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Nemiroff S, Chai R, Fan J, Ramer-Bass I. Ectopic Cervical Thymoma in a Patient Diagnosed With Graves Disease: A Systematic Literature Review. J Clin Endocrinol Metab 2024; 109:1198-1201. [PMID: 37897424 DOI: 10.1210/clinem/dgad635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/17/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
Thymomas are benign thymic epithelial neoplasms, rarely found outside the anterior mediastinum. Although hyperthyroid states have been associated with thymic hyperplasia, only 3 thymoma cases have been previously reported in patients with Graves disease (GD), all within the anterior mediastinum. Here, we report a case of ectopic cervical thymoma in a 22-year-old female patient previously treated for GD. The patient underwent ultrasonography, computed tomography, inconclusive fine-needle aspiration, and ultimately gross dissection for diagnostic workup and definitive treatment of an anterior neck mass, producing a 2.5 × 2.3 × 1.5-cm entity consistent with Masaoka stage I and type B2 thymoma per World Health Organization classification. The patient underwent an uncomplicated subsequent clinical course, with no adjuvant radiotherapy administered. After conducting a systematic literature review, we conclude that of the 109 cases of ectopic cervical thymoma reported, this is the first to describe a case of ectopic cervical thymoma in a patient with a past medical history of GD. For GD patients in stable euthyroid remission with the persistent or recurrent presence of an anterior neck mass, the extrathyroidal origin of the mass should always be considered, including the exceptional presence of a cervical ectopic thymoma.
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Affiliation(s)
- Samuel Nemiroff
- Internal Medicine Resident at Mount Sinai Morningside and West, New York, NY 10019, USA
| | - Raymond Chai
- Department of Otolaryngology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Jun Fan
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Ilana Ramer-Bass
- Division of Endocrinology at Mount Sinai Morningside and West, Icahn School of Medicine at Mount Sinai, New York, NY 10019, USA
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2
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Ahn Y, Lee SM, Choi S, Choe J, Oh SY, Do KH, Seo JB. CT-guided pretreatment biopsy diagnosis in patients with thymic epithelial tumours: diagnostic accuracy and risk of seeding. Clin Radiol 2024; 79:263-271. [PMID: 38220515 DOI: 10.1016/j.crad.2023.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 11/10/2023] [Accepted: 12/10/2023] [Indexed: 01/16/2024]
Abstract
AIM To investigate the diagnostic performance of computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB) for thymic epithelial tumours (TETs) and the complication rate after PTNB including seeding after PTNB. MATERIALS AND METHODS This retrospective study identified PTNBs for anterior mediastinal lesions between May 2007 and September 2021. The diagnostic performance for TETs and complications were investigated. The concordance of the histological grades of TETs between PTNB and surgery was evaluated. The factors associated with pleural seeding after PTNB were determined using Cox regression analysis. RESULTS Of 387 PTNBs, 235 PTNBs from 225 patients diagnosed as TETs (124 thymomas and 101 thymic carcinomas) and 150 PTNBs from 133 patients diagnosed as other than TETs were included. The sensitivity, specificity, and accuracy for TETs were 89.4% (210/235), 100% (210/210), and 93.5% (360/385), respectively, with an immediate complication rate of 4.4% (17/385). The concordance rate of the histological grades between PTNB and surgery was 73.3% (77/105) after excluding uncategorised types of thymomas. During follow-up after PTNB (median duration, 38.8 months; range, 0.3-164.6 months), no tract seeding was observed. Pleural seeding was observed in 26 patients. Thymic carcinoma (hazard ratio [HR], 5.94; 95% confidence interval [CI], 2.07-17.08; p=0.001) and incomplete resection (HR, 3.29; 95% CI, 1.20-9.02; p=0.02) were associated with pleural seeding, while the biopsy approach type (transpleural versus parasternal) was not associated (p=0.12). CONCLUSIONS Pretreatment biopsy for TETs was accurate and safe and may be considered for diagnosing TETs, particularly when the diagnosis is challenging and histological diagnosis is mandatory.
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Affiliation(s)
- Y Ahn
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - S M Lee
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea.
| | - S Choi
- Department of Cardiothoracic Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J Choe
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - S Y Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - K-H Do
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
| | - J B Seo
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, South Korea
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Huang X, Wang X, Liu Y, Wang Z, Li S, Kuang P. Contrast-enhanced CT-based radiomics differentiate anterior mediastinum lymphoma from thymoma without myasthenia gravis and calcification. Clin Radiol 2024; 79:e500-e510. [PMID: 38242804 DOI: 10.1016/j.crad.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/30/2023] [Accepted: 12/19/2023] [Indexed: 01/21/2024]
Abstract
AIM To explore the value of a radiomics model based on enhanced computed tomography (CT) in differentiating anterior mediastinal lymphoma (AML) and thymoma without myasthenia gravis (MG) and calcification. MATERIALS AND METHODS The present study analysed patients who were diagnosed histologically with AML and thymoma in three independent institutions. All pre-treatment patients underwent enhanced CT. In the training group of patients from institutions 1 (the First Affiliated Hospital of Kunming Medical University) and 3 (the Yunnan Cancer Hospital), two radiologists independently analysed the enhanced CT images and performed manual segmentation of each tumour. Radiomics features were screened using interobserver interclass coefficient (ICC) analysis, feature correlation analysis, and L1 regularisation. The discriminative efficacy of the logistic regression model was evaluated using receiver operating characteristic (ROC) analysis. Validation group of patients from institution 2 (the Second Affiliated Hospital of Zhejiang University School of Medicine) was used to validate the proposed models. RESULTS A total of 114 patients were enrolled in this study and 1,743 radiomics features were extracted from the enhanced CT images. After feature screening, the remaining 37 robust radiomics features were used to construct the model. In the training group, the AUC of the model was 0.987 (95% confidence interval [CI]: 0.976-0.999), the sensitivity, specificity, and accuracy were 0.912, 0.946, and 0.924, respectively. In the validation group, the AUC of the model was 0.798 (95% CI: 0.683-0.913), the sensitivity, specificity, and accuracy were 0.760, 0.700, and 0.743, respectively. CONCLUSION The radiomics model created provided effective information to assist in the selection of clinical strategies, thus reducing unnecessary procedures in patients with AML and guiding direct surgery in patients with thymoma to avoid biopsy.
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Affiliation(s)
- X Huang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - X Wang
- Department of Thoracic Surgery, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Y Liu
- Department of Radiology, Yunnan Cancer Hospital, Kunming, China
| | - Z Wang
- Department of Radiology, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - S Li
- School of Basic Medical Sciences, Kunming Medical University, Kunming, Yunnan, China
| | - P Kuang
- Department of Radiology, The Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.
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Palazzo S, Rahman Z, Femia F, Harrison-Phipps K, Simpson T. Massive thymoma mimicking a pleural mass. Thorax 2024; 79:382-383. [PMID: 38359925 DOI: 10.1136/thorax-2023-221296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 01/28/2024] [Indexed: 02/17/2024]
Affiliation(s)
- Stefano Palazzo
- Respiratory Medicine, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Zaid Rahman
- Lewisham and Greenwich NHS Trust, London, UK
| | - Federico Femia
- Thoracic Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Yankov G, Alexieva M, Mekov E, Petkov R. Resection and a rare type of reconstruction of the superior vena cava with the left brachiocephalic vein. Folia Med (Plovdiv) 2024; 66:142-146. [PMID: 38426478 DOI: 10.3897/folmed.66.e102981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 06/13/2023] [Indexed: 03/02/2024] Open
Abstract
Resection and reconstruction of the superior vena cava (SVC) are required in a selected group of patients with anterior mediastinal tumors and lung neoplasms. We present the case of a 63-year-old woman who underwent invasive type B2 thymoma resection and a rare type of reconstruction of the superior vena cava using a patch of the left brachiocephalic vein (LBV). The various types of reconstruction of the superior vena cava are discussed.
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Watanabe Y, Hirai K, Hirata M, Kitano T, Ito K, Ookawara S, Oshiro H, Morishita Y. Steroid-resistant minimal change nephrotic syndrome associated with thymoma treated effectively with rituximab following thymectomy and cyclosporine: a case report. BMC Nephrol 2024; 25:53. [PMID: 38336671 PMCID: PMC10858521 DOI: 10.1186/s12882-024-03485-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/28/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND Minimal change nephrotic syndrome (MCNS) can be complicated by thymoma; however, no standard therapy for thymoma-associated MCNS has yet been established. We herein describe a case of steroid-resistant MCNS associated with thymoma, treated effectively with rituximab. CASE PRESENTATION A 71-year-old Japanese man was referred to our department with severe proteinuria (20 g/gCr). Renal biopsy showed minimal change disease and computed tomography revealed an anterior mediastinal mass. Based on these findings, he was diagnosed with thymoma-associated MCNS. He was treated with oral prednisolone (50 mg/day) and cyclosporine, and underwent thymectomy and plasma exchange. However, no improvement in proteinuria was observed. He therefore received intravenous rituximab 500 mg, resulting in a marked decrease in proteinuria from 5328 to 336 mg/day after 1 week. CONCLUSIONS This case suggests that rituximab might be an effective therapy in patients with steroid-resistant MCNS associated with thymoma.
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Affiliation(s)
- Yusaku Watanabe
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Keiji Hirai
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan.
| | - Momoko Hirata
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Taisuke Kitano
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Kiyonori Ito
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Susumu Ookawara
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
| | - Hisashi Oshiro
- Department of Diagnostic Pathology, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Yoshiyuki Morishita
- Division of Nephrology, First Department of Integrated Medicine, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma-cho, Omiya-ku, Saitama-shi, Saitama-ken, 330-8503, Japan
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7
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Russell S, Navadgi S, Clay T, Starac D. Advanced thymic carcinoma with a hepatic metastasis treated with chemotherapy and staged resection. BMJ Case Rep 2024; 17:e258431. [PMID: 38320822 PMCID: PMC10860030 DOI: 10.1136/bcr-2023-258431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Thymic carcinoma is rare, with resulting treatment of patients with extrathoracic metastasis being on a case-by-case basis. We describe the management of a woman in her 70s with an incidentally discovered cystic hepatic lesion with confirmation of a solitary extrathoracic metastasis from a synchronous primary thymic carcinoma. Following chemotherapy and staged resection of the metastasis and the primary tumour, the patient remained free of disease on radiological surveillance 6 months postoperatively.
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Affiliation(s)
- Sheldon Russell
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Suresh Navadgi
- Department of General Surgery, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Timothy Clay
- St John of God Subiaco Hospital, Subiaco, Western Australia, Australia
| | - Diana Starac
- Australian Clinical Labs SJGP Subiaco, Subiaco, Western Australia, Australia
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8
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Tanaka K, Suzuki H, Inage T, Ito T, Sakairi Y, Yoshino I. Lobulated tumor contour as a predictor of preoperative tumor invasion of the lung or pericardium in thymoma patients. Surg Today 2024; 54:162-167. [PMID: 37340140 DOI: 10.1007/s00595-023-02719-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 05/19/2023] [Indexed: 06/22/2023]
Abstract
PURPOSE Preoperative investigations to detect invasion to neighboring organs are important for deciding on the most appropriate surgical approach for thymoma. We evaluated preoperative computed tomography (CT) findings in thymoma patients to identify the CT features associated with tumor invasion. METHODS Clinicopathologic information on 193 patients who underwent surgical resection for thymoma at Chiba University Hospital between 2002 and 2016 was collected retrospectively. The surgical pathology identified invasion of thymoma in 35 patients: in the lung (n = 18), pericardium (n = 11), or both (n = 6). Contact lengths between the tumor contour and lung (CLTL) or pericardium (CLTP) were measured at the maximum section of the tumor on axial CT. Univariate and multivariate analyses were performed to analyze the relationship between pathological invasion of the lung or pericardium and the clinicopathologic features. RESULTS The mean CLTL and CLTP were significantly longer in patients with invasion of the neighboring organs than in those without invasion. A lobulated tumor contour was identified in 95.6% of the patients with invasion of the neighboring organs. A multivariate analysis revealed that a lobulated tumor contour was significantly associated with both lung and pericardial invasion. CONCLUSIONS A lobulated tumor contour was significantly associated with lung and/or pericardial invasion in thymoma patients.
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Affiliation(s)
- Kazuhisa Tanaka
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Hidemi Suzuki
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan.
| | - Terunaga Inage
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Takamasa Ito
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Yuichi Sakairi
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
| | - Ichiro Yoshino
- Department of General Thoracic Surgery, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chiba, 260-8670, Japan
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Liu M, Zhang Y, Liu LH. Histogram analysis based on unenhanced CT for identifying thymoma and lymphoma among prevascular mediastinal incidentalomas. Cancer Imaging 2024; 24:5. [PMID: 38178266 PMCID: PMC10768309 DOI: 10.1186/s40644-023-00617-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 10/07/2023] [Indexed: 01/06/2024] Open
Abstract
OBJECTIVE To determine whether histogram analysis based on unenhanced CT can play a role in the differential diagnosis of thymoma and lymphoma from thymic hyperplasia and cyst (mean CT attenuation > 10 HU). MATERIALS AND METHODS This retrospective study included consecutive asymptomatic participants who have prevascular mediastinal lesions incidentally detected by unenhanced CT between December 2013 and August 2020, and with definitive diagnosis by pathology or additional radiologic work-ups. A total of thirteen histogram parameters on enhanced CT were calculated for each lesion, then were compared between tumor (thymoma + lymphoma) and non-tumor (hyperplasia + cyst). Receiver operating characteristic analysis was conducted to investigate the performance of histogram parameter for identifying tumor. RESULTS The study population included 192 patients (106 men and 86 women) with a mean age of 50.5 years at the time of CT examination. Of them, 94 patients have tumor (87 thymomas and 7 lymphoma) and 98 have non-tumor (48 thymic hyperplasia and 50 cysts). Nine of the thirteen histogram parameters revealed significant difference between the two groups, including median, minimum, range, 10th percentile, 90th percentile, kurtosis, skewness, uniformity and entropy. No significant difference was observed in the mean CT attenuation between groups. Higher median was found to be independent predictors for distinguishing tumor from non-tumor, and can achieve an area under the curve (AUC) of 0.785 (95% confidence interval [95% IC], 0.720-0.841). CONCLUSIONS Histogram analysis based on unenhanced CT may be able to provide some help in the differential diagnosis of incidental lesions in prevascular mediastinal. GRAND SUPPORT This study was sponsored by Natural Science Foundation of Shanghai (No. 21ZR1459700).
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Affiliation(s)
- Ming Liu
- Department of Radiation Oncology, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China
| | - Yang Zhang
- Department of Radiology, Dongying People's Hospital, Shandong, China
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China
| | - Li-Heng Liu
- Department of Radiology, Zhongshan Hospital, Fudan University, No. 180 Fenglin Road, Shanghai, China.
- Shanghai Institute of Medical Imaging, Shanghai, China.
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Sugai K, Nakaoka K, Tobita R, Kikuchi S, Inoue K, Enokido M, Kiyoshima M. A case of a shrunken multilocular mediastinal cyst that developed into thymic carcinoma with lung metastases 13 years later. Thorac Cancer 2024; 15:94-97. [PMID: 38018322 PMCID: PMC10761612 DOI: 10.1111/1759-7714.15174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 11/13/2023] [Accepted: 11/14/2023] [Indexed: 11/30/2023] Open
Abstract
Multilocular thymic cysts (MTC) are acquired multilocular cysts caused by inflammation. The rarity of such lesions and a lack of recognition make diagnosis and treatment difficult. Herein, we present our experience with a multilocular mediastinal cyst that resulted in the development of thymic cancer with metastasis over a period of 13 years. Computed tomography findings revealed an anterior mediastinal mass that was suspected to be an MTC in a 49-year-old man. The mass shrank gradually over a period of 7 years; however, growth was observed at 10 years after initial detection. At 13 years after detection, thymic carcinoma with multiple lung metastases was diagnosed. Resection was recommended during the follow-up period, but the patient refused treatment. A multilocular wall and location are factors that indicate MTC. However, even if a definitive diagnosis is not made, resection of multilocular anterior mediastinal cysts should be considered as determining the preoperative diagnosis is difficult. Nevertheless, our case suggests that the coexistence of tumors with cysts is possible, and the potential for malignant tumor development exists.
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Affiliation(s)
- Kazuto Sugai
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
| | - Kojiro Nakaoka
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
| | - Rika Tobita
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
| | - Shinji Kikuchi
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
- Department of Thoracic SurgeryUniversity of TsukubaTsukubaJapan
| | - Kei Inoue
- Department of Diagnostic RadiologyIbaraki Prefectural Central HospitalKasamaJapan
| | - Midori Enokido
- Department of Diagnostic RadiologyIbaraki Prefectural Central HospitalKasamaJapan
| | - Moriyuki Kiyoshima
- Department of Thoracic SurgeryIbaraki Prefectural Central HospitalKasamaJapan
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11
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Chen J, Zhou M, Hu J, Xu F. A case of intrathyroid thymic carcinoma. Asian J Surg 2024; 47:634-635. [PMID: 37805320 DOI: 10.1016/j.asjsur.2023.09.141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 09/22/2023] [Indexed: 10/09/2023] Open
Affiliation(s)
- Jia Chen
- Shaoxing People's Hospital, Shaoxing, 312000, China; School of Medicine, ShaoXing University, Shaoxing, 312000, China
| | - Minghui Zhou
- School of Medicine, ShaoXing University, Shaoxing, 312000, China; Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Jingjing Hu
- School of Medicine, ShaoXing University, Shaoxing, 312000, China; Shaoxing People's Hospital, Shaoxing, 312000, China
| | - Feng Xu
- Shaoxing People's Hospital, Shaoxing, 312000, China.
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12
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Han L, Wang EH, Wang L. Sclerosing micronodular thymoma with lymphoid stroma: A case report. Asian J Surg 2024; 47:701-703. [PMID: 37821250 DOI: 10.1016/j.asjsur.2023.09.155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/27/2023] [Indexed: 10/13/2023] Open
Affiliation(s)
- Lihua Han
- The Central Laboratory of Morphology, Shenyang Medical College, Shenyang, China.
| | - En-Hua Wang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Liang Wang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
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13
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Liu X, Wu R, Tang Z, Li L. Synchronous thymic carcinoma and lung adenocarcinoma: A rare case report. Asian J Surg 2023; 46:5915-5916. [PMID: 37718208 DOI: 10.1016/j.asjsur.2023.08.222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 08/30/2023] [Indexed: 09/19/2023] Open
Affiliation(s)
- Xiangjin Liu
- First Clinical Medical College, The Gannan Medical University, Ganzhou, China
| | - Rongqian Wu
- First Clinical Medical College, The Nanchang University, Nanchang, China
| | - Zhixian Tang
- Department of Thoracic Surgery, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China.
| | - Ling Li
- Department of Pathology, The First Affiliated Hospital of Gannan Medical University, Ganzhou, China
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Gao R, Zhou J, Zhang J, Zhu J, Wang T, Yan C. Quantitative CT parameters combined with preoperative systemic inflammatory markers for differentiating risk subgroups of thymic epithelial tumors. BMC Cancer 2023; 23:1158. [PMID: 38012604 PMCID: PMC10683274 DOI: 10.1186/s12885-023-11332-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 08/24/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Thymic epithelial tumors (TETs) are the most common primary neoplasms of the anterior mediastinum. Different risk subgroups of TETs have different prognosis and therapeutic strategies, therefore, preoperative identification of different risk subgroups is of high clinical significance. This study aims to explore the diagnostic efficiency of quantitative computed tomography (CT) parameters combined with preoperative systemic inflammatory markers in differentiating low-risk thymic epithelial tumors (LTETs) from high-risk thymic epithelial tumors (HTETs). METHODS 74 Asian patients with TETs confirmed by biopsy or postoperative pathology between January 2013 and October 2022 were collected retrospectively and divided into two risk subgroups: LTET group (type A, AB and B1 thymomas) and HTET group (type B2, B3 thymomas and thymic carcinoma). Statistical analysis were performed between the two groups in terms of quantitative CT parameters and preoperative systemic inflammatory markers. Multivariate logistic regression analysis was used to determine the independent predictors of risk subgroups of TETs. The area under curve (AUC) and optimal cut-off values were calculated by receiver operating characteristic (ROC) curves. RESULTS 47 TETs were in LTET group, while 27 TETs were in HTET group. In addition to tumor size and CT value of the tumor on plain scan, there were statistical significance comparing in CT value of the tumor on arterial phase (CTv-AP) and venous phase (CTv-VP), and maximum enhanced CT value (CEmax) of the tumor between the two groups (for all, P < 0.05). For systemic inflammatory markers, HTET group was significantly higher than LTET group (for all, P < 0.05), including platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and systemic immune-inflammation index (SII). Multivariate logistic regression analysis showed that NLR (odds ratio [OR] = 2.511, 95% confidence interval [CI]: 1.322-4.772, P = 0.005), CTv-AP (OR = 0.939, 95%CI: 0.888-0.994, P = 0.031) and CTv-VP (OR = 0.923, 95%CI: 0.871-0.979, P = 0.008) were the independent predictors of risk subgroups of TETs. The AUC value of 0.887 for the combined model was significantly higher than NLR (0.698), CTv-AP (0.800) or CTv-VP (0.811) alone. The optimal cut-off values for NLR, CTv-AP and CTv-VP were 2.523, 63.44 Hounsfeld Unit (HU) and 88.29HU, respectively. CONCLUSIONS Quantitative CT parameters and preoperative systemic inflammatory markers can differentiate LTETs from HTETs, and the combined model has the potential to improve diagnostic efficiency and to help the patient management.
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Affiliation(s)
- Rongji Gao
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China
| | - Jian Zhou
- Department of Radiology, Taian City Central Hospital, No.29, Longtan Road, Taian, Shandong Province, 271000, China
| | - Juan Zhang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China
| | - Jianzhong Zhu
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China
| | - Tiantian Wang
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China.
| | - Chengxin Yan
- Department of Radiology, The Second Affiliated Hospital of Shandong First Medical University, No.366, Taishan Street, Taian, Shandong Province, 271000, China.
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15
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Shell D, Malone J, Kho J, Yap CH. Multifocal primary intrapulmonary thymoma successfully resected via robotic-assisted thoracoscopic surgery. BMJ Case Rep 2023; 16:e257789. [PMID: 38000810 PMCID: PMC10679981 DOI: 10.1136/bcr-2023-257789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2023] Open
Abstract
Primary intrapulmonary thymoma (PIT) represents a rare subset of ectopic thymoma that arises solely from inside the pulmonary parenchyma. Multifocal PIT, where multiple isolated PIT origins coexist in the lungs, has only been confirmed in one previous case report, in which the patient died before surgical resection. These tumours are difficult to diagnose as imaging findings are non-specific, and non-invasive biopsy often yields inaccurate results. We present the case of a man in his 70s who was referred to thoracic surgery for resection of a presumptive endobronchial pulmonary carcinoid tumour. Only after surgical resection did we identify that the patient had multifocal PIT. In this report, we describe our diagnostic and management process for this patient and review the current literature on PIT.
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Affiliation(s)
- Daniel Shell
- Cardiothoracic Surgery, Barwon Health, Geelong, Victoria, Australia
| | - James Malone
- Respiratory Medicine, Barwon Health, Geelong, Victoria, Australia
| | - Jane Kho
- Anatomical Pathology, Melbourne Pathology, Collingwood, Victoria, Australia
| | - Cheng-Hon Yap
- Cardiothoracic Surgery, Barwon Health, Geelong, Victoria, Australia
- School of Medicine, Deakin University Faculty of Health, Geelong, Victoria, Australia
- Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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16
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Dong W, Xiong S, Wang X, Hu S, Liu Y, Liu H, Wang X, Chen J, Qiu Y, Fan B. Development and validation of a contrast-enhanced CT-based radiomics nomogram for differentiating mass-like thymic hyperplasia and low-risk thymoma. J Cancer Res Clin Oncol 2023; 149:14901-14910. [PMID: 37604939 DOI: 10.1007/s00432-023-05263-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/08/2023] [Indexed: 08/23/2023]
Abstract
PURPOSE To explore the efficiency of a contrast-enhanced CT-based radiomics nomogram integrated with radiomics signature and clinically independent predictors to distinguish mass-like thymic hyperplasia (ml-TH) from low-risk thymoma (LRT) preoperatively. METHODS 135 Patients with histopathology confirmed ml-TH (n = 65) and LRT (n = 70) were randomly divided into training set (n = 94) and validation set (n = 41) at a ratio of 7:3. The least absolute shrinkage and selection operator (LASSO) algorithm was used to obtain the optimal features. Based on the selected features, four machine learning models, support vector machine (SVM), logistic regression (LR), extreme gradient boosting (XGBOOST), and random forest (RF) were constructed. Multivariate logistic regression was used to establish a radiomics nomogram containing clinically independent predictors and radiomics signature. Receiver operating characteristic (ROC), DeLong test, and calibration curves were used to detect the performance of the radiomics nomogram in training set and validation set. RESULTS In the validation set, the area under the curve (AUC) value of LR (0.857; 95% CI: 0.741, 0.973) was the highest of the four machine learning models. Radiomics nomogram containing radiomics signature and clinically independent predictors (including age, shape, and net enhancement degree) had better calibration and identification in the training set (AUC: 0.959; 95% CI: 0.922, 0.996) and validation set (AUC: 0.895; 95% CI: 0.795, 0.996). CONCLUSION We constructed a contrast-enhanced CT-based radiomics nomogram containing clinically independent predictors and radiomics signature as a noninvasive preoperative prediction method to distinguish ml-TH from LRT. The radiomics nomogram we constructed has potential for preoperative clinical decision making.
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Affiliation(s)
- Wentao Dong
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Situ Xiong
- Medical College of Nanchang University, Nanchang University, Nanchang, China
| | - Xiaolian Wang
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Shaobo Hu
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Yangchun Liu
- Department of Thoracic Surgery, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China
| | - Hao Liu
- R&D, Yizhun Medical AI, Beijing, China
| | - Xin Wang
- R&D, Yizhun Medical AI, Beijing, China
| | | | - Yingying Qiu
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
| | - Bing Fan
- Department of Radiology, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, China.
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17
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Gao Y, Li R, Wu L, Yang H, Mao J, Zhao W. Thymoma in multiple endocrine neoplasia type 1: a case report and systematic review. Endocrine 2023; 82:442-449. [PMID: 37668926 DOI: 10.1007/s12020-023-03440-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/21/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Multiple endocrine neoplasia type 1 (MEN1) is a rare syndrome that combines endocrine and non-endocrine tumors. Thymic neuroendocrine tumors are uncommon components that predict poor prognosis in patients with MEN1. We aimed to summarize the clinical characteristics of thymoma in MEN1 by reviewing the current reports from the literature. METHODS A patient with multiple endocrine neoplasia type 1 (parathyroid hyperplasia, pituitary adenoma, and insulinoma) was found to have a 2 × 1.5 cm thymic mass during long-term follow-up. Thoracoscope surgery was performed, and a histopathology examination revealed WHO Type B3 thymoma. A pathogenic mutation of c.783 + 1G > A in the MEN1 gene was identified. We further searched PubMed and EMBASE for thymoma in association with MEN1. RESULTS A comprehensive overview of the literature concerning characteristics of MEN1-related thymoma was summarized. Clinical characteristics and differences between thymoma and thymic carcinoid are highlighted. CONCLUSIONS Besides carcinoid, other tumors, including thymoma, need to be identified for thymic space-occupying lesions in MEN1 patients. The impact of thymoma on the long-term prognosis of MEN1 patients needs further investigation.
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Affiliation(s)
- Yuting Gao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Ran Li
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Lingge Wu
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Hongbo Yang
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Jiangfeng Mao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China
| | - Weigang Zhao
- Key Laboratory of Endocrinology of National Health Commission, Department of Endocrinology, State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital, Chinese Academy of Medical Science and Peking Union Medical College, No. 1 Shuaifuyuan, Dongcheng District, 100730, Beijing, China.
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18
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Yu C, Li T, Yang X, Xin L, Zhao Z, Yang Z, Zhang R. The maximal contrast-enhanced range of CT for differentiating the WHO pathological subtypes and risk subgroups of thymic epithelial tumors. Br J Radiol 2023; 96:20221076. [PMID: 37486626 PMCID: PMC10546431 DOI: 10.1259/bjr.20221076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 07/01/2023] [Accepted: 07/11/2023] [Indexed: 07/25/2023] Open
Abstract
OBJECTIVE To explore the value of maximal contrast-enhanced (CEmax) range using contrast-enhanced CT (CECT) imaging in differentiating the pathological subtypes and risk subgroups of thymic epithelial tumors (TETs). METHODS The pre-treatment-CECT images of 319 TET patients from May 2012 to November 2021 were analyzed retrospectively. The CEmax was defined as the maximum difference between the CT value of the solid tumor on pre-contrast and contrast-enhanced images. The mean CEmax value was calculated at three different tumor levels. RESULTS There was a significant difference in the CEmax among the eight main pathological subtypes [types A, AB, B1, B2, and B3 thymoma, thymic carcinoma (TC), low-grade neuroendocrine tumor (NET) and high-grade NET] (p < 0.001). Among the eight subtypes, the CEmax values of types A, AB, and low-risk NET were higher than those of the other subtypes (all p < 0.001), and there was no difference among types B1-B3 and high-risk NET (all p > 0.05). There was no difference for CEmax values between NET and TC (p = 0.491). For the risk subgroups, the CEmax of TC (including NET) was 35.35 ± 11.41 HU, which was lower than that of low-risk thymoma (A and AB) (57.73±21.24 HU) (P < 0.001) and was higher than that of high-risk thymoma (B1-B3) (27.37±8.27 HU) (P < 0.001). The CEmax cut-off values were 38.5 HU and 30.5 HU respectively (AUC: 0.829 and 0.712; accuracy, 72.4% and 67.7%). CONCLUSION The tumor CEmax on CECT helps differentiate the pathological subtypes and risk subgroups of TETs. ADVANCES IN KNOWLEDGE In this study, an improved simplified risk grouping method was proposed based on the traditional (2004 edition) simplified risk grouping method for TETs. If Type B1 thymoma is classified as high-risk, radiologists using this improved method may improve the accuracy in differentiating risk level of TETs compared with the traditional method.
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Affiliation(s)
- Chunhai Yu
- Department of Radiology, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China
| | - Ting Li
- Department of Nephrology, Taiyuan People's Hospital, Taiyuan, China
| | - Xiaotang Yang
- Department of Radiology, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China
| | - Lei Xin
- Department of Radiology, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China
| | - Zhikai Zhao
- Department of Radiology, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China
| | - Zhao Yang
- Department of Radiology, Cancer Hospital Affiliated to Shanxi Medical University, Shanxi Province Cancer Hospital, Shanxi Hospital Affiliated to Cancer Hospital, Chinese Academy of Medical Sciences, Taiyuan, China
| | - Ruiping Zhang
- First Hospital of Shanxi Medical University, Taiyuan, China
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19
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Liu W, Wang W, Zhang H, Guo M, Xu Y, Liu X. Development and Validation of Multi-Omics Thymoma Risk Classification Model Based on Transfer Learning. J Digit Imaging 2023; 36:2015-2024. [PMID: 37268842 PMCID: PMC10501978 DOI: 10.1007/s10278-023-00855-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 05/17/2023] [Accepted: 05/19/2023] [Indexed: 06/04/2023] Open
Abstract
The paper aims to develop prediction model that integrates clinical, radiomics, and deep features using transfer learning to stratifying between high and low risk of thymoma. Our study enrolled 150 patients with thymoma (76 low-risk and 74 high-risk) who underwent surgical resection and pathologically confirmed in Shengjing Hospital of China Medical University from January 2018 to December 2020. The training cohort consisted of 120 patients (80%) and the test cohort consisted of 30 patients (20%). The 2590 radiomics and 192 deep features from non-enhanced, arterial, and venous phase CT images were extracted and ANOVA, Pearson correlation coefficient, PCA, and LASSO were used to select the most significant features. A fusion model that integrated clinical, radiomics, and deep features was developed with SVM classifiers to predict the risk level of thymoma, and accuracy, sensitivity, specificity, ROC curves, and AUC were applied to evaluate the classification model. In both the training and test cohorts, the fusion model demonstrated better performance in stratifying high and low risk of thymoma. It had AUCs of 0.99 and 0.95, and an accuracy of 0.93 and 0.83, respectively. This was compared to the clinical model (AUCs of 0.70 and 0.51, accuracy of 0.68 and 0.47), the radiomics model (AUCs of 0.97 and 0.82, accuracy of 0.93 and 0.80), and the deep model (AUCs of 0.94 and 0.85, accuracy of 0.88 and 0.80). The fusion model integrating clinical, radiomics and deep features based on transfer learning was efficient for noninvasively stratifying high risk and low risk of thymoma. The models could help to determine surgery strategy for thymoma cancer.
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Affiliation(s)
- Wei Liu
- School of Health Management, China Medical University, Shenyang, China
| | - Wei Wang
- Department of Radiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Hanyi Zhang
- Department of Radiology, Liaoning Cancer Hospital and Institute, Shenyang, China
| | - Miaoran Guo
- Department of Radiology, The First Affiliated Hospital of China Medical University, Shenyang, China
| | - Yingxin Xu
- School of Health Management, China Medical University, Shenyang, China
| | - Xiaoqi Liu
- School of Health Management, China Medical University, Shenyang, China
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20
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Mizutani H, Fujimoto N, Saihara K, Ishida M, Sakuma H, Dohi K. Long-term Consequence of Mediastinal Radiation Therapy for Thymoma on Cardiovascular System Confirmed by Cardiovascular Imaging. Circ Cardiovasc Imaging 2023; 16:e015653. [PMID: 37772413 DOI: 10.1161/circimaging.123.015653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/30/2023]
Affiliation(s)
- Hana Mizutani
- Department of Cardiology and Nephrology (H.M., N.F., K.D.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Naoki Fujimoto
- Department of Cardiology and Nephrology (H.M., N.F., K.D.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Kazushi Saihara
- Department of Radiology (K.S., M.I., H.S.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Masaki Ishida
- Department of Radiology (K.S., M.I., H.S.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Hajime Sakuma
- Department of Radiology (K.S., M.I., H.S.), Mie University Graduate School of Medicine, Tsu, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology (H.M., N.F., K.D.), Mie University Graduate School of Medicine, Tsu, Japan
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21
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Affiliation(s)
- Rei Yamakawa
- Department of Cardiology, Aso Iizuka Hospital, Japan
| | | | | | - Shujiro Inoue
- Department of Cardiology, Aso Iizuka Hospital, Japan
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22
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Koo CW, Lo YC. Good's Syndrome: Thymoma with Acquired Immunodeficiency. Am J Respir Crit Care Med 2023; 208:322-324. [PMID: 37071872 DOI: 10.1164/rccm.202211-2159im] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023] Open
Affiliation(s)
| | - Ying-Chun Lo
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
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23
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Tamburini N, D'Urbano F, Bagolini F, Trapella GS, Quarantotto F, Cavallesco G, Maniscalco P. Unilateral Thoracoscopic Thymectomy for Thymoma: Does Side Matter? A Single Institutional Experience. Thorac Cardiovasc Surg 2023; 71:418-424. [PMID: 34521142 DOI: 10.1055/s-0041-1731778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Thoracoscopic thymectomy is increasingly performed for the treatment of early stage thymoma. It is characterized by shorter postoperative hospital stay, decreased intraoperative blood loss, and fewer complications compared with transsternal thymectomy. Unilateral video-assisted thoracic surgery (VATS) thymectomy can be easily performed from either side of the thorax, because thymus is located in the middle of mediastinum. However, the side that provides better outcomes remains controversial. The purpose of this study was to compare the efficacy of right and left approaches in performing unilateral thoracoscopic thymectomy for thymoma. METHODS Consecutive patients affected by thymoma who underwent VATS thymectomy on either side between February 2001 and March 2020 were enrolled in the study. Clinicopathologic, surgical, and oncological outcomes were retrospectively analyzed and compared among the two surgical approaches. RESULTS Unilateral VATS approaches were performed on 29 patients: 12 (41%) on the left side and 17 (59%) on the right side. The mean age was 63.1 ± 11.3 years and the female/male ratio was 1.73:1. The mean operative time and the hospital stay for the left-side VATS and right-side VATS groups were, respectively, 168 ± 49.5 versus 171 ± 47.9 minutes (p = 0.9) and 3 ± 1.03 days versus 3.65 ± 1.93 days (p = 0.7). Postoperative complications occurred in one patient (3%) for left-side VATS group and one patient (3%) for right-side VATS. The 5-year disease-free survival was comparable between two groups (p = 0.74). CONCLUSION Unilateral VATS thymectomy in patients with thymoma can be safely and effectively performed by experienced surgeons in either side of the thorax with equivalent oncological outcomes.
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Affiliation(s)
- Nicola Tamburini
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Francesco D'Urbano
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Francesco Bagolini
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Giulia Salerno Trapella
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Francesco Quarantotto
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Giorgio Cavallesco
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
| | - Pio Maniscalco
- Section of General and Thoracic Surgery, Department of Morphology, Experimental Medicine and Surgery, Ferrara, Italy
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24
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Takahashi N. [Video-assisted Thoracoscopic Surgery for Mediastinal Tumor and Thoracic Wall Tumor]. Kyobu Geka 2023; 76:576-581. [PMID: 37475105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
"A final conceptual change concerns the appreciation that all major thymoma subtypes can behave in a clinically aggressive fashion and, therefore, should no longer be called benign tumors, irrespective tumor stage. Accordingly, their International Classification of Disease for Oncology( ICD)-O codes now have a /3 suffix, thymomas, for as malignant.1)" This manuscript indicated that almost all mediastinal tumors, which could not be easy to diagnose per-operatively, should be removed. There were two large problems for mediastinal tumors resection with video-assisted thoracoscopic surgery (VATS). First is management or approach for the thymic vein, which have a short distance but large diameter relatively, and individual variation about the position and the number. Some solutions were 1) performance of pre-operative enhanced computed tomograpy( CT) or magnetic resonance imaging( MRI), 2) transcervical approach with Kent retractor, 3) sternal-L shape approach. Second is for the patients, which have thymoma or thymic tumor with myasthenia gravis, to what extent should be removed anterior fatty tissue. For the moment including beneath the innominate vein it should be removed as extent as possible. Liga Sure Impact was useful to remove a large thoracic wall tumor with VATS for resection of thick muscle.
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Affiliation(s)
- Noriyuki Takahashi
- Department of Thoracic Surgery, Muroran City General Hospital, Muroran, Japan
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25
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Łukasiewicz M, Śledziński M, Szymański M, Kowalski J, Hellmann A. Therapeutic challenge: a giant, infiltrating intrathyroidal thymic carcinoma of the thyroid gland. Pol Arch Intern Med 2023; 133:16475. [PMID: 37022105 DOI: 10.20452/pamw.16475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Affiliation(s)
- Martyna Łukasiewicz
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Maciej Śledziński
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Michał Szymański
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland
| | - Jacek Kowalski
- Department of Pathomorphology, Medical University of Gdansk, Gdańsk, Poland
| | - Andrzej Hellmann
- Department of General, Endocrine and Transplant Surgery, Medical University of Gdansk, Gdańsk, Poland.
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26
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Mayoral M, Pagano AM, Araujo-Filho JAB, Zheng J, Perez-Johnston R, Tan KS, Gibbs P, Fernandes Shepherd A, Rimner A, Simone II CB, Riely G, Huang J, Ginsberg MS. Conventional and radiomic features to predict pathology in the preoperative assessment of anterior mediastinal masses. Lung Cancer 2023; 178:206-212. [PMID: 36871345 PMCID: PMC10544811 DOI: 10.1016/j.lungcan.2023.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Revised: 01/14/2023] [Accepted: 02/19/2023] [Indexed: 02/23/2023]
Abstract
OBJECTIVES The aim of this study was to differentiate benign from malignant tumors in the anterior mediastinum based on computed tomography (CT) imaging characteristics, which could be useful in preoperative planning. Additionally, our secondary aim was to differentiate thymoma from thymic carcinoma, which could guide the use of neoadjuvant therapy. MATERIALS AND METHODS Patients referred for thymectomy were retrospectively selected from our database. Twenty-five conventional characteristics were evaluated by visual analysis, and 101 radiomic features were extracted from each CT. In the step of model training, we applied support vector machines to train classification models. Model performance was assessed using the area under the receiver operating curves (AUC). RESULTS Our final study sample comprised 239 patients, 59 (24.7 %) with benign mediastinal lesions and 180 (75.3 %) with malignant thymic tumors. Among the malignant masses, there were 140 (58.6 %) thymomas, 23 (9.6 %) thymic carcinomas, and 17 (7.1 %) non-thymic lesions. For the benign versus malignant differentiation, the model that integrated both conventional and radiomic features achieved the highest diagnostic performance (AUC = 0.715), in comparison to the conventional (AUC = 0.605) and radiomic-only (AUC = 0.678) models. Similarly, regarding thymoma versus thymic carcinoma differentiation, the model that integrated both conventional and radiomic features also achieved the highest diagnostic performance (AUC = 0.810), in comparison to the conventional (AUC = 0.558) and radiomic-only (AUC = 0.774) models. CONCLUSION CT-based conventional and radiomic features with machine learning analysis could be useful for predicting pathologic diagnoses of anterior mediastinal masses. The diagnostic performance was moderate for differentiating benign from malignant lesions and good for differentiating thymomas from thymic carcinomas. The best diagnostic performance was achieved when both conventional and radiomic features were integrated in the machine learning algorithms.
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Affiliation(s)
- Maria Mayoral
- Department of Radiology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Medical Imaging Department. Hospital Clinic of Barcelona, 170 Villarroel street, Barcelona 08036, Spain.
| | - Andrew M Pagano
- Department of Radiology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Jose Arimateia Batista Araujo-Filho
- Department of Radiology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA; Department of Radiology. Hospital Sirio-Libanes, 91 Dona Adma Jafet street, São Paulo 01308-050, Brazil
| | - Junting Zheng
- Department of Epidemiology and Biostatistics. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Rocio Perez-Johnston
- Department of Radiology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Kay See Tan
- Department of Epidemiology and Biostatistics. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Peter Gibbs
- Department of Radiology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Annemarie Fernandes Shepherd
- Department of Radiation Oncology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Andreas Rimner
- Department of Radiation Oncology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Charles B Simone II
- Department of Radiation Oncology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Gregory Riely
- Department of Surgery. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - James Huang
- Department of Surgery. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
| | - Michelle S Ginsberg
- Department of Radiology. Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, USA
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Abstract
ABSTRACT 18F-FDG PET/CT performed for staging of colon cancer in a 60-year-old woman revealed a thymic neoplasm with increased radiopharmaceutical uptake in the anterior mediastinum. 68Ga-FAPI PET/CT showed low FAPI uptake in the anterior mediastinal mass. The patient was diagnosed with type B3 thymoma by histopathologic evaluation. In this case, thymoma demonstrated lower uptake with FAPI than FDG. Larger studies are required for the differentiation of malignant and benign mediastinal masses with FAPI.
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Affiliation(s)
| | | | | | - Nilgün Söğütçü
- Pathology, Gazi Yaşargil Training and Research Hospital, University of Health Sciences, Diyarbakir, Turkey
| | - Canan Can
- From the Departments of Nuclear Medicine
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28
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Byrd CT, Trope WL, Bhandari P, Konsker HB, Moradi F, Lui NS, Liou DZ, Backhus LM, Berry MF, Shrager JB. Positron emission tomography/computed tomography differentiates resectable thymoma from anterior mediastinal lymphoma. J Thorac Cardiovasc Surg 2023; 165:371-381.e1. [PMID: 35568521 DOI: 10.1016/j.jtcvs.2022.02.055] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 01/16/2022] [Accepted: 02/01/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Discrete anterior mediastinal masses most often represent thymoma or lymphoma. Lymphoma treatment is nonsurgical and requires biopsy. Noninvasive thymoma is ideally resected without biopsy, which may potentiate pleural metastases. This study sought to determine if clinical criteria or positron emission tomography/computed tomography could accurately differentiate the 2, guiding a direct surgery versus biopsy decision. METHODS A total of 48 subjects with resectable thymoma and 29 subjects with anterior mediastinal lymphoma treated from 2006 to 2019 were retrospectively examined. All had pretreatment positron emission tomography/computed tomography and appeared resectable (solitary, without clear invasion or metastasis). Reliability of clinical criteria (age and B symptoms) and positron emission tomography/computed tomography maximum standardized uptake value were assessed in differentiating thymoma and lymphoma using Wilcoxon rank-sum test, chi-square test, and logistic regression. Receiver operating characteristic analysis identified the maximum standardized uptake value threshold most associated with thymoma. RESULTS There was no association between tumor type and age group (P = .183) between those with thymoma versus anterior mediastinal lymphoma. Patients with thymoma were less likely to report B symptoms (P < .001). The median maximum standardized uptake value of thymoma and lymphoma differed dramatically: 4.35 versus 18.00 (P < .001). Maximum standardized uptake value was independently associated with tumor type on multivariable regression. On receiver operating characteristic analysis, lower maximum standardized uptake value was associated with thymoma. Maximum standardized uptake value less than 12.85 was associated with thymoma with 100.00% sensitivity and 88.89% positive predictive value. Maximum standardized uptake value less than 7.50 demonstrated 100.00% positive predictive value for thymoma. CONCLUSIONS Positron emission tomography/computed tomography maximum standardized uptake value of resectable anterior mediastinal masses may help guide a direct surgery versus biopsy decision. Tumors with maximum standardized uptake value less than 7.50 are likely thymoma and thus perhaps appropriately resected without biopsy. Tumors with maximum standardized uptake value greater than 7.50 should be biopsied to rule out lymphoma. Lymphoma is likely with maximum standardized uptake value greater than 12.85.
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Affiliation(s)
- Catherine T Byrd
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Winston L Trope
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Prasha Bhandari
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Harrison B Konsker
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Farshad Moradi
- Division of Nuclear Medicine, Department of Radiology, Stanford University School of Medicine, Stanford, Calif
| | - Natalie S Lui
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Douglas Z Liou
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Leah M Backhus
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Mark F Berry
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif
| | - Joseph B Shrager
- Division of Thoracic Surgery, Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, Calif.
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29
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Yang X, Hu Z, You Z, Chen Y, Liu H. Mediastinal diffuse large B-cell lymphoma mimicking invasive thymoma on 68Ga-FAPI PET/CT. J Nucl Cardiol 2022; 29:3583-3585. [PMID: 33913095 DOI: 10.1007/s12350-021-02623-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 03/30/2021] [Indexed: 01/18/2023]
Affiliation(s)
- Xiao Yang
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, People's Republic of China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China
| | - Zhi Hu
- Department of Thoracic Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Zhouxiang You
- Department of Thoracic Surgery, The Affiliated Hospital of Southwest Medical University, Luzhou, People's Republic of China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, People's Republic of China
- Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China
| | - Huipan Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University, No. 25 TaiPing St, Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, People's Republic of China.
- Academician (Expert) Workstation of Sichuan Province, Luzhou, People's Republic of China.
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30
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Ito Y, Miyauchi A, Hirokawa M, Kihara M, Onoda N, Miya A. Clinicopathological features and outcomes of intrathyroidal thymic carcinoma: a single institution study. Endocr J 2022; 69:1351-1356. [PMID: 35768280 DOI: 10.1507/endocrj.ej22-0141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Intrathyroidal thymic carcinoma (ITTC) is a rare malignancy of the thyroid. It is thought to originate from ectopic thymic tissue or embryonic thymic rest, in, or adjacent to, the thyroid. We analyzed the backgrounds, clinicopathological features, and prognosis of 20 patients with ITTC, treated at our hospital. Thirteen of the 15 patients (86%) who underwent ultrasonography were diagnosed as malignant, based on imaging findings. 16 of the 17 patients (93%) who underwent cytology, were diagnosed or suspected to be malignant. Locally curative surgery (thyroidectomy and lymph node dissection) was performed for 19 patients. Large tumor size (>4 cm) was positively related to pathological node metastasis (p = 0.0389). Fourteen patients, including nine Ex-positive patients, underwent adjuvant external beam radiotherapy (EBRT) of the neck after surgery. Two patients showed recurrence of thyroid bed after and neither of them underwent adjuvant EBRT after surgery. Two patients who underwent EBRT showed recurrences of the lateral nodes (level V and level II), but they were easily dissected by re-operation. Ten- and 20-year local recurrence-free survival rates were 84.9% and 60.6%, respectively. To date, four patients showed distant recurrence, and 10- and 20-year distant recurrence-free survival rates were 75.0% and 75.0%, respectively. Our findings indicate that 1) the prognosis of ITTC is generally favorable, and 2) large tumor size is significantly related to lymph node metastasis. Two patients showing recurrence of the central region did not undergo EBRT; thus, further comparative studies are desirable to elucidate whether EBRT can prevent significant local recurrence.
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Affiliation(s)
- Yasuhiro Ito
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akira Miyauchi
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | | | - Minoru Kihara
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Naoyoshi Onoda
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
| | - Akihiro Miya
- Department of Surgery, Kuma Hospital, Hyogo 650-0011, Japan
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31
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Anh Tuan P, Minh Duc N. The efficiency of chemical-shift MRI for the evaluation of thymoma in patients with myasthenia gravis. Clin Ter 2022; 173:572-578. [PMID: 36373457 DOI: 10.7417/ct.2022.2484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
PURPOSES This research aimed to evaluate the efficiency of using chemical-shift magnetic resonance imaging (MRI) to differentiate thy-moma from non-thymoma in patients with myasthenia gravis (MG). METHODS A total of 137 subjects were split into thymoma and non-thymoma groups. The qualitative parameters and the chemical-shift ratio (CSR) were compared between the two groups, using the Chi-square test and the Student's t-test, respectively. Logistic regression was performed to investigate the significant factors associated with both the qualitative parameters and CSR values that can be used to predict thymoma. The discriminative capability of CSR was defined by the area under the receiver operating characteristic (ROC) curve (AUROC), which was used to compute an optimal cut-off point for thymoma distinction. RESULTS Although significant differences between groups were identified by univariate analyses for most of the qualitative parameters, during the multivariate logistic regression, only CSR was significant for the distinction between two groups, with an odds ratio (OR) of 9.700 [95% confidence interval (CI): 1.874-50.200, p = 0.007). The CSR values for the thymoma and non-thymoma groups were 1.020 ± 0.073 and 0.604 ± 0.126, respectively. With an optimal cut-off point defined at 0.825, the AUROC of CSR was 0.982. When applying this cut-off point, the sensitivity and specificity of chemical-shift MRI for the detection of thymoma were 100% and 97.22%, respectively. CONCLUSIONS CSR values, calculated from chemical-shift MRI, was exceedingly valuable for distinguishing thymoma from non-thymoma in patients with MG.
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Affiliation(s)
- P Anh Tuan
- Department of Radiology, Vietnam Military Medical University, Hanoi, Vietnam
| | - N Minh Duc
- Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City, Vietnam
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32
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Endo K, Kato M, Sano M. [Thymic Cancer Associated with Spontaneous Regression of Multilocular Thymic Cysts]. Kyobu Geka 2022; 75:617-621. [PMID: 35892302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Thymic cancer associated with spontaneous regression of thymic cysts is a rare disease. A 47-yearold man was referred to our hospital for right chest pain and chest abnormal shadow. Chest computed tomography( CT) revealed a solid lesion 1.3 cm in diameter and a cystic lesion 1.0 cm in diameter at the right anterior mediastinum. A second CT study after six months showed a solid lesion increased to 1.7 cm in diameter and a cystic lesion reduced to 0.7 cm in diameter. A second magnetic resonance imaging (MRI) showed a cystic lesion reduced and high signal intensity region in the thymus enlarged on T2-weighted imaging. Under the diagnosis of thymoma associated with multilocular thymic cysts, total thymectomy was performed for these mediastinal lesions by video-assisted thoracic surgery. Histopathological finding was thymic squamous cell carcinoma (Masaoka stage II) associated with multilocular thymic cysts. Additional postoperative radiotherapy was performed, and there has been no recurrence after one postoperative year.
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Affiliation(s)
- Katsuhiko Endo
- Department of Surgery, Nagoya Memorial Hospital, Nagoya, Japan
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33
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Aksu A, Şin C, Yilmaz B. Adult Tiger Man: A Case of Dermatomyositis Associated With Thymoma. Clin Nucl Med 2022; 47:e448-e449. [PMID: 35353758 DOI: 10.1097/rlu.0000000000004154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT The scan demonstrated multiple linear and patchy hypermetabolic lesions in skeletal muscles, mimicking the coat of a tiger, and was referred to as "a tiger man" sign. A 38-year-old man was admitted to our hospital with weakness, shortness of breath, and muscle pain. A CT scan showed a mass in the anterior mediastinum. 18F-FDG PET/CT was performed to evaluate the mass with a preliminary diagnosis of thymoma; heterogeneous 18F-FDG uptake in the mediastinal mass and tiger man findings in skeletal muscles were observed in PET/CT images.
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Affiliation(s)
- Ayşegül Aksu
- From the Department of Nuclear Medicine, Health Sciences University, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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34
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Bellini P, Albano D, Bertoli M, Peli A, Dondi F, Bertagna F, Giubbini R. Incidental thymoma detection during myocardial perfusion imaging by CZT camera. J Nucl Cardiol 2022; 29:866-870. [PMID: 33000409 DOI: 10.1007/s12350-020-02371-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 08/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Pietro Bellini
- Department of Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, P.Le Spedali Civili, 1, 25123, Brescia, Italy.
| | - Domenico Albano
- Department of Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, P.Le Spedali Civili, 1, 25123, Brescia, Italy
| | - Mattia Bertoli
- Department of Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy
| | - Alessia Peli
- Department of Nuclear Medicine, ASST Spedali Civili Brescia, Brescia, Italy
| | - Francesco Dondi
- Department of Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, P.Le Spedali Civili, 1, 25123, Brescia, Italy
| | - Francesco Bertagna
- Department of Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, P.Le Spedali Civili, 1, 25123, Brescia, Italy
| | - Raffaele Giubbini
- Department of Nuclear Medicine, University of Brescia and ASST Spedali Civili Brescia, P.Le Spedali Civili, 1, 25123, Brescia, Italy
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35
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Sakamoto N, Kurokawa R, Watadani T, Morikawa T, Nakaya M, Cho S, Fujita N, Kamio S, Koyama H, Suzuki S, Yamada H, Abe O, Gonoi W. Differential diagnosis of thymic epithelial neoplasms on computed tomography using the diameter of the thymic vein. Medicine (Baltimore) 2021; 100:e27942. [PMID: 34797351 PMCID: PMC8601265 DOI: 10.1097/md.0000000000027942] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 11/03/2021] [Indexed: 01/05/2023] Open
Abstract
Although differentiating benign and malignant thymic epithelial lesions is important to avoid unnecessary treatment and predict prognosis, it is challenging because of overlaps in the chest computed tomography (CT) findings. In this study, we investigated whether the diameter of the thymic vein and other CT findings could differentiate between benign (thymoma and thymic cysts) and malignant (thymic carcinoma, [TCa]) lesions.We conducted a retrospective study across two tertiary referral hospitals in Japan between November 2009 and June 2018. We included 12 patients with TCa, 34 patients with thymomas, and 17 patients with thymic cysts. We analyzed the receiver operating characteristic (ROC) curve to determine the best cut-off values and performed univariate and multivariate analyses of CT findings to distinguish TCa from other benign lesions. Post-hoc analysis was performed for the maximum short axis of the thymic vein using the Mann-Whitney U test, and the number of the maximum short axis of the thymic vein ≥ the cutoff was determined using the Fisher exact test with a family-wise error-correction using Bonferroni's method.ROC analysis showed that a maximum short axis of the thymic vein ≥2 mm was considerably more frequent in TCa than in the other lesions (P < .001 for both), with 83% sensitivity and 86% specificity. Univariate and multivariate analyses revealed the association with TCa of the number of the maximum short axis of the thymic vein ≥2 mm (P = .005, multivariate generalized linear model analysis), ill-defined margin (P = .001), and mediastinal lymphadenopathy (P < .001). Thymic vein diameter was in descendimg order of TCa > thymoma > thymic cysts with statistically significant differences between the groups (Ps < .05).Thymic vein diameter was significantly longer in TCa than in thymoma and thymic cysts. Measurement of the maximum short axis of the thymic vein could be a powerful diagnostic tool to differentiate TCa from thymoma and thymic cysts.
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Affiliation(s)
- Naoya Sakamoto
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Ryo Kurokawa
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Takeyuki Watadani
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Teppei Morikawa
- Department of Diagnostic Pathology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, Japan
| | - Moto Nakaya
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Shinichi Cho
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Nana Fujita
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Satoru Kamio
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Hiroaki Koyama
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Satoshi Suzuki
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Haruyasu Yamada
- Department of Radiology, NTT Medical Center Tokyo, 5-9-22 Higashi-Gotanda, Shinagawa-ku, Tokyo, Japan
| | - Osamu Abe
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
| | - Wataru Gonoi
- Department of Radiology, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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36
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Kamimura R, Matsuoka H, Kashima Y. [Ectopic Cervical Thymoma that was Difficult to Differentiate from Thyroid Tumor:Report of a Case]. Kyobu Geka 2021; 74:717-719. [PMID: 34446629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We report a case of ectopic cervical thymoma that was difficult to differentiate from thyroid tumor. A 69-year-old woman was referred to our hospital with a tumor on the left side of the neck. Fine-needle aspiration cytology could not establish the diagnosis and the surgery was then performed for diagnosis and treatment. Since the intraoperative pathological diagnosis was also inconclusive, thymectomy was performed because of the macroscopic finding suggesting close relation to the thymus. The final pathological diagnosis was type AB thymoma.
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Affiliation(s)
- Ryosuke Kamimura
- Department of Thoracic Surgery, Hyogo Prefectural Awaji Medical Center, Sumoto, Japan
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37
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Matsuoka S, Eguchi T, Koyama T, Takeda T, Miura K, Hamanaka K, Shimizu K. Three-dimensional computed tomography-guided excision of an intrathoracic giant thymoma with elongated thymic vessels. Multimed Man Cardiothorac Surg 2021; 2021. [PMID: 34491637 DOI: 10.1510/mmcts.2021.039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
We report the case of an intrathoracic giant thymoma with elongated thymic vessels, which was successfully resected under three-dimensional computed tomography guidance. A large, left-sided intrathoracic mass was incidentally found in a 41-year-old woman during a routine work-up for uterine cancer. Six vessels were noted arising from the tumor, five of which were connected to the anterosuperior mediastinum. The vasculature suggested that the tumor originated from the thymus and grew into the left pleural cavity, which pulled and elongated the associated vessels. Preoperative computed tomography imaging demonstrated that these vessels were located behind the tumor, which increased the risk for catastrophic intraoperative bleeding. We created a detailed surgical plan using our preoperative computed tomography data and successfully excised the tumor using intraoperative three-dimensional computed tomography guidance. Histopathological examination revealed a type AB thymoma without capsular invasion. This case highlighted the role of preoperative planning and intraoperative imaging in resecting an intrathoracic giant thymoma safely. In the video, we demonstrate how we performed the procedure under three-dimensional navigation.
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Affiliation(s)
- Shunichiro Matsuoka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takashi Eguchi
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tsutomu Koyama
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsu Takeda
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kentaro Miura
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kazutoshi Hamanaka
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kimihiro Shimizu
- Division of General Thoracic Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan
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38
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Hutt E, Hachamovitch R, Jaber WA. The Mediastinum is LIT. J Nucl Cardiol 2021; 28:1802-1804. [PMID: 32394404 DOI: 10.1007/s12350-020-02162-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 04/06/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Erika Hutt
- Department of Cardiovascular Medicine, Fellow in Training, Cleveland Clinic Foundation, Cleveland, OH, USA.
| | - Rory Hachamovitch
- Department of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Wael A Jaber
- Department of Cardiovascular Imaging, Cleveland Clinic Foundation, Cleveland, OH, USA
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39
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Liu H, Chen Y. Mediastinal seminoma mimicking invasive thymoma on 18F-FDG PET/CT. J Nucl Cardiol 2021; 28:1788-1790. [PMID: 32378116 DOI: 10.1007/s12350-020-02127-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/24/2022]
Affiliation(s)
- Huipan Liu
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University/Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, No. 25 TaiPing St., Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital of Southwest Medical University/Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, No. 25 TaiPing St., Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
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40
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Tsuchiya T, Sano A, Kawashima M. Micronodular Thymoma with Lymphoid Stroma: A Case Report. Tokai J Exp Clin Med 2021; 46:94-96. [PMID: 34216482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 03/05/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Micronodular thymoma with lymphoid stroma (MNT) is a rare subtype of thymic neoplasms. Therefore, clinical guidelines, histopathological diagnostic criteria, prognostic factors, and therapeutic regimens have not been established. CASE PRESENTATION A 69-year-old woman was admitted to our hospital because of an abnormal shadow detected by chest radiography. Further imaging revealed an anterior mediastinal tumor measuring 65×28×15 mm. We performed thymectomy for diagnosis and treatment. Histopathological examination revealed spindle cells comprised multiple micronodules separated by abundant interstitial lymphocytes and lymphoid follicles. Immunohistochemical staining showed that the tumor was positive for cell adhesion molecule (CAM), cytokeratin (CK) 5/6, and terminal deoxynucleotidyl transferase. The histopathological diagnosis was MNT and the stage was I by the World Health Organization classification. The patient remained free of recurrence for seven years after surgery. CONCLUSION When the lesion is completely resected, MNT has a good prognosis. Therefore, MNT is considered to be a borderline tumor with good prognosis and no reports of recurrences, distant metastasis, or tumor-related deaths exist thus far. However, preoperative diagnosis is difficult in most cases. Hence, complete surgical resection is recommended for suspicious mediastinal masses, if feasible, for both accurate diagnosis and to ensure long-term survival.
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Affiliation(s)
- Takehiro Tsuchiya
- Department of Thoracic Surgery, Chigasaki Municipal Hospital, Honson 5-15-1, Chigasaki, Kanagawa 253-0042, Japan.
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41
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Duxbury B, Marroquin S, Ung K. The Importance of Incidental Findings: A Case Report on Thymic Carcinoma. S D Med 2021; 74:322-323. [PMID: 34449995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- Brian Duxbury
- General Surgery Resident, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Sara Marroquin
- General Surgery Resident, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota
| | - Keung Ung
- Sanford Health, Sioux Falls, South Dakota
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42
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Gorospe-Sarasúa L, Ajuria-Illarramendi O, Vicente-Zapata I, Muñoz-Molina GM, Fra-Fernández S, Cabañero-Sánchez A, García-Cosío-Piqueras M, Bueno-Sacristán D, Arrieta P, Mirambeaux-Villalona RM. Diagnosis of two synchronous thymomas with imaging techniques (CT and PET/CT) and confirmation with percutaneous biopsy. Arch Bronconeumol 2021; 57:560-562. [PMID: 34059450 DOI: 10.1016/j.arbr.2021.05.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Accepted: 12/21/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Luis Gorospe-Sarasúa
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | | | - Irene Vicente-Zapata
- Servicio de Radiodiagnóstico, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Sara Fra-Fernández
- Servicio de Cirugía Torácica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | - Diego Bueno-Sacristán
- Servicio de Anatomía Patológica, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Paola Arrieta
- Servicio de Neumología, Hospital Universitario Ramón y Cajal, Madrid, Spain
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43
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Kanazawa H, Sasaki N, Kobayashi T, Fukushima T, Kanda S, Koizumi T, Iwaya M. Direct Intraesophageal Growth from Metastatic Mediastinal Lymphadenopathy in Thymic Carcinoma. Intern Med 2021; 60:923-926. [PMID: 33087667 PMCID: PMC8024948 DOI: 10.2169/internalmedicine.5501-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We herein report a case of thymic carcinoma that initially exhibited dysphagia and an intraesophageal mass lesion. A 68-year-old man was admitted to our hospital because of dysphagia. An endoscopic examination revealed a mass on the middle esophagus. Chest computed tomography (CT) showed a huge anterior mediastinal mass and subcarinal lymph node swelling, directly invading into the esophageal lumen. An immunohistological examination of the esophageal and anterior mediastinal masses revealed squamous cell carcinoma originating from the thymus. This is the first report of a thymic carcinoma spreading into the esophageal lumen and forming a mass lesion.
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Affiliation(s)
- Hiroki Kanazawa
- Second Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Nobukazu Sasaki
- Second Department of Internal Medicine, Shinshu University School of Medicine, Japan
| | - Takashi Kobayashi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Japan
| | - Toshirou Fukushima
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Japan
| | - Shintaro Kanda
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Japan
| | - Tomonobu Koizumi
- Department of Comprehensive Cancer Therapy, Shinshu University School of Medicine, Japan
| | - Mai Iwaya
- Department of Centarl Laboratory, Shinshu University School of Medicine, Japan
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44
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Brien PJ, Cha A, Fulham MJ. An Intraocular Thymic Metastasis Identified on 18F-FDG PET/CT Before and After Treatment. Clin Nucl Med 2021; 46:240-242. [PMID: 33234936 DOI: 10.1097/rlu.0000000000003431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT We present the imaging findings pretreatment and posttreatment in a 58-year-old woman with recurrent thymic carcinoma. Two years after treatment, the patient presented with a 3-week history of right eye pain and blurred vision. Ophthalmological examination and MRI of the orbits showed a right superolateral choroidal lesion. Neurologic and whole-body FDG PET/CT scans showed a markedly glucose-avid right choroidal mass and extensive lung parenchymal, pleural, and thoracic nodal disease. There was a good response to chemoradiotherapy with a reduction in size and metabolism at all sites.
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Affiliation(s)
- Peter J Brien
- From the Department of Molecular Imaging, Royal Prince Alfred Hospital, Camperdown
| | - Andrew Cha
- From the Department of Molecular Imaging, Royal Prince Alfred Hospital, Camperdown
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45
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Komori K, Tsubochi H, Ohno K, Minegishi K, Endo S. [Metaplastic Thymoma Underwent Surgery:Report of a Case]. Kyobu Geka 2021; 74:241-243. [PMID: 33831883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Metaplastic thymoma is a rare histologic variant of thymic epithelial tumors and is characterized by a biphasic growth pattern. We herein report the case of 44-year-old woman who underwent surgery for metaplastic thymoma. Computed tomography scan revealed a well-circumscribed mediastinal tumor: 56 mm in diameter with homogenous enhancement. The tumor was suspected to be a non-invasive thymoma, and thymomectomy with resection of the surrounding thymus was performed using thoracoscopy. The resected tumor measured 60 mm and was grossly well-encapsulated. The cut surface was gray to white and homogenous. Microscopically, the epithelial components took the form of an anastomosing nest to broad trabeculae intertwining with the bundle of spindle cells. Mitosis was not found and the Ki-67 index was < 1%. Cytokeratin 5/6 was strongly positive in the epithelial components composed of polygonal cells. Terminal deoxynucleotidyl transferase positive immature T cells were not observed. Based on these pathologic findings, the tumor was identified as metaplastic thymoma.
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Affiliation(s)
- Kenjiro Komori
- Department of Thoracic Surgery, Jichi Medical Univergity Saitama Medical Center, Saitama, Japan
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46
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Abstract
ABSTRACT A 68-year-old man with a history of prostate cancer post-primary treatment presented with rising prostate-specific antigen levels and was referred for 18F-fluciclovine PET/MRI to localize recurrent disease. PET/MRI revealed a solitary focus of uptake in a soft tissue nodule in the anterior mediastinum, which was resected and found to be a type B2 thymoma. 18F-fluciclovine uptake is mediated by amino acid transporters, primarily alanine-serine-cysteine transporter 2 and l-type amino acid transporter 1, previously demonstrated to be expressed on thymic carcinomas. This case highlights the possibility of overexpression of amino acid transporters in thymomas as well, rarely described before.
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Affiliation(s)
- Lucas Tsikitas
- From the Department of Radiology, New York University Long Island School of Medicine, Mineola
| | - Shawn Karls
- Nuclear Medicine, Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Anca-Oana Kranz
- From the Department of Radiology, New York University Long Island School of Medicine, Mineola
| | - Kent P Friedman
- Nuclear Medicine, Department of Radiology, New York University Grossman School of Medicine, New York, NY
| | - Sonia Mahajan
- Nuclear Medicine, Department of Radiology, New York University Grossman School of Medicine, New York, NY
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47
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Jun JE, Hwang YC, Ahn KJ, Chung HY, Jeong IK. A rare case of multiple endocrine neoplasia type 1 initially presenting as an asymptomatic, huge mediastinal mass: case report. BMC Endocr Disord 2021; 21:31. [PMID: 33632163 PMCID: PMC7905909 DOI: 10.1186/s12902-021-00695-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 02/09/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Multiple endocrine neoplasia type 1 (MEN1) is a rare inherited syndrome that concurrently involves various endocrine glands. We report a rare case of MEN1 in a 43-year-old man whose first manifestation was an asymptomatic mediastinal mass. CASE PRESENTATION A 13-cm-sized mediastinal mass was diagnosed as an atypical thymic carcinoid by computed tomography and percutaneous needle biopsy. In addition, hypercalcemia from a left inferior parathyroid hyperplasia, and a non-functioning gastric neuroendocrine tumor seen on esophagogastroduodenoscopy were found. Therefore, the patient was clinically diagnosed with MEN1 syndrome, and underwent surgical resection of thymic carcinoid tumor after pre-operative concurrent chemoradiation therapy to decrease tumor size and volume. Parathyroid lesion and gastric neuroendocrine tumor were also removed. Finally, a MEN1 gene mutation was observed in the patient and his 7-year-old son. CONCLUSION Despite its rare occurrence, thymic carcinoid tumor should be considered as a MEN1-associated tumor and necessitates screening of other endocrine glands. Thymic carcinoid tumor carries a poor prognosis in patients with MEN1, and thus it needs to be carefully monitored even after radical excision.
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Affiliation(s)
- Ji Eun Jun
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - You-Cheol Hwang
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Kyu Jeong Ahn
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - Ho Yeon Chung
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea
| | - In-Kyung Jeong
- Department of Endocrinology and Metabolism, Kyung Hee University Hospital at Gangdong, Kyung Hee University School of Medicine, 892 Dongnam-ro, Gangdong-gu, Seoul, 05278, Republic of Korea.
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48
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Dudgeon MG, Sonavane SK, Parent EE, Khoor A, Thomas M. Co-existent Epicardial Paraganglioma and Anterior Mediastinal Thymoma. J Radiol Case Rep 2020; 14:16-30. [PMID: 33708339 PMCID: PMC7942970 DOI: 10.3941/jrcr.v14i10.4101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Thymoma and paraganglioma are known causes of mediastinal masses, the latter being extremely rare. Thymomas arise from remnant thymic tissue in the anterior mediastinum; whereas, thoracic paragangliomas arise from para-aortic or para-vertebral sympathetic chain ganglion (derivatives of embryonic neural crest) in the middle or posterior mediastinum. We report a case of a middle-aged woman with two mediastinal masses, originally believed to be a single tumor or primary malignancy with adjacent metastasis on Computed Tomography (CT) that were further delineated with Magnetic Resonance Imaging (MRI) and [68Ga]-DOTA-(Tyr3)-octreotate (DOTA-TATE) Positron Emission Tomography-Computed Tomography (PET-CT) and surgical pathology as two distinct entities: left epicardial paraganglioma and anterior mediastinal thymoma. A comprehensive discussion of both entities is included.
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Affiliation(s)
| | - Sushilkumar K Sonavane
- Department of Radiology, Division of Cardiothoracic Imaging, Mayo Clinic, Jacksonville, FL, USA
| | - Ephraim E Parent
- Department of Radiology, Division of Nuclear Medicine, Mayo Clinic, Jacksonville, FL, USA
| | - Andras Khoor
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL, USA
| | - Mathew Thomas
- Department of Cardiovascular/Thoracic Surgery, Mayo Clinic, Jacksonville, FL, USA
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49
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Xiao G, Hu YC, Ren JL, Qin P, Han JC, Qu XY, Rong WC, Yan WQ, Tian Q, Han Y, Wang WP, Wang SM, Ma J, Wang W, Cui GB. MR imaging of thymomas: a combined radiomics nomogram to predict histologic subtypes. Eur Radiol 2020; 31:447-457. [PMID: 32700020 DOI: 10.1007/s00330-020-07074-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 05/15/2020] [Accepted: 07/13/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Accurately predicting the WHO classification of thymomas is urgently needed to optimize individualized therapeutic strategies. We aimed to develop and validate a combined radiomics nomogram for personalized prediction of histologic subtypes in patients with thymomas. METHODS A total of 182 thymoma patients were divided into training (n = 128) and test (n = 54) cohorts. Radiomics features were extracted from T2-weighted, T2-weighted fat suppression, and diffusion-weighted images to establish a radiomics signature in the training cohort. Multivariate logistic regression analysis was used to develop a combined radiomics nomogram that incorporated clinical, conventional MR imaging variables, apparent diffusion coefficient (ADC) value, and radiomics signature. The efficacy of clinical, conventional MR imaging, or ADC model was also evaluated respectively. The performances of different models were compared by receiver operating characteristic analysis and Delong test. The discrimination, calibration, and clinical usefulness of the combined radiomics nomogram were assessed. RESULTS The radiomics signature, consisting of 14 features, achieved favorable predictive efficacy in differentiating low-risk from high-risk thymomas, outperforming clinical, conventional MR imaging, and ADC models. The combined radiomics nomogram incorporating tumor shape, ADC value, and radiomics signature yielded the best performance (training cohort: area under the curve [AUC] = 0.946, test cohort: AUC = 0.878). The calibration curve and decision curve analysis indicated the clinical utility of the combined radiomics nomogram. CONCLUSIONS The radiomics signature is a useful tool that can be used to predict histologic subtypes of thymomas. The combined radiomics nomogram improved the individualized subtype prediction in patients with thymomas. KEY POINTS • Fourteen robust features were selected to develop a radiomics signature for preoperative prediction of thymoma subtype. • MRI-based radiomics signature can differentiate low-risk thymomas from high-risk thymomas with favorable predictive efficacy compared with clinical, conventional MR imaging, and ADC models. • Combined radiomics nomogram based on tumor shape, ADC value, and radiomics signature could improve the individualized subtype prediction in patients with thymomas.
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Affiliation(s)
- Gang Xiao
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Yu-Chuan Hu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | | | - Peng Qin
- Student Brigade, Fourth Military Medical University, 169 Changle Road, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Jia-Cheng Han
- Student Brigade, Fourth Military Medical University, 169 Changle Road, Xi'an, 710032, Shaanxi, People's Republic of China
| | - Xiao-Yan Qu
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China
| | - Wei-Cheng Rong
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Wei-Qiang Yan
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Qiang Tian
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Yu Han
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China
| | - Wu-Ping Wang
- Department of Thoracic Surgery, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Shu-Mei Wang
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Jiao Ma
- Department of Pathology, Tangdu Hospital, Fourth Military Medical University, Xi'an, Shaanxi, People's Republic of China
| | - Wen Wang
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China.
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China.
| | - Guang-Bin Cui
- Department of Radiology, Tangdu Hospital, Fourth Military Medical University, Xi'an, 710038, Shaanxi, People's Republic of China.
- Functional and Molecular Imaging Key Lab of Shaanxi Province, Xi'an, Shaanxi, People's Republic of China.
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50
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Liu H, Chen Y. Mediastinal T-lymphoblastic lymphoma mimicking invasive thymoma on 18F-FDG PET/CT in a young patient. J Nucl Cardiol 2020; 27:1059-1062. [PMID: 31602570 DOI: 10.1007/s12350-019-01919-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 09/27/2019] [Accepted: 09/27/2019] [Indexed: 01/15/2023]
Affiliation(s)
- Huipan Liu
- Department of Nuclear Medicine, The Affiliated Hospital, Southwest Medical University, No. 25 TaiPing St., Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, People's Republic of China
| | - Yue Chen
- Department of Nuclear Medicine, The Affiliated Hospital, Southwest Medical University, No. 25 TaiPing St., Jiangyang District, Luzhou, 646000, Sichuan, People's Republic of China.
- Nuclear Medicine and Molecular Imaging Key Laboratory of Sichuan Province, Luzhou, Sichuan, People's Republic of China.
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