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Obstetrical & Gynecological Survey Apr 1984The natural history of slow, localized progression usually seen with thymomas seems to be transformed by pregnancy into one of rapid growth and distant metastatic...
The natural history of slow, localized progression usually seen with thymomas seems to be transformed by pregnancy into one of rapid growth and distant metastatic spread. Five of the six previously reported cases had died of the malignancy within 6 months postpartum. The one previous long-term survivor died of treatment-induced complications. Two important questions remain unresolved: What is the risk of recurrence in the patient who has no residual disease at the time of conception? Approximately 50 per cent of female patients can anticipate having complete resection of their thymoma, and their recurrence risk is about 2 per cent. Potentially, there are many patients who have conceived and delivered after surgical therapy. Documentation of these case histories is needed for an accurate prediction of the true risk. Two of the cases within the present review fall within this category. The clinical course in these two patients is consistent with the natural history of the disease. One exhibited local recurrence and progression. The other patient died from sepsis, probably related to immunosuppression. Whether there is a cause and effect relationship between pregnancy and their recurrences is unknown. What is the risk to the patient who is first diagnosed while pregnant? The only survivor in this category was presented by Goldman. This patient underwent immediate therapeutic abortion following diagnosis. She had radiation therapy for invasive unresectable disease and subsequently delivered two term pregnancies, but died of postcesarean cardiac arrest. She had no evidence of recurrence.(ABSTRACT TRUNCATED AT 250 WORDS)
Topics: Adult; Combined Modality Therapy; Female; Humans; Neoplasm Recurrence, Local; Pregnancy; Pregnancy Complications; Prognosis; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 6717862
DOI: 10.1097/00006254-198404000-00002 -
Journal of Thoracic Oncology : Official... Oct 2010Thymomas are tumors of thymic epithelial cells. They associate more often than any other human tumors with various autoimmune diseases; myasthenia gravis is the... (Review)
Review
Thymomas are tumors of thymic epithelial cells. They associate more often than any other human tumors with various autoimmune diseases; myasthenia gravis is the commonest, occurring in 10-50% of thymoma patients, depending on the World Health Organization-defined histologic subtype. Most thymomas generate many polyclonal maturing T lymphocytes but in disorganized microenvironments Failure to induce self-tolerance may be a key factor leading to the export of potentially autoreactive CD4 progeny, thus predisposing to autoimmune diseases. Normally, the master Autoimmune Regulator promotes expression of peripheral tissue-restricted antigens such as insulin by medullary thymic epithelial cells and induction of tolerance to them. The failure of approximately 95% of thymomas to express autoimmune regulator is another feature potentially contributing to autoimmunity.
Topics: Autoimmune Diseases; Autoimmunity; Humans; Thymoma; Thymus Neoplasms; Transcription Factors; AIRE Protein
PubMed: 20859117
DOI: 10.1097/JTO.0b013e3181f1f63f -
The Annals of Thoracic Surgery Jan 2005The thymus or thymoma plays a role in the pathogenesis of myasthenia gravis (MG). Although previous studies have reported that the presence of MG in thymoma patients is... (Comparative Study)
Comparative Study
BACKGROUND
The thymus or thymoma plays a role in the pathogenesis of myasthenia gravis (MG). Although previous studies have reported that the presence of MG in thymoma patients is an indicator of poor prognosis, recent reports have shown that the presence of MG no longer influences the prognosis or indicates a more favorable prognosis in thymoma patients.
METHODS
To clarify the difference in tumor behavior between thymoma with MG and that without MG, we compiled 1,089 thymomas treated between 1990 and 1994 from 115 institutes in Japan and analyzed the clinical characteristics of thymoma with MG compared with thymoma without MG.
RESULTS
MG was associated with 270 cases (24.8%) of thymoma. The total resection cases comprised 94.6% and 91.4%, and the recurrent cases comprised 6.4% and 8.3% in the groups with and without MG, respectively. The 5-year survival rates for thymoma with and without MG in stage III were 85.7% and 89.3%, respectively; and those in stage IV were 85.1% and 63.9%, respectively. The prognosis of thymoma with MG in stage IV tended to be better than that of thymoma without MG (p = 0.0523). The thymoma with MG group had fewer stage IVb thymomas than did the thymoma without MG group (15% vs 34%). The resectability rate in the thymoma with MG group was higher than that in the thymoma without MG group (60% vs 38%).
CONCLUSIONS
Thymoma with MG is equally or less malignant than that without MG. The infrequency of stage IVb thymomas and the high resectability rate had an influence on the favorable prognosis of stage IV thymoma with MG.
Topics: Academies and Institutes; Adolescent; Adult; Aged; Aged, 80 and over; Chemotherapy, Adjuvant; Child; Child, Preschool; Combined Modality Therapy; Female; Humans; Japan; Life Tables; Male; Middle Aged; Myasthenia Gravis; Neoplasm Staging; Prognosis; Radiotherapy, Adjuvant; Recurrence; Surveys and Questionnaires; Survival Analysis; Survival Rate; Thymectomy; Thymoma; Thymus Neoplasms; Treatment Outcome
PubMed: 15620947
DOI: 10.1016/j.athoracsur.2004.06.090 -
The American Journal of Surgical... Dec 1996Thymic epithelial neoplasms are unusual tumors that may span the gamut from clinically benign, well-differentiated lesions (encapsulated thymoma) to overtly malignant,... (Review)
Review
Thymic epithelial neoplasms are unusual tumors that may span the gamut from clinically benign, well-differentiated lesions (encapsulated thymoma) to overtly malignant, poorly differentiated neoplasms (thymic carcinoma). It has been commonly believed that lesions displaying obvious cytologic features of malignancy (i.e., thymic carcinoma) represent a unique and separate group that is histogenetically distinct from thymoma. We have studied 22 cases of thymic epithelial neoplasms characterized by the admixture of areas displaying conventional features of thymoma with areas showing features of thymic carcinoma. The tumors occurred in six women and 16 men whose ages ranged from 23 to 83 years (median, 53). The lesions presented in eight patients with symptoms of chest discomfort resulting from the involvement of surrounding structures; in 14 patients, they were asymptomatic and discovered incidentally on routine chest radiographs. Histologically, most tumors showed a combination of conventional thymomatous elements with well-differentiated squamous-cell carcinoma (10 cases), followed by thymoma and poorly-differentiated squamous carcinoma (seven cases) and spindle-cell thymoma with poorly-differentiated squamous carcinoma (five cases). Areas of transition between the two different components could be identified in most cases. In five cases, areas showing the features of clear-cell carcinoma could be seen either arising from squamous carcinomatous elements or within the thymomatous component, and in one case transitions between lymphoepithelioma-like carcinoma and anaplastic carcinoma could be observed. Two patients had a history of myasthenia gravis with biopsy-proven thymomas in whom the tumors had been monitored without treatment for 10 and 14 years before the sudden enlargement of the mass. The resected specimens in both patients showed the emergence of a carcinoma arising from a thymoma. The present cases appear to support the existence of a continuum in the spectrum of differentiation between thymoma and thymic carcinoma, suggesting a close histogenetic relationship between these two conditions. Such findings are important not only for our understanding of these tumors but may also play a significant role in the assessment of the biologic behavior and management of these lesions.
Topics: Adult; Aged; Female; Humans; Male; Middle Aged; Neoplasms, Glandular and Epithelial; Thymoma; Thymus Neoplasms
PubMed: 8944040
DOI: 10.1097/00000478-199612000-00006 -
American Journal of Clinical Oncology Aug 2006Thymic malignancies are rare tumors on the superior anterior mediastinum. Treatment of advanced stages includes chemotherapy. The objective of this analysis was to...
OBJECTIVES
Thymic malignancies are rare tumors on the superior anterior mediastinum. Treatment of advanced stages includes chemotherapy. The objective of this analysis was to review the treatment of this disease in the past decade.
METHODS
This is a retrospective analysis of the results obtained in a total of 29 patients with advanced malignant thymomas who underwent systemic chemotherapy in the past 10 years at our institution. Sixteen received neoadjuvant chemotherapy in the attempt to shrink the tumor and then perform a radical operation. The others received chemotherapy as palliation. Platinum based chemotherapy was mainly used.
RESULTS
The response rate to first-line chemotherapy was 50% in the neoadjuvant setting and 31% in the advanced setting. A better survival was observed in patients who underwent chemotherapy as part of their combined modality treatment, in patients with thymomas, and in patients without visceral metastases. Some patients responded to targeted therapies at relapse.
CONCLUSIONS
A better understanding of the biology of this rare tumor may allow in the future the development of better therapies for the more aggressive tumor types (WHO type C), which appear to be increasing in frequency.
Topics: Adult; Aged; Aged, 80 and over; Antineoplastic Combined Chemotherapy Protocols; Female; Humans; Male; Middle Aged; Neoadjuvant Therapy; Palliative Care; Retrospective Studies; Survival Analysis; Thymoma; Thymus Neoplasms
PubMed: 16891859
DOI: 10.1097/01.coc.0000227481.36109.e7 -
Archives of Pathology & Laboratory... Apr 1986A 45-year-old woman presented with a five-year history of neck swelling and occasional difficulty in swallowing. The clinical impression was of a thyroid nodule, and...
A 45-year-old woman presented with a five-year history of neck swelling and occasional difficulty in swallowing. The clinical impression was of a thyroid nodule, and fine-needle aspiration biopsy cytology revealed a monotonous lymphoid population, raising the suspicion of Hashimoto's thyroiditis. At surgery, the mass was identified at the level of the cricoid cartilage, displacing the right lobe of the thyroid gland superiorly and extending posteriorly to the prevertebral fascia. Although a frozen-section diagnosis of malignant lymphoma had been suggested at the time of surgery, permanent sections favored a diagnosis of thymoma. Surface marker studies showed the majority of cells to be of thymic T-cell phenotype, and ultrastructural examination demonstrated a dual population of lymphoid and epithelial cells, thus confirming the presence of thymoma. Cervical thymomas are extremely rare and this case report illustrates the difficulties in diagnosis; we speculate that cervical thymoma may be an underdiagnosed entity.
Topics: Female; Head and Neck Neoplasms; Humans; Middle Aged; T-Lymphocytes; Thymoma; Thymus Gland
PubMed: 3485417
DOI: No ID Found -
Interactive Cardiovascular and Thoracic... Apr 2017Patients with thymoma are reported to have an increased risk for developing second malignancies. The aim of this study was to assess the incidence of second malignancies...
OBJECTIVES
Patients with thymoma are reported to have an increased risk for developing second malignancies. The aim of this study was to assess the incidence of second malignancies among patients with thymoma. We focused especially on the impact that lung cancer has on survival in these patients.
METHODS
Three hundred and thirty-five patients who underwent surgery for thymoma in Chiba University Hospital from January 1971 to November 2012 were included in this study. Patient records were reviewed retrospectively for data on background, treatment, second malignancies and clinical outcome.
RESULTS
Fourteen patients had a history of malignancy until the time of operation, with an additional 20 diagnosed simultaneously with the thymoma. Forty-three malignant lesions in 33 patients were found post-thymectomy. Lung cancer was diagnosed in 17 patients, far exceeding the expected number in the cohort, which was calculated according to Japanese national data. The median survival time of the thymoma patients who had lung cancer at the time of surgery was 5.8 years. The survival of patients with thymoma and lung cancer was poor in comparison with that of others.
CONCLUSIONS
Secondary lung cancer is frequently found in thymoma patients and could be one of the factors limiting survival. We recommend an annual computed tomographic scan of the thorax to detect not only recurrent thymoma but also lung cancer at an early stage in order to improve the survival of these patients.
Topics: Adult; Aged; Female; Humans; Incidence; Male; Middle Aged; Neoplasms, Second Primary; Retrospective Studies; Survival Rate; Thymectomy; Thymoma; Thymus Neoplasms
PubMed: 28040768
DOI: 10.1093/icvts/ivw354 -
World Journal of Surgical Oncology Feb 2015Malignant thymomas are rare epithelial neoplasms of the anterior superior mediastinum that are typically invasive in nature and have a higher risk of relapse that may...
Malignant thymomas are rare epithelial neoplasms of the anterior superior mediastinum that are typically invasive in nature and have a higher risk of relapse that may ultimately lead to death. Here we report a case of an advanced malignant thymoma that was successfully treated with neoadjuvant chemotherapy followed by surgical resection and subsequently with advanced and novel radiation therapy techniques. A 65-year-old male was diagnosed with a stage IV malignant thymoma with multiple metastatic lesions involving the left peripheral lung and pericardium. Initial neoadjuvant chemotherapy with a cisplatin-based regimen resulted in a partial response allowing the inoperable tumor to become operable. Following surgical resection of the residual disease, the tumor recurred within a year. The patient then underwent a course of targeted three-dimensional intensity modulated radiation therapy (IMRT) and image-guided radiation therapy (IGRT). Five years after radiation therapy, the localized soft tissue thickening at the left upper lung anterior pleural space had resolved. Seven years after radiation therapy the tumor mass had completely resolved. No recurrences were seen and the patient is well even 8 years after IMRT/IGRT with a favorable outcome. Chemotherapy with targeted three-dimensional IMRT/IGRT should be considered the primary modality for the management of advanced malignant thymoma patients.
Topics: Aged; Antineoplastic Combined Chemotherapy Protocols; Chemoradiotherapy; Disease Management; Humans; Lung Neoplasms; Male; Pericardium; Prognosis; Thymoma; Thymus Neoplasms
PubMed: 25889080
DOI: 10.1186/s12957-014-0427-z -
Surgery Today 1998Extrathoracic invasions or metastases from thymomas are extremely rare. We describe herein the case of a patient with malignant thymoma which recurred three times during...
Extrathoracic invasions or metastases from thymomas are extremely rare. We describe herein the case of a patient with malignant thymoma which recurred three times during an 8-year period and invaded directly into the peritoneal cavity, involving the gastrointestinal tract. The huge thymoma was completely resected, along with the fornix of the stomach, the transverse colon, and the 8th, 9th, and 10th ribs. Careful observation and multidisciplinary treatment against recurrent thymoma will be requisite for this patient, even though the tumor has been completely resected.
Topics: Gastrointestinal Neoplasms; Humans; Male; Middle Aged; Neoplasm Invasiveness; Peritoneal Neoplasms; Recurrence; Thymoma; Thymus Neoplasms
PubMed: 9590719
DOI: 10.1007/s005950050163 -
Journal of Thoracic Oncology : Official... Oct 2010Thymomas are relatively uncommon. Nevertheless, an accumulation of studies (mostly retrospective, single-institution series) have made it important to approach this... (Review)
Review
Thymomas are relatively uncommon. Nevertheless, an accumulation of studies (mostly retrospective, single-institution series) have made it important to approach this disease in a knowledgeable, evidence-based fashion. This begins with the approach to evaluation of a patient with an anterior mediastinal mass, in whom a reliable clinical diagnosis is usually possible in experienced centers. Surgical resection is the mainstay of treatment, and every effort must be made to achieve a complete resection.
Topics: Humans; Neoplasm Staging; Prognosis; Thymoma; Thymus Neoplasms
PubMed: 20859126
DOI: 10.1097/JTO.0b013e3181f20dab