1
|
Quevedo R, Garcia S, Cravero JC, Horton A, Berger B, Aguirre RI. Thymic Adenocarcinoma With Metastasis to the Left Orbit: A Case Report. Cureus 2024; 16:e56139. [PMID: 38618298 PMCID: PMC11015354 DOI: 10.7759/cureus.56139] [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] [Accepted: 03/12/2024] [Indexed: 04/16/2024] Open
Abstract
We present the case of a 57-year-old female who initially presented with a chief complaint of left-sided orbital headaches and associated left eyelid swelling. Initial imaging work-up with CT head/orbit revealed soft tissue enhancement of the left orbital roof, concerning for neoplastic process (primary lymphoma versus extracranial primary tumor versus metastatic tumor). Further imaging studies with CT chest/abdomen/pelvis revealed an anterior mediastinal mass, concerning for possible thymoma versus lymphoma. The patient underwent further consultation with the Hematology/Oncology and Ophthalmology Departments, which recommended definitive biopsies from both sites, which showed matching histologic findings of moderately differentiated enteric-type adenocarcinoma with positive staining for CDX2, an intestinal marker. Thymic carcinomas are rare cancers that account for approximately 0.06% of all malignancies and require a high degree of clinical suspicion. Extrathoracic metastases from thymic carcinomas, especially to the orbit, is a rare occurrence and the exact incidence of this phenomenon is unknown. This case represents the diagnostic challenges associated with a rare cancer type and underscores the importance of a multidisciplinary approach to patient care.
Collapse
Affiliation(s)
- Renata Quevedo
- Internal Medicine, Tecnologico de Monterrey, Monterrey, MEX
| | - Sebastian Garcia
- Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - John C Cravero
- Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Andrew Horton
- Pathology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Blaine Berger
- Pathology, Baylor Scott & White Medical Center - Temple, Temple, USA
| | - Roberto I Aguirre
- Internal Medicine, Baylor Scott & White Medical Center - Temple, Temple, USA
| |
Collapse
|
2
|
Gao X. Systemic chemotherapy for unresectable or recurrent primary thymic adenocarcinoma of enteric type. Int Cancer Conf J 2023; 12:46-48. [PMID: 36605837 PMCID: PMC9807699 DOI: 10.1007/s13691-022-00575-6] [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: 06/06/2022] [Accepted: 08/30/2022] [Indexed: 01/09/2023] Open
Abstract
Primary thymic adenocarcinoma of enteric type is a very rare subtype of thymic carcinoma. Choosing appropriate systemic chemotherapy for patients with unresectable or recurrent disease remain a big challenge. We present a case of 38-year-old man with primary thymic adenocarcinoma of enteric type. The patient received multiline chemotherapy. Metastatic lesions were effectively controlled by FOLFOX (oxaliplatin/5-fluorouracil/leucovorin) chemotherapy. According to the present case and the literature review, FOLFOX and XELOX (capecitabine/oxaliplatin) regimens are reasonable treatment choice for unresectable or recurrent primary thymic adenocarcinoma of enteric type, even in the first-line chemotherapy.
Collapse
Affiliation(s)
- Xiaofang Gao
- Department of Lung Cancer, Beijing Arion Cancer Center, Youlong Road 3A, Daxing District, Beijing, 100070 China
| |
Collapse
|
3
|
Suster DI, Mejbel H, Mackinnon AC, Suster S. Desmoplastic Adamantinoma-like Thymic Carcinoma: Clinicopathologic, Immunohistochemical, and Molecular Study of 5 Cases. Am J Surg Pathol 2022; 46:1722-1731. [PMID: 35993584 DOI: 10.1097/pas.0000000000001947] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Five cases of a heretofore unreported rare variant of thymic carcinoma characterized by a striking resemblance to adamantinoma of the mandible are described. The tumors occurred in 4 women and 1 man aged 58 to 76 years (mean: 67.8 y); they arose in the anterior mediastinum and measured from 5.3 to 12.0 cm in greatest diameter (mean: 8.9 cm). Presenting symptoms included chest pain, shortness of breath, and in 2 patients, pleural effusion. One tumor was asymptomatic and discovered incidentally. Histologically, the tumors were extensively desmoplastic, and the cellular proliferation was characterized by multiple islands of squamous epithelium with striking peripheral palisading of nuclei and central areas containing clear cells resembling a stellate reticulum. Areas of preexisting spindle cell thymoma were identified in 2 cases; these areas gradually merged with the higher-grade component of the lesion. Cystic changes were noted in 3 cases. Immunohistochemical studies in 3 cases showed the tumor cells were positive for cytokeratins, p40 and p63, and all showed a high proliferation rate (>50% nuclear positivity) with Ki-67. Next-generation sequencing was performed in 2 cases that showed amplification of the AKT1 gene (copy numbers 6 and 13). Clinical follow-up in 3 patients showed recurrence and metastasis after 1 and 2 years; 1 patient passed away 2 years after diagnosis due to the tumor. Desmoplastic adamantinoma-like thymic carcinoma represents an unusual histologic variant of thymic carcinoma that needs to be distinguished from metastases from similar tumors to the mediastinum.
Collapse
Affiliation(s)
- David I Suster
- Department of Pathology, Rutgers University New Jersey Medical School, Newark, NJ
| | - Haider Mejbel
- Department of Pathology, University of Alabama at Birmingham, Birmingham, AL
| | | | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
| |
Collapse
|
4
|
Alqaidy D, Moran CA. Thymic Carcinoma: A Review. Front Oncol 2022; 12:808019. [PMID: 35463355 PMCID: PMC9024054 DOI: 10.3389/fonc.2022.808019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/10/2022] [Indexed: 11/16/2022] Open
Abstract
The diagnosis of thymic carcinoma may pose significant problems not necessarily in the histopathological diagnosis but rather in assigning the thymus as specific origin. Often the tissue available for interpretation is obtained via a mediastinocopic biopsy, which raises two different issues -minimal tissue and lack of specific features to make a carcinoma of thymic origin. In addition, if to that conundrum we add that there is no magic immunohistochemical stain that will unequivocally lead to the interpretation of thymic carcinoma, then we are left with a true clinical-radiological-pathological correlation. In this review, we will highlight some of those challenges that diagnostic surgical pathologists may encounter in the histopathological assessment of thymic carcinoma as well as in the staging of these tumors.
Collapse
Affiliation(s)
- Doaa Alqaidy
- Department of Pathology and Laboratory Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Cesar A. Moran
- Department of Pathology, MD Anderson Cancer Center, University of Texas, Houston, TX, United States
- *Correspondence: Cesar A. Moran,
| |
Collapse
|
5
|
Hamanaka R, Nakano K, Tsuboi T, Hatanaka K, Kohno M, Masuda R, Iwazaki M. Enteric-type thymic adenocarcinoma: a case report and literature review focusing on prognosis based on histological subtypes. Gen Thorac Cardiovasc Surg 2022; 70:501-505. [DOI: 10.1007/s11748-022-01779-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 01/19/2022] [Indexed: 11/30/2022]
|
6
|
Marx A, Chan JKC, Chalabreysse L, Dacic S, Detterbeck F, French CA, Hornick JL, Inagaki H, Jain D, Lazar AJ, Marino M, Marom EM, Moreira AL, Nicholson AG, Noguchi M, Nonaka D, Papotti MG, Porubsky S, Sholl LM, Tateyama H, Thomas de Montpréville V, Travis WD, Rajan A, Roden AC, Ströbel P. The 2021 WHO Classification of Tumors of the Thymus and Mediastinum: What Is New in Thymic Epithelial, Germ Cell, and Mesenchymal Tumors? J Thorac Oncol 2021; 17:200-213. [PMID: 34695605 DOI: 10.1016/j.jtho.2021.10.010] [Citation(s) in RCA: 115] [Impact Index Per Article: 38.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 01/12/2023]
Abstract
This overview of the fifth edition of the WHO classification of thymic epithelial tumors (including thymomas, thymic carcinomas, and thymic neuroendocrine tumors [NETs]), mediastinal germ cell tumors, and mesenchymal neoplasms aims to (1) list established and new tumor entities and subtypes and (2) focus on diagnostic, molecular, and conceptual advances since publication of the fourth edition in 2015. Diagnostic advances are best exemplified by the immunohistochemical characterization of adenocarcinomas and the recognition of genetic translocations in metaplastic thymomas, rare B2 and B3 thymomas, and hyalinizing clear cell carcinomas. Advancements at the molecular and tumor biological levels of utmost oncological relevance are the findings that thymomas and most thymic carcinomas lack currently targetable mutations, have an extraordinarily low tumor mutational burden, but typically have a programmed death-ligand 1high phenotype. Finally, data underpinning a conceptual advance are illustrated for the future classification of thymic NETs that may fit into the classification scheme of extrathoracic NETs. Endowed with updated clinical information and state-of-the-art positron emission tomography and computed tomography images, the fifth edition of the WHO classification of thymic epithelial tumors, germ cell tumors, and mesenchymal neoplasms with its wealth of new diagnostic and molecular insights will be a valuable source for pathologists, radiologists, surgeons, and oncologists alike. Therapeutic perspectives and research challenges will be addressed as well.
Collapse
Affiliation(s)
- Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, Heidelberg University, Mannheim, Germany.
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong SAR, People's Republic of China
| | - Lara Chalabreysse
- Department of Pathology, Groupement Hospitalier Est, Bron Cedex Lyon, France
| | - Sanja Dacic
- Department of Pathology, University Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Frank Detterbeck
- Department of Surgery, Yale University School of Medicine, New Haven, Connecticut
| | - Christopher A French
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jason L Hornick
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hiroshi Inagaki
- Department of Pathology and Molecular Diagnostics, Nagoya City University, Nagoya, Japan
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alexander J Lazar
- Department of Pathology and Genomic Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Mirella Marino
- Department of Pathology, Istituto di Ricovero e Cura a Carattere Scientifico Regina Elena National Cancer Institute, Rome, Italy
| | - Edith M Marom
- Department of Diagnostic Imaging, Chaim Sheba Medical Center, affiliated with Tel Aviv University, Ramat Gan, Israel
| | - Andre L Moreira
- Department of Pathology, New York University Langone Health, New York, New York
| | - Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield Hospitals and National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Masayuki Noguchi
- Department of Diagnostic Pathology, University of Tsukuba, Tsukuba-shi, Japan
| | - Daisuke Nonaka
- Department of Cellular Pathology, Guy's and St Thomas' NHS Foundation Trust, St Thomas' Hospital, London, United Kingdom
| | | | - Stefan Porubsky
- Department of Pathology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany
| | - Lynette M Sholl
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Hisashi Tateyama
- Department of Pathology, Kasugai Municipal Hospital, Kasugai, Japan
| | | | - William D Travis
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic Rochester, Rochester, Minnesota
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center Göttingen, Göttingen, Germany
| |
Collapse
|
7
|
Hamahiro T, Maeda R, Ayabe T, Sato Y, Tomita M. Primary mucinous adenocarcinoma of the thymus: A case report. Respir Med Case Rep 2021; 34:101497. [PMID: 34430195 PMCID: PMC8371243 DOI: 10.1016/j.rmcr.2021.101497] [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: 06/23/2021] [Revised: 07/26/2021] [Accepted: 08/10/2021] [Indexed: 01/31/2023] Open
Abstract
Primary thymic mucinous adenocarcinoma is extremely rare; to our knowledge, only 16 cases have been reported to date. A 68-year-old man presented to a previous hospital due to massive pericardial effusion. Cytological examination of the pericardial effusion revealed the presence of adenocarcinoma, and computed tomography showed an anterior mediastinal mass lesion invading the pericardium. Because systemic examination failed to detect other lesions, except for liver metastasis, mediastinal lymph node swelling, and pleural dissemination, a thoracoscopic biopsy of the mediastinal and pleural tumor was performed. The pathological diagnosis was thymic mucinous adenocarcinoma. Although he received chemotherapy, he died due to cancer 6 months after the biopsy.
Collapse
Affiliation(s)
- Tomoka Hamahiro
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, 889-1692, Japan
| | - Ryo Maeda
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, 889-1692, Japan
| | - Takanori Ayabe
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, 889-1692, Japan
| | - Yuichiro Sato
- Department of Pathology, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, 889-1692, Japan
| | - Masaki Tomita
- Department of Thoracic and Breast Surgery, Faculty of Medicine, University of Miyazaki, Kihara 5200, Kiyotake, Miyazaki, 889-1692, Japan
| |
Collapse
|
8
|
Tomoshige K, Tomoshi T, Keitaro M, Miyazaki T, Doi R, Machino R, Mizoguchi S, Matumoto T, Maeda Y, Nagayasu T. Primary mucinous adenocarcinoma of the thymus; a rare type of thymic carcinoma. Case Report. SN COMPREHENSIVE CLINICAL MEDICINE 2021; 3:1233-1237. [PMID: 34151190 PMCID: PMC8211018 DOI: 10.1007/s42399-021-00839-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Mucinous adenocarcinoma of the thymus is a particularly rare type among thymic carcinomas. Here, we report a patient who underwent complete surgical resection of the primary mucinous adenocarcinoma of the thymus. She was 74 years old and presented with a 60-mm multilocular cystic tumor in her right anterior mediastinum. We performed extended thymo-thymectomy with partial resection of the right upper lobe and pathologically diagnosed the patient with Masaoka stage II mucinous adenocarcinoma of the thymus. Immunohistochemistry showed the absence of PD-L1, suggesting that immune check point inhibitors targeting PD-1/PD-L1 might not be effective in this case. The increased preoperative serum levels of CA19-9 decreased after the operation. CA19-9 is a biomarker for disease status. Future reports should help elucidate the pathogenesis of this disease.
Collapse
Affiliation(s)
- Koichi Tomoshige
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Tsuchiya Tomoshi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Matsumoto Keitaro
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Takuro Miyazaki
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Ryoichiro Doi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Ryusuke Machino
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Satoshi Mizoguchi
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Takamune Matumoto
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| | - Yutaka Maeda
- Perinatal Institute, Divisions of Neonatology, Perinatal and Pulmonary Biology, Cincinnati Children’s Hospital Medical Center and the University of Cincinnati College of Medicine, Cincinnati, OH 45229, USA
| | - Takeshi Nagayasu
- Department of Surgical Oncology, Nagasaki University Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
| |
Collapse
|
9
|
Zheng YW, Bai LL, Jiang GY, Lin XY, Liu Y, Xu HT. Thymic adenocarcinoma accompanied by type A thymoma and pulmonary minimally invasive adenocarcinoma and harboring distinct gene alterations: A case report. Medicine (Baltimore) 2021; 100:e25254. [PMID: 33847622 PMCID: PMC8052068 DOI: 10.1097/md.0000000000025254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2021] [Revised: 02/23/2021] [Accepted: 03/04/2021] [Indexed: 01/04/2023] Open
Abstract
RATIONALE Thymic adenocarcinoma is an extremely rare thymic carcinoma. The exact genetic alteration associated with thymic adenocarcinoma is unclear. Here, we report a case of thymic adenocarcinoma accompanied by type A thymoma and pulmonary minimally invasive adenocarcinoma (MIA). PATIENT CONCERNS A 53-year-old woman presented with multiple nodules in the mediastinum and lung. Thoracic computed tomography revealed nodules in the anterior superior mediastinum and anterior mediastinum near the right pericardium and ground-glass opacity (GGO) in the right superior lobe of the lung. DIAGNOSIS The tumor in the anterior superior mediastinum was diagnosed as primary thymic papillary adenocarcinoma. The tumor in the anterior mediastinum near the right pericardium was diagnosed as type A thymoma. The GGO of the right superior lobe of the lung was diagnosed as a MIA. INTERVENTION The patient underwent thoracoscopic mediastinal tumor resection and partial lobectomy in our hospital. OUTCOMES The postoperative course was uneventful. The patient is alive and free of the disease for 22 months after diagnosis. LESSONS Thyroid transcription factor 1 (TTF-1) was positive in this case of thymic adenocarcinoma, which indicated that a thymic adenocarcinoma with TTF-1-positive may not necessarily be a metastasis of lung or thyroid adenocarcinoma. The positive staining of CD5 and CD117 can help us to confirm the thymic origin. Molecular genetic analysis indicated that these tumors harbored different mutations. The thymic adenocarcinoma and type A thymoma both had the mutation of KMT2A, but the mutation sites were different. KMT2A mutation may be a common genetic change in thymic tumorigenesis. The genetic alterations disclosed in this study will help expand the understanding of thymic tumors.
Collapse
Affiliation(s)
- Yi-Wen Zheng
- Department of Pathology, the First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang
| | - Lin-Lin Bai
- Department of Pathology, Shenyang 242 Hospital, Shenyang, China
| | - Gui-Yang Jiang
- Department of Pathology, the First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang
| | - Xu-Yong Lin
- Department of Pathology, the First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang
| | - Yang Liu
- Department of Pathology, the First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang
| | - Hong-Tao Xu
- Department of Pathology, the First Hospital and College of Basic Medical Sciences, China Medical University, Shenyang
| |
Collapse
|
10
|
Li M, Pu XY, Dong LH, Chang PY. Metastatic thymic-enteric adenocarcinoma responding to chemoradiation plus anti-angiogenic therapy: A case report. World J Clin Cases 2021; 9:1676-1681. [PMID: 33728312 PMCID: PMC7942030 DOI: 10.12998/wjcc.v9.i7.1676] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 12/26/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Thymic-enteric adenocarcinoma with positive expression of CDX2 and CK20 is rare in adults, with only 16 reported cases. However, standard treatment options for this type of thymic adenocarcinoma has not yet been established. Therefore, we report a case of stage IV thymic-enteric adenocarcinoma treated with radiotherapy, chemotherapy, and anti-angiogenesis therapy.
CASE SUMMARY We report a case of thymic-enteric adenocarcinoma occurring in a 44-year-old woman. The tumor was considered unresectable owing to its invasiveness. The patient was treated with six cycles of oxaliplatin (130 mg/m2, day 1) and capecitabine (1000 mg/m2 BID, days 1-14). During the first three cycles of chemotherapy, concurrent radiotherapy (60 Gy/30 fractions) and anti-angiogenic therapy using apatinib were recommended. The primary tumor achieved partial remission based on the Response Evaluation Criteria in Solid Tumors. During follow-up, there was no evidence of disease relapse, except a high serum CA19-9 level. The patient is alive and regularly followed. Based on the previous literature and the present case, we believe that early diagnosis of thymic-enteric adenocarcinoma is important.
CONCLUSION XELOX (capecitabine plus oxaliplatin) combined with radiotherapy is an optional therapy for inoperable thymic-enteric adenocarcinoma.
Collapse
Affiliation(s)
- Man Li
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Xiao-Yu Pu
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Li-Hua Dong
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| | - Peng-Yu Chang
- Department of Radiation Oncology, The First Hospital of Jilin University, Changchun 130021, Jilin Province, China
| |
Collapse
|
11
|
Roden AC, Szolkowska M. Common and rare carcinomas of the thymus. Virchows Arch 2021; 478:111-128. [PMID: 33389148 DOI: 10.1007/s00428-020-03000-6] [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] [Received: 09/02/2020] [Revised: 12/04/2020] [Accepted: 12/14/2020] [Indexed: 12/15/2022]
Abstract
Thymic carcinoma encompasses a diverse group of rare tumors that occur almost exclusively in the prevascular (anterior) mediastinum. Thymic carcinomas have a worse outcome than thymomas with a median time to death of under 3 years. These tumors lack the typical lobulation of thymomas, exhibit commonly more cytologic atypia, are associated with a desmoplastic stromal reaction, and lack thymocytes, features that distinguish them from thymomas. The most common thymic carcinoma is squamous cell carcinoma; other subtypes include mucoepidermoid carcinoma, NUT carcinoma, and adenocarcinoma, among others. Largely due to multi-institutional and global efforts and meta-analysis of case reports and series, some of the thymic carcinoma subtypes have been studied in more detail and molecular studies have also been performed. Morphology and immunophenotype for the vast majority of thymic carcinoma subtypes are similar to their counterparts in other organs. Therefore, the distinction between thymic carcinoma and metastatic disease, which is relatively common in the prevascular mediastinum, can be challenging and in general requires clinical and radiologic correlation. Although surgical resection is the treatment of choice, only 46 to 68% of patients with thymic carcinoma can undergo resection as many other tumors present at high stage with infiltration into vital neighboring organs. These patients are usually treated with chemotherapy and/or radiation. The search for better biomarkers for prognosis and treatment of thymic carcinomas is important for improved management of these patients and possible targeted therapy.
Collapse
Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine & Pathology, Mayo Clinic Rochester, Hilton 11, 200 First St SW, Rochester, MN, 55905, USA.
| | - Malgorzata Szolkowska
- Department of Pathology, The National Tuberculosis and Lung Diseases Research Institute, Warsaw, Poland
| |
Collapse
|
12
|
Conforti F, Tarantino P, Trillo P, Pala L, Zagami P, Pirola S, Di Venosa B, Catania C, Queirolo P, Pennacchioli E, Della Vigna P, Curigliano G, De Pas TM. Pathological and clinical features of enteric adenocarcinoma of the thymus. A pooled analysis of cases from a reference center and systematic review of the literature. Cancer Treat Rev 2020; 92:102133. [PMID: 33296826 DOI: 10.1016/j.ctrv.2020.102133] [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: 09/08/2020] [Revised: 10/28/2020] [Accepted: 11/16/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Primary enteric adenocarcinoma of the thymus (EAT) is a recently proposed rare subtype of thymic carcinoma. Unlike thymic carcinomas with squamous histology, for which clinical guidelines are available, little knowledge is available regarding the clinical and pathological features of EAT, and there is no consensus on the best treatment algorithm for such tumors. METHODS We performed a systematic review of the literature, searching for all cases of EAT reported. We also retrospectively reviewed all cases of EAT treated at the European Institute of Oncology (IEO) between January 2000 and January 2020. Individual patient data were extracted and analyzed in order to delineate clinical and pathological features, as well as patients' prognosis and treatments outcome, evaluated in terms of Disease free Survival (DFS), Progression free survival (PFS) and overall survival (OS). RESULTS Thirty-three cases (29 reported in literature and 4 new cases treated at IEO) of thymic adenocarcinoma deploying enteric differentiation as defined by WHO-criteria were analyzed. All tumors showed positive immunoreactivity for cytokeratin (CK) 20 and/or caudal type homeobox 2 (CDX2). Data on molecular profiling by next-generation sequencing were available in only 3 cases, and did not show actionable findings. At diagnosis, 11 pts had an early-stage (Masaoka I-II) and 22 a locally advanced (10 pts) or metastatic (12 pts) disease. Median-DFS of patients with localized disease was 12 months (95% CI, 7-19). Patients who received systemic chemotherapy were mostly treated with regimens commonly used for thymic epithelial tumors, with a discouraging PFS of 3-5 months for patients with stage IV disease. Median OS of the whole population was 34 months (95% CI, 24-NA:. mOS was not reached for patients with stage I-II disease versus 34 months in stage III-IV (p < 0.05). CONCLUSION Available evidence suggests that EAT represents a distinct entity in the context of thymic epithelial tumors, characterized by aggressive clinical behavior, poor responsiveness to chemotherapy and dismal patients prognosis. More research is needed to better define optimal management strategies for patients with such rare disease.
Collapse
Affiliation(s)
- Fabio Conforti
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Paolo Tarantino
- Division of Early Drug Development for IEO, of Oncology IRCCS, Milan, Italy
| | - Pamela Trillo
- Division of Early Drug Development for IEO, of Oncology IRCCS, Milan, Italy
| | - Laura Pala
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paola Zagami
- Division of Early Drug Development for IEO, of Oncology IRCCS, Milan, Italy
| | - Sara Pirola
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Benedetta Di Venosa
- Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Chiara Catania
- Division of Thoracic Oncology, IEO, European Institute of Oncology IRCCS, of Milan, Italy
| | - Paola Queirolo
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Elisabetta Pennacchioli
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Paolo Della Vigna
- Division of Interventional Radiology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giuseppe Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, 20122 Milan, Italy; Division of Early Drug Development for Innovative Therapies, IEO, European Institute of Oncology IRCCS, 20141 Milan, Italy
| | - Tommaso Martino De Pas
- Division of Medical Oncology for Melanoma & Sarcoma, IEO, European Institute of Oncology IRCCS, Milan, Italy
| |
Collapse
|
13
|
Abstract
Thymomas and thymic carcinomas (TCs) are neoplasms of thymic epithelial cells. Thymomas exhibit a low mutational burden and a few recurrently mutated genes. The most frequent missense mutation p.(Leu404His) affects the general transcription factor IIi (GTF2I) and is specific for thymic epithelial tumors (TETs). The clinically indolent types A and AB thymomas express the miRNA cluster C19MC. This miRNA cluster known to be the largest in the human genome, is-with expression otherwise restricted mostly to embryonal tissue-silenced in the more aggressive type B thymomas and TCs. Thymomas associated with the autoimmune disease myasthenia gravis (MG) exhibit more frequent gene copy number changes and an increased expression of proteins homologous to molecules that are targets for autoantibodies. TCs, however, display a higher mutational burden, with frequent mutations of TP53 and epigenetic regulatory genes and loss of CDKN2A. The knowledge of molecular alterations in TETs fosters the understanding of their pathogenesis and provides guidance for further studies that may lead to the development of targeted therapies.
Collapse
Affiliation(s)
| | - Leonhard Müllauer
- Institute of Pathology, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
14
|
STK11/LKB1 Mutation-positive Primary Thymic Mucinous Adenocarcinoma Accompanied by Cerebellar Metastasis: A Case Report and Literature Review. Clin Lung Cancer 2020; 22:e659-e664. [PMID: 33221174 DOI: 10.1016/j.cllc.2020.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Revised: 10/07/2020] [Accepted: 10/15/2020] [Indexed: 11/22/2022]
|
15
|
Liu HW, Liu CY, Yeh YC. Disseminated and massive tumor burden in a case of primary thymic mucinous adenocarcinoma. JOURNAL OF CANCER RESEARCH AND PRACTICE 2019. [DOI: 10.4103/jcrp.jcrp_13_19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
|
16
|
Primary thymic adenocarcinomas: a clinicopathological and immunohistochemical study of 16 cases with emphasis on the morphological spectrum of differentiation. Hum Pathol 2018; 74:73-82. [DOI: 10.1016/j.humpath.2018.01.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 12/31/2017] [Accepted: 01/05/2018] [Indexed: 01/02/2023]
|
17
|
Tamai M, Ishida M, Ebisu Y, Okamoto H, Miyasaka C, Ohe C, Uemura Y, Saito T, Murakawa T, Tsuta K. Thymic enteric type adenocarcinoma: A case report with cytological features. Diagn Cytopathol 2017; 46:92-97. [PMID: 28888068 DOI: 10.1002/dc.23806] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 08/21/2017] [Indexed: 12/15/2022]
Abstract
Primary thymic adenocarcinoma is an extremely rare tumor, and thymic enteric type adenocarcinoma has recently been proposed as a distinct pathological entity. Herein, we report the first cytological description of thymic enteric type adenocarcinoma. A 29-year-old Japanese female without a significant past medical history was found to have an abnormal chest shadow. Chest computed tomography demonstrated a well-circumscribed tumor in the anterior mediastinum, and thymectomy was performed. The Papanicolaou staining of the touch smear of the resected tumor demonstrated tightly cohesive epithelial cell clusters in a necrotic background. These cells were cuboidal to columnar in shape and had large round to oval nuclei with conspicuous nucleoli. Some of these neoplastic cells had intracytoplasmic mucin. Immunocytochemically, the neoplastic cells were positive for cytokeratin 20 and CDX-2. Histopathological study revealed tubular and papillotubular neoplastic growth composed of cuboidal to columnar neoplastic cells that contained large round to oval nuclei. Some of the neoplastic cells had intracytoplasmic mucin. Immunohistochemical study confirmed the expression of cytokeratin 20 and CDX-2. The final diagnosis of thymic enteric type adenocarcinoma was made. The cytological and immunocytochemical features of this case led to a diagnosis of enteric type adenocarcinoma. However, these features alone cannot be differentiated from a metastatic adenocarcinoma arising from the gastrointestinal tract. Cytological examination of a fine-needle aspiration of the mediastinal tumor has been reported to be useful in making a diagnosis. Therefore, an awareness of this new pathological entity is important for differentiating a thymic tumor from a metastatic carcinoma in the thymus.
Collapse
Affiliation(s)
- Marie Tamai
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Mitsuaki Ishida
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Yusuke Ebisu
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Hisashi Okamoto
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Chika Miyasaka
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Chisato Ohe
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Yoshiko Uemura
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| | - Tomohito Saito
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Tomohiro Murakawa
- Department of Thoracic Surgery, Kansai Medical University, Osaka, Japan
| | - Koji Tsuta
- Department of Pathology and Laboratory Medicine, Kansai Medical University, Osaka, Japan
| |
Collapse
|
18
|
Kwon AY, Han J, Cho HY, Kim S, Bang H, Hyeon J. Cytologic Characteristics of Thymic Adenocarcinoma with Enteric Differentiation: A Study of Four Fine-Needle Aspiration Specimens. J Pathol Transl Med 2017; 51:509-512. [PMID: 28772352 PMCID: PMC5611527 DOI: 10.4132/jptm.2017.03.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 03/14/2017] [Accepted: 03/22/2017] [Indexed: 02/04/2023] Open
Abstract
Thymic adenocarcinoma is extremely rare. Although its histologic features have been occasionally reported, a lack of description of the cytologic features has hampered the prompt and accurate diagnosis of this condition. Herein, we describe the cytologic findings and histology of four aspiration cytology specimens of thymic adenocarcinoma. The specimens were obtained from primary tumors, metastatic lymph nodes, and pericardial effusions. All four specimens showed three-dimensional glandular clusters with a loss of polarity and nuclear overlapping. One specimen had extensive extracellular mucinous material. Three specimens contained tumor cells with intracytoplasmic vacuoles. While the specimen with extracellular mucin showed relatively mild cytologic atypia, other specimens exhibited more atypical cytologic changes: irregular nuclear membranes, a coarse chromatin pattern, and prominent nucleoli. The cytologic features were correlated with the histologic features in each case of enteric type thymic adenocarcinoma. The differential diagnosis included other thymic carcinomas, yolk sac tumors, and metastatic adenocarcinoma from the lung or colorectum.
Collapse
Affiliation(s)
- Ah-Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hae-Yon Cho
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seokhwi Kim
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Heejin Bang
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jiyeon Hyeon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| |
Collapse
|
19
|
Sakanoue I, Hamakawa H, Fujimoto D, Imai Y, Minami K, Tomii K, Takahashi Y. KRAS mutation-positive mucinous adenocarcinoma originating in the thymus. J Thorac Dis 2017; 9:E694-E697. [PMID: 28932588 DOI: 10.21037/jtd.2017.07.11] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Thymic carcinoma is a rare, aggressive disease with a low 5-year survival rate. The most common histological neoplastic thymic tumor subtype is squamous cell. We describe an interesting case of a 39-year-old woman who presented with mucinous adenocarcinoma that originated in the thymus and was treated via radical resection and venoplasty of the superior vena cava (SVC). Macroscopically, the resected tumor contained a solid region and multiple cysts with abundant mucin. Microscopic examination showed a papillary growth pattern of goblet cells with round nuclei. Based on the histopathological and immunohistochemical findings and other inspections, the tumor was eventually diagnosed as a mucinous adenocarcinoma of the thymus. It was classified as Masaoka-Koga stage III owing to tumor invasion into the left brachiocephalic vein and pericardium. Polymerase chain reaction identified a Kirsten rat sarcoma viral oncogene homolog (KRAS) G12V mutation in the tumor. There were no mutations in the epidermal growth factor (EGFR) gene or a fusion gene of the echinoderm microtubule-associated protein-like 4 (EML4) and the anaplastic lymphoma kinase (ALK). A year later, multiple lung metastases were detected, and the patient underwent chemotherapy. She is alive 34 months after the initial surgery. This is the first report of a KRAS mutation-positive mucinous adenocarcinoma originating in the thymus. The treatment, diagnosis, and pathological findings of the patient are discussed.
Collapse
Affiliation(s)
- Ichiro Sakanoue
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Hiroshi Hamakawa
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Daichi Fujimoto
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yukihiro Imai
- Department of Clinical Pathology, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Kazuhiro Minami
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Keisuke Tomii
- Department of Respiratory Medicine, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Yutaka Takahashi
- Department of Thoracic Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| |
Collapse
|
20
|
Lee Y, Park S, Lee SH, Lee H. Characterization of genetic aberrations in a single case of metastatic thymic adenocarcinoma. BMC Cancer 2017; 17:330. [PMID: 28506304 PMCID: PMC5432996 DOI: 10.1186/s12885-017-3282-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 04/13/2017] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Thymic adenocarcinoma is an extremely rare subtype of thymic epithelial tumors. Due to its rarity, there is currently no sequencing approach for thymic adenocarcinoma. METHODS We performed whole exome and transcriptome sequencing on a case of thymic adenocarcinoma and performed subsequent validation using Sanger sequencing. RESULTS The case of thymic adenocarcinoma showed aggressive behaviors with systemic bone metastases. We identified a high incidence of genetic aberrations, which included somatic mutations in RNASEL, PEG10, TNFSF15, TP53, TGFB2, and FAT1. Copy number analysis revealed a complex chromosomal rearrangement of chromosome 8, which resulted in gene fusion between MCM4 and SNTB1 and dramatic amplification of MYC and NDRG1. Focal deletion was detected at human leukocyte antigen (HLA) class II alleles, which was previously observed in thymic epithelial tumors. We further investigated fusion transcripts using RNA-seq data and found an intergenic splicing event between the CTBS and GNG5 transcript. Finally, enrichment analysis using all the variants represented the immune system dysfunction in thymic adenocarcinoma. CONCLUSION Thymic adenocarcinoma shows highly malignant characteristics with alterations in several cancer-related genes.
Collapse
Affiliation(s)
- Yeonghun Lee
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005 South Korea
| | - Sehhoon Park
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongnogu, Seoul, 110-744 South Korea
| | - Se-Hoon Lee
- Division of Hematology and Medical Oncology, Department of Internal Medicine, Seoul National University Hospital, 101 Daehakro, Jongnogu, Seoul, 110-744 South Korea
- Division of Hematology/Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-Ro Gangnam-gu, Seoul, 06351 South Korea
| | - Hyunju Lee
- School of Electrical Engineering and Computer Science, Gwangju Institute of Science and Technology, 123 Cheomdangwagi-ro, Buk-gu, Gwangju, 61005 South Korea
| |
Collapse
|
21
|
Kinoshita F, Shoji F, Takada K, Toyokawa G, Okamoto T, Yano T, Oda Y, Maehara Y. Mucinous adenocarcinoma of the thymus: report of a case. Gen Thorac Cardiovasc Surg 2017; 66:111-115. [DOI: 10.1007/s11748-017-0781-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 04/28/2017] [Indexed: 12/01/2022]
|
22
|
Yamamoto Y, Kodama K, Ide Y, Takeda M. Thymic and Mediastinal Lymph Node Metastasis of Colon Cancer. Ann Thorac Surg 2017; 103:e13-e15. [DOI: 10.1016/j.athoracsur.2016.06.099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 05/14/2016] [Accepted: 06/20/2016] [Indexed: 10/20/2022]
|
23
|
Kwon AY, Han J, Chu J, Choi YS, Jeong BH, Ahn MJ, Ahn YC. Histologic characteristics of thymic adenocarcinomas: Clinicopathologic study of a nine-case series and a review of the literature. Pathol Res Pract 2016; 213:106-112. [PMID: 28038793 DOI: 10.1016/j.prp.2016.11.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Revised: 11/03/2016] [Accepted: 11/11/2016] [Indexed: 11/27/2022]
Abstract
Primary thymic adenocarcinoma is an extraordinarily rare malignancy; only 49 cases have been reported in the medical literature to date. Because of its rarity, clinical and pathologic characteristics of thymic adenocarcinoma are unclear. We present nine cases of primary thymic adenocarcinoma and discuss clinicopathologic findings in the context of the existing literature. Two-hundred twenty-six thymic carcinoma cases were diagnosed at Samsung Medical Center in Korea, from January, 2001 to July, 2016. Nine of these 226 cases were primary thymic adenocarcinomas. The mean age of primary thymic adenocarcinoma patients was 53.6 years, slightly younger than the mean age of patients with thymic squamous cell carcinomas. The male to female ratio was 2:1. Symptoms, if present, were usually due to compression by the tumor. Tumors showed an extra- or intra-cellular mucin and tubular growth pattern, with CK20- and CDX2-immunoreactivity, similar to adenocarcinomas of the lower intestinal tract. Twenty-five previously reported cases, classified as mucinous adenocarcinoma and adenocarcinoma, not otherwise specified, also had similar characteristics to enteric-type adenocarcinoma and generally expressed CK20, CDX2, CEA, and/or MUC2. Some of these cases had a thymic cyst. These characteristics are different from those of papillary thymic carcinomas, which are morphologically similar to papillary thyroid carcinomas, express CK7 but not CK20, and are often associated with thymoma. The prognosis of thymic adenocarcinoma, enteric type appeared to be worse than the prognosis of papillary thymic carcinoma or carcinoma with adenoid cystic carcinoma-like features. In summary, we demonstrated that common primary thymic adenocarcinomas show enteric-type differentiation with mucin. This tumor type has distinct clinical, pathological, immunohistochemical and prognostic characteristics and is different from other subtypes of thymic adenocarcinoma, papillary thymic carcinoma, and carcinoma with adenoid cystic carcinoma-like features.
Collapse
Affiliation(s)
- Ah-Young Kwon
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Joungho Han
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
| | - Jinah Chu
- Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Soo Choi
- Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Department of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Myung-Ju Ahn
- Department of Hematology and Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yong Chan Ahn
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| |
Collapse
|
24
|
The 2015 World Health Organization Classification of Tumors of the Thymus: Continuity and Changes. J Thorac Oncol 2016; 10:1383-95. [PMID: 26295375 DOI: 10.1097/jto.0000000000000654] [Citation(s) in RCA: 370] [Impact Index Per Article: 46.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This overview of the 4th edition of the World Health Organization (WHO) Classification of thymic tumors has two aims. First, to comprehensively list the established and new tumor entities and variants that are described in the new WHO Classification of thymic epithelial tumors, germ cell tumors, lymphomas, dendritic cell and myeloid neoplasms, and soft-tissue tumors of the thymus and mediastinum; second, to highlight major differences in the new WHO Classification that result from the progress that has been made since the 3rd edition in 2004 at immunohistochemical, genetic and conceptual levels. Refined diagnostic criteria for type A, AB, B1-B3 thymomas and thymic squamous cell carcinoma are given, and it is hoped that these criteria will improve the reproducibility of the classification and its clinical relevance. The clinical perspective of the classification has been strengthened by involving experts from radiology, thoracic surgery, and oncology; by incorporating state-of-the-art positron emission tomography/computed tomography images; and by depicting prototypic cytological specimens. This makes the thymus section of the new WHO Classification of Tumours of the Lung, Pleura, Thymus and Heart a valuable tool for pathologists, cytologists, and clinicians alike. The impact of the new WHO Classification on therapeutic decisions is exemplified in this overview for thymic epithelial tumors and mediastinal lymphomas, and future perspectives and challenges are discussed.
Collapse
|
25
|
Haruki T, Wakahara M, Taniguchi Y, Nakamura Y, Nishimura M, Nakamura H. Successful multimodality treatment for locally advanced primary thymic adenocarcinoma: report of a case. J Surg Case Rep 2016; 2016:rjw148. [PMID: 27605661 PMCID: PMC5635608 DOI: 10.1093/jscr/rjw148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Although the optimal treatment strategy for locally advanced thymic carcinomas has yet to be determined, complete resection of the tumor after induction chemoradiotherapy (CRT) can sometimes provide a good chance of being cured. A 61-year-old woman was diagnosed with locally advanced primary thymic carcinoma, which invaded bilateral brachiocephalic veins and superior vena cava with intraluminal tumor thrombus. Induction CRT was performed, and a partial response to the treatment was achieved. Subsequent radical surgery was successfully performed by the median full sternotomy with a right transmanubrial osteomuscular sparing approach (TMA). The patient is currently alive and has remained disease-free for a year. The TMA is useful for extensive surgery of locally advanced thymic carcinoma because it can provide good exposure of the operative field without post-operative functional limitation of upper limbs.
Collapse
Affiliation(s)
- Tomohiro Haruki
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan,
| | - Makoto Wakahara
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yuji Taniguchi
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Yoshinobu Nakamura
- Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Motonobu Nishimura
- Division of Cardiovascular Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| | - Hiroshige Nakamura
- Division of General Thoracic Surgery, Department of Surgery, Faculty of Medicine, Tottori University, Yonago 683-8504, Japan
| |
Collapse
|
26
|
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.
Collapse
|
27
|
Lee M, Choi SJ, Yoon YH, Kim JT, Baek WK, Kim YS. Metastatic Thymic Adenocarcinoma from Colorectal Cancer. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2015; 48:447-51. [PMID: 26665119 PMCID: PMC4672987 DOI: 10.5090/kjtcs.2015.48.6.447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Revised: 10/17/2015] [Accepted: 10/19/2015] [Indexed: 02/02/2023]
Abstract
This report describes the case of a 57-year-old man with an anterior mediastinal tumor. Four years previously, he underwent laparoscopic anterior resection for sigmoid colon cancer. Thirty months after that procedure, bilateral pulmonary metastasectomy was performed. Twelve months later, follow-up computed tomography revealed a 1-cm pulmonary nodule on the upper lobe of the right lung and a solid mass on the anterior mediastinum, and the patient was also observed to have an elevated serum carcinoembryonic antigen (CEA) level. Repeated pulmonary nodule resection and total thymectomy were performed. Immunohistochemical staining of the anterior mediastinal tumor revealed adenocarcinoma, and his serum CEA level returned to normal after the operation. These findings strongly suggested metastatic thymic adenocarcinoma from a colorectal cancer.
Collapse
Affiliation(s)
- Mina Lee
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
| | - Suk Jin Choi
- Department of Pathology, Inha University Hospital
| | - Yong Han Yoon
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
| | - Joung-Taek Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
| | - Wan Ki Baek
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
| | - Young Sam Kim
- Department of Thoracic and Cardiovascular Surgery, Inha University Hospital
| |
Collapse
|
28
|
Sawaki A, Ishihara M, Kozuka Y, Oda H, Tamaru S, Sugawara Y, Yamashita Y, Mizuno T, Shiraishi T, Katayama N. Colon cancer chemotherapy for a patient with CDX2-expressing metastatic thymic adenocarcinoma: a case report and literature review. Int Cancer Conf J 2015; 5:113-119. [PMID: 31149437 DOI: 10.1007/s13691-015-0239-1] [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: 08/21/2015] [Accepted: 11/19/2015] [Indexed: 11/26/2022] Open
Abstract
We report the case of a 59-year-old man with thymic adenocarcinoma who was treated with colon cancer chemotherapy. He was referred to our hospital for an anterior mediastinal mass and multiple bone metastases that were found by computed tomography. Needle biopsy of the mediastinal tumor revealed a caudal-type homeobox 2 (CDX2)-positive adenocarcinoma. Neither upper nor lower gastrointestinal endoscopic examinations revealed any evidence of a primary tumor. The patient was administered CapeOX (capecitabine and oxaliplatin) and FOLFIRI (fluorouracil, leucovorin and irinotecan)/cetuximab. He died 6 months after diagnosis. Primary thymic adenocarcinoma was confirmed by autopsy. As far as we know, this is the first report in which colon cancer chemotherapy was used to treat CDX2-positive metastatic thymic adenocarcinoma.
Collapse
Affiliation(s)
- Akihiko Sawaki
- 1Department of Hematology and Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Mikiya Ishihara
- 1Department of Hematology and Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Yuji Kozuka
- 2Department of Pathology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Hiroyasu Oda
- 1Department of Hematology and Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Satoshi Tamaru
- 1Department of Hematology and Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Yumiko Sugawara
- 1Department of Hematology and Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Yoshiki Yamashita
- 1Department of Hematology and Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Toshiro Mizuno
- 1Department of Hematology and Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Taizo Shiraishi
- 2Department of Pathology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| | - Naoyuki Katayama
- 1Department of Hematology and Oncology, Mie University Hospital, 2-174 Edobashi, Tsu, Mie 514-8507 Japan
| |
Collapse
|
29
|
Akiba J, Harada H, Yokoyama S, Hashiguchi T, Kawahara A, Mitsuoka M, Takamori S, Yano H. Mucinous cystic tumor with CK20 and CDX2 expression of the thymus: Is this a benign counterpart of adenocarcinoma of the thymus, enteric type? Pathol Int 2015; 66:29-33. [DOI: 10.1111/pin.12361] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/21/2015] [Indexed: 01/01/2023]
Affiliation(s)
- Jun Akiba
- Department of Pathology; Kurume University School of Medicine; Kurume Japan
| | - Hiroshi Harada
- Department of Diagnostic Pathology; Seichokai Fuchu Hospital; Izumi Japan
| | - Shintaro Yokoyama
- Department of Pathology; Kurume University School of Medicine; Kurume Japan
- Department of Surgery; Kurume University School of Medicine; Kurume Japan
| | - Toshihiro Hashiguchi
- Department of Pathology; Kurume University School of Medicine; Kurume Japan
- Department of Surgery; Kurume University School of Medicine; Kurume Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology; Kurume University Hospital; Kurume Japan
| | - Masahiro Mitsuoka
- Department of Surgery; Kurume University School of Medicine; Kurume Japan
| | - Shinzo Takamori
- Department of Surgery; Kurume University School of Medicine; Kurume Japan
| | - Hirohisa Yano
- Department of Pathology; Kurume University School of Medicine; Kurume Japan
| |
Collapse
|
30
|
Jung HY, Cho H, Chung JH, Bae SB, Lee JH, Lee HJ, Jang SH, Oh MH. A Rare Case of Primary Tubular Adenocarcinoma of the Thymus, Enteric Immunophenotype: A Case Study and Review of the Literature. J Pathol Transl Med 2015; 49:331-4. [PMID: 26040775 PMCID: PMC4508571 DOI: 10.4132/jptm.2015.04.16] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Revised: 04/08/2015] [Accepted: 04/16/2015] [Indexed: 12/16/2022] Open
Abstract
Thymic carcinomas are uncommon malignant tumors, and thymic adenocarcinomas are extremely rare. Here, we describe a case of primary thymic adenocarcinoma in a 59-year-old woman. Histological examination of the tumor revealed tubular morphology with expression of cytokeratin 20 and caudal-type homeobox 2 according to immunohistochemistry, suggesting enteric features. Extensive clinical and radiological studies excluded the possibility of an extrathymic primary tumor. A review of the literature revealed only two global cases of primary tubular adenocarcinomas of the thymus with enteric immunophenotype.
Collapse
Affiliation(s)
- Hae Yoen Jung
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyundeuk Cho
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Jin-Haeng Chung
- Department of Pathology and Respiratory Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sang Byoung Bae
- Division of Hematology and Oncology, Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Ji-Hye Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hyun Ju Lee
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Si-Hyong Jang
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Mee-Hye Oh
- Department of Pathology, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| |
Collapse
|