The role of needle core biopsies in the evaluation of thymic epithelial neoplasms

Suster, David; Suster, Saul

doi:10.1016/j.jasc.2020.04.006

Cited by 7 publications

(5 citation statements)

References 55 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Not only are the spindle cells in both types identical, but they share the same immunophenotype, similar growth pattern and biologic behavior, and they share the same molecular genetic abnormality. As acknowledged by the WHO, a close relationship between type A and AB thymomas is suggested by the similar high frequency of a GTF2I missense mutation found in both of these tumors, compared with the rarity of this mutation in the various type B thymomas 1,13,25. Evaluation of our histologic, molecular, and ultrastructural data in light of the recently described genetic landscape of thymic epithelial tumors coming from the TCGA20 suggests that the lymphocyte rich spindle cell thymomas described here represent the same tumor currently designated as type AB thymoma by the WHO.…”

Section: Discussionsupporting

confidence: 62%

“…As acknowledged by the WHO, a close relationship between type A and AB thymomas is suggested by the similar high frequency of a GTF2I missense mutation found in both of these tumors, compared with the rarity of this mutation in the various type B thymomas. 1,13,25 Evaluation of our histologic, molecular, and ultrastructural data in light of the recently described genetic landscape of thymic epithelial tumors coming from the TCGA 20 suggests that the lymphocyte rich spindle cell thymomas described here represent the same tumor currently designated as type AB thymoma by the WHO. Considering that the neoplastic epithelial cells in these tumors are spindle rather than round or polygonal, referring to these tumors as type AB is inaccurate and instead, they should be called lymphocyte-rich spindle cell thymoma (or lymphocyte-rich type A thymoma) and regarded as a variant of type A thymoma.…”

Section: Discussionmentioning

confidence: 80%

See 1 more Smart Citation

Lymphocyte-Rich Spindle Cell Thymoma

Suster

Mackinnon

Pihán

et al. 2022

American Journal of Surgical Pathology

Self Cite

View full text Add to dashboard Cite

A study of 80 cases of spindle cell thymoma in which the spindle cell component was overshadowed by massive numbers of stromal lymphocytes is presented. The patients were 38 women and 42 men, aged 8 to 81 years (mean = 54 y). All tumors presented as an anterior mediastinal mass; 5 patients had myasthenia gravis and one had Good syndrome. The tumors were well-circumscribed, encapsulated, and measured 2.9 to 26.0 cm in greatest diameter (mean = 7.3 cm). Using modified Masaoka staging, 66 tumors were stage I, 10 were stage IIa, 2 were stage III and 1 was stage IV. Histologically the tumors were characterized by a predominant lymphocytic population admixed with scattered small spindle epithelial cells. The neoplastic spindle cells in these tumors demonstrated 2 major growth patterns: in 33 cases, the tumors were exclusively composed of dense sheets of lymphocytes containing scattered spindle cells resembling a lymphocyte-rich thymoma (WHO type B1); in the remaining cases the tumors showed admixtures of a predominantly lymphocytic component with areas that were lymphocyte-poor and contained a pure spindle cell population similar to WHO type A. Immunohistochemical stains and electron microscopy corroborated the spindle cell morphology in both types. The GTF2I p.L424H variant was identified in 53 of 63 (84%) cases analyzed. Clinical follow-up in 27 cases showed that most of the tumors behaved in an indolent manner. Our study expands the spectrum of spindle cell thymoma by demonstrating the existence of cases that are predominantly composed of lymphocyte-rich elements and lack areas with a pure (lymphocyte poor) spindle cell morphology.

show abstract

Section: Discussionsupporting

confidence: 62%

Section: Discussionmentioning

confidence: 80%

Lymphocyte-Rich Spindle Cell Thymoma

Suster

Mackinnon

Pihán

et al. 2022

American Journal of Surgical Pathology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Type A thymoma, the tumor diagnosed in the first case, is characterized by its great variability of morphologic growth patterns and, as such, the possibility of mimicking a wide variety of other neoplastic mediastinum disorders (5). In particular for the first case, if we compare the output of the transthoracic needle biopsy with the final result of the tumor extracted by surgery we can only reconfirm what the experts are sustaining, that the final diagnosis should be reserved until after the examination of the completely resected specimen has been carried out (6). In adults, the most common mediastinal tumors are epithelial (46%), followed by hematopoietic (23%), endocrine (16%), and germ cell tumors (15%) (7).…”

Section: Discussionmentioning

confidence: 99%

Oligosymptomatic tumors – Traps for doctors and patients

et al. 2021

View full text Add to dashboard Cite

Few patients are fortunate enough to get detected in the early stages of tumors whether benignant or malignant. This chance, with multiple hidden ethical issues, has pitfalls for both doctors and patients. We are presenting two cases, a male and a female with diagnosis problems successfully managed even if they are not convinced about the necessity of the surgery. The male, aged 63 years, non-smoker, with occupational exposure for 41 years, oligosymptomatic, during a preoperative routine X-ray and thorax CT for a left hydrocele operated in June 2020, was identified an acidophilic tumor formation, located in the anterior mediastinum. Additional investigations revealed a left vocal cord paresis and the transthoracic needle biopsy raised suspicion of thymoma with glandular areas and clear cells, also confirmed by surgery, an N0 stage. In the second case, a 42 years female with a recent history of SARS-COV-2 viral infection, mild clinical form, while performing a CT scan to assess COVID status, discovered a tumor mass located in the anterior mediastinum. ENT examination establishes the diagnoses of subacute laryngitis, dysphonic syndrome under etiological observation, and chronic rhinitis. The excision of the mediastinal formation is performed with favorable postoperative evolution. Histopathological examination highlighted changes that argue the diagnosis of mature intrathymic teratoma. Apparently, there were fortunate cases with curative resection, but being oligosymptomatic also involved substantial efforts to convince the patient and the caregivers about the need for urgent surgery.

show abstract

“…The need for pre-treatment biopsy depends on the resectability of the tumour, and it is not required if the diagnosis of thymic tumour is highly probable and upfront surgical resection is achievable [IV, E]. In other scenarios, either surgical or percutaneous core needle biopsy, which has a sensitivity of up to 90%, is required [ 11 ]. Pleural spaces should be respected to avoid tumour cell seeding.…”

Section: Diagnosismentioning

confidence: 99%

SEOM-GECP-GETTHI Clinical Guidelines for the treatment of patients with thymic epithelial tumours (2021)

et al. 2022

View full text Add to dashboard Cite

Thymic epithelial tumours (TET) represent a heterogeneous group of rare malignancies that include thymomas and thymic carcinoma. Treatment of TET is based on the resectability of the tumour. If this is considered achievable upfront, surgical resection is the cornerstone of treatment. Platinum-based chemotherapy is the standard regimen for advanced TET. Due to the rarity of this disease, treatment decisions should be discussed in specific multidisciplinary tumour boards, and there are few prospective clinical studies with new strategies. However, several pathways involved in TET have been explored as potential targets for new therapies in previously treated patients, such as multi-tyrosine kinase inhibitors with antiangiogenic properties and immune checkpoint inhibitors (ICI). One third of patient with thymoma present an autoimmune disorders, increasing the risk of immune-related adverse events and autoimmune flares under ICIs. In these guidelines, we summarize the current evidence for the therapeutic approach in patients with TET and define levels of evidence for these decisions.

show abstract

The role of needle core biopsies in the evaluation of thymic epithelial neoplasms

Cited by 7 publications

References 55 publications

Lymphocyte-Rich Spindle Cell Thymoma

Lymphocyte-Rich Spindle Cell Thymoma

Oligosymptomatic tumors – Traps for doctors and patients

SEOM-GECP-GETTHI Clinical Guidelines for the treatment of patients with thymic epithelial tumours (2021)

Contact Info

Product

Resources

About