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Journal of Veterinary Diagnostic... Nov 2020Persistent small-cell lymphocytosis in dogs with a concurrent mediastinal mass has been associated with both thymoma and small-cell lymphoma. In thymomas, neoplastic...
Persistent small-cell lymphocytosis in dogs with a concurrent mediastinal mass has been associated with both thymoma and small-cell lymphoma. In thymomas, neoplastic thymic epithelial cells induce overproduction and release of polyclonal lymphocytes, whereas thymic lymphoma results in thymic effacement by a clonal expansion of neoplastic lymphocytes and subsequent leukemic phase of lymphoma. Flow cytometry has been used to differentiate these 2 entities by immunophenotyping mediastinal mass aspirates. It has been reported that cases with mediastinal masses in which ≥ 10% of the associated small-cell lymphocytes were double positive for CD4 and CD8 were thymomas, whereas masses associated with < 10% were suggestive of lymphoma. We report a unique case of thymoma-associated lymphocytosis lacking the classic CD4+CD8+ immunophenotype. Our findings suggest that there may be more diversity in the thymoma-associated lymphocyte immunophenotype than has been identified previously; immunophenotyping alone might not be sufficient to differentiate thymic small-cell lymphoma from thymoma-associated lymphocytosis. In dogs with mediastinal masses and peripheral lymphocytosis, employing a variety of testing modalities to avoid misdiagnosis is prudent. These modalities include cytologic and/or histologic evaluation, immunophenotyping, and clonality assessment.
Topics: Animals; Dog Diseases; Dogs; Female; Flow Cytometry; Immunophenotyping; Lymphocytosis; Lymphoma; Male; T-Lymphocytes; Thymoma; Thymus Neoplasms
PubMed: 32814519
DOI: 10.1177/1040638720948628 -
Asian Journal of Surgery Jan 2020In this study, the perioperative outcomes of video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) were compared in patients with... (Comparative Study)
Comparative Study
OBJECTIVE
In this study, the perioperative outcomes of video-assisted thoracoscopic surgery (VATS) and robot-assisted thoracoscopic surgery (RATS) were compared in patients with clinical stage I and stage II thymoma.
METHODS
The outcomes of 24 patients (10 males and 14 females; mean age: 42.5 years; range: 18-65 years) with diagnoses of clinical stage I and stage II thymoma who underwent VATS in our clinic between April 2010 and March 2018 were compared with the outcomes of 21 patients (8 males and 13 females; mean age: 41.2 years; range: 19-63 years) with the same clinical stages of thymoma who underwent RATS between March 2013 and May 2018. The operative times, postoperative complications, lengths of hospital stay, and total amounts of chest tube drainage of the patients were evaluated.
RESULTS
No postoperative mortality was observed in either group. In general, VATS was performed from the right side, and RATS was performed from the right hemithorax. The operative time was significantly longer in the VATS group than in the RATS group (106.5 min versus 75.7 min, respectively; p < 0.001). In the VATS group, the total amount of postoperative drainage from the chest tubes was greater than that in the RATS group (210 ml versus 325 ml, respectively), and the drainage time was longer in the VATS group than in the RATS group (3 days versus 5 days, respectively; p < 0.001). The length of hospital stay was longer for the patients in the VATS group than for those in the RATS group (5.3 days versus 4.1 days, respectively; p < 0.001). The levels of pain were similar in both groups. No difference in the complication rates was found between the 2 groups.
CONCLUSION
In the treatment of clinical stage I and stage II thymoma patients, the robotic approach and excision with VATS are techniques with equal reliability. However, the use of robot-assisted thoracoscopic thymectomy technique is advantageous in terms of decreasing the total amount of postoperative drainage and shortening the length of hospital stay.
Topics: Adult; Drainage; Female; Humans; Length of Stay; Male; Middle Aged; Neoplasm Staging; Postoperative Care; Robotic Surgical Procedures; Thoracic Surgery, Video-Assisted; Thymoma; Thymus Gland; Thymus Neoplasms; Time Factors; Treatment Outcome; Young Adult
PubMed: 31047770
DOI: 10.1016/j.asjsur.2019.04.005 -
The Annals of Thoracic Surgery Jul 2018The aim of this study was to assess preoperative computed tomography characteristics of thymic carcinomas and to investigate which features could predict an incomplete...
BACKGROUND
The aim of this study was to assess preoperative computed tomography characteristics of thymic carcinomas and to investigate which features could predict an incomplete surgical resection. A secondary aim was to correlate preoperative imaging features with Masaoka stage.
METHODS
In this study, approved by our Institutional Review Board, two readers retrospectively reviewed preoperative computed tomography scans at our tertiary referral oncology center between 1994 and 2014. Imaging features analyzed included tumor morphology, infiltration of surrounding mediastinal fat, loss of surrounding fat plane, degree of contact between tumor and great vessels, and associated pulmonary or pleural abnormality. Surgical and pathologic records were reviewed for completeness of surgical resection and Masaoka stage.
RESULTS
Forty-one patients were included, with Masaoka stage I (n = 3), stage II (n = 4), stage III (n = 12), and stage IV (n = 22). Twenty-one patients (51%) had a complete surgical resection. Ten had microscopic residual disease (R1) with involved surgical margins at pathology, and 10 patients had macroscopic residual disease (R2) at surgery. In addition to lesion size, the feature associated with incomplete surgical resection was the degree of tumor contact with adjacent mediastinal vessels on the preoperative computed tomography image (p = 0.038). Many of the more common features associated with incomplete resection were also more likely to be present in patients with late Masaoka stage (III/IV), including infiltration of the mediastinal fat, which was present in all 34 patients with Masaoka stage III/IV compared with 5 patients (71%) with stage I/II (p = 0.03).
CONCLUSIONS
Preoperative computed tomography imaging features may help to identify patients at risk for an incomplete surgical resection.
Topics: Adult; Aged; Cohort Studies; Disease-Free Survival; Female; Humans; Ireland; Male; Middle Aged; Multivariate Analysis; Neoplasm Invasiveness; Neoplasm Staging; Predictive Value of Tests; Preoperative Care; Retrospective Studies; Risk Assessment; Statistics, Nonparametric; Survival Rate; Thymectomy; Thymoma; Tomography, X-Ray Computed; Treatment Outcome
PubMed: 29534953
DOI: 10.1016/j.athoracsur.2018.02.019 -
Journal of Radiology Case Reports Oct 2020Thymoma and paraganglioma are known causes of mediastinal masses, the latter being extremely rare. Thymomas arise from remnant thymic tissue in the anterior mediastinum;...
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.
Topics: Female; Heart Neoplasms; Humans; Magnetic Resonance Imaging; Mediastinal Neoplasms; Middle Aged; Paraganglioma; Positron Emission Tomography Computed Tomography; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed
PubMed: 33708339
DOI: 10.3941/jrcr.v14i10.4101 -
Endocrine Journal Nov 2022Intrathyroidal 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...
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.
Topics: Humans; Carcinoma, Papillary; Thyroid Neoplasms; Thymoma; Thyroidectomy; Prognosis; Thymus Neoplasms; Neoplasm Recurrence, Local; Neck Dissection; Retrospective Studies
PubMed: 35768280
DOI: 10.1507/endocrj.EJ22-0141 -
Journal of B.U.ON. : Official Journal... 2020Thymoma is a thymic epithelial tumor characterized by the presence of epithelial cells and lymphocytes in the thymus. Although the incidence of thymoma is not high, we...
PURPOSE
Thymoma is a thymic epithelial tumor characterized by the presence of epithelial cells and lymphocytes in the thymus. Although the incidence of thymoma is not high, we know very little about its treatment mechanism. Therefore, this study was intended to explore its potential targets and provide a new approach for perfect targeted therapy.
METHODS
We identified a series of non-coding (nc) RNAs (including BCL11A, miR-3977, miR-4460 and miR-542-3p) and TF (FAM185A, MGAM2, SEC14L4, ACTBL2), and predicted transcription factors (including AHR, ATF4, CEBPA and DDIT3) that have significant regulatory effects on the module by difference analysis, co-expression analysis, enrichment analysis of thymoma gene expression profiling and using hypergeometric test to calculate the potential regulatory effects of multiple factors on the module.
RESULTS
We obtained 15 modules from the thymoma dysfunction modules and found that the module genes are involved in a variety of immune-related biological functions. For example, neutrophil activation involved in immune response, neutrophil mediated immunity and response to extracellular stimulus indicate that neutrophil-mediated regulation plays an important regulatory role in the thymoma disorder module.
CONCLUSION
Overall, a dysfunction module for thymoma was identified, and significant pivotal regulators in the module were used as important components of thymoma molecular dysregulation, of which ACTBL2 could serve as a potential therapeutic target in thymoma, which provides an effective theoretical reference for subsequent researchers.
Topics: Biomarkers, Tumor; Humans; Neoplasm Proteins; Thymoma
PubMed: 33277874
DOI: No ID Found -
Journal of Cardiothoracic Surgery May 2022Post-thymectomy myasthenia gravis (PTMG) is defined as thymoma patients without signs of myasthenia gravis (MG) pre-operation, but develop MG after radical surgical...
BACKGROUND
Post-thymectomy myasthenia gravis (PTMG) is defined as thymoma patients without signs of myasthenia gravis (MG) pre-operation, but develop MG after radical surgical resection. PTMG might be misdiagnosed not only because of its rare incidence, but also the uncertain interval between the removal of thymoma and the new onset MG. Additionally, some surgeons and anesthesiologists pay less attention to those asymptomatic thymoma patients in perioperative management, leading to the neglect of new onset PTMG, and miss the best time to treat it.
CASE PRESENTATION
Majority of cases of PTMG with onset at stage I-II on the basis of Myasthenia Gravis Foundation of America (MGFA) classification have been reported, but rarely at stage V, which requiring intubation or non-invasive ventilation to avoid intubation. Herein, we presented a 70-year-old male with PTMG onset at MGFA stage V, meanwhile, he had severe pulmonary infection interfering with the diagnosis of PTMG, and eventually progressed to refractory PTMG, which requiring much more expensive treatments and longer hospital stays.
CONCLUSION
In the perioperative management of asymptomatic thymoma patients, careful preoperative evaluation including physical examination, electrophysiological test and acetylcholine receptor antibodies (AChR-Ab) level should be done to identify subclinical MG. Complete resection should be performed during thymectomy, if not, additional postoperative adjuvant therapy is neccessary to avoid recurrence. It's important to identify PTMG at a early stage, especially when being interfered with by postoperative complications, such as lung infection, so that treatments could be initiated as soon as possible to avoid developing to refractory PTMG.
Topics: Aged; Humans; Length of Stay; Male; Myasthenia Gravis; Retrospective Studies; Testicular Neoplasms; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 35551621
DOI: 10.1186/s13019-022-01872-0 -
The Thoracic and Cardiovascular Surgeon Aug 2023Thoracoscopic thymectomy is increasingly performed for the treatment of early stage thymoma. It is characterized by shorter postoperative hospital stay, decreased...
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 ( = 0.9) and 3 ± 1.03 days versus 3.65 ± 1.93 days ( = 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 ( = 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.
Topics: Humans; Male; Female; Middle Aged; Aged; Thymoma; Thymectomy; Retrospective Studies; Treatment Outcome; Thymus Neoplasms; Thoracic Surgery, Video-Assisted
PubMed: 34521142
DOI: 10.1055/s-0041-1731778 -
BMC Cancer Feb 2023The classification of thymomas is based on the morphology of epithelial tumor cells and the proportion of lymphocytes. Type A thymomas are composed of the spindle or...
BACKGROUND
The classification of thymomas is based on the morphology of epithelial tumor cells and the proportion of lymphocytes. Type A thymomas are composed of the spindle or oval tumor epithelial cells. Tumor cells of B thymomas are epithelioid-shaped with increasing atypia. Type AB thymomas have the features of epithelial tumor cells of A and B thymomas. The diagnosis can be difficult because of the complex morphology. Some novel thymic epithelial markers have been reported in several preclinical studies, but they have not been applied to clinical practice. Here, we investigated the expression of 3 cortical and 3 medullary markers, which are thymoproteasome-specific subunit β5t (β5t), thymus-specific serine protease 16 (PRSS16), cathepsin V, autoimmune regulator (AIRE), CD40 and claudin-4.
METHODS
Immunohistochemistry was used to analyze 53 cases of thymomas and thymic squamous cell carcinomas (TSCC), aiming to explore the expression of cortical and medullary epithelial markers and their correlation with histological classification, Masaoka-Koga stage, and prognosis.
RESULTS
Our results found that for cortical epithelial markers the expression of β5t, PRSS16, and cathepsin V was higher in type AB and B thymomas than in micronodular thymoma with lymphoid stroma (MNT), and we observed a dramatic increase of β5t and PRSS16 expression in type AB compared to type A thymomas. In medullary epithelial markers, the expression of AIRE was higher in type A than in B3 thymomas. CD40 and β5t expression were associated with the Masaoka-Koga stage. High cathepsin V expression was related to a good prognosis and a longer progression-free survival.
CONCLUSION
This is the first comprehensive analysis of the role of thymic cortical and medullary epithelial markers as biomarkers for differential diagnosis and prognosis in thymic tumors. Thymic medullary epithelial immunophenotype was found to exhibit in type A, MNT, and TSCC. Type B thymomas primarily exhibited a cortical epithelial immunophenotype. Type AB thymomas showed cortical, medullary, or mixed corticomedullary epithelial immunophenotype. Our results demonstrated that thymic cortical and medullary epithelial markers including β5t, PRSS16, cathepsin V, and AIRE could be used as ancillary markers in the diagnosis and prognosis of thymic epithelial tumors.
Topics: Humans; Thymoma; Thymus Neoplasms; Carcinoma, Squamous Cell; Neoplasms, Glandular and Epithelial; CD40 Antigens; Cathepsins
PubMed: 36797681
DOI: 10.1186/s12885-023-10619-6 -
Journal of Veterinary Diagnostic... Sep 2018A 12-y-old neutered male Portuguese Water dog was presented because of a 1-y history of persistent hyporexia, diarrhea, and recurrent pyelonephritis. Abdominal...
A 12-y-old neutered male Portuguese Water dog was presented because of a 1-y history of persistent hyporexia, diarrhea, and recurrent pyelonephritis. Abdominal ultrasound revealed hepatic nodules and diffuse splenomegaly, and radiographs revealed a mediastinal mass. Fine-needle aspirates of the liver, spleen, and mediastinal mass were suspicious for lymphoma. Flow cytometry identified small T cells that co-expressed CD4 and CD8 at all sites, most suspicious for thymoma, but lymphoma could not be ruled out. PCR for antigen receptor rearrangements analysis identified polyclonal amplification of the T-cell receptor genes, more consistent with thymoma than lymphoma. Histopathology of the liver and thymic mass confirmed thymoma with hepatic metastasis.
Topics: Animals; Biopsy, Fine-Needle; Diagnosis, Differential; Diarrhea; Dog Diseases; Dogs; Flow Cytometry; Liver Neoplasms; Male; Neoplasm Metastasis; Pyelonephritis; Thymoma; Thymus Neoplasms
PubMed: 30117785
DOI: 10.1177/1040638718791222