-
The American Surgeon Jun 2024Current practice patterns suggest open rather than minimally invasive (MIS) approaches for thymomas >4 cm. We hypothesized there would be similar perioperative outcomes...
BACKGROUND
Current practice patterns suggest open rather than minimally invasive (MIS) approaches for thymomas >4 cm. We hypothesized there would be similar perioperative outcomes and overall survival between open and MIS approaches for large (>4 cm) thymoma resection.
METHODS
The National Cancer Database was queried for patients who underwent thymectomy from 2010 to 2020. Surgical approach was characterized as either open or MIS. The primary outcome was overall survival and secondary outcomes were margin status, and length of stay (LOS). Differences between approach cohorts were compared after a 1:1 propensity match.
RESULTS
Among 4121 thymectomies, 2474 (60%) were open and 1647 (40%) were MIS. Patients undergoing MIS were older, had fewer comorbidities, and had smaller tumors (median; 4.6 vs 6 cm, < .001). In the unmatched cohort, MIS and open had similar 90-day mortality (1.1% vs 1.8%, = .158) and rate of positive margin (25.1% vs 27.9%, = .109). MIS thymectomy was associated with shorter LOS (2 (1-4) vs 4 (3-6) days, < .001). Propensity matching reduced the bias between the groups. In this cohort, overall survival was similar between the groups by log-rank test ( = .462) and multivariate cox hazard analysis (HR .882, = .472). Multivariable regression showed shorter LOS with MIS approach (Coef -1.139, < .001), and similar odds of positive margin (OR 1.130, = .150).
DISCUSSION
MIS has equivalent oncologic benefit to open resection for large thymomas, but is associated with shorter LOS. When clinically appropriate, MIS thymectomy may be considered a safe alternative to open resection for large thymomas.
Topics: Humans; Thymoma; Male; Female; Middle Aged; Thymectomy; Thymus Neoplasms; Aged; Minimally Invasive Surgical Procedures; Length of Stay; Propensity Score; Retrospective Studies; Adult; Margins of Excision; Treatment Outcome
PubMed: 38584508
DOI: 10.1177/00031348241246180 -
Revue Neurologique May 2024The European literature has reported high variability in the incidence and prevalence rates of myasthenia gravis (MG), but no specific epidemiological data for France...
BACKGROUND
The European literature has reported high variability in the incidence and prevalence rates of myasthenia gravis (MG), but no specific epidemiological data for France have been published. This study aimed to assess the incidence and prevalence rates of myasthenia gravis in France based on data extracted from the French National Health Insurance Claims Database (the SNIIRAM database).
METHODS
We conducted a retrospective repeated cross-sectional population study from 2008 to 2018 using a representative sample of the French population (Échantillon généraliste des bénéficiaires) covered by health insurance. We calculated the incidence, prevalence, and sex ratio of MG and screened for comorbidities associated with MG (standardized to the general population).
RESULTS
In total, 331 MG patients were identified between 2008 and 2018. The average incidence of MG in France was 50 per million person-years, while the mean prevalence was 465 per million people. The female-to-male ratio was 1.33. The Incidence of MG gradually increased from 40years of age for women and 60 for men. Thymoma was present for 5.1% of MG patients and a thymectomy was performed for 4.7%. Thyroid disease was the most prevalent autoimmune comorbidity, affecting approximately 8.5% of cases. MG patients had an increased cancer risk, with a standardized rate ratio of 2.38 (95% CI: 1.64-3.46).
CONCLUSION
The incidence and prevalence rates of MG are significantly higher than those previously reported in the literature and the incidence increases with age. The excess risk of cancer raises concerns for MG patients, in particular, concerning the management of immunosuppressive drugs.
Topics: Humans; Myasthenia Gravis; France; Male; Female; Middle Aged; Incidence; Prevalence; Adult; Comorbidity; Aged; Retrospective Studies; Young Adult; Cross-Sectional Studies; Adolescent; Child; National Health Programs; Aged, 80 and over; Infant; Child, Preschool; Databases, Factual; Infant, Newborn
PubMed: 38582663
DOI: 10.1016/j.neurol.2024.02.392 -
Journal of Thoracic Oncology : Official... Apr 2024
Topics: Humans; Thymoma; Lung Neoplasms; Thymus Neoplasms; Carcinoma; Postoperative Period
PubMed: 38582543
DOI: 10.1016/j.jtho.2024.01.010 -
Journal of Cardiothoracic Surgery Apr 2024Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease, is a rare, self-limiting disease that predominantly affects children and young...
BACKGROUND
Sinus histiocytosis with massive lymphadenopathy, also known as Rosai-Dorfman disease, is a rare, self-limiting disease that predominantly affects children and young adults. Moreover, the disease is characterized by painless bilateral cervical lymphadenopathy in 95% of the patients. However, few reports are available on the Rosai-Dorfman disease of the thymus.
CASE PRESENTATION
We report a rare case of thymic Rosai-Dorfman disease detected using computed tomography. During a medical examination, a 50-year-old man underwent a chest computed tomography scan, which revealed an anterior mediastinal single mass with fat in the thymus. A thymectomy was performed to completely remove the tumor using a thoracoscopic technique due to a clinical suspicion of thymoma. Furthermore, Rosai-Dorfman disease was confirmed using histological and immunohistochemical analyses.
CONCLUSIONS
To the best of our knowledge, this is the sixth case of thymus-affecting solitary Rosai-Dorfman disease with histological and immunohistochemical evidence. Fat in the thymus, as was present in this case, has never been described in Rosai-Dorfman disease previously. Our results highlight the challenge of diagnosing this uncommon tumor before surgery, and more cases need to be reported to help with the preoperative diagnosis of such a rare tumor.
Topics: Humans; Male; Middle Aged; Diagnosis, Differential; Histiocytosis, Sinus; Mediastinal Diseases; Neoplasms; Tomography, X-Ray Computed
PubMed: 38575975
DOI: 10.1186/s13019-024-02714-x -
Lung Cancer (Amsterdam, Netherlands) May 2024Mediastinal neoplasms are typical but uncommon thoracic diseases with increasing incidence and unfavorable prognoses. A comprehensive understanding of their... (Observational Study)
Observational Study
OBJECTIVES
Mediastinal neoplasms are typical but uncommon thoracic diseases with increasing incidence and unfavorable prognoses. A comprehensive understanding of their spatiotemporal distribution is essential for accurate diagnosis and timely treatment. However, previous studies are limited in scale and data coverage. Therefore, this study aims to elucidate the distribution of mediastinal lesions, offering valuable insights into this disease.
MATERIALS AND METHODS
This multi-center, hospital-based observational study included 20 nationwide institutions. A retrospective search of electronic medical records from January 1st, 2009, to December 31st, 2020, was conducted, collecting sociodemographic data, computed tomography images, and pathologic diagnoses. Analysis focused on age, sex, time, location, and geographical region. Comparative assessments were made with global data from a multi-center database.
RESULTS
Among 7,765 cases, thymomas (30.7%), benign mediastinal cysts (23.4%), and neurogenic tumors (10.0%) were predominant. Distribution varied across mediastinal compartments, with thymomas (39.6%), benign cysts (28.1%), and neurogenic tumors (51.9%) most prevalent in the prevascular, visceral, and paravertebral mediastinum, respectively. Age-specific variations were notable, with germ cell tumors prominent in patients under 18 and aged 18-29, while thymomas were more common in patients over 30. The composition of mediastinal lesions across different regions of China remained relatively consistent, but it differs from that of the global population.
CONCLUSION
This study revealed significant heterogeneity in the spatiotemporal distribution of mediastinal neoplasms. These findings provide useful demographic data when considering the differential diagnosis of mediastinal lesions, and would be beneficial for tailoring disease prevention and control strategies.
Topics: Humans; Male; Female; Mediastinal Neoplasms; Adult; Middle Aged; Retrospective Studies; Adolescent; Young Adult; Aged; Child; Spatio-Temporal Analysis; Child, Preschool; Tomography, X-Ray Computed; Incidence
PubMed: 38569278
DOI: 10.1016/j.lungcan.2024.107558 -
Clinical Radiology Jun 2024Due to the rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and...
Due to the rising demand in cross-sectional thoracic imaging, anterior mediastinal lesions are being identified with increasing frequency. Following iterative and multidisciplinary discussions, the BTOG Thymic Malignancies Special Interest Group have developed an algorithm to standardise the diagnostic approach for these relatively uncommon but important conditions which span from benign (thymic remnant, thymic hyperplasia and thymic cysts) to suspected localised thymomas to suspected more aggressive malignancy (thymic carcinoma, lymphoma and germ cell tumours). For each condition, we provide a brief description, an overview of the key radiological findings and a description of the proposed algorithm including the rationale behind the recommendations. We also highlight the role of magnetic resonance (MR) imaging for the characterisation of anterior mediastinal masses in specific indications when the necessary local resources and expertise exist. In addition, we hope this provides the rationale for service development in MR of the anterior mediastinum where current resource and expertise requires development. Through this standardised pathway, we hope to drive improvements in patient care by rationalising surveillance schedules, avoiding unnecessary resections of benign entities with their associated morbidity and optimising the diagnostic work-up prior to the appropriate treatment of anterior mediastinal malignancies.
Topics: Humans; Algorithms; Diagnosis, Differential; Magnetic Resonance Imaging; Mediastinal Neoplasms; Mediastinum; Thymoma; Thymus Neoplasms
PubMed: 38565483
DOI: 10.1016/j.crad.2024.03.003 -
Veterinary Anaesthesia and Analgesia 2024
Topics: Dogs; Animals; Myasthenia Gravis; Dog Diseases; Thymoma; Sugammadex; Neuromuscular Blockade; Thymus Neoplasms; Neuromuscular Nondepolarizing Agents; Male; Female; gamma-Cyclodextrins
PubMed: 38561309
DOI: 10.1016/j.vaa.2024.03.004 -
International Journal of Oral and... Jul 2024
Topics: Humans; Parotid Neoplasms; Thymus Neoplasms; Thymoma; Diagnosis, Differential
PubMed: 38556433
DOI: 10.1016/j.ijom.2024.03.006 -
Asian Journal of Surgery Jun 2024
Topics: Humans; Vena Cava, Superior; Thymoma; Heart Atria; Thymus Neoplasms; Multimodal Imaging; Tomography, X-Ray Computed; Male; Neoplasm Invasiveness; Heart Neoplasms; Female; Middle Aged
PubMed: 38553265
DOI: 10.1016/j.asjsur.2024.03.138 -
Archivos de Bronconeumologia May 2024
Topics: Humans; Bronchoscopy; Neoplasm Recurrence, Local; Neoplastic Cells, Circulating; Thymoma; Thymus Neoplasms
PubMed: 38553257
DOI: 10.1016/j.arbres.2024.03.006