. Therefore, the diagnoses of squamous cell carcinoma, lymphoepithelial carcinoma, or micronodular thymic carcinoma with lymphoid hyperplasia were excluded. Even though the carcinoma cells showed high-grade nuclear pleomorphism with prominent nucleoli, these two cases presented indolent clinical courses, which were consistent with the previous report.
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Affiliation(s)
- Lihua Han
- The Central Laboratory of Morphology, Shenyang Medical College, Shenyang, People’s Republic of China
- Correspondence: Lihua Han, The Central Laboratory of Morphology, Shenyang Medical College, Shenyang, People’s Republic of China, Email
| | - En-Hua Wang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, People’s Republic of China
| | - Liang Wang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, People’s Republic of China
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12
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Piton N. Histoséminaire de pathologie oncothoracique : cas no 6. Ann Pathol 2021; 42:160-163. [DOI: 10.1016/j.annpat.2021.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/15/2021] [Indexed: 10/19/2022]
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13
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Liu PP, Su YC, Niu Y, Shi YF, Luo J, Zhong DR. Comparative clinicopathological and immunohistochemical study of micronodular thymoma and micronodular thymic carcinoma with lymphoid stroma. J Clin Pathol 2021; 75:jclinpath-2021-207819. [PMID: 34493600 PMCID: PMC9510435 DOI: 10.1136/jclinpath-2021-207819] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/23/2021] [Indexed: 12/11/2022]
Abstract
AIM To elucidate the clinicopathological and immunohistochemical characteristics of micronodular thymomas (MNTs) and micronodular thymic carcinomas (MNCs) with lymphoid stroma. METHODS We examined four cases of MNTs and three cases of MNCs pathologically and immunohistochemically. RESULTS There were prominent cystic changes infive of the seven cases. The neoplasms contained epithelial tumour cells arranged in a micronodular growth pattern lined by cystic walls and separated by abundant lymphoid stroma. Only the tumour cell component of MNCs showed signs of malignancy characterised by cytological atypia and increased mitotic activity. Neoplastic MNC epithelial cells showed strong positivity for CD5 and CD117. However, no immature lymphocytes (TdT-positive and CD99-positive) were present in and around the tumour nodules. None of the patients died or suffered from disease due to MNTs or MNCs. CONCLUSION MNTs and MNCs are rare and less aggressive forms of thymic tumours and can be differentially diagnosed by immunohistochemistry.
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Affiliation(s)
- Ping Ping Liu
- Department of Pathology, China Japan Friendship Hospital, Beijing, China
| | - Yun Chao Su
- Department of Pathology, China Japan Friendship Hospital, Beijing, China
| | - Yun Niu
- Department of Pathology, China Japan Friendship Hospital, Beijing, China
| | - Yan Fen Shi
- Department of Pathology, China Japan Friendship Hospital, Beijing, China
| | - Jie Luo
- Department of Pathology, China Japan Friendship Hospital, Beijing, China
| | - Ding Rong Zhong
- Department of Pathology, China Japan Friendship Hospital, Beijing, China
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14
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Hulme KR, Mahar A, Cao C, McCaughan B, Cooper WA. Micronodular thymoma with lymphoid stroma: a clinicopathological study of five cases. Pathology 2021; 53:930-933. [PMID: 33947520 DOI: 10.1016/j.pathol.2021.01.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 01/21/2021] [Indexed: 10/21/2022]
Affiliation(s)
- Katherine R Hulme
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Annabelle Mahar
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Christopher Cao
- Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Brian McCaughan
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Sydney Cardiothoracic Surgeons, Royal Prince Alfred Hospital Medical Centre, Sydney, NSW, Australia
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; School of Medicine, Western Sydney University, Sydney, NSW, Australia.
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15
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Yagi H, Nakaguro M, Ito M, Okumura Y, Takahashi S, Aoshima Y, Enomoto Y, Meguro S, Kawasaki H, Kosugi I, Shimoyama Y, Ogawa H, Tateyama H, Iwashita T. Difference in the distribution of tumor-infiltrating CD8+ T cells and FOXP3+ T cells between micronodular thymoma with lymphoid stroma and micronodular thymic carcinoma with lymphoid stroma. Pathol Int 2021; 71:453-462. [PMID: 33819365 PMCID: PMC8359975 DOI: 10.1111/pin.13099] [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: 12/02/2020] [Accepted: 03/14/2021] [Indexed: 11/30/2022]
Abstract
Micronodular thymoma with lymphoid stroma (MNT) is a rare thymic epithelial neoplasm subtype characterized by a micronodular tumor cell growth pattern and abundant lymphoid stroma. Micronodular thymic carcinoma with lymphoid stroma (MNCA) is considered as a malignant counterpart of MNT and exhibits a growth pattern similar to that of MNT but has histologic features reminiscent of thymic squamous cell carcinoma, such as cytologic atypia and CD5 and CD117 immunoexpression. Although both MNT and MNCA are characterized by abundant lymphoid stroma, it remains unknown whether there are differences in infiltrating lymphocytes between MNT and MNCA. We analyzed the immune microenvironment profile in eight MNT and three MNCA cases. The cell density of CD8‐positive T cells was significantly higher in MNT than in MNCA, whereas that of FOXP3‐positive T cells was significantly higher in MNCA than in MNT. There was no significant difference in the cell density of programmed death protein 1‐positive T cells and programmed death ligand 1 expression between the MNT and MNCA cases. Our findings indicated that the immune microenvironment of MNCA differed from that of MNT and, compared with the T‐cell profile of MNT, that of MNCA was more suppressive to patients′ antitumor immune response.
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Affiliation(s)
- Haruna Yagi
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Masato Nakaguro
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Masafumi Ito
- Department of Pathology, Japanese Red Cross, Nagoya First Hospital, Nagoya, Japan
| | - Yuki Okumura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Seishiro Takahashi
- Department of Diagnostic Pathology, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Yoichiro Aoshima
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yasunori Enomoto
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Shiori Meguro
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hideya Kawasaki
- Institute for NanoSuit Research, Preeminent Medical Photonics Education and Research Center, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Isao Kosugi
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Yoshie Shimoyama
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Hiroshi Ogawa
- Department of Diagnostic Pathology, Seirei Mikatahara Hospital, Hamamatsu, Japan
| | - Hisashi Tateyama
- Department of Pathology, Clinical Laboratory, Kasugai Municipal Hospital, Kasugai, Japan
| | - Toshihide Iwashita
- Department of Regenerative and Infectious Pathology, Hamamatsu University School of Medicine, Hamamatsu, Japan
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Bakshi N, Dhawan S, Rao S, Singh Rawat K. Micronodular Thymoma With Lymphoid Stroma: A Trio of Cases, With Diverse-associated Histological Features. Int J Surg Pathol 2021; 29:693-697. [PMID: 33683925 DOI: 10.1177/10668969211001110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction. Micronodular thymoma with lymphoid stroma (MNTLS) is a rare thymoma subtype characterized by distinctive histological appearance, unique clinical profile, and indolent course with good prognosis. In addition to its distinctive morphology, MNTLS may be associated with diverse histological features, such as thymic cysts and conventional thymoma, complicating the diagnostic picture further. Materials and methods. We report herein an account of 3 elderly patients (male-02; female-01), who presented with anterior mediastinal mass, and underwent robotic thymectomy. Microscopic examination revealed MNTLS in all 3 cases. In addition, 2 cases showed associated histological features in the form of a multilocular thymic cyst and conventional (type B2) thymoma, respectively. All 3 patients are doing well without recurrence or metastasis at 34, 28, and 19 months postsurgery. Conclusions. Awareness of this rare thymoma subtype is vital among pathologists to avoid misdiagnosis and ensure appropriate patient management. To date, only a few cases of this rare thymoma subtype have been reported in the literature, mostly as single case reports.
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Affiliation(s)
- Neha Bakshi
- 28928Sir Ganga Ram Hospital, New Delhi, India
| | | | - Seema Rao
- 28928Sir Ganga Ram Hospital, New Delhi, India
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17
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A case of thymoma with type A and micronodular thymoma with lymphoid stroma elements. HUMAN PATHOLOGY: CASE REPORTS 2021. [DOI: 10.1016/j.ehpc.2021.200487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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18
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Thomas de Montpreville V, Mansuet-Lupo A, Le Naoures C, Chalabreysse L, De Muret A, Hofman V, Rouquette I, Piton N, Dubois R, Benitez JC, Girard N, Besse B, Marx A, Molina TJ. Micronodular thymic carcinoma with lymphoid hyperplasia: relevance of immunohistochemistry with a small panel of antibodies for diagnosis-a RYTHMIC study. Virchows Arch 2021; 479:741-746. [PMID: 33629132 DOI: 10.1007/s00428-021-03044-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 01/16/2021] [Accepted: 01/24/2021] [Indexed: 01/05/2023]
Abstract
Micronodular thymic carcinoma with lymphoid hyperplasia (MNTCLH) is a rare form of thymic carcinoma. We present the experience of RYTHMIC, the French national network devoted to the treatment of thymic epithelial tumors through multidisciplinary tumor boards with a review of all tumors by pathologists for classification and staging. Six cases of MNTCLH were diagnosed during a review of 1007 thymic epithelial tumors. Histologically, epithelial cells with atypia and mitoses formed micronodules that were surrounded by an abundant lymphoid background with follicles. There was neither obvious fibro-inflammatory stroma nor necrosis. Spindle cells areas were common. Initial diagnosis was micronodular thymoma in two cases, cellular atypia being overlooked, eclipsed by the micronodular pattern. Immunohistochemistry with a panel of five antibodies showed that cytokeratins (AE1-AE3) and p63-positive epithelial cells also expressed CD5 and that there was no TdT-positive cells within the tumors. CD20 highlighted the lymphoid hyperplasia. Additionally epithelial cells also expressed CD117 and diffusely Glut 1. Twenty-seven micronodular thymomas with lymphoid stroma diagnosed during the same period did not show the CD5 and CD117 positivities seen in MNTCLH and contained TdT-positive lymphocytes. Three of the 6 patients with MNTCLH had adjuvant radiotherapy. Three patients with follow-up information were alive without recurrence at 38, 51, and 95 months. Our study shows that immunohistochemistry, such as that used in the RYTHMIC network with a small panel of antibodies, may easily help to confirm the correct diagnosis of MNTCLH, a rare and low-aggressive form of thymic carcinoma, and avoid the misdiagnosis of micronodular thymoma.
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Affiliation(s)
- Vincent Thomas de Montpreville
- Department of Pathology, Marie Lannelongue Hospital, Hôpital Marie Lannelongue, 133 avenue de la Résistance, 92350, Le Plessis Robinson, France.
| | | | | | | | - Anne De Muret
- Département de Pathologie, CHU de Tours, Tours, France
| | - Véronique Hofman
- Hôpital Pasteur, Laboratoire de Pathologie Clinique et Expérimentale, CHU de Nice, Nice, France
| | | | - Nicolas Piton
- Département de Pathologie, CHU de Rouen, Rouen, France
| | - Romain Dubois
- Département de Pathologie, CHU de Lille, Lille, France
| | | | | | - Benjamin Besse
- Département de Médecine, Institut Gustave Roussy, Villejuif, France
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, Mannheim, Germany
| | - Thierry Jo Molina
- Department of Pathology, AP-HP.5, University of Paris, Paris, France
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Isono T, Wakasa T, Kusumoto H, Shimada K, Ogawa T, Shiono H. SS-A52 antigen expression in thymic carcinoma accompanied with Sjögren syndrome: A case report. Medicine (Baltimore) 2021; 100:e24491. [PMID: 33592902 PMCID: PMC7870235 DOI: 10.1097/md.0000000000024491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/07/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE The relationship between thymic tumors and Sjögren syndrome (SjS) is unknown, and surgical resection has not been optimized. Especially, thymic carcinoma with autoimmune disease is rare. Analysis of SS-A52, germinal centers, plasma cells, and Foxp3+ Treg in thymic carcinoma has never been reported, and their pathological roles in causing SjS have not been studied. PATIENT CONCERNS A 78-year-old man presented with sputum production and xerostomia while asleep. Chest computed tomography showed a homogeneous and hypodense mass in the anterosuperior mediastinum. Serum levels of the antinuclear antibody, antibody to SS-A, and antibody to SS-B were positive. DIAGNOSES Thymic carcinoma (squamous cell carcinoma) and SjS. INTERVENTIONS Video-assisted thoracoscopic resection of the mediastinal tumor and postoperative radiation therapy was performed. OUTCOMES The histological diagnosis was thymic squamous cell carcinoma. Histologically, the squamous carcinomatous cells were arranged in nests and cords in the fibrohyaline stroma with capsular invasion. In the stroma, dense lymphoid tissues containing large reactive germinal centers and many plasma cells were also noted. In the involuted thymus, CD20-positive mature lymphocytes infiltrated, and germinal centers were noted. Double immunohistochemical staining revealed that SS-A52 antigen was positive in both the carcinoma component and CD20-positive mature B cells. Postoperatively, the xerostomia persisted, and serum SS-A and SS-B remained positive. No evidence of carcinoma recurrence with chest computed tomography scan was observed at 18-months follow-up. LESSONS In the surgical treatment of thymic tumors with SjS, extended thymectomy might be worth considering to stop the progressive destruction of the targets of SjS-specific autoantibodies. However, the postoperative symptoms may not dramatically improve because the target organs might have changed irreversibly, and memory B cells might persist. This is the first report that demonstrated the SS-A52 antigen presentation in a thymic tumor to the best of our knowledge.
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Affiliation(s)
| | - Tomoko Wakasa
- Department of Diagnostic Pathology, Kindai University Nara Hospital, Ikoma
| | | | - Keiji Shimada
- Department of Diagnostic Pathology, Nara City Hospital, Nara
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20
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[Thymoma and squamous thymic carcinoma diagnosis; experience from the RYTHMIC network]. Ann Pathol 2020; 41:154-165. [PMID: 33309329 DOI: 10.1016/j.annpat.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 10/10/2020] [Accepted: 11/11/2020] [Indexed: 11/23/2022]
Abstract
The RYTHMIC network, supported by the French National Cancer Institute is dedicated to the management of patients with thymic epithelial tumors through regional and national multidisciplinary tumor boards. Tumor board decisions are based on the initial pathology diagnoses. However, following clinical inclusion in the network, a central pathology review is organized, implicating a panel of pathologists, for histotype and stage classification, which is different from a classical second opinion from pathologist to pathologist for a difficult case. Thanks to the participation of all French pathologists, more than 1000 cases have been reviewed by the panel. The aim of this review is to share with the French pathology community, the experience of the group. It underlines the importance of macroscopy and surgeon-pathologist involvement to allow a good central review, the main histopathological and immunophenotypical patterns of the most frequent thymomas and thymic carcinoma types, the differential diagnoses, as well as the difficulties for the panel to reproducibly assess on slides, stage, for some cases.
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21
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Oramas DM, Moran CA. Micronodular Thymomas With Prominent Cystic Changes: A Clinicopathological and Immunohistochemical Study of 25 Cases. Int J Surg Pathol 2020; 29:352-357. [PMID: 33026263 DOI: 10.1177/1066896920963803] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twenty-five cases of micronodular thymomas with prominent cystic changes are presented. The patients are 13 men and 12 women between the ages of 38 and 69 years. Clinically, the majority of patients presented with nonspecific symptoms of cough, chest pain, and dyspnea. Four patients were asymptomatic. Diagnostic imaging showed the presence of an anterior mediastinal mass and surgical resection of the tumor mass was performed in all the patients. Histologically, all the tumors were characterized by the presence of cystic structures of varying sizes lined by different types of epithelium. In addition, the tumors were characterized by nodules of epithelial cells embedded in a lymphocyte-rich stroma with germinal centers. Twenty-one tumors were encapsulated while 4 tumors were minimally invasive. Immunohistochemical stains were positive for keratin in the nodular epithelial component while CD45 and CD20 were positive in the lymphoid component. Clinical follow-up ranging from 12 to 24 months was obtained in 19 patients. All the patients were alive and well without disease. No clinical follow-up was available in 6 patients. The cases presented in this article highlight the existence of cystic micronodular thymomas, which can be easily misdiagnosed as a multilocular thymic cyst.
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Affiliation(s)
- Diana M Oramas
- 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cesar A Moran
- 4002The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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22
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Szolkowska M, Szczepulska-Wojcik E, Maksymiuk B, Burakowska B, Winiarski S, Gatarek J, Rudzinski P, Orlowski T, Langfort R. Primary mediastinal neoplasms: a report of 1,005 cases from a single institution. J Thorac Dis 2019; 11:2498-2511. [PMID: 31372287 PMCID: PMC6626773 DOI: 10.21037/jtd.2019.05.42] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 04/25/2019] [Indexed: 01/21/2023]
Abstract
BACKGROUND This study was an epidemiological analysis of all primary mediastinal neoplasms (PMNs) diagnosed between 2000 and 2016 at the National Tuberculosis and Lung Diseases Research Institute, Poland. METHODS All patients with any mediastinal abnormality were included in the analysis. The patients' age and gender were obtained from the institutional database. RESULTS From a cohort of 5,108 patients, 3,691 primary mediastinal lesions were found, including 1,005 (19%) PMNs: lymphomas (533, 53% of PMNs), thymomas (215, 21%), neurogenic tumors (NTs) (100, 10%), germ cell tumors (GCTs) (62, 6%), soft tissue tumors (STTs) (47, 5%) and thymic carcinomas/thymic neuroendocrine tumors (TCs/TNETs) (37 in total, 4%). The most frequent lymphomas were classical Hodgkin lymphomas [256] and primary mediastinal large B-cell lymphomas [163]. Type AB [73] predominated in thymomas and squamous cell carcinomas [9] and carcinoids [10] in TCs/TNETs. NTs encompassed mainly schwannomas [49], ganglioneuromas [21] and neurofibromas [10]. The most frequent STTs were hemangiomas [13] and lymphangiomas [11]. Lymphomas, thymomas and NT were more often in women, TCs/TNETs in men (P<0.001). Lymphomas predominated between the 2nd and 4th decade of life, NTs under the 3rd decade and thymic epithelial tumors between the 6th and 8th decade (P<0.001). There was no correlation between the subtypes of thymomas and the patients' gender (P=0.389) but it was found between histology and patients' age: in patients <30 years of age type B2 and B3 thymomas and >70 years of age AB type and micronodular thymomas with lymphoid stroma (P<0.001) predominated. In the group of GCTs half of them were malignant and these were noted exclusively in men. No correlation between subtypes of NTs or TCs/TNETs and patients' age and gender was found (P>0.05). CONCLUSIONS PMNs are rare conditions thus awareness of basic epidemiology may be very helpful for final diagnosis.
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Affiliation(s)
- Malgorzata Szolkowska
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Ewa Szczepulska-Wojcik
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Beata Maksymiuk
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Barbara Burakowska
- Department of Radiology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Sebastian Winiarski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Juliusz Gatarek
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Piotr Rudzinski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Tadeusz Orlowski
- Clinics of Surgery, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| | - Renata Langfort
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
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Kaminuma Y, Tanahashi M, Yukiue H, Suzuki E, Yoshii N, Fujino T, Ogawa H, Niwa H. Micronodular thymoma with lymphoid stroma diagnosed 10 years after the first operation: a case report. J Med Case Rep 2019; 13:69. [PMID: 30876482 PMCID: PMC6420736 DOI: 10.1186/s13256-019-2006-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 02/04/2019] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Micronodular thymoma with lymphoid stroma is a rare subtype of thymoma. Here we report a case of micronodular thymoma with lymphoid stroma that was completely resected after incomplete resection 10 years earlier. CASE PRESENTATION A 70-year-old Japanese woman who had undergone resection for a thymic cyst 10 years earlier was found to have a solid nodule with a multilocular lesion at the site of the previous operation. We suspected that the tumor was a malignant tumor and performed trans-sternal radical thymectomy and diagnosed the lesion as micronodular thymoma with lymphoid stroma pathologically. When we reassessed the thymic cyst that had been resected 10 years earlier, a few lesions of micronodular thymoma with lymphoid stroma were found in the cyst wall. Based on these findings, we concluded that only the cystic component of micronodular thymoma with lymphoid stroma had been removed, and that the residual lesion grew locally over the next 10 years before being completely resected by reoperation. CONCLUSION We experienced an unusual case of micronodular thymoma with lymphoid stroma, which is a rare subtype of thymoma. Greater care should be taken to exclude a thymoma with a cystic lesion, even if a thymic cyst is strongly suspected on computed tomography and magnetic resonance imaging.
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Affiliation(s)
- Yasunori Kaminuma
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan.
| | - Masayuki Tanahashi
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Haruhiro Yukiue
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Eriko Suzuki
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Naoko Yoshii
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Toshio Fujino
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Hiroshi Ogawa
- Department of Pathology, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
| | - Hiroshi Niwa
- Division of Thoracic Surgery, Respiratory Disease Center, Seirei Mikatahara General Hospital, 3453, Mikatahara-cho, Kita-ku Hamamatsu, Shizuoka, Japan
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24
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Wang R, Nie L. Mixed Type A Thymoma and Micronodular Thymoma With Lymphoid Stroma. Int J Surg Pathol 2017; 26:336-337. [PMID: 29161955 DOI: 10.1177/1066896917742723] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Renqing Wang
- 1 The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
| | - Ling Nie
- 1 The Affiliated Drum Tower Hospital, Nanjing University, Nanjing, Jiangsu Province, China
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25
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Qu L, Xiong Y, Yao Q, Zhang B, Li T. Micronodular thymoma with lymphoid stroma: Two cases, one in a multilocular thymic cyst, and literature review. Thorac Cancer 2017; 8:734-740. [PMID: 28941195 PMCID: PMC5668509 DOI: 10.1111/1759-7714.12517] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2017] [Revised: 08/23/2017] [Accepted: 08/24/2017] [Indexed: 12/28/2022] Open
Abstract
Micronodular thymoma with lymphoid stroma (MTWLS) is a rare type of thymoma that shows a similar pattern but varied morphology and immunophenotype of tumor cells. Because of the extremely limited number of cases reported, the pathology and biology of MTWLS are equivocal. Herein, we report two cases located in the anterior mediastinum: Case 1: a 58‐year‐old woman with a cystic mass measuring 5 × 3.0 × 2.5 cm in Mosaoka stage I; and Case 2: a 50‐year‐old man with a solid mass measuring 2.5 × 2.5 × 2.0 cm in stage IIb. Both patients were treated by thymectomy and are alive without recurrence or metastasis 15 and 17 months after surgery, respectively. Regardless of the spectrum of pathology and stage of MTWLS, this unique type of thymoma has a homogeneously favorable prognosis.
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Affiliation(s)
- Linlin Qu
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Yan Xiong
- Department of Pathology, Peking University First Hospital, Beijing, China
| | - Qian Yao
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Bo Zhang
- Department of Pathology, Peking University Third Hospital, Beijing, China
| | - Ting Li
- Department of Pathology, Peking University First Hospital, Beijing, China
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26
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Phenotypic variation of thymic epithelial cells and partial spontaneous regression in thymoma of a cow. ACTA ACUST UNITED AC 2017. [DOI: 10.1007/s00580-017-2557-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Abstract
Thymic carcinomas (TC) are approximately 10 times less prevalent than thymomas but of high clinical relevance because they are more aggressive, less frequently resectable than thymomas and usually refractory to classical and targeted long-term treatment approaches. Furthermore, in children and adolescents TC are more frequent than thymomas and particularly in this age group, germ cell tumors need to be a differential diagnostic consideration. In diagnostic terms pathologists face two challenges: a), the distinction between thymic carcinomas and thymomas with a similar appearance and b), the distinction between TC and histologically similar metastases and tumor extensions from other primary tumors. Overcoming these diagnostic challenges is the focus of the new WHO classification of thymic epithelial tumors. The objectives of this review are to highlight novel aspects of the WHO classification of thymic carcinomas and to address therapeutically relevant diagnostic pitfalls.
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Yu M, Meng Y, Xu B, Zhao L, Zhang Q. Ectopic micronodular thymoma with lymphoid stroma in the cervical region: a rare case associated with Langerhans cells proliferation. Onco Targets Ther 2016; 9:4317-22. [PMID: 27486334 PMCID: PMC4958359 DOI: 10.2147/ott.s110802] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Micronodular thymoma (MNT) with lymphoid stroma is a rare thymic epithelial neoplasm with the characteristics of multiple nodules separated by abundant lymphoid stroma. MNTs mainly arise in the anterior mediastinum and thymus, while ectopic MNTs are extremely rarely seen. Here, we report an ectopic MNT that occurred in the neck of a 62-year-old woman. There were also scattered eosinophilic granulocytes and S100+/CD1a+ Langerhans cells within the tumor. This case provides a better understanding of such rare, poorly understood cases.
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Affiliation(s)
- Min Yu
- Department of Cell Biology, Key Laboratory of Cell Biology, Ministry of Public Health, and Key Laboratory of Medical Cell Biology, Ministry of Education, China Medical University, Shenyang, People's Republic of China
| | - Yuan Meng
- Department of Pathology, Fushun Central Hospital, Fushun, People's Republic of China
| | - Bin Xu
- Department of Pathology, Fushun Central Hospital, Fushun, People's Republic of China
| | - Lin Zhao
- Second Department of Medical Oncology, The General Hospital of Fushun Mining Bureau, Fushun, People's Republic of China
| | - Qingfu Zhang
- Department of Pathology, College of Basic Medical Sciences, China Medical University, Shenyang, People's Republic of China
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