Clinical Features of Thymic Epithelial Tumors

흉선 상피 종양의 임상적 고찰

  • Mok, Jeong Ha (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Seol, Hee Yun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ji Eun (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Kim, Ki Uk (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Hye-Kyung (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Ho Seok (Department of Thoracic Surgery, Pusan National University School of Medicine) ;
  • Kim, Young Dae (Department of Thoracic Surgery, Pusan National University School of Medicine) ;
  • Kim, Yun Seong (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Lee, Chang Hun (Department of Pathology, Pusan National University School of Medicine) ;
  • Lee, Min Ki (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Park, Soon Kew (Department of Internal Medicine, Pusan National University School of Medicine)
  • 목정하 (부산대학교 의학전문대학원 내과학교실) ;
  • 설희윤 (부산대학교 의학전문대학원 내과학교실) ;
  • 김지은 (부산대학교 의학전문대학원 내과학교실) ;
  • 김기욱 (부산대학교 의학전문대학원 내과학교실) ;
  • 박혜경 (부산대학교 의학전문대학원 내과학교실) ;
  • 이호석 (부산대학교 의학전문대학원 흉부외과학교실) ;
  • 김영대 (부산대학교 의학전문대학원 흉부외과학교실) ;
  • 김윤성 (부산대학교 의학전문대학원 내과학교실) ;
  • 이창훈 (부산대학교 의학전문대학원 병리학교실) ;
  • 이민기 (부산대학교 의학전문대학원 내과학교실) ;
  • 박순규 (부산대학교 의학전문대학원 내과학교실)
  • Received : 2008.06.03
  • Accepted : 2008.06.25
  • Published : 2008.07.30

Abstract

Background: Thymic epithelial tumors are the most common tumors affecting the anterior mediastinum. The aim of this study is to investigate clinical features of the patients who were diagnosed with thymic epithelial tumors at Pusan National University Hospital. Methods: We retrospectively reviewed the records of thirty-seven patients who were diagnosed with thymic epithelial tumors from Jan. 1997 to Jan. 2007. The pathological classification and clinical stage of the thymic epithelial tumors were based on the WHO classification and Masaoka's staging system. A total 37 patients were enrolled: 23 were males and 14 were females, and their mean age was 51.3 years. Results: Thirty patients presented symptoms at the time of diagnosis and their symptoms were as follows: chest pain (53%), dyspnea (23%), and cough (17%). Myasthenia gravis was diagnosed in five patients. With respect to the tumor staging, three cases (8%) were stage I, 10 cases (28%) were stage II, 12 cases (32%) were stage III, 6 cases (16%) were stage IVA and 6 cases (16%) were stage IVB. Twenty-four cases (67%) displayed stage III or IV disease. The pathological types according to the WHO classification were as follows: B1 (32%), C (23%), B3 (20%), B2 (16%), AB (6%) and A (3%). Twenty-four patients underwent thymothymectomy and four of these patients relapsed. Stage III or type B3 was common in the relapsed patients. Five patientsexpired. Stage IV or type B3 and C were common in the expired patients. Conclusion: In this study, stage III or IV disease and type B3 or C were common at the time of diagnosis and these findings might contribute to postoperative recurrence and a poor outcome.

References

  1. Detterbeck FC. Clinical value of the WHO classification system of thymoma. Ann Thorac Surg 2006;81:2328-34. https://doi.org/10.1016/j.athoracsur.2005.11.067
  2. Levine GD, Rosai J. Thymic hyperplasia and neoplasia: a review of current concepts. Hum Pathol 1978;9:495-515. https://doi.org/10.1016/S0046-8177(78)80131-2
  3. Marino M, Muller-Hermelink HK. Thymoma and thymic carcinoma. Relation of thymoma epithelial cells to the cortical and medullary differentiation of thymus. Virchows Arch A Pathol Anat Histopathol 1985;407:119-49. https://doi.org/10.1007/BF00737071
  4. Masaoka A, Monden Y, Nakahara K, Tanioka T. Followup study of thymomas with special reference to their clinical stages. Cancer 1981;48:2485-92. https://doi.org/10.1002/1097-0142(19811201)48:11<2485::AID-CNCR2820481123>3.0.CO;2-R
  5. Eng TY, Fuller CD, Jagirdar J, Bains Y, Thomas CR Jr. Thymic carcinoma: state of the art review. Int J Radiat Oncol Biol Phys 2004;59:654-64. https://doi.org/10.1016/j.ijrobp.2003.11.021
  6. Engels EA, Pfeiffer RM. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies. Int J Cancer 2003;105:546-51. https://doi.org/10.1002/ijc.11099
  7. Drachman DB. Myasthenia gravis. N Engl J Med 1994;330:1797-810. https://doi.org/10.1056/NEJM199406233302507
  8. Okumura M, Ohta M, Tateyama H, Nakagawa K, Matsumura A, Maeda H, et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer 2002;94:624-32. https://doi.org/10.1002/cncr.10226
  9. Strobel P, Bauer A, Puppe B, Kraushaar T, Krein A, Toyka K, et al. Tumor recurrence and survival in patients treated for thymomas and thymic squamous cell carcinoma: a retrospective analysis. J Clin Oncol 2004;22:1501-9. https://doi.org/10.1200/JCO.2004.10.113
  10. Chen G, Marx A, Wen-Hu C, Yong J, Puppe B, Stroebel P, et al. New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from China. Cancer 2002;95:420-9. https://doi.org/10.1002/cncr.10665
  11. Maggi G, Casadio C, Cavallo A, Cianci R, Molinatti M, Ruffini E. Thymoma: results of 241 operated cases. Ann Thorac Surg 1991;51:152-6. https://doi.org/10.1016/0003-4975(91)90478-9
  12. Hernandez-Ilizaliturri FJ, Tan D, Cipolla D, Connolly G, Debb G, Ramnath N. Multimodality therapy for thymic carcinoma (TCA): results of a 30-year single-institution experience. Am J Clin Oncol 2004;27:68-72. https://doi.org/10.1097/01.coc.0000046301.83671.09
  13. Lucchi M, Mussi A, Basolo F, Ambrogi MC, Fontanini G, Angeletti CA. The multimodality treatment of thymic carcinoma. Eur J Cardiothorac Surg 2001;19:566-9. https://doi.org/10.1016/S1010-7940(01)00666-2
  14. Macchiarini P, Chella A, Ducci F, Rossi B, Testi C, Bevilacqua G, et al. Neoadjuvant chemotherapy, surgery, and postoperative radiation therapy for invasive thymoma. Cancer 1991;68:706-13. https://doi.org/10.1002/1097-0142(19910815)68:4<706::AID-CNCR2820680407>3.0.CO;2-H
  15. Berruti A, Borasio P, Gerbino A, Gorzegno G, Moschini T, Tampellini M, et al. Primary chemotherapy with adriamycin, cisplatin, vincristine and cyclophosphamide in locally advanced thymomas: a single institution experience. Br J Cancer 1999;81:841-5. https://doi.org/10.1038/sj.bjc.6690773
  16. Rea F, Sartori F, Loy M, Calabro F, Fornasiero A, Daniele O, et al. Chemotherapy and operation for invasive thymoma. J Thorac Cardiovasc Surg 1993;106:543-9.
  17. Shin DM, Walsh GL, Komaki R, Putnam JB, Nesbitt J, Ro JY, et al. A multidisciplinary approach to therapy for unresectable malignant thymoma. Ann Intern Med 1998;129:100-4. https://doi.org/10.7326/0003-4819-129-2-199807150-00006
  18. Kim ES, Putnam JB, Komaki R, Walsh GL, Ro JY, Shin HJ, et al. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer 2004;44:369-79. https://doi.org/10.1016/j.lungcan.2003.12.010
  19. Curran WJ Jr, Kornstein MJ, Brooks JJ, Turrisi AT 3rd. Invasive thymoma: the role of mediastinal irradiation following complete or incomplete surgical resection. J Clin Oncol 1988;6:1722-7. https://doi.org/10.1200/JCO.1988.6.11.1722
  20. Ogawa K, Uno T, Toita T, Onishi H, Yoshida H, Kakinohana Y, et al. Postoperative radiotherapy for patients with completely resected thymoma: a multi-institutional, retrospective review of 103 patients. Cancer 2002;94:1405-13. https://doi.org/10.1002/cncr.10373
  21. Haniuda M, Miyazawa M, Yoshida K, Oguchi M, Sakai F, Izuno I, et al. Is postoperative radiotherapy for thymoma effective? Ann Surg 1996;224:219-24. https://doi.org/10.1097/00000658-199608000-00016
  22. Rena O, Papalia E, Maggi G, Oliaro A, Ruffini E, Filosso P, et al. World Health Organization histologic classification: an independent prognostic factor in resected thymomas. Lung Cancer 2005;50:59-66. https://doi.org/10.1016/j.lungcan.2005.05.009
  23. Park MS, Chung KY, Kim KD, Yang WI, Chung JH, Kim YS, et al. Prognosis of thymic epithelial tumors according to the new World Health Organization histologic classification. Ann Thorac Surg 2004;78:992-7. https://doi.org/10.1016/j.athoracsur.2004.03.097