1
|
Roden AC, Judge M, den Bakker MA, Fang W, Jain D, Marx A, Moreira AL, Rajan A, Stroebel P, Szolkowska M, Cooper WA. Dataset for reporting of thymic epithelial tumours: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2023; 83:967-980. [PMID: 37722860 DOI: 10.1111/his.15047] [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] [Received: 06/27/2023] [Revised: 08/11/2023] [Accepted: 08/25/2023] [Indexed: 09/20/2023]
Abstract
AIMS Thymic epithelial tumours (TET), including thymomas and thymic carcinomas and thymic neuroendocrine neoplasms, are malignant neoplasms that can be associated with morbidity and mortality. Recently, an updated version of the World Health Organization (WHO) Classification of Thoracic Tumours 5th Edition, 2021 has been released, which included various changes to the classification of these neoplasms. In addition, in 2017 the Union for International Cancer Control (UICC) / American Joint Committee on Cancer (AJCC) published the 8th Edition Staging Manual which, for the first time, includes a TNM staging that is applicable to thymomas, thymic carcinomas, and thymic neuroendocrine neoplasms. METHODS AND RESULTS To standardize reporting of resected TET and thymic neuroendocrine neoplasms the accrediting bodies updated their reporting protocols. The International Collaboration on Cancer Reporting (ICCR), which represents a collaboration between various National Associations of Pathology, updated its 2017 histopathology reporting guide on TET and thymic neuroendocrine neoplasms accordingly. This report will highlight important changes in the reporting of TET and thymic neuroendocrine neoplasms based on the 2021 WHO, emphasize the 2017 TNM staging, and also comment on the rigour and various uncertainties for the pathologist when trying to follow that staging. CONCLUSION The ICCR dataset provides a comprehensive, standardized template for reporting of resected TET and thymic neuroendocrine neoplasms.
Collapse
Affiliation(s)
- Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Meagan Judge
- International Collaboration on Cancer Reporting, Sydney, NSW, Australia
| | - Michael A den Bakker
- Maasstad Hospital, Rotterdam, The Netherlands
- Academic Hospital Erasmus MC, Rotterdam, The Netherlands
| | - Wentao Fang
- Department of Thoracic Surgery, Shanghai Chest Hospital, Shanghai, China
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Andre L Moreira
- Department of Pathology, New York University Grossman School of Medicine, New York, NY, USA
| | - Arun Rajan
- Thoracic and Gastrointestinal Malignancies Branch, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Philipp Stroebel
- Institute of Pathology, University Medical Center Göttingen, University of Göttingen, Göttingen, Germany
| | - Malgorzata Szolkowska
- Department of Pathology, Institute of Tuberculosis and Lung Diseases, Warsaw, Poland
| | - Wendy A Cooper
- Department of Tissue Pathology and Diagnostic Oncology, NSW Health Pathology, Royal Prince Alfred Hospital, NSW, Sydney, Australia
- Institute of Medicine and Health Pathology, University of Sydney, NSW, Sydney, Australia
- School of Medicine, Western Sydney University, Sydney, NSW, Australia
| |
Collapse
|
2
|
Fukuhara M, Higuchi M, Owada Y, Inoue T, Watanabe Y, Yamaura T, Muto S, Hasegawa T, Suzuki H. Clinical and pathological aspects of microscopic thymoma with myasthenia gravis and review of published reports. J Thorac Dis 2017; 9:1592-1597. [PMID: 28740673 DOI: 10.21037/jtd.2017.05.22] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Microscopic thymomas, defined as epithelial proliferations smaller than 1 mm in diameter, characteristically occur in patients with myasthenia gravis without macroscopic thymic epithelial tumors. However, some clinical and pathological aspects of this entity are still unclear. METHODS This retrospective study includes five consecutive patients who had undergone extended thymectomy for myasthenia gravis at our institution from April 2007 to March 2016 and in whom microscopic thymomas were diagnosed by histopathological examination of the resected specimens. During the same period, we performed 32 extended transsternal thymothymectomies/thymectomies in patients with myasthenia gravis, including the above five cases. We here review 18 cases of microscopic thymoma, including our five cases and 13 previously reported cases. RESULTS The incidence of previously undiagnosed microscopic thymoma in patients undergoing thymectomy for myasthenia gravis in our institution is 15.2%. Serum preoperative anti-acetylcholine receptor antibody (anti-AchR Ab) titers were abnormally high in all of our five cases h (74.4±53.3 nmol/L) and decreased significantly after surgery (11.7±13.5 nmol/L, P=0.037). We divided our cases into the following three groups: microscopic thymoma group (Group M), thymoma group (Group T) and non-thymic tumor group (Group N). The mean preoperative anti-AchR Ab titers of these groups were 74.4, 26.5, and 368 nmol/L, respectively. All these values decreased postoperatively. The mean anti-AchR Ab titer was significantly higher in Group M than in Group T (P=0.034). All five cases in Group M were found by post-operative pathological examination to have multifocal type A thymomas. CONCLUSIONS Microscopic thymomas tend to be multifocal type A thymomas. Anti-AchR Ab titers decreased significantly in all groups. It is very important to both perform complete extended thymectomies in patients with myasthenia gravis and pathological examination of thin slices of thymic tissue to maximize detection of microscopic thymomas.
Collapse
Affiliation(s)
- Mitsuro Fukuhara
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Mitsunori Higuchi
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuki Owada
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takuya Inoue
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Yuzuru Watanabe
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takumi Yamaura
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Satoshi Muto
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Takeo Hasegawa
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| | - Hiroyuki Suzuki
- Department of Chest Surgery, Fukushima Medical University School of Medicine, Fukushima, Japan
| |
Collapse
|
3
|
Nicholson AG, Detterbeck F, Marx A, Roden AC, Marchevsky AM, Mukai K, Chen G, Marino M, den Bakker MA, Yang WI, Judge M, Hirschowitz L. Dataset for reporting of thymic epithelial tumours: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2016; 70:522-538. [PMID: 27735079 DOI: 10.1111/his.13099] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022]
Abstract
AIMS The International Collaboration on Cancer Reporting (ICCR) is a not-for-profit organization formed by the Royal Colleges of Pathologists of Australasia and the United Kingdom, the College of American Pathologists, the Canadian Association of Pathologists-Association Canadienne des Pathologists in association with the Canadian Partnership Against Cancer, and the European Society of Pathology. Its goal is to produce standardized, internationally agreed, evidence-based datasets for use throughout the world. METHODS AND RESULTS This article describes the development of a cancer dataset by the multidisciplinary ICCR expert panel for the reporting of thymic epithelial tumours. The dataset includes 'required' (mandatory) and 'recommended' (non-mandatory) elements, which are validated by a review of current evidence and supported by explanatory text. Seven required elements and 12 recommended elements were agreed by the international dataset authoring committee to represent the essential information for the reporting of thymic epithelial tumours. CONCLUSIONS The use of an internationally agreed, structured pathology dataset for reporting thymic tumours provides all of the necessary information for optimal patient management, facilitates consistent and accurate data collection, and provides valuable data for research and international benchmarking. The dataset also provides a valuable resource for those countries and institutions that are not in a position to develop their own datasets.
Collapse
Affiliation(s)
- Andrew G Nicholson
- Department of Histopathology, Royal Brompton and Harefield NHS Foundation Trust and National Heart and Lung Division, Imperial College, London, UK
| | - Frank Detterbeck
- Division of Thoracic Surgery, Department of Surgery, Yale University, New Haven, CN, USA
| | - Alexander Marx
- Department of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Anja C Roden
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Alberto M Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Kiyoshi Mukai
- Department of Diagnostic Pathology, Saiseikai Central Hospital, Tokyo, Japan
| | - Gang Chen
- Department of Pathology, Zhongshan Hospital Fudan University, Shanghai, China
| | - Mirella Marino
- Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy
| | - Michael A den Bakker
- Department of Pathology, Maasstad Hospital and Department of Pathology of the Erasmus MC, Rotterdam, the Netherlands
| | - Woo-Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Meagan Judge
- Royal College of Pathologists of Australasia, Sydney, Australia
| | - Lynn Hirschowitz
- Department of Cellular Pathology, Birmingham Women's Hospital, Birmingham, UK
| |
Collapse
|
4
|
Walton B, Gleinser D, Boroumand N, Watts T, Underbrink M. Microscopic thymoma and parathyroid adenoma: rare combination of two distinct pathologies. Rare Tumors 2014; 6:5197. [PMID: 25002944 PMCID: PMC4083664 DOI: 10.4081/rt.2014.5197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Revised: 03/21/2014] [Accepted: 03/26/2014] [Indexed: 11/24/2022] Open
Abstract
While there is an intimate anatomical and embryological relationship between the inferior parathyroid gland and thymus, concurrent pathology is rare. Three cases have been reported in the literature of a parathyroid adenoma in conjunction with a thymoma. We present a case report of a 60-year-old female with a past medical history of hypercalcemia subsequently found to have primary hyperparathyroidism. Sestamibi scan of the parathyroid revealed increased uptake in the lower left neck consistent with a parathyroid adenoma. A standard transverse neck incision was performed with exploration of the lower left thyroid pole. Further dissection was required to identify the parathyroid gland which was intimately associated with thymic tissue in the superior mediastinum. Both thymic tissue and the parathyroid gland were sent for pathology. Permanent pathology subsequently revealed a parathyroid adenoma with an incidental spindle cell thymoma. The embryological relationship of the inferior parathyroid glands and the thymus is well known as both are derived from the third branchial pouch. However, there are only 3 other previous reports of parathyroid adenoma associated with a thymoma in the current literature. Interestingly, up to 16% of parathyroid adenomas are found in the mediastinum, and the current literature states the incidence of thymoma varies from 10-42%.
Collapse
Affiliation(s)
- Benjamin Walton
- Departments of Otolaryngology, University of Texas Medical Branch , Galveston, TX, USA
| | - David Gleinser
- Departments of Otolaryngology, University of Texas Medical Branch , Galveston, TX, USA
| | - Nahal Boroumand
- Departments of Pathology, University of Texas Medical Branch , Galveston, TX, USA
| | - Tammara Watts
- Departments of Otolaryngology, University of Texas Medical Branch , Galveston, TX, USA
| | - Michael Underbrink
- Departments of Otolaryngology, University of Texas Medical Branch , Galveston, TX, USA
| |
Collapse
|
5
|
Mori T, Nomori H, Ikeda K, Kobayashi H, Iwatani K, Yoshioka M, Iyama KI. Microscopic-sized "microthymoma" in patients with myasthenia gravis. Chest 2007; 131:847-849. [PMID: 17356102 DOI: 10.1378/chest.06-2014] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In 2005, Cheuk et al reported two patients with microscopic-sized thymomas and proposed the term microthymoma to distinguish it from the nodular hyperplasia of thymic epithelium, so-called microscopic thymoma. Here, we present microthymomas that were found in 196 patients with myasthenia gravis (MG) who had undergone thymectomy. MATERIALS AND METHODS Thymic tissues in 196 patients with MG who underwent thymectomy or thymothymomectomy were examined. Of these patients, 73 patients had thymoma indicated by CT before surgery, and the other 123 patients had no mediastinal tumors. From the resected thymic tissues, an average of 14 hematoxylin-eosin-stained sections (range, 4 to 55 sections) were prepared for microscopic examination. The histologic type of the thymoma was classified according to the World Health Organization (WHO) classification. RESULTS From the 196 patients, we found three microthymomas in 3 patients (1.5%). While these three tumors could not be seen grossly in pathology section, they were found microscopically (range, 2 to 4 mm). The histologic subtype according to the WHO classification system was B1 in one patient and B2 in two patients. CONCLUSION Microthymoma was found in 3 of 196 patients (1.5%) with MG. Microthymoma might exist in thymus of patients with MG, even in patients who have no thymoma indicated by CT.
Collapse
Affiliation(s)
- Takeshi Mori
- Department of Thoracic Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Hiroaki Nomori
- Department of Thoracic Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan.
| | - Koei Ikeda
- Department of Thoracic Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Hironori Kobayashi
- Department of Thoracic Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Kazunori Iwatani
- Department of Thoracic Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Masakazu Yoshioka
- Department of Thoracic Surgery, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| | - Ken-Ichi Iyama
- Graduate School of Medical Sciences, and Department of Surgical Pathology, Kumamoto University Hospital, 1-1-1 Honjo, Kumamoto 860-8556, Japan
| |
Collapse
|
6
|
Pelosi G, Cattaneo L, Maffini F. Images in pathology: micronodular epithelial hyperplasia in ectopic thymus. Int J Surg Pathol 2006; 14:73-4. [PMID: 16501838 DOI: 10.1177/106689690601400112] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Giuseppe Pelosi
- Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan School of Medicine, Milan, Italy
| | | | | |
Collapse
|
7
|
Abstract
We report 2 cases of microscopic-sized thymoma, which probably represents the earliest phase of thymoma development. The 2 patients presented with pure red cell aplasia and myasthenia gravis, respectively. The thymectomy specimens did not reveal tumor on gross examination, but histologically each contained small thymomas measuring 5 mm and 7 mm in largest dimension, respectively. One of the tumors was unencapsulated and involved a single lobule only, and the other was encapsulated and comprised two lobules. The tumors consisted of ovoid epithelial cells with pale nuclei and distinct nucleoli, scattered in a background of small lymphocytes. Foci of medullary differentiation and perivascular space were identified in the 2 cases, respectively. The lymphocytes were confirmed to be immature T cells on immunohistochemical studies (CD3+, TdT+). Except for the microscopic size, the morphology of the two tumors conforms to conventional type B1/B2 and type B2 thymoma, respectively. We propose calling such incidental small tumor "microthymoma" to distinguish it from the so-called microscopic thymoma, which is composed of small thymic epithelial nests and probably more appropriately termed "nodular hyperplasia" of the thymic epithelium.
Collapse
Affiliation(s)
- Wah Cheuk
- Department of Pathology, Queen Elizabeth Hospital, Hong Kong, SAR China.
| | | | | |
Collapse
|
8
|
Kitami A, Suzuki T, Suzuki S, Hori G. Tiny thymic carcinoma completely surrounded by thymic tissue. The possibility of de novo carcinoma. THE JAPANESE JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY : OFFICIAL PUBLICATION OF THE JAPANESE ASSOCIATION FOR THORACIC SURGERY = NIHON KYOBU GEKA GAKKAI ZASSHI 2000; 48:670-2. [PMID: 11080959 DOI: 10.1007/bf03218227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/15/2022]
Abstract
We report a case of a 61-year-old man with a tiny thymic carcinoma completely surrounded by thymic tissue. First, a thoracoscopic resection of about two-thirds of the right inferior part of the thymus containing the tumor was performed to obtain the histological diagnosis. Frozen-section diagnosis at operation revealed a thymic carcinoma. Therefore we performed a median sternotomy and resected the remnant of the thymus. A tiny thymic carcinoma completely surrounded by thymic tissue is extremely rare. In this case, as the tumor was tiny and there was a homogeneous mass without a thymoma-like component, we concluded that this tumor was de novo.
Collapse
Affiliation(s)
- A Kitami
- Department of Thoracic and Cardiovascular Surgery, Showa University Fujigaoka Hospital, Yokohama, Japan
| | | | | | | |
Collapse
|
9
|
|