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Ambrogi MC, Aprile V, Lenzini A, Bacchin D, Mastromarino MG, Korasidis S, Lucchi M. TNM Staging System in Thymoma: A Critical Appraisal? J Clin Med 2024; 13:610. [PMID: 38276116 PMCID: PMC10817025 DOI: 10.3390/jcm13020610] [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: 11/23/2023] [Revised: 01/11/2024] [Accepted: 01/19/2024] [Indexed: 01/27/2024] Open
Abstract
Thymomas are rare tumors of the anterior mediastinum with peculiar clinical and pathological features. They have been deeply analyzed by pioneer authors, who strictly linked their name to the main pathological and staging classifications. Before the latest edition of the WHO classification of thymic epithelial tumors, the history of thymoma pathological classification inherited the name of the pathologists who systematically addressed the issue, from Levine-Rosai to Muller-Hermelink. Similarly, the thymoma staging system is intimately related to the name of two surgeons, Masaoka and Koga, who historically dealt with this disease. More recently, the traditional tumor-nodes-metastasis (TNM) system has been developed for the staging of this condition, in a rational attempt to put thymomas in conformity with the other solid tumors. The efforts of the International Thymic Malignancies Interest Group (ITMIG) and the Thymic Domain of the Staging and Prognostic Factors Committee (TD-SPFC) of the International Association for the Study of Lung Cancer (IASLC) resulted in the TNM classification of thymic tumors, which have been included in the eighth edition of the American Joint Committee on Cancer's (AJCC) Cancer Staging Manual. Herein, we report a narrative review of the evolution of the thymic epithelial tumors (TET) staging system and present a critical appraisal of the actual TNM classification compared with the historical Masaoka-Koga classification, with special focus on the proposal for the ninth edition of the TNM, expected in 2024.
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Affiliation(s)
- Marcello Carlo Ambrogi
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Vittorio Aprile
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Alessandra Lenzini
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Diana Bacchin
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
| | - Maria Giovanna Mastromarino
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
| | - Stylianos Korasidis
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
| | - Marco Lucchi
- Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy; (M.C.A.); (A.L.); (D.B.); (M.G.M.); (S.K.); (M.L.)
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy
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Maluf H. Mark Wick contributions to pathology of the mediastinum. Semin Diagn Pathol 2024:S0740-2570(24)00005-4. [PMID: 38199878 DOI: 10.1053/j.semdp.2024.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 01/02/2024] [Indexed: 01/12/2024]
Abstract
Mark Wick made a wide range of contributions to the field of mediastinal pathology. Early papers amplified the spectrum of neuroendocrine carcinomas of the thymus and brought attention to the aggressive nature of this tumor, also highlighting the occurrence of coexisting carcinoid tumor and small cell carcinoma of this organ. The controversial issue of thymoma classification was addressed in several papers and editorial comments, while also reporting a case of metastatic thymoma. A series of thymic carcinomas as well a report on the unusual clear cell variant bear his name as one of the authors. He summarized the topic of mediastinal cyst in a review published in 2005. Sarcomas arising in mediastinal germ cell tumors were also within the purview of his interests, with a publication of series of seven cases. He reviewed the topic of inflammatory myofibroblastic tumor of the heart and added a case to the existing literature. Two books dedicated to different aspect of mediastinal pathology also carry his name in the front cover in association with Drs Taazelar in one and Marchevsky in the other.
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Affiliation(s)
- Horacio Maluf
- Department of Pathology, RM 8612, Cedars-Sinai Medical Center, 8700 Beverly Blvd, Los Angeles, CA 90048, US.
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3
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Suster D, Suster S. On the Histologic Classification of Thymoma. Adv Anat Pathol 2024; 31:22-33. [PMID: 37702296 DOI: 10.1097/pap.0000000000000412] [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: 09/14/2023]
Abstract
The classification of thymoma continues to be a source of controversy in pathology. The difficulties in histologic classification are evident from the number of proposals that have been offered over the years, as well as for the continuous changes and modifications introduced by the World Health Organization to their classification system over the past 20 years. We analyze here some of the issues involved in the classification of these tumors and the difficulties encountered for practicing pathologists in deciphering the "letters and numbers" system devised by the World Health Organization. We would like to propose an alternate approach to thymoma histologic classification that capitalizes on the basic observation of their cytologic features and incorporates the pattern of growth resulting from the interplay of the tumor cells with other cellular constituents as a secondary characteristic. The proposed histologic classification provides a simplified, reproducible means of histologically categorizing these tumors and can be easily understood by most practicing pathologists in simple and clear morphologic terms.
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Affiliation(s)
- David Suster
- Department of Pathology, Rutgers University Hospital, Newark, NJ
| | - Saul Suster
- Department of Pathology, Medical College of Wisconsin, Milwaukee, WI
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4
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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.
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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
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Alqaidy D. Thymoma: An Overview. Diagnostics (Basel) 2023; 13:2982. [PMID: 37761349 PMCID: PMC10527963 DOI: 10.3390/diagnostics13182982] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 09/15/2023] [Accepted: 09/16/2023] [Indexed: 09/29/2023] Open
Abstract
Thymomas are considered one of the most prevalent types of mediastinal epithelial tumors, which frequently develop in the anterior mediastinum. Due to their rarity, these tumors' nomenclature, classification, and staging are likely to be the subject of debate and argument for most expert pathologists. Furthermore, the significance of thymoma histologic classifications have been debated over the past twenty years. While certain advocates argue that staging at the time of diagnosis is more significant, others believe that histologic subtyping has a significant impact on how patients behave clinically. In this review, we will focus on some of the challenges that diagnostic surgical pathologists may experience while evaluating the histopathology of thymomas and staging these tumors. We will additionally glance over the clinical characteristics of these distinct tumors and the current management strategy.
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Affiliation(s)
- Doaa Alqaidy
- Department of Pathology, King Abdulaziz University, Jeddah 21589, Saudi Arabia
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Marchevsky AM, Walts AE, Lissenberg-Witte BI, Thunnissen E. Pathologists should probably forget about kappa. Percent agreement, diagnostic specificity and related metrics provide more clinically applicable measures of interobserver variability. Ann Diagn Pathol 2020; 47:151561. [PMID: 32623312 DOI: 10.1016/j.anndiagpath.2020.151561] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 06/19/2020] [Indexed: 02/09/2023]
Abstract
Kappa statistics have been widely used in the pathology literature to compare interobserver diagnostic variability (IOV) among different pathologists but there has been limited discussion about the clinical significance of kappa scores. Five representative and recent pathology papers were queried using clinically relevant specific questions to learn how IOV was evaluated and how the clinical applicability of results was interpreted. The papers supported our anecdotal impression that pathologists usually assess IOV using Cohen's or Fleiss' kappa statistics and interpret the results using some variation of the scale proposed by Landis and Koch. The papers did not cite or propose specific guidelines to comment on the clinical applicability of results. The solutions proposed to decrease IOV included the development of better diagnostic criteria and additional educational efforts, but the possibility that the entities themselves represented a continuum of morphologic findings rather than distinct diagnostic categories was not considered in any of the studies. A dataset from a previous study of IOV reported by Thunnissen et al. was recalculated to estimate percent agreement among 19 international lung pathologists for the diagnosis of 74 challenging lung neuroendocrine neoplasms. Kappa scores and diagnostic sensitivity, specificity, positive and negative predictive values were calculated using the majority consensus diagnosis for each case as the gold reference diagnosis for that case. Diagnostic specificity estimates among multiple pathologists were > 90%, although kappa scores were considerably more variable. We explain why kappa scores are of limited clinical applicability in pathology and propose the use of positive and negative percent agreement and diagnostic specificity against a gold reference diagnosis to evaluate IOV among two and multiple raters, respectively.
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Affiliation(s)
- Alberto M Marchevsky
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Ann E Walts
- Department of Pathology & Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
| | | | - Erik Thunnissen
- Department of Pathology, UMC, Vrije Universiteit Amsterdam, the Netherlands
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Guleria P, Parshad R, Malik PS, Ray R, Pandey RM, Jain D. Histotyping of Indian thymomas: A clinicopathologic study from north India. Indian J Med Res 2020; 150:153-160. [PMID: 31670270 PMCID: PMC6829775 DOI: 10.4103/ijmr.ijmr_530_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background & objectives: Thymomas are rare, but most common anterior mediastinal lesions. The histomorphologic spectrum of thymic epithelial tumours (TETs) in Indian population has not been explored in depth. This study was aimed to assess the histomorphology of TETs in the Indian patients and correlate clinical parameters with pathological features. Methods: It was a retrospective study conducted in a tertiary referral hospital in north India. All morphologically confirmed cases of TETs since 2009 were included. Clinical details and histology slides were reviewed using the Modified Masaoka-Koga staging system and WHO 2015 classification. Clinicopathological correlation and survival analysis were done. A comparative review from other published Indian studies was performed. Results: A total of 219 cases of TETs (138 resections and 81 biopsies) were identified. The most common histomorphologic type was B2, and the most frequent stage was I. Types A/AB were common in older age (P<0.01). Clinically, higher stage tumours were found mostly in men (P<0.01), and these were Type B thymomas (P<0.01). Myasthenia gravis was more common in women (P<0.02) and in lower stages (P<0.05). Survival analysis revealed significant association between recurrence and tumour stage. Although thymic carcinoma was diagnosed on biopsy, no resectable case was identified. Interpretation & conclusions: Our findings showed that the thymomas in Indian patients were most commonly Stage I tumours of B2 and AB histotypes. Resected thymic carcinomas were conspicuously absent in our study. More studies need to be done to establish the frequency and biology of TETs from India.
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Affiliation(s)
- Prerna Guleria
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Rajinder Parshad
- Department of Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Prabhat Singh Malik
- Department of Medical Oncology, B.R.A. Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi, India
| | - Ruma Ray
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - R M Pandey
- Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India
| | - Deepali Jain
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
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8
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Thymoma: a clinicopathological correlation of 1470 cases. Hum Pathol 2018; 73:7-15. [DOI: 10.1016/j.humpath.2017.08.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 08/02/2017] [Accepted: 08/18/2017] [Indexed: 02/07/2023]
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Roden AC. Evolution of Classification of Thymic Epithelial Tumors in the Era of Dr Thomas V. Colby. Arch Pathol Lab Med 2017; 141:232-246. [PMID: 28134578 DOI: 10.5858/arpa.2016-0057-ra] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT -Numerous histomorphologic and staging classifications of thymic epithelial tumors (TETs) have been proposed during the last century, suggesting that the classification of these tumors is challenging and controversial. Difficulties of classifying TETs include various combinations of epithelial cells and lymphocytes and the paucity of these tumors. The prognostic significance, specifically of the histomorphologic classifications, has been debated. Early classifications were also challenged by the uncertainty of the neoplastic component(s) of the tumor. OBJECTIVE -To discuss the evolution of the histomorphologic classification and the staging system of TET. Controversies and problems of some classifications and their importance for therapeutic management and prognosis will be reviewed. Classifications that incorporated new concepts and approaches at the time or outcome studies will be highlighted. Current classifications will be discussed and the staging system that was recently proposed for the upcoming eighth American Joint Committee on Cancer staging will be described. DATA SOURCES -Search of literature database (PubMed) and current (2015) World Health Organization classification. CONCLUSIONS -Histomorphologic and staging classifications of TET have evolved during the last century and especially during the era of Thomas V. Colby, MD. Evidence supports that the staging system has prognostic implications independent of and superior to the histomorphologic classification. Histomorphology appears to be important for biologic features of TET.
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Bürger T, Schaefer IM, Küffer S, Bohnenberger H, Reuter-Jessen K, Chan JKC, Emmert A, Hinterthaner M, Marx A, Ströbel P. Metastatic type A thymoma: morphological and genetic correlation. Histopathology 2016; 70:704-710. [PMID: 27926794 DOI: 10.1111/his.13138] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2016] [Accepted: 12/02/2016] [Indexed: 01/08/2023]
Abstract
AIMS The vast majority of type A thymomas are diagnosed in tumour stages 1 or 2, and metastatic cases are exceedingly rare. The histological and genetic features of such metastatic type A thymomas have not been described in detail. METHODS AND RESULTS Five metastatic type A thymomas in tumour stage Masaoka IVb that had been reviewed by a panel of expert pathologists were analysed using comparative genomic hybridization (CGH). Cases 1, 2 and 3 showed the prototypical morphology of type A thymomas with mainly solid growth patterns. These cases displayed only very subtle nuclear irregularities and slight nuclear crowding, but no other atypical features. Mitoses were absent. Cases 3 and 4, in contrast, had a distinctly atypical morphology. CGH revealed partially recurrent alterations in four cases (with and without atypical morphology), including gains on chromosome 1q (one case), 17q (two cases), chromosome 19 (three cases) and 22q (one case) and losses on chromosome 17p (two cases) and 22q (one case). CONCLUSION Rare metastatic type A thymomas, both with typical and 'atypical' histological features, show partially recurrent genomic alterations that differ from the much more frequent localized and indolent tumours. The fact that these alterations were recurring points to a link between clinical behaviour and molecular features. Our findings may have implications for the management and treatment of such tumours.
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Affiliation(s)
- Tobias Bürger
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Inga-Marie Schaefer
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stefan Küffer
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Hanibal Bohnenberger
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | - Kirsten Reuter-Jessen
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
| | | | - Alexander Emmert
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany
| | - Marc Hinterthaner
- Department of Thoracic and Cardiovascular Surgery, University Medical Center, Georg-August University, Göttingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany
| | - Philipp Ströbel
- Institute of Pathology, University Medical Center, Georg-August University, Göttingen, Germany
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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.
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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
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12
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Belharazem D, Schalke B, Gold R, Nix W, Vitacolonna M, Hohenberger P, Roessner E, Schulze TJ, Saruhan-Direskeneli G, Yilmaz V, Ott G, Ströbel P, Marx A. cFLIP overexpression in T cells in thymoma-associated myasthenia gravis. Ann Clin Transl Neurol 2015; 2:894-905. [PMID: 26401511 PMCID: PMC4574807 DOI: 10.1002/acn3.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 03/31/2015] [Accepted: 04/07/2015] [Indexed: 12/02/2022] Open
Abstract
Objective The capacity of thymomas to generate mature CD4+ effector T cells from immature precursors inside the tumor and export them to the blood is associated with thymoma-associated myasthenia gravis (TAMG). Why TAMG(+) thymomas generate and export more mature CD4+ T cells than MG(−) thymomas is unknown. Methods Unfixed thymoma tissue, thymocytes derived thereof, peripheral blood mononuclear cells (PBMCs), T-cell subsets and B cells were analysed using qRT-PCR and western blotting. Survival of PBMCs was measured by MTT assay. FAS-mediated apoptosis in PBMCs was quantified by flow cytometry. NF-κB in PBMCs was inhibited by the NF-κB-Inhibitor, EF24 prior to FAS-Ligand (FASLG) treatment for apoptosis induction. Results Expression levels of the apoptosis inhibitor cellular FLICE-like inhibitory protein (c-FLIP) in blood T cells and intratumorous thymocytes were higher in TAMG(+) than in MG(−) thymomas and non-neoplastic thymic remnants. Thymocytes and PBMCs of TAMG patients showed nuclear NF-κB accumulation and apoptosis resistance to FASLG stimulation that was sensitive to NF-κB blockade. Thymoma removal reduced cFLIP expression in PBMCs. Interpretation We conclude that thymomas induce cFLIP overexpression in thymocytes and their progeny, blood T cells. We suggest that the stronger cFLIP overexpression in TAMG(+) compared to MG(−) thymomas allows for the more efficient generation of mature CD4+ T cells in TAMG(+) thymomas. cFLIP overexpression in thymocytes and exported CD4+ T cells of patients with TAMG might contribute to the pathogenesis of TAMG by impairing central and peripheral T-cell tolerance.
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Affiliation(s)
- Djeda Belharazem
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg Mannheim, Germany
| | - Berthold Schalke
- Department of Neurology, University of Regensburg Regensburg, Germany
| | - Ralf Gold
- Department of Neurology, University of Bochum Bochum, Germany
| | - Wilfred Nix
- Department of Neurology, University of Mainz Mainz, Germany
| | - Mario Vitacolonna
- Department of Thoracic Surgery, University Medical Centre Mannheim Mannheim, Germany
| | - Peter Hohenberger
- Department of Thoracic Surgery, University Medical Centre Mannheim Mannheim, Germany
| | - Eric Roessner
- Department of Thoracic Surgery, University Medical Centre Mannheim Mannheim, Germany
| | - Torsten J Schulze
- Institute for Transfusion Medicine and Immunology, German Red Cross Blood Service, University Medical Centre Mannheim Mannheim, Germany
| | | | - Vuslat Yilmaz
- Department of Physiology, School of Medicine, Istanbul University Istanbul, Turkey
| | - German Ott
- Department of Pathology, Robert-Bosch Hospital Stuttgart, Germany
| | - Philipp Ströbel
- Institute of Pathology, University of Goettingen Goettingen, Germany
| | - Alexander Marx
- Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg Mannheim, Germany
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The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2015; 9:S65-72. [PMID: 25396314 DOI: 10.1097/jto.0000000000000290] [Citation(s) in RCA: 278] [Impact Index Per Article: 30.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A universal and consistent stage classification system, which describes the anatomic extent of a cancer, provides a foundation for communication and collaboration. Thymic epithelial malignancies have seen little progress, in part because of the lack of an official system. The International Association for the Study of Lung Cancer and the International Thymic Malignancies Interest Group assembled a large retrospective database, a multispecialty international committee and carried out extensive analysis to develop proposals for the 8th edition of the stage classification manuals. This tumor, node, metastasis (TNM)-based system is applicable to all types of thymic epithelial malignancies. This article summarizes the proposed definitions of the T, N, and M components and describes how these are combined into stage groups. This represents a major step forward for thymic malignancies.
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The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the T Component for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol 2015; 9:S73-80. [PMID: 25396315 DOI: 10.1097/jto.0000000000000303] [Citation(s) in RCA: 109] [Impact Index Per Article: 12.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Despite longstanding recognition of thymic epithelial neoplasms, there is no official American Joint Committee on Cancer/Union for International Cancer Control stage classification. This article summarizes proposals for classification of the T component of stage classification for use in the 8th edition of the tumor, node, metastasis classification for malignant tumors. This represents the output of the International Association for the Study of Lung Cancer and the International Thymic Malignancies Interest Group Staging and Prognostics Factor Committee, which assembled and analyzed a worldwide database of 10,808 patients with thymic malignancies from 105 sites. The committee proposes division of the T component into four categories, representing levels of invasion. T1 includes tumors localized to the thymus and anterior mediastinal fat, regardless of capsular invasion, up to and including infiltration through the mediastinal pleura. Invasion of the pericardium is designated as T2. T3 includes tumors with direct involvement of a group of mediastinal structures either singly or in combination: lung, brachiocephalic vein, superior vena cava, chest wall, and phrenic nerve. Invasion of more central structures constitutes T4: aorta and arch vessels, intrapericardial pulmonary artery, myocardium, trachea, and esophagus. Size did not emerge as a useful descriptor for stage classification. This classification of T categories, combined with a classification of N and M categories, provides a basis for a robust tumor, node, metastasis classification system for the 8th edition of American Joint Committee on Cancer/Union for International Cancer Control stage classification.
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Reproducibility of 3 Histologic Classifications and 3 Staging Systems for Thymic Epithelial Neoplasms and Its Effect on Prognosis. Am J Surg Pathol 2015; 39:427-41. [DOI: 10.1097/pas.0000000000000391] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Marchevsky AM, Wick MR. Evidence-based pathology: systematic literature reviews as the basis for guidelines and best practices. Arch Pathol Lab Med 2014; 139:394-9. [PMID: 25356986 DOI: 10.5858/arpa.2014-0106-ra] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Evidence-based medicine has been proposed as a new paradigm for the identification and evaluation of medical information. Best available evidence or data are identified and used as the basis for the diagnosis and treatment of individual patients. Evidence-based pathology has adapted basic evidence-based medicine concepts to the specific needs of pathology and laboratory medicine. OBJECTIVES To briefly review the history and basic concepts of evidence-based medicine and evidence-based pathology, describe how to perform and interpret systematic reviews, and discuss how to integrate best evidence into guidelines. DATA SOURCES PubMed (National Library of Medicine, Washington, DC) and Web of Science (Thompson Reuters, New York, New York) were used. CONCLUSIONS Evidence-based pathology provides methodology to evaluate the quality of information published in pathology journals and apply it to the diagnosis of tissue samples and other tests from individual patients. Information is gathered through the use of systematic reviews, using a method that is less biased and more comprehensive than ad hoc literature searches. Published data are classified into evidence levels to provide readers with a quick impression about the quality and probable clinical validity of available information. Best available evidence is combined with personal experience for the formulation of evidence-based, rather than opinion-based, guidelines that address specific practice needs.
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Affiliation(s)
- Alberto M Marchevsky
- From the Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, California (Dr Marchevsky)
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Detterbeck F, Youssef S, Ruffini E, Okumura M. [A review of prognostic factors in thymic malignancies]. ZHONGGUO FEI AI ZA ZHI = CHINESE JOURNAL OF LUNG CANCER 2014; 17:130-6. [PMID: 24581164 PMCID: PMC6131240 DOI: 10.3779/j.issn.1009-3419.2014.02.11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Samuel Youssef
- Yale University School of Medicine, New Haven, Connecticut
| | - Enrico Ruffini
- Department of Thoracic Surgery, University of Torino, Torino, Italy
| | - Meinoshin Okumura
- Department of General Thoracic Surgery, Osaka University Graduate School of Medicine, Osaka, Japan
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Manoly I, Whistance RN, Sreekumar R, Khawaja S, Horton JM, Khan AZ, Casali G, Thorpe JA, Amer K, Woo E. Early and mid-term outcomes of trans-sternal and video-assisted thoracoscopic surgery for thymoma. Eur J Cardiothorac Surg 2014; 45:e187-93. [DOI: 10.1093/ejcts/ezu077] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Genestreti G, Ampollini L, Burgio MA, Rolli L, Sanna S, Scarpi E, Monti M, Salvatore LB, Giannone L, Santo A, Mezzetti M, Casanova C, Buosi R, Rusca M, Amadori D, Gavelli G. Multicenter Institutional Experience of Surgically Resected Thymic Epithelial Tumors (TETs): An Observational Report on Behalf of F.O.N.I.C.A.P. (Forza Operativa Nazionale Interdisciplinare Contro il Cancro del Polmone). Ann Surg Oncol 2013; 20:2958-2963. [DOI: 10.1245/s10434-013-3018-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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Thymoma—A Clinico-Pathological Long-Term Study with Emphasis on Histology and Adjuvant Radiotherapy Dose. J Thorac Oncol 2012; 7:1867-1871. [DOI: 10.1097/jto.0b013e3182745f73] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW Thymomas are the most common tumors of the anterior mediastinum. Although surgery remains the only curative treatment, the use of multimodality therapy for primary unresectable thymomas has led to change the clinical management of these tumors. RECENT FINDINGS Nowadays Masaoka stage, WHO, and radical surgical resection are considered by many authors as independent prognostic factors for long-term survival. Radiotherapy may be useful as adjuvant therapy in cases of incomplete surgical resection with microscopic or macroscopic residual disease, or for those patients with locally advanced or metastatic unresectable disease. Chemotherapy is considered a valid option in selected patients with residual disease after local treatments or as a neoadjuvant approach to improve resectability in Masaoka stages III or IV-a thymomas. Currently, no standardized regimen for chemotherapy or agreed timing exists. SUMMARY So far, multimodality treatment has been related to low morbidity and long survival rate, but there are still many concerns regarding a different regimen of therapy and the correct timing.
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Moran CA, Walsh G, Suster S, Kaiser L. Thymomas II: a clinicopathologic correlation of 250 cases with a proposed staging system with emphasis on pathologic assessment. Am J Clin Pathol 2012; 137:451-61. [PMID: 22338058 DOI: 10.1309/ajcp36alguzwosea] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
We present 250 cases of thymomas with emphasis on their clinical staging and follow-up. The patients were 120 males and 130 females between the ages of 13 and 92 years. Surgical resection was performed and histopathologic material evaluated in every case. Grossly, the tumors resected varied in size from 3 to 20 cm in greatest diameter. According to our proposed staging system, 31 cases were stage 0, 128 were stage I, 70 stage II, and 21 stage III at the time of resection. Histologically, approximately 53% of thymomas were of mixed histologic types. Follow-up information ranging from 1 to 16 years was obtained, showing significant statistical P values of .044 and .016 for overall and recurrence-free survival, respectively. We consider that our proposed staging system offers better stratification of cases and improved histologic definitions for proper staging of cases of thymoma.
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Abstract
INTRODUCTION Thirty years have gone by since the Masaoka staging system of thymoma was proposed in 1981. Although the Masaoka staging system has been accepted by many surgeons and pathologists, some proposals of revision and improvements have been suggested. At this time, I reinvestigated the Masaoka staging system based on the recent follow-up study of the thymomas resected at Nagoya City University. METHODS Using the follow-up results of 211 thymomas in Nagoya, I analyzed the following aspects: (1) evaluation of the Masaoka staging system as a prognostic factor in the Nagoya series and (2) critical assessment of the proposals of revision to the Masaoka staging system. RESULTS (1) Univariate analysis showed that Masaoka stages were significantly prognostic for overall survival (p < 0.0001). (2) The difference of survivals between stage I and II was not significant, but progression-free survival of stage I was 100% for up to 20 years, whereas one tumor death case in stage II was found. (3) Differences of survival between the cases with and without great vessel invasion in stage III were not significant. (4) Prognosis of N tumors was yet better defined. CONCLUSION (1) The Masaoka staging system remains a valuable prognostic factor. (2) Combination of stage I with II and separation of stage III into subgroups are not recommended. (3) At the moment, it is better to include N tumors in stage IVb.
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Marchevsky AM, Gupta R, Kusuanco D, Mirocha J, McKenna RJ. The presence of isolated tumor cells and micrometastases in the intrathoracic lymph nodes of patients with lung cancer is not associated with decreased survival. Hum Pathol 2010; 41:1536-43. [PMID: 20656322 DOI: 10.1016/j.humpath.2010.04.006] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Revised: 03/21/2010] [Accepted: 04/02/2010] [Indexed: 11/16/2022]
Affiliation(s)
- Alberto M Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
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Wick MR. Histopathologic prognosis of thymomas: another example of medical surrogacy. Am J Clin Pathol 2010; 134:703-5. [PMID: 20959651 DOI: 10.1309/ajcpf4kt2pexzusd] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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MARIUSDOTTIR ELIN, NIKULASSON SIGFUS, BJORNSSON JOHANNES, GUDBJARTSSON TOMAS. Thymic epithelial tumours in Iceland: incidence and histopathology, a population-based study. APMIS 2010; 118:927-33. [DOI: 10.1111/j.1600-0463.2010.02686.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Marchevsky AM, Gupta R, Casadio C, Hiroshima K, Jambhekar NA, Kim DJ, Nakatani Y, Okumura M, Rena O, Yoshida S. World Health Organization classification of thymomas provides significant prognostic information for selected stage III patients: evidence from an international thymoma study group. Hum Pathol 2010; 41:1413-21. [PMID: 20573368 DOI: 10.1016/j.humpath.2010.02.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 02/22/2010] [Accepted: 02/25/2010] [Indexed: 11/24/2022]
Abstract
Information regarding prognosis of thymoma patients stratified by both World Health Organization classification and Masaoka staging system is very limited. Analyze 5-year survival data from a large number of thymoma patients stratified by both World Health Organization histologic type and Masaoka stage using meta-analysis. Perform power analysis to estimate the number of cases that would be needed to test the null hypothesis to a power of 80%. Five-year survival data from 905 thymoma patients treated with thymectomy at seven hospitals in America, Japan, Korea, India, Italy, and Germany. Survival data was reported as "dead" or "alive" to facilitate meta-analysis. Significant differences were detected only when comparing survival rates of thymoma patients in stages I to III with those of stage IV disease. Analysis by World Health Organization histologic type and stage yielded significant differences only in patients with thymomas A vs. B2 and A vs. B3 in stage III disease. No significant data heterogeneity was detected with funnel plots and Egger's regression test. Power analysis estimated that a study with 7077 patients is needed to evaluate the prognostic significance of all thymomas stratified by both World Health Organization histologic type and stage to a power of 80%. Selected World Health Organization histologic types are significantly associated with prognosis in stage III thymoma patients and may help select individuals benefiting from neoadjuvant therapy. Power analysis shows that studies with much larger number of patients are needed to exclude the possibility that histologic type may provide significant prognostic information in other stages of the disease.
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Affiliation(s)
- Alberto M Marchevsky
- Department of Pathology, Cedars Sinai Medical Center, Los Angeles, CA 90048, USA.
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Interobserver diagnostic variability at "moderate" agreement levels could significantly change the prognostic estimates of clinicopathologic studies: evaluation of the problem using evidence from patients with diffuse lung disease. Ann Diagn Pathol 2010; 14:88-93. [PMID: 20227013 DOI: 10.1016/j.anndiagpath.2009.12.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2009] [Accepted: 12/01/2009] [Indexed: 11/24/2022]
Abstract
Does interobserver diagnostic variability (IODV) influence the accuracy of prognostic estimates of clinicopathologic studies? "Best evidence" from usual interstitial pneumonia (UIP) and nonspecific interstitial pneumonia (NSIP) patients was used to investigate the effects of IODV. Systematic literature review identified studies of UIP and NSIP providing "best evidence." Survival proportions from studies were compared using chi(2) and meta-analysis. Interobserver diagnostic variability was simulated in the data arbitrarily at 5% to 30% intervals. The various "diagnoses" were evaluated with kappa, and chi(2) statistics were used to evaluate the interobserver agreement and compare survival proportions. The survival proportions for UIP and NSIP patients in 7 retrospective level III studies ranged from 11% to 58% and 39% to 100%, respectively. Analysis of simulation results with kappa and chi(2) statistics showed that IODV greater than 10% resulted in significantly different survival proportion estimations. Interobserver diagnostic variability at moderate agreement levels significantly influences prognostic estimates. Evaluation and minimization of IODV in future clinicopathologic studies are indicated.
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Marchevsky AM, Walts AE, Bose S, Gupta R, Fan X, Frishberg D, Scharre K, Zhai J. Evidence-based evaluation of the risks of malignancy predicted by thyroid fine-needle aspiration biopsies. Diagn Cytopathol 2010; 38:252-9. [PMID: 19813257 DOI: 10.1002/dc.21185] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
A National Cancer Institute (NCI) "Thyroid Fine-Needle Aspiration (FNA) State of the Science Conference" recently proposed standardized nomenclature and "risks of malignancies" associated with various diagnostic categories. We evaluated the evidence levels of the data used by NCI to predict malignancy risks and whether those estimates had clinical validity in our patient population.Eight hundred seventy-nine patients underwent thyroid FNA during 2006. FNA diagnoses were translated into NCI diagnostic categories, and 2-year follow-up retrospective information was obtained. Four percentages of malignancies were calculated for each diagnostic category using follow-up information from FNA, thyroidectomy, both, and all patients as denominators. 95% confidence intervals (CI) were estimated for all proportions, and results were analyzed with chi-square statistics. "Relative risk" calculations were performed using the percentage of malignancies in the entire population under study as a denominator.Most of the studies cited by the NCI provided incomplete and variable level III evidence based mainly on surgical follow-up. Among our patients, the percentages of malignancies calculated with follow-up data from all patients as the denominator were similar to the "risk estimates" proposed by the NCI, but estimates based on surgical follow-up overestimated the probability of thyroid malignancy for patients with FNA diagnosis of "benign" and "follicular lesions of undetermined significance" (FLUS). Relative risk and 95% CI calculations suggested that the NCI classification could be simplified into three categories: "benign," "FLUS + neoplasm," and "suspicious + malignant."
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Affiliation(s)
- A M Marchevsky
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA90048, USA.
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Okereke IC, Kesler KA, Morad MH, Mi D, Rieger KM, Birdas TJ, Badve S, Henley JD, Turrentine MW, Nelson RP, Loehrer PJ. Prognostic indicators after surgery for thymoma. Ann Thorac Surg 2010; 89:1071-7; discussion 1077-9. [PMID: 20338309 DOI: 10.1016/j.athoracsur.2010.01.026] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2009] [Revised: 01/04/2010] [Accepted: 01/07/2010] [Indexed: 11/29/2022]
Abstract
BACKGROUND We undertook a 20-year retrospective institutional study to investigate prognostic indicators after surgery for thymoma. METHODS From 1989 to 2009, 83 patients underwent surgical resection of thymoma or thymic carcinoma at our institution. Twelve of these patients were determined to have either World Health Organization type C disease or Masaoka stage IV-B disease and were excluded from analysis. The remaining 71 patients were reviewed. RESULTS The majority of patients in this series were female 64.7% (n=46) with an overall average age of 51.0 years. The distribution of Masaoka stages I, II, III, and IV-A was 40.8% (n=29), 19.7% (n=14), 18.3% (n=13), and 21.1% (n=15), respectively. Thirteen of the 28 (46.2%) patients who presented with stage III or IV-A disease received preoperative chemotherapy. After a mean follow-up of 66 months (range, 6 to 241 months), 54 (75.3%) patients are alive and well while six are alive with disease. Eleven (16.0%) patients have died, but only 3 (4.3%) of these patients died of thymoma. The overall disease-specific survival was 97% and 89% at 5 and 10 years. Of the variables analyzed, only age was predictive of overall survival (p=0.03). Masaoka stages I to III as compared with stage IV-A was significantly predictive of disease-free survival (p<0.01). CONCLUSIONS Long-term disease-specific survival can be expected not only after surgery for early stage thymoma but also after surgery for advanced disease, including patients with pleural metastases. However, patients who undergo surgery for stage IV-A disease have reduced disease-free survival. Late mortality due to secondary cancers and associated immunologic disorders was more frequent than mortality from thymoma in this series.
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Affiliation(s)
- Ikenna C Okereke
- Department of Surgery-Cardiothoracic Division, Indiana University School of Medicine, Indianapolis, Indiana 46204, USA.
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Venuta F, Anile M, Rendina EA, Vitolo D, De Giacomo T, Coloni GF. The value of transcapsular invasion in patients with thymoma. Arch Pathol Lab Med 2009; 133:1364-5. [PMID: 19722737 DOI: 10.5858/133.9.1364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Wu M, Sun K, Gil J, Gan L, Burstein DE. Immunohistochemical detection of p63 and XIAP in thymic hyperplasia and thymomas. Am J Clin Pathol 2009; 131:689-93. [PMID: 19369629 DOI: 10.1309/ajcpvtz06dhkcogp] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
We subjected 23 formalin-fixed, paraffin-embedded tissue blocks (11 cases of thymic hyperplasia and 12 thymomas [3 encapsulated, 8 with capsular invasion, and 1 atypical]) to incubation with monoclonal anti-X-linked inhibitor of apoptosis protein (XIAP) (BD Biosciences, San Jose, CA) and monoclonal anti-p63 (4A4, Santa Cruz, Santa Cruz, CA). Granular or heterogeneous cytoplasmic XIAP staining and nuclear p63 staining were considered positive. We compared thymic hyperplasia with thymoma and capsulated thymoma with thymoma with capsular invasion or atypia. p63 was positive in virtually all thymic epithelial cells in hyperplasia and thymoma. XIAP was negative in all hyperplasia cases except one. Of 12 thymomas, 9 were XIAP+ with focal/weak to diffuse/strong positivity: 2 of 3 encapsulated and 7 of 8 thymomas with capsular invasion were XIAP+. One atypical thymoma was XIAP-. XIAP expression differed significantly between hyperplasia and thymoma (P = .0007) but not between capsulated and invasive thymomas (P = .3797). p63 is consistently positive in nonneoplastic and neoplastic thymic epithelium. XIAP expression in thymoma suggests a possible role in the pathogenesis of thymoma and may be helpful in differentiating thymic hyperplasia from thymoma, especially in small biopsy specimens. However, the level of expression does not correlate with capsular invasion or atypia.
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Herbst J, Jenders R, McKenna R, Marchevsky A. Evidence-based criteria to help distinguish metastatic breast cancer from primary lung adenocarcinoma on thoracic frozen section. Am J Clin Pathol 2009; 131:122-8. [PMID: 19095575 DOI: 10.1309/ajcpf42avkhgdrze] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
The distinction between primary lung adenocarcinoma and metastatic breast carcinoma in patients with a history of breast cancer is difficult by frozen section (FS) analysis. Our experience with 129 FSs from 121 patients with a pulmonary nodule and a history of breast cancer was reviewed. The pretest odds ratio of primary pulmonary carcinoma/metastatic breast carcinoma was 2.6. The incidence of 12 histopathologic features was assessed in a "training set" composed of 20 FSs, 10 with primary lung adenocarcinoma and 10 with metastatic breast cancer. A differential diagnosis model composed of significant pathologic features that favor the diagnosis of primary lung adenocarcinoma (acini, lepidic growth, nuclear pseudoinclusions, and scar) or metastatic breast carcinoma (comedonecrosis, solid nests, trabecular architecture, and cribriform growth) was identified. The external validity of this model was successfully tested by challenging 19 pathologists and trainees with a test set of 20 unknown FSs, supporting the clinical applicability of the diagnostic model.
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Affiliation(s)
| | - Robert Jenders
- Medicine, University of California-Los Angeles
- Medicine, University of California-Los Angeles
| | - Robert McKenna
- Thoracic Surgery, Cedars-Sinai Medical Center, Los Angeles, University of California-Los Angeles
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Rosai J. Evidence-based pathology and the pathologic evaluation of thymomas. Arch Pathol Lab Med 2008; 132:1859; author reply 1859. [PMID: 19061277 DOI: 10.5858/132.12.1859.a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Marchevsky AM. In Reply. Arch Pathol Lab Med 2008. [DOI: 10.5858/132.12.1859.b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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