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The Annals of Thoracic Surgery Dec 2014A 59-year-old man was referred to our department for evaluation of an asymptomatic abnormal mediastinal shadow detected on chest roentgenogram. Computed tomography (CT)...
A 59-year-old man was referred to our department for evaluation of an asymptomatic abnormal mediastinal shadow detected on chest roentgenogram. Computed tomography (CT) of the chest showed an anterior mediastinal tumor with ring calcification. Thymectomy through a median sternotomy was performed. Pathologic examination showed an encapsulated type B2 thymoma with ring calcification. Microscopically, the calcified layer was within the fibrous capsule layer. A part of the fibrous capsule was thought to become calcified like a ring. Although focal calcification is sometimes found in thymomas, ring calcification is rare.
Topics: Calcinosis; Humans; Male; Middle Aged; Sternotomy; Thymectomy; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed
PubMed: 25468089
DOI: 10.1016/j.athoracsur.2014.01.084 -
Chest Apr 1993Thymomas are the most frequently encountered neoplasm of the anterior mediastinum. Thymic neoplasms can be divided into 3 broad categories based on histologic appearance... (Review)
Review
Thymomas are the most frequently encountered neoplasm of the anterior mediastinum. Thymic neoplasms can be divided into 3 broad categories based on histologic appearance and behavior. Thymomas are tumors with benign-appearing cellular features. If there is no gross or microscopic invasion beyond the capsule, the tumor is considered benign. Any tumor with gross or microscopic invasion through the capsule is considered malignant. In a third category, thymic tumors which have histologically malignant epithelial features, are considered thymic carcinomas and generally have an adverse prognosis. Microscopically, thymomas consist of a variable component of lymphocytic, epithelial, and fusiform (spindle) cell elements. The tumors may be classified according to the predominant cell type or are considered mixed if no cell type predominates. Prognosis is most strongly linked to clinical stage. The role of adjuvant radiotherapy or chemotherapy in the treatment of such tumors is controversial, but malignant thymomas are generally responsive to radiotherapy. Associated myasthenia gravis does not adversely affect the prognosis of thymoma, and medical attention to the myasthenia may contribute to earlier diagnosis of the thymoma. Cisplatin-based chemotherapy may be used to treat advanced disease with a modest response rate.
Topics: Adult; Humans; Mediastinal Neoplasms; Middle Aged; Myasthenia Gravis; Neoplasm Staging; Thymoma
PubMed: 8462324
DOI: 10.1378/chest.103.4_supplement.334s -
Archives of Pathology & Laboratory... Jan 1997An unusual thymoma is reported in a 32-year-old woman. The tumor presented as diffuse pleural thickening with encasement of the left lung. Computed tomographic scan and... (Review)
Review
An unusual thymoma is reported in a 32-year-old woman. The tumor presented as diffuse pleural thickening with encasement of the left lung. Computed tomographic scan and pleural biopsy of this pleural-based lesion were interpreted as favoring a diffuse pleural mesothelioma. After pleuropneumonectomy, pathologic examination revealed a characteristic epithelial thymoma. However, neither mediastinal involvement nor a concurrent mediastinal mass was found at surgery or by radiographic examinations. To our knowledge, only six previous cases of thymomas have been reported as pleural-based tumors for which a mediastinal origin could be excluded (namely, primary pleural thymomas). It is emphasized that in clinical and pathologic diagnosis of a pleural-based lesion thymoma should be considered in the differential diagnosis.
Topics: Adult; Anatomy, Cross-Sectional; Diagnosis, Differential; Female; Humans; Mesothelioma; Pleural Neoplasms; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed
PubMed: 9111099
DOI: No ID Found -
Thoracic Surgery Clinics Feb 2011Thymic epithelial tumors, such as thymomas and thymic carcinomas, are the most common primary neoplasms of the mediastinum. In 1999, the World Health Organization (WHO)... (Review)
Review
Thymic epithelial tumors, such as thymomas and thymic carcinomas, are the most common primary neoplasms of the mediastinum. In 1999, the World Health Organization (WHO) proposed a consensus classification of thymic epithelial tumors based on the morphology of the epithelial cells and the ratio of lymphocytes to epithelial cells, which was revised in 2004. The latest classification system stratifies thymic epithelial tumors into six categories: types A, AB, B1, B2, B3, and thymic carcinoma. This article describes the prediction of thymoma histology and stage on the basis of radiographic criteria by reviewing the following: the WHO histologic classification of thymic epithelial tumors, the clinical staging of thymomas based on prognosis, and the radiographic appearance of thymomas according to the WHO histologic classification.
Topics: Humans; Neoplasm Staging; Positron-Emission Tomography; Thymoma; Thymus Neoplasms; Tomography, X-Ray Computed
PubMed: 21070982
DOI: 10.1016/j.thorsurg.2010.08.008 -
The Oncologist Apr 2020Thymomas comprise a group of rare epithelial neoplasms of the anterior mediastinum. Whereas localized disease carries a favorable prognosis, the majority of patients... (Review)
Review
Thymomas comprise a group of rare epithelial neoplasms of the anterior mediastinum. Whereas localized disease carries a favorable prognosis, the majority of patients with metastatic thymomas experience progression or recurrence over a 10-year period. Although targeted therapies have become standard of care in many malignancies, no clinically actionable mutations have consistently been identified in metastatic thymomas. Here, we describe a patient with an aggressive thymoma complicated by extensive pleural metastases. Over a 16-year period, she progressed on multiple treatment regimens. To identify additional treatment options, tissue from a pleural metastasis was sent for next-generation sequencing, revealing mutations in BRCA2, tyrosine kinase 2, and SET domain containing 2. Based on supporting evidence for poly (ADP-ribose) polymerase (PARP) inhibition in other BRCA-mutated tumors, the patient was started on the PARP inhibitor olaparib. She derived significant clinical benefit from treatment, with imaging showing overall stabilization of her disease. Here, we review the genotyping results of her tumor and discuss the functional and clinical significance of the mutations in her cancer as well as implications for managing patients with advanced BRCA-mutant thymomas. KEY POINTS: Targeted therapy has yet to enter the standard clinical management of metastatic thymomas. Patients with BRCA2-mutant thymomas may benefit from poly (ADP-ribose) polymerase inhibition.
Topics: BRCA1 Protein; BRCA2 Protein; Female; Humans; Mutation; Neoplasm Recurrence, Local; Ovarian Neoplasms; Phthalazines; Piperazines; Thymoma; Thymus Neoplasms
PubMed: 32297440
DOI: 10.1634/theoncologist.2019-0393 -
Thoracic Surgery Clinics Feb 2011With a knowledgeable assessment of the clinical presentation and demographic and radiologic characteristics, most thymomas can be reliably identified preoperatively... (Review)
Review
With a knowledgeable assessment of the clinical presentation and demographic and radiologic characteristics, most thymomas can be reliably identified preoperatively without the need for a biopsy. Surgery is the mainstay of treatment for stage I and II thymoma. The rate of complete resection is essentially 100% by open techniques, and recurrences are rare. A complete thymectomy via a sternotomy is the standard approach. Adjuvant radiotherapy after a complete resection does not appear to be of benefit. In the rare event of a recurrence, an aggressive approach should be taken with re-resection whenever possible.
Topics: Humans; Neoplasm Recurrence, Local; Neoplasm Staging; Prognosis; Radiotherapy, Adjuvant; Thymoma; Thymus Neoplasms
PubMed: 21070987
DOI: 10.1016/j.thorsurg.2010.08.001 -
Cancer Treatment and Research 2001Thymomas and thymic carcinomas are unique tumors of the anterior mediastinum. The association of a variety of different paraneoplastic syndromes with such lesions has... (Review)
Review
Thymomas and thymic carcinomas are unique tumors of the anterior mediastinum. The association of a variety of different paraneoplastic syndromes with such lesions has fascinated physicians and researchers for years. Most recently, it has been demonstrated by numerous authors that thymomas are chemosensitive tumors. Their indolent nature and relative rarity have made evaluation through prospective randomized clinical trials extremely difficult. Further information regarding the molecular nature of these neoplasms and immunologic aspects is needed in future investigation.
Topics: Adrenal Cortex Hormones; Agammaglobulinemia; Antineoplastic Agents; Antineoplastic Combined Chemotherapy Protocols; Autoimmune Diseases; Carcinoma; Cisplatin; Clinical Trials as Topic; Epithelial Cells; Humans; Ifosfamide; Immunologic Factors; Interleukin-2; Multicenter Studies as Topic; Myasthenia Gravis; Neoplasm Staging; Neoplasms, Second Primary; Paraneoplastic Syndromes; Radiotherapy, Adjuvant; Red-Cell Aplasia, Pure; Thymectomy; Thymoma; Thymus Gland; Thymus Neoplasms; Treatment Outcome
PubMed: 11224991
DOI: 10.1007/978-1-4615-1589-0_11 -
Der Pathologe Sep 2016Thymomas are rare tumors but are one of the most common mediastinal neoplasms in adults and exhibit an enormous variability in histological, biological and genetic... (Review)
Review
Thymomas are rare tumors but are one of the most common mediastinal neoplasms in adults and exhibit an enormous variability in histological, biological and genetic features. The morphological spectrum within a given entity is enormous and some tumors with histological patterns of more than one entity are more common than pure histological subtypes. Due to a lack of subtype-specific markers classification of thymomas often requires complex diagnostic algorithms. The refined presentation including the definition of obligatory and optional features and of diagnostic immunohistochemical profiles, is the focus of the new World Health Organization (WHO) classification of thymomas, aiming at improving diagnostic reproducibility. This review highlights novel aspects of the WHO classification of thymomas and addresses typical differential diagnostic challenges with a focus on diagnostic pitfalls.
Topics: Adult; Algorithms; Biomarkers, Tumor; Diagnosis, Differential; Humans; Immunohistochemistry; International Classification of Diseases; Thymoma; Thymus Gland; Thymus Neoplasms; World Health Organization
PubMed: 27558364
DOI: 10.1007/s00292-016-0223-3 -
International Journal of Surgical... Sep 2023Thymic epithelial neoplasms are the most common tumors of thymic origin but are overall rare in the general population. Their morphologic diversity, ranging from low... (Review)
Review
Thymic epithelial neoplasms are the most common tumors of thymic origin but are overall rare in the general population. Their morphologic diversity, ranging from low grade to overtly malignant lesions, along with various histologic growth patterns make them a diagnostically challenging group of tumors. Very occasionally, thymomas and thymic carcinomas may develop in combination with other benign or malignant lesions of thymic origin, further complicating the diagnostic process. The focus of this review lies on the spectrum of thymic epithelial tumors that present with other thymic lesions in the same tumor mass, such as multilocular thymic cysts, neuroendocrine neoplasms, lymphomas, and germ cell tumors among others. Awareness of the existence of such unusual tumors may not only aid in their diagnosis but may also have implications for prognostic and therapeutic purposes.
Topics: Humans; Thymoma; Thymus Neoplasms; Lymphoma; Neoplasms, Glandular and Epithelial
PubMed: 36036356
DOI: 10.1177/10668969221118324 -
Journal of the National Comprehensive... May 2013A better understanding of the biology of both thymomas and thymic carcinomas has occurred in recent years thanks to advanced technologies such as comparative genomic... (Review)
Review
A better understanding of the biology of both thymomas and thymic carcinomas has occurred in recent years thanks to advanced technologies such as comparative genomic hybridization, expression array analysis, and next-generation sequencing. Gene expression profiling and genomic clustering studies have shown that thymic tumors as classified by the 2004 WHO system do have different molecular features. Because of the rarity of these tumors, there is a paucity of high-quality clinical research data, and treatment decisions are often guided by the small amount of prospective trial data, retrospective series, and individual case reports. The literature does report on several advanced thymic tumors that have responded to new targeted agents, indicating that across the spectrum of thymic malignancies there may be clinically relevant molecular subsets. Genomic profiling distinguishes type B3 thymoma and thymic carcinoma from type A and B2 thymomas. Furthermore, type B2 thymomas can be separated from other subgroups in that it has a more distinctly lymphocytic component than the other groups in which epithelial cells predominate. The presence of KIT mutations in thymic carcinomas rather than in thymomas further adds to a growing body of evidence showing that underlying tumor biology may in the future lead to molecular classifications, which may enhance therapies for these rare tumors.
Topics: Diagnosis, Differential; Humans; Neoplasm Staging; Thymoma; Thymus Neoplasms
PubMed: 23667207
DOI: 10.6004/jnccn.2013.0073