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NCI CANCERLIT^® Search: Malignant Thymoma - August 2002

National Cancer Institute^®
Last Modified: August 1, 2002

New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from
Evidence for distinct mechanisms in the shaping of the CD4 T cell repertoire in histologically distinct myasthenia gravis-associated
Thymomas.
Differential diagnosis between thymoma and non-thymoma by dynamic MR imaging.
[A long-term surviving patient with invasive thymoma who underwent radiotherapy and/or resection for chest wall, intrathoracic and
[Diagnosis, treatment and prognosis of thymoma: analysis of 116 cases]
[An original thymoma]
Graft-versus-host disease-type colitis: an unusual association of malignant thymoma.
Thymoma and myotonic dystrophy: successful treatment with chemotherapy and radiation: case report and review of the literature.
[Combined treatment of thymoma: surgery and chemotherapy]

Table of Contents

1
UI - 12124843
AU - Chen G; Marx A; Wen-Hu C; Yong J; Puppe B; Stroebel P; Mueller-Hermelink
TI - HK New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from China.
SO - Cancer 2002 Jul 15;95(2):420-9
AD - Department of Pathology, Shanghai Chest Hospital, People's Republic of China. chengang888@online.sh.cn
BACKGROUND: In 1999, a World Health Organization (WHO) committee published histologic criteria for distinct thymoma entities (labeled as Type A, AB, B1, B2, B3 thymomas) and for the heterogeneous group of thymic carcinomas, collectively called Type C thymomas. Whether WHO-defined histologic thymoma subtypes are of independent prognostic relevance has yet to be proved. METHODS: Two hundred thymomas from the Shanghai Chest Hospital with a mean follow-up time of 15 years (range, 1-246 months) were studied for the relevance of WHO histologic subtype and other factors (stage, therapy, and myasthenia gravis [MG]) for survival. RESULTS: In order of frequency, 68 patients (34.0%) had Type AB, 39 (19.5%) had Type B2, 36 (18.0%) had Type C, 27 (13.5%) had Type B3, 17 (8.5%) had Type B1, and 8 (4.0%) had Type A thymoma. Five cases (2.5%) were rare thymomas not mentioned in the WHO classification. Survival data showed significant differences among the histologic subtypes (log rank test: P < 0.001). Among patients with Type A and AB thymomas, none died of tumor; of the Type B1 thymoma patients, only one (5.9%) died at 22 months. Type B2, B3, and C thymomas had a significantly worse prognosis with 5-year survival rates of 75.0%, 70.0%, and 48.0%, respectively. Ninety-six patients (48.0%) were in Masaoka Stage I, 26 (13.0%) were in Stage II, 65 (32.5%) were in Stage III, and 13 (6.5%) were in Stage IV. Stage was highly significant in predicting survival (log rank, test P < 0.001). The association between histologic subtype and invasive behavior (stage) was statistically significant (P < 0.001). However, histology was an independent predictive factor of survival in Stage I and II thymomas: Type B2, B3, and C thymomas had a worse prognosis than Type A, AB, and B1 thymomas (log rank test: P < 0.003). Thirty patients (15.0%) presented with MG. MG was significantly more frequent in Type B2 and B3 than in Type A, AB, and B1 thymomas (P < 0.01). On multivariate analysis, MG had no adverse effect on survival (P = 0.17). Radiation or chemotherapy improved patients' survival at 5 and 10 years in Type B2, B3, and C thymomas (log rank test: P < 0.003). CONCLUSIONS: Tumor stage is the most important determinant of survival in thymoma patients, but the WHO histologic subtype is an independent prognostic factor in Stage I and II thymomas, among which WHO Type A, AB, and B1 thymomas form a low-risk group. Patients with high-risk thymomas might profit from novel adjuvant radiochemotherapy regimens. Copyright 2002 American Cancer Society.DOI 10.1002/cncr.10665

2
UI - 11785677
AU - Strobel P; Helmreich M; Kalbacher H; Muller-Hermelink HK; Marx A
TI - Evidence for distinct mechanisms in the shaping of the CD4 T cell repertoire in histologically distinct myasthenia gravis-associated thymomas.
SO - Dev Immunol 2001;8(3-4):279-90
AD - Department of Pathology, University of Wurzburg, Germany. path036@mail.uni-wuerzburg.de
The major histocompatibility complex (MHC) class II is involved both in thymocyte maturation and peptide presentation and might thus play a key role in the pathogenesis of paraneoplastic myasthenia gravis (MG) in thymomas. To further investigate this issue, we analyzed and scored the expression of epithelial class II expression in 35 thymomas (medullary, MDT; mixed, MXT; cortical and well differentiated thymic carcinoma, CT/WDTC) and correlated it with the histological tumor subtype, prevalence of MG and thymocyte maturation, which was analyzed by flow cytometry and RT-PCR. Our results show that both MHC class II expression and thymocyte maturation are highly dependent on the histological tumor subtype. CT/WDTC retain features of the normal outer thymic cortex, namely substantial MHC class II expression together with normal early thymocyte maturation until late phases of positive selection, but disturbed terminal thymopoiesis. By contrast, MDT and MXT retain features of the normal inner cortex and the medulla with low to absent class II expression and highly abnormal early thymocyte maturation including impaired positive selection, while terminal T cell maturation in MXT appeared undisturbed. There was no correlation between MHC class II expression and MG status for a given tumor subtype. In conclusion, our results provide evidence for a different histogenesis of cortical thymomas and well differentiated carcinomas on the one hand and mixed and medullary thymomas on the other. Decreased expression levels of MHC class II, although of crucial importance for abnormal intratumorous maturation, are not sufficient to explain the emergence of paraneoplastic MG.

3
UI - 12100318
AU - Anonymous
TI - Thymomas.
SO - Acta Radiol 2002 May;43(3):241

4
UI - 12100322
AU - Sakai S; Murayama S; Soeda H; Matsuo Y; Ono M; Masuda K
TI - Differential diagnosis between thymoma and non-thymoma by dynamic MR imaging.
SO - Acta Radiol 2002 May;43(3):262-8
AD - Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
PURPOSE: To evaluate the usefulness of dynamic MR imaging for differential diagnosis of anterior mediastinal tumors. MATERIAL AND METHODS: Fifty-nine patients with anterior mediastinal tumors were examined. According to histological diagnosis confirmed by surgery or biopsy, 31 had thymomas and 28 had non-thymoma lesions. The patients underwent dynamic MR imaging with gadopentetate dimeglumine administered as a bolus injection. Sequential images were obtained at 30-s intervals for 5 min. Significant differences in the mean peak times of time intensity curves (TICs) were found by histological type, using the Mann-Whitney test. RESULTS: The mean peak time of the TIC was 1.5 min in thymoma and 3.2 min in non-thymoma cases. The difference was statistically significant. Stages I and II of thymoma showed a mean value of 1.3 min, which was significantly shorter than that of 2.5 min in stage III. Differentiation of thymoma/non-thymoma based on the peak time of dynamic MR imaging showed optimal sensitivity (79%) and specificity (84%) when defining thymomas as lesions having peak time appearing earlier than 2 min and non-thymomas later than 2.5 min, with an accuracy of 81%. CONCLUSION: Dynamic MR imaging may improve the differential diagnosis between thymoma and non-thymoma and the staging of thymoma.

5
UI - 12096505
AU - Matsumoto H; Yanagi M; Kawabata M; Aikou T
TI - [A long-term surviving patient with invasive thymoma who underwent radiotherapy and/or resection for chest wall, intrathoracic and intrapelvic recurrent tumors]
SO - Nihon Kokyuki Gakkai Zasshi 2002 Apr;40(4):331-6
AD - First Department of Surgery, Kagoshima University School of Medicine.
A 49-year-old woman with myasthenia gravis who underwent left panpleuropneumonectomy for an invasive thymoma that disseminated through the left thoracic cavity. After six year, radiotherapy was conducted on the recurrent tumor in the left anterior chest wall. Two years later, the recurrent tumors in the intrapelvic and intrathoracic cavities were resected. It was thought that long-term survival was obtained by combining radiotherapy and surgical treatment in view of the patient's general condition, and of the recurrent invasive thymoma present in this case.

6
UI - 12133364
AU - Wang Y; Sun Y; Zhang J; Liu Y; Xu Y
TI - [Diagnosis, treatment and prognosis of thymoma: analysis of 116 cases]
SO - Zhonghua Wai Ke Za Zhi 2002 Apr;40(4):294-7
AD - Department of Thoracic Surgery, General Hospital of People's liberation Army, Beijing 100853, China.
OBJECTIVES: To study the diagnosis and treatment of thymoma and to assess prognosis factors. METHODS: The clinical data on 116 patients with thymoma were collected. A retrospective analysis was performed by comparison of their survival rates computed by the actuarial method and rate of recurrence and metastasis. RESULTS: Chest radiograph was used chiefly for the preoperative diagnosis of thymoma; myasthenia gravis (MG) (25.0%, 29/116) was the most common paraneoplastic disease. An extensive and radical resection was carried out to reduce the recurrence rate of thymoma with stage I and stage II (chi(2) = 4.941 P = 0.0219). The survival time was prolonged by postoperative radiotherapy and chemotherapy. A strong correlation was noted between the clinical stage and histologic subtype of M-H classification, by which the invasive behavior of thymoma was predicted (r = 0.385, P = 0.007). The 3-, 5-, and 10-year survival rates were 81.2%, 67.9% and 40.5%, respectively. Statistical analysis showed a significant negative correlation between stage and survival rate (r = -0.897, P = 0.0000). CONCLUSION: The prognosis of thymoma depends mainly on the histologic subtype, clinical stage and multimodality treatment rather than paraneoplastic diseases.

7
UI - 12124498
AU - Saint-Blancard P; Soulard R; Delmas JM; Guigay J; Vaylet F; Pernot P;
TI - Jancovici R [An original thymoma]
SO - Ann Pathol 2002 Apr;22(2):137-8
AD - Service d'Anatomie Pathologique, Hopital d'Instruction des Armees Percy, France.

8
UI - 12078795
AU - Sader C; Sharma S; Edwards MG
TI - Graft-versus-host disease-type colitis: an unusual association of malignant thymoma.
SO - Ann Thorac Surg 2002 Jun;73(6):1947-8
AD - Department of Cardiothoracic Surgery, Royal Perth Hospital, Western Australia, Australia. chady.sader@health.wa.gov.au
We present the case of a patient with a malignant thymoma associated with a graft-versus-host disease-type colitis, of which there has only been a solitary case report in the world literature. Complete surgical resection of the thymoma was achieved; however, the gastrointestinal symptoms persisted.

9
UI - 12065378
AU - Kudva GC; Maliekel K; Kim HJ; Naunheim KS; Stolar C; Fletcher JW; Puri S
TI - Thymoma and myotonic dystrophy: successful treatment with chemotherapy and radiation: case report and review of the literature.
SO - Chest 2002 Jun;121(6):2061-3
AD - Division of Hematology and Oncology, Saint Louis University Health Sciences Center, St. Louis, MO, USA. kudvagc@slu.edu
We present the case of a 42-year-old woman with myotonic dystrophy and thymoma. She was treated with combination chemotherapy followed by external beam radiation, and remains in remission 19 months after thymoma was diagnosed. The myotonic dystrophy is unchanged. Only six cases of this nature have been reported in the literature, and this patient is the first to be successfully treated with combined modality therapy.

10
UI - 12145858
AU - Peliukhovskii SV; Mamchich VI
TI - [Combined treatment of thymoma: surgery and chemotherapy]
SO - Klin Khir 2002 Apr;(4):40-2
From 1992 to 2000 yr 79 patients were operated on for the thymoma, including I-II stage--33.3%, III stage--41.7%, IV stage--25%. Completed course chemotherapy was conducted in 12 (15.2%) patients, index of five-year survival in I-II stage had constituted 94%, in III stage--85% and IV stage--32%.

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