T hymic malignancies are relatively uncommon, which mandates that the experience from many different institutions be combined to achieve a better understanding of the disease. Nevertheless, this is hampered by many ambiguities in how results are reported and interpreted. This problem is aggravated by the fact that smaller institutions often encounter these tumors only sporadically. A prerequisite to interinstitutional collaboration is a common language and consistency in the definition of findings (e.g., whether a complete resection was accomplished or not).This article summarizes the policies adopted by the International Thymic Malignancy Interest Group (ITMIG) regarding handling of a resection specimen by the surgeon and pathologist and reporting of the surgical and pathologic findings. These policies are based as much as possible on reported evidence, but this is lacking or limited in many areas. Nevertheless, adoption of a consistent approach is crucial to conduct valid studies moving forward that can clarify areas of uncertainty.This publication addresses only how to handle and process the tissue specimen at the time of a resection. It does not address handling and interpretation of biopsies or cytologic specimens, which is an important topic that is addressed in a separate publication. 1 This article is limited to an open resection (by sternotomy). Although other approaches are sometimes used (e.g., thoracoscopy), the issues involved are also covered in another publication. 2 Furthermore, this article is written with the assumption that resection of a thymoma involves a complete thymectomy along with any adjacent structures that may be involved and that the goal is a complete (R0) resection (i.e., not debulking). METHODSThe process used in development of this document was designed to represent both underlying evidence and a broad consensus of ITMIG members. An initial workgroup consisting of pathologists and surgeons
A quantitative assessment of the effect of localized magnetic-loop hyperthermia on blood flow was performed in 12 human tumors using the 133Xe clearance method. Because blood flow in these tumors changed in response to needle injection, a physiologically based, one-compartment model was developed that included both a hyperemic and a steady-state component. In six tumors, changes in blood flow induced by heat were also observed. The ability of tumor vessels to respond dynamically to stress and the degree of response may be predictive of tumor heating capacity and subsequent therapeutic response.
Hyperthermia greater than or equal to 42 degrees C is tumoricidal in vitro and in many animal models, although such temperatures have only recently been achieved experimentally in some human cancers. A recently developed radio frequency device that provides safe hyperthermia to any depth without surface tissue injury now permits evaluation of the effects of hyperthermia on advanced human sarcomas. Twelve patients with large sarcomas located intraabdominally [7], in the chest wall [2], proximal extremity [2], and the neck [1], were evaluated in this study. Tumor types include liposarcoma [3], rhabdomyosarcoma [2], leiomyosarcoma [2], neurofibrosarcoma [2], and one each malignant mesothelioma, undifferentiated sarcoma, and osteosarcoma. Intratumor temperatures greater than or equal to 42 degrees C were observed in all tumors, with virtually no normal tissue injury. Selective tumor heating greater than or equal to 45 degrees C occurred in 9/12 (75%) and greater than or equal to 50 degrees C in 6/12 (50%). One to five weekly treatments greater than or equal to 50 degrees C and ten daily treatments greater than or equal to 45 degrees C resulted in significant tumor necrosis and pain relief in some patients. Hyperthermia of advanced sarcomas is possible with little host toxicity and may be of potential therapeutic benefit.
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