Thymoma and thymic carcinoma

Abstract

Thymic tumors comprise a heterogeneous group of neoplasms with a wide spectrum of clinical presentations. The evolution of the disease is often unpredictable, ranging from an indolent attitude to the possibility of intra- and extrathoracic spread. From the histological point of view, thymoma and thymic carcinoma are the most frequent subtypes and arise only from thymic epithelial cells. Other histological types are even more rare and are usually considered separately. A number of prognostic factors have been validated as predictors of outcome: staging, World Health Organization histological classification, diameter of the tumor, associated paraneoplastic syndromes, completeness of resection, and early onset of recurrence. Complete surgical resection is the key factor for cure and should be considered the gold standard at any stage. Especially for more aggressive lesions, surgery should be considered with a multimodality approach, involving induction and adjuvant therapy according to the stage. Multimodality therapy protocols have been designed based on the integration of clinical staging and histology. Neoadjuvant therapy is now administered before surgical resection in patients with tumors considered inoperable as it improves resectability and survival and reduces the risk of recurrence. Adjuvant treatment has been extensively reported after both complete or partial resection. New targeted therapies are in the developmental stage, and in the future they will be part of the standard protocols. Integrated treatment modalities require strict cooperation between medical and radiation oncologists, thoracic surgeons, and pathologists.

The role of histology in predicting recurrence of type A thymomas: a clinicopathologic correlation of 23 cases

“…The extent of surgery has been documented to impact the likelihood of recurrence in thymomas. 10 It was often stated in older literature that subclassifying noninvasive carcinoma by histology was unnecessary. In the current series, recurrences and metastases were seen irrespective of margin status.…”

“…10 Pan et al 12 have classified type A thymomas into two subtypes, short spindled and long spindled variants in addition to micronodular variants. The latter were not included in the current series.…”

Circulating miR-21-5p and miR-148a-3p as emerging non-invasive biomarkers in thymic epithelial tumors

“…1 TET can occur at all ages, with a peak of frequency around 30-40 or 60-70 years of age in thymomas associated or not, respectively, with Myasthenia Gravis (MG). 1,2 The evolution of the disease is often unpredictable, ranging from an indolent attitude to multiple local relapses and, more rarely, to extrathoracic spread. 2 The modern histological classifications of TET identify 5 major thymoma subtypes.…”

“…1,2 The evolution of the disease is often unpredictable, ranging from an indolent attitude to multiple local relapses and, more rarely, to extrathoracic spread. 2 The modern histological classifications of TET identify 5 major thymoma subtypes. Although Type A, Type AB and Type B1 thymomas have an excellent prognosis when discovered in initial stages, Type B2 and especially Type B3 thymomas, together with thymic carcinomas, show an unfavorable outcome, particularly when discovered at advanced stages.…”

Molecular Markers for Patients with Thymic Malignancies: not Feasible at Present?

“…The paraneoplastic syndromes, such as myasthenia gravis, red cell aplasia, autoimmune diseases, and opportunistic infections, are uncommon in thymic carcinomas. However, myasthenia gravis has been repeatedly described in the well-differentiated form of thymoma (Venuta et al, 2012).…”