Carcinoide atípico de timo en varón de 39 años: Reporte de caso / Atypical carcinoid of thymus in a 39-year-old-man: A case report

RESUMEN El carcinoide atípico (CA) de timo es la neoplasia más agresiva y rara que surge en el mediastino anterior y que pertenece a los tumores primarios neuroendocrinos de timo. La mayoría de los pacientes son asintomáticos y según la extensión de la enfermedad pueden presentar desde tos, disnea, dolor torácico hasta síndrome de vena cava superior. Esta presentación clínica inespecífica disminuye la probabilidad del diagnóstico temprano que, sumado con el estadio avanzado al debut y la imposibilidad de resección quirúrgica reduce la tasa de supervivencia. El objetivo es dar a conocer la presentación clínica, imagenológica y patológica en un varón de 39 años con CA de timo cuyo diagnóstico definitivo se basó en el estudio histopatológico (morfología carcinoide, mitosis 0-1/2 mm2, necrosis, Ki 67 = 12%) y marcadores inmunofenotípicos del tumor (CD 56 (+), Panqueratina (+), Sinaptofisina (+), TTF -1 (-)).

ABSTRACT The atypical carcinoid (AC) of thymus is the most aggressive and uncommon neoplasm in the anterior mediastinum, that belongs to the neuroendocrine primary tumors of thymus. Most patients are asymptomatic and according to the disease extension they may present with cough, dyspnea, chest pain, and superior cava vein syndrome. This non-specific clinical presentation reduces the likelihood for making an early diagnosis; and this, together with disease stage and lack of surgical resection reduces the survival rate. The aim of this paper is to describe the clinical presentation in a 39-year old male with thymus carcinoid whose diagnosis was based on histopathological studies (carcinoid morphology, 0-1/2 mitoses/mm2), necrosis, Ki67, 12%), and immunophenotypic tumor markers (CD56(+), Pankeratin (+), Synaptophysin (+), and TTF-1 (-)).

Congenital thymoma

Thymomas are a heterogeneous group of tumors arising from the epithelium of the thymus. They are categorized by the proportion of neoplastic epithelia to lymphocytes and by the degree of cytologic atypia. Thymomas constitute 0.2-1.5% of all malignancies and nearly all occur in patients over 20 years. We reviewed the available literature and found less than 50 cases of thymoma reported in children (<18 years of age), the youngest being 4 years old, and no cases in newborns. They represent less than 1% of all mediastinal tumors in children. Due to the limited number of cases in the pediatric population, the diagnosis and treatment in this population is extremely challenging. Thymomas in all age groups may be associated with paraneoplastic syndromes, being myasthenia gravis the most common, which is associated with a worse prognosis in the pediatric population. We present the first case of a newborn infant with congenital thymoma. This case demonstrates a rare tumor in an unusual age group and emphasizes the importance of multidisciplinary teamwork in the decision-making and management of this condition.

Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience / Cirurgia torácica robótica para ressecção de timoma e tumores tímicos: desenvolvimento técnico e experiência inicial

ABSTRACT Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.

RESUMO Objetivo: Avaliar os resultados da ressecção de tumores tímicos por cirurgia torácica robótica, verificando a radicalidade da ressecção, complicações pós-operatórias, tempo de cirurgia e tempo de internação. Métodos: Estudo retrospectivo a partir de um banco de dados envolvendo pacientes com diagnóstico de tumor tímico e submetidos à cirurgia torácica robótica em sete hospitais no Brasil entre outubro de 2015 e junho de 2018. Resultados: Durante o período estudado, houve 18 casos de ressecção de tumores tímicos (timomas, em 12; carcinoma tímico, em 2; e tumor carcinoide tímico, sarcoma tímico de alto grau, teratoma tímico e timolipoma, em 1 cada). A média do tamanho das lesões foi de 60,1 ± 32,0 mm. Tumores tímicos foram ressecados com margens livres em 17 casos. As medianas (intervalos interquartis) de tempo de dreno pleural e de internação, em dias, foram 1 (1-3) e 2 (2-4), respectivamente. Não houve necessidade de conversão cirúrgica nem complicações maiores. Conclusões: A cirurgia torácica robótica para a ressecção de tumores tímicos demonstrou ser factível e segura, com baixo risco de complicações e desfechos pós-operatórios comparáveis aos de outras técnicas.

Tumores del timo: Experiencia del Instituto Nacional de Cancerología de Colombia / Thymic tumors: Experience of the National Cancer Institute of Colombia

Resumen Objetivos: Los tumores del timo tienen incidencia global de 0,13 por 100.000 habitantes, pero representan un importante porcentaje de tumores del mediastino. Hay poca literatura basada en nuestra población, por esto, hacemos un aporte de nuestra experiencia en el Instituto Nacional de Cancerología (INC). Métodos: Se hizo un estudio tipo series de caso, revisando las historias clínicas de los pacientes con tumores del timo tratados en el INC entre 2006 y 2017. Resultados: Desde el 2006 al 2017 se encontraron 31 pacientes con tumores del timo tales como timoma, hiperplasia tímica, quistes tímicos y carcinomas tímicos, predominando en el género femenino y con una mediana de 62 años de edad. 2 pacientes presentaron miastenia gravis (MG). 27 fueron sometidos a timectomía por medio de esternotomía, videotoracoscopia, toracotomía, entre otros, obteniendo una supervivencia global mayor al 90% a 5 años de seguimiento. Los estadios de Masaoka I, II y III tienen mejor pronóstico que los tipos IV independientemente de la histología. Conclusiones: La timectomía es el tratamiento de primera línea en los casos resecables, incluso en los que existe compromiso de estructuras vecinas que permiten una resección quirúrgica completa. Los resultados presentados describen conductas y resultados similares a los encontrados en la literatura mundial.

Abstract Objectives: Thymic tumors have an overall incidence of 0.13 per 100,000 inhabitants, but they represent a significant percentage of mediastinal tumors. There is little literature based on our population, we make a contribution of our experience in the National Cancer Institute. Methods: We did a case series study, reviewing the clinical histories of patients with thymic tumors treated at the National Cancer Institute from 2006 to 2017. Results: From 2006 to 2017, 31 patients with thymic tumors such as thymoma, thymic hyperplasia, thymic cysts and thymic carcinomas were found, mainly in the female gender and with a median of 62 years of age. 2 patients presented Myasthenia Gravis (MG). 27 patients underwent thymectomy through sternotomy, video-thoracoscopy, thoracostomy among others, obtaining an overall survival greater than 90% at 5 years of follow-up. The stages of Masaoka I, II and III have a better prognosis than type IV regardless of the histological type. Conclusions: Thymectomy is the first-line treatment in resectable cases, even when there is a compromise of nearby structures that allow a complete surgical resection. Our results describe behaviors and results similar to those found in the world literature.

Short-term clinical efficacy of radioactive125i seed implantation in treatment of pleural recurrence of thymoma / 第二军医大学学报

Objective To investigate the short-term clinical efficacy of radioactive125I seed implantation in the treatment of patients with thymoma recurrence. Methods Clinical data of patients with thymoma, who underwent radioactive125I seed implantation in Huadong Hospital of Fudan University during Sep. 2016 and Jun. 2017, were retrospectively collected. Inclusion criteria: local pleural recurrence lesions; intolerable to systemic chemotherapy or failure in previous chemotherapy; previously received high-dose chest radiotherapy; and normal coagulation function. All the patients were examined by computed tomography (CT), ultrasound and positron emission tomography-computed tomography (PET-CT) before operation. According to the Radiotherapy Planning System (TPS), the patients were inserted with the particle needles at the puncture point under the guidance of CT or ultrasound, and the distance between the sources was generally 0.5 cm. The clinical efficacy and adverse reactions were observed at 2 months after treatment. The patients were followed up for 3-9 months. Results A total of 13 patients underwent radioactive125I seed implantation, aged from 30 to 78 years, with 7 males and 6 females. The median number of implanted particles was 30, ranging from 20 to 58; the median dose of the particles was 1.9×107 Bq, and the range was (1.5-2.6)×107 Bq. The objective response rate was 100% (7 cases in complete remission and 6 in partial remission) after 2 months of follow-up, and all the 4 patients with chest wall pain were relieved. Pneumothorax occurred in 1 patient during particle implantation. During 3 to 9 months of follow-up, no patient developed disease progression at the site of particle implantation. Conclusion Radioactive125I seed implantation is a safe and effective method in the treatment of pleural recurrence of patients with thymoma, and can be used as a salvage therapy after the failure of traditional radiotherapy and chemotherapy, but its long-term effect needs further observation.

Quiste tímico multiloculado en un paciente adulto: presentación de caso y revisión de la literatura / Multiloculated thymic cyst in an adult patient: case report and literature review

Los quistes tímicos multiloculados son lesiones generalmente adquiridas, que se diagnostican de manera incidental en la mayoría de pacientes y se asocian con condiciones de naturaleza diversa, como: inflamación, infección, trauma y radioterapia. Se presenta el caso de una mujer de 55 años con un quiste tímico multiloculado, sin antecedentes de importancia o condición clínica particular al momento del diagnóstico.

Multiloculated thymic cysts are acquired lesions, diagnosed incidentally in most patients and associated with other conditions such as inflammation, infection, trauma and radiothera. We present the case of a 55-year-old woman with a multilocular thymic cyst, with no relevant history or particular clinical condition at the time of diagnosis.

Clinicopathologic study of primary thymic extranodal marginal zone lymphoma of mucosa associated lymphoid tissue and lymphoepithelial sialadenitis-like thymic hyperplasia / 临床与实验病理学杂志

Purpose To discuss the clinicopathological features of primary thymic extranodal marginal zone lymphoma of mucosa associated lymphoid tissue (MALT) lymphoma and lymphoepithelial sialadenitis (LESA)-like thymic hyperplasia,their relationship and differential diagnosis.Methods Three cases of thymic MALT lymphoma and one LESA-like thymic hyperplasia were evaluated by HE staining,immunohistochemistry and immunoglobulin (Ig) gene rearrangement technology.Results The symptoms of Sjsgren syndrome were found in the two patients with thymic MALT lymphoma.Microscopically,the normal architecture of thymus was effaced by dense lymphoid infiltration composed predominantly of centrocyte-like and monocytoid B cells with prominent lymphoepithelial lesions.Immunohistochemically,the tumor cells were positive CD20,PAX-5,and BCL-2.The plasma cells showed lambda light chain restriction in one case with prominent plasmacytoid differentiation.In LESA-like thymic hyperplasia,the normal lobular architecture of thymus was generally reserved and abundant lymphoid tissue containing lymphoid follicles was seen with prominent lymphoepithelial lesions in expanding islands of thymic epithelial cells and epithelium lining the cysts,but a monocytoid B-cell population was absent.Immunohistochemically,a mixed B-cell and T-cell population was identified.A monoclonal rearrangement of the Ig gene was detected in all three thymic MALT lymphomas but not in the case of LESA-like hyperplasia.Conclusion Primary thymic MALT lymphoma and LESA-like thymic hyperplasia are both rare lymphoid proliferative lesions and the two lesions have overlapping histological and immunohistochemical features.A combination of genetic rearrangement and analysis of the differential points is helpful to distinguish between them.

Clinical features and prognosis of thymoma with myasthenia gravis: an analysis of 126 patients / 中华放射肿瘤学杂志

Objective To investigate the clinical and pathological features and prognostic factors for thymoma with myasthenia gravis (MG).Methods The clinical and pathological data of 126 patients with thymoma and MG confirmed by postoperative pathological examination from 2008 to 2014 were analyzed retrospectively.The Kaplan-Meier method was used to calculate survival rates;the log-rank test was applied for univariate prognostic analysis;the Cox regression model was applied for multivariate prognostic analysis.Results The numbers of patients who received the follow-up visits at 3 and 5 years were 88 and 45,respectively (the patients who were admitted before the end of October 2011 and the end of October 2009).The 3-and 5-year survival rates were 97.9％ and 91.8％,respectively.The 3-and 5-year survival rates for patients with WHO types A+AB+B1 +B2 and B3 were 98.6％/95.2％ and 90.6％/92.9％,respectively (P=0.764),and those for patients with Masaoka stages Ⅰ-Ⅱ and Ⅲ-Ⅳ were 98.6％/95.2％ and 97.4％/72.7％,respectively (P=0.791).The 3-and 5-year survival rates for patients with complete and partial resection were 97.8％/91.7％ and 100.0％/50.0％,respectively (P=0.964),and those for patients with complete resection alone and complete resection+postoperative radiotherapy were 96.8％/93.1％ and 100.0％/94.7％,respectively (P=1.000).Conclusions The major treatment modality for thymoma with MG is complete resection followed by radiotherapy according to the specific circumstances after surgery.Complete resection,postoperative radiotherapy,WHO type,and Masaoka stage may be associated with prognosis.

Linfoma primario del mediastino (tímico): Presentación de caso / Primary Mediastinal Lymphoma (Thymic): A Case Report

Los linfomas mediastinales anteriores pueden hacer parte del linfoma sistémico y comprenden aproximadamente el 50 % de los tumores mediastinales. El linfoma no Hodgkin primario del mediastino es un subtipo de menor prevalencia, representando un 10 % de los casos; este tiene dos subtipos histológicos que son el linfoma T linfoblástico y el linfoma B difuso de célula grande. Este último es agresivo y tiende a infiltrar la pleura, las estructuras óseas y el pulmón; se origina de las células B de la médula del timo. En este artículo se describe un caso de linfoma no Hodgkin primario del mediastino del subtipo B difuso de células grandes, sus hallazgos por imágenes, patología y una breve revisión de la literatura.

Anterior mediastinal lymphomas may be part of systemic lymphoma and they comprise approximately 50 % of mediastinal neoplasms. Primary non-Hodgkin's lymphoma of the mediastinum is a subtype with lower prevalence, representing 10 % of all cases; it has two histologic subtypes that include T-cell lymphoblastic lymphoma and diffuse large B-cell lymphoma. The latter is an aggressive neoplasm that tends to infiltrate the pleura, bone structures and the lung; it originates from thymic medullary B cells. This article presents a case of primary non-Hodgkin's lymphoma of the mediastinum with diffuse large B-cell subtype, its radiologic findings, pathology and a brief review of the literature.

Role of P63 expression in diagnosis of thymoma subtypes / 第二军医大学学报

Objective To study the expression of P63 in 76 patients with thymic epithelial tumors (TET, including thymomas and thymic carcinomas) and its role in pathological diagnosis of TET based on World Health Organization classification. Methods Immunohistochemistry (SP method) was used to detect P63 expression in 76 different subtypes of TET tissues. The initial diagnostic results, further diagnosis results and diagnostic results considering P63 expression were analyzed and compared. Results The further diagnosis results identified 9 cases of misdiagnosis (mainly AB and B subtypes) and 3 uncertain cases. Different degrees of P63 expression (located in the nuclei) was observed in 72 cases, and different subtypes had different expression patterns. The diagnostic results considering P63 expression were more accurate than those not considering P63 expression (TET, P = 0. 017 and thymoma, P = 0. 032, respectively). Detection of P63 expression helped to confirm the diagnosis of the 3 uncertain cases according to the further diagnosis results. Conclusion Considering that P63 expression can help to better differentiate the subtypes of thymoma, it should be used as a routine marker for clinical diagnosis, especially for AB and B subtype thymoma.

Analysis of treatment outcome for stage Ⅲ thymoma / 中华放射肿瘤学杂志

Objective To analyze survival and recurrence rates of patients with Masaoka stage Ⅲ thymoma and to explore the prognostic factors.Methods Between September 1965 and December 2010,a total of 111 patients with stage Ⅲ thymoma treated in our hospital were retrospectively analyzed.Sixty-eight patientsreceived comple te rescction ± radiotherapy,whilc 23 patients received incomplete resection ±radiotherapy and 20 patients received biopsy ± radiotherapy.Eighty-seven patients received postoperative radiotherapy (12 patients received preoperative radiotherapy) while 24 patients received surgery alone.Results The median follow-up time was 66 months (5-540) with a follow-up rate of 92.5％ (111/120).Compared with incomplete resection ± radiotherapy and biopsy ± radiotherapy,the 5-year overall survival (OS) (88％ vs.59％ and 57％,x2 =12.11,P =0.002),disease free survival (DFS) (74％ vs.40％ and 41％,x2 =11.49,P =0.003) and disease specific survival (DSS) (94％ vs.69％ and 60％,x2 =10.95,P =0.004) could be improved with complete resected ± radiotherapy.Compared with surgery alone,postoperative radiotherapy did not improve OS,DFS and DSS (55％ vs.77％ (x2 =1.01,P =0.316),61％vs.61％ (x2 =0.12,P =0.729) and 72％ vs.85％ (x2 =0.27,P =0.601),respectively).For the 68 patients received complete resection,radiotherapy after complete resection (56 patients) did not improve OS,DFS and DSS (82％ vs.89％ (x2 =0.31,P =0.576),72％ vs.81％ (x2 =0.05,P=0.819) and 89％vs.95 ％ (x2 =0.05,P =0.825),respectively) compared with surgery alone (8 patients).Conclusions Stage Ⅲ thymoma patients received complete resection had better outcome than patients received incomplete resection or biopsied only.The role of postoperative radiotherapy is still controversial for stage Ⅲ thymoma,randomized clinical trial is needed

The clinical characteristics of patients with thymoma-associated myasthenia gravis / 中华内科杂志

Objective To investigation the clinical characteristics in myasthenia gravis (MG)patients with thymomas.Methods A total of 856 MG patients admitted to the department during 2008.7-2010.12 were reviewed retrospectively.The patients with MG were divided into two groups based on thymic pathology,which were 162 cases with thymoma and 694 cases without thymoma.We compared the different clinical features including the gender,age of onset,MG symptoms and the incidence rate of myasthenia crisis.And the relationship between the WHO types,Maosaoka stages of thymoma and the severe of MG was also studied.Results The percentage of thymoma-associated MG patients was 18.9 percent of hospitalized MG patients at the same period.Of the 162 thymoma-associated patients,94 were male and 68 were female,with a ratio of 1.38∶1 and a mean age of (42.9 ± 12.4)years old.Thymoma was more frequent in middle-old aged patients than in children.Compared with non-thymoma MG,more thymomatous patients showed generalised MG,but not only ocular muscles weakness (90.1％ vs 62.4％,P ＜ 0.001 ).There were significant differences of the incidence rate of myasthenic crisis in the two groups ( 14.8％ vs 2.3％ ).(2)WHO type B2 and Maosaoka Ⅰ,Ⅱ thymoma were the commonest types among all potentially MG-associated thymoma.No differences of Osserman MG classification was found in thymomatous patients with different pathologic changes.Conclusions The thymomatous MG patients had its distinctive clinical features:thymomas occured in about 19.7％ of MG patients with more men than women,more common in generalized,higher incidence of myasthenia crisis,with B2 type thymic pathology and Maosaoka Ⅰ,Ⅱstages.No correlation was found between pathologic and clinical stagcs.

Thymoma followed by aplastic anemia: two different responses to immunosuppressive therapy

Aplastic anemia is an uncommon complication of thymoma and is extremely infrequent after the surgical removal of a thymic tumor. Aplastic anemia is a result of marrow failure and is characterized by peripheral pancytopenia and severely depressed marrow cellularity; it may be an autoimmune manifestation of thymoma. As thymoma-associated hematological dyscrasias, which include pure red cell aplasia, aplastic anemia and myasthenia gravis, are supposed to be of immunologic origin, two cases of very severe aplastic anemia following the resection of lymphocytic thymomas treated with immunosuppression are herein presented.

A Case of Tuberculous Pericardial Abscess Mimicking Thymic Carcinoma / 결핵및호흡기질환

We report here an unusual case of pericardial tuberculoma that was misdiagnosed as thymic carcinoma on an imaging study. A 48-year-old woman was referred for evaluation of an anterior mediastinal mass. Computed tomography (CT) scans of the chest displayed cystic masses mimicking thymic carcinoma at the anterior mediastinum. Pericardiotomy and surgical drainage of the cystic masses were done, and pathologic examination of the excised pericardial specimen showed a chronic granulomatous inflammation with necrosis, compatible with tuberculosis. Acid-fast bacilli were also identified in the specimen. After treatment with anti-tuberculosis drugs and steroids, the patient showed clinical improvement. Although tuberculous pericarditis usually presents as pericardial effusion or constrictive pericarditis, it can also present as a pericardial mass mimicking thymic carcinoma on CT. Therefore, we suggest that tuberculous pericardial abscess should be included in the differential diagnosis of a mediastinal mass in Korea, with intermediate tuberculosis prevalence.

Comparison of clinical features and CT findings between atypical thymoma and thymic carcinoma / 中华放射学杂志

ObjectiveTo investigate the differences and the similarities of clinical presentations and CT features between type B3 thymoma ( atypical thymoma) and type C thymoma ( thymic carcinoma) in the WHO classification of thymic epithelial tumors.MethodsComplete CT findings of thirty cases of type B3 and seventeen cases of type C thymic epithelial tumors confirmed by histopathology according to WHO 2004 Classification System and clinical features including the prognosis of each case were reviewed retrospectively.Statistical analyses of the data for the age and the long diameter were performed with Independent-Samples t test between the two groups.Statistical analysis for gender,association with myasthenia gravis,method of the operation,contours,shapes,calcification,necrosis,enhancement pattern of the tumors on CT,presence of mediastinal lymphadenopathy,invasion of mediastinal fat,chest wall,pericardium,great vessel,pleural mediastinum,metastasis to the plural,pleural effusion,distant metastasis were performed with Fisher exact test.Kaplan-Meier method was employed for survival analysis.Results Clinical data:the average age of type B3 group was significantly younger ( t = - 2.905,P = 0.006).90.0％(27/30) of patients in type B3 group were complicated by myasthenia gravis,while only 5.9％ (1/17) of patients in type C group were complicated by myasthenia gravis.The difference between the two groups was statistically significant ( P = 0.000 ).The ratio of complete resection of type B3 group ( 80.0％ ) was significantly higher than that in type C group ( P = 0.001 ),70.6％ (12/17) of patients in type C group died within 2 years after surgical resection,while only 20.0％ (6/30) of patients in type B3 group died within one to nine years after surgical resection.Three years'survival ratio of C group was 29.4％,and five years'survival ratio of C group was lower than 14.7％,which was significantly lower than B3 group( five years'survival ratio was 94.7％ ),which was statistically significant (P =0.000).CT features:the average long diameter of tumor in type C group was ( 6.4 ± 2.1 ) cm,significantly longer than that in type B3 group,which was (4.6 ± 2.3) cm (t = - 2.778,P = 0.008 ),and the contour of tumor in type C group usually showed irregularity ( 13/17,76.5％ ),while it usually showed lobulated ( 18/30,60.0％ ) in type B3 group (P = 0.019 ),more necrosis found in C group ( 15/17,88.2％ ) than B3 group ( 17/30,56.7％ ),compared with type B3 group on enhanced CT,more tumor in type C group showed heterogeneous enhancement (P =0.042),and more great vessel invasion ( 15/17,88.2％,P =0.001 ) and more distant metastasis (8/17,47.0％,P = 0.028) occurred in type C group.ConclusionMost of type B3 and type C thymoma have a certain significant difference in clinical factor,prognosis and CT findings,which are helpful for differentiation.

Study of the relationship between world health organization histological classification of thymic epithelial tumors and CT features / 中华放射学杂志

ObjectiveTo investigate the CT findings of thymic epithelial tumors (TETs).Methods The CT images of 133 cases with TETs confirmed pathologically were reviewed retrospectively.The TETs were reclassified according to WHO 2004 Classification System.The CT features of different histopathological types of TETs were analyzed.The frequencies of demonstrating these CT features were compared between different types using Chi-square exact test.ResultsType A(9/10,90.0％),AB(15/17,88.2％),B1 (10/13,76.9％ ),and B2( 31/46,67.4％ ) tumors were more likely to have spherical or oval shapes and smooth contours on CT.TETs with irregular or lobular contours were mostly seen in type B3 (21/30,70.0％ )and thymic carcinoma (15/17,88.2％ ).TETs with cyst and necrosis formation were common in type A(6/10,60％ ),B3 ( 19/30,63.3％ ) and thymic carcinoma ( 15/17,88.2％ ).Calcification was more frequently seen in type B2 and B3 (32/76,42.1％ ) than any other type ofTETs (8/57,14.0％ ;x2 =12.20,P ＜ 0.01 ).Type A,AB,B3 and thymic carcinoma had higher prevalence of significant enhancement (39/74,52.7％) than type B1 and B2 (8/57,13.6％;x2=22.01,P＜0.01).ConclusionAccording to WHO 2004 histologic classification system,different types of TET have corresponding CT features.CT has showed the potentiality in differentiating histological subtypes of TETs.

Correlation between the CT manifestations and post-operative survival time in patients with thymic epithelial tumor / 中华放射学杂志

Objective To describe the CT manifestations of thymic epithelial tumor and explore the correlation between CT findings and post-operative tumor-related survival time. Methods Ninety-one patients who underwent CT scan before operation were reviewed retrospectively. All cases had operation and were classified according to the WHO classification. The size, contour, shape, density and enhancement of the tumors on CT were assessed. Presence of mediastinal lymphadenopathy, great vessel invasion, metastasis to the lung or plural, myasthenia gravis (MG) were also analyzed. The survival rate was obtained using the Kaplan-Meier method. The Cox model was applied to determine the factors affecting the tumor-related survivals. Chi square test was used to analyze the relationship between CT findings and WHO classification. Results Two patients were excluded because of dying of myocardial infarction and colon cancer. The total 5-year survival rate was 84.3%(n=75). Eighty-nine patients had total 91 tumors. Tumors with diameter larger than 5 cm, lobular contour, heterogenous density, and presence of great vessel invasion, mediastinal lymphadenopathy, and metastasis were adverse factors which could significantly affect the survival time. Five-year survival rates of these factors were 72.7%, 77.3%, 76.7%, 73.8%, 30.0%, and 68.8%, respectively. Presence of MG was a favorable factor which also significantly affected the survival time (P＜0.05). While the shape and enhancement of the tumors and the age, gender of the patients did not significantly affect the survival time (P＞0.05). The result of the Cox multivariate analysis was consistent with that of the Log-rank test. For different WHO classification, there were significant different among the size or contour of the tumors, presence of great vessel invasion, mediastinal lymphadenopathy, and metastasis (x2 value were 6.598, 5.737, 18.307, 8.465, and 15.608, respectively P＜0.05). Conclusions CT findings may be served as predictors of clinical prognosis of the thymic epithelial tumors. Adverse factors for survival time are the size of the tumors and presence of mediastinal lymphadenopathy, while MG is a favorable factor for survival time.

Tratamento cirúrgico da síndrome da veia cava superior causado por timoma invasivo / Surgical treatment of superior vena cava syndrome caused by invasive thymoma

Paciente do sexo masculino, branco, 57 anos, portador de síndrome da veia cava superior havia 3 meses, devido a timoma invasivo em mediastino médio e anterior, levando a comprometimento da veia cava superior intrínseca e extrinsecamente. Após avaliação por tomografia computadorizada e angiorressonância magnética de tórax, o paciente foi submetido à ressecção radical do timoma - derivação venosa da veia subclávia esquerda para átrio direito, com tubo de PTFE (politetrafluoroetileno). Relevante caso de timoma invasivo ocasionando a oclusão da veia cava superior. A evolução clínica, após 7 meses, foi considerada satisfatória.

We report on a case of a 57 years-old white male, patient, who presented superior vena cava syndrome (SVC) for 3 months, derived from an invasive thymoma in the medium and anterior mediastinum, compromising intrinsic and extrinsic to the SVC. After evaluation by computed tomography and magnetic angioresonance of the thorax, the patient underwent radical resection of the thymoma - bypass from left subclavian vein to right atrium, using polytetrafluoroethylene tube. Relevant case of invasive thymoma causing the occlusion of SVC. The clinic evolution of the patient after 7 months was considered satisfactory.

Preliminary study of microsatellite instability and loss of heterozygosity in thymic squamous cell carcinoma / 中华胸心血管外科杂志

Objective To investigate the frequency of micresatellite instability (MSI) and loss of heterozygosity (LOH) and select sensitive loci for studying microsatellite DNA imbalance in thymic squamous cell carcinoma. Methods 5 microsat-ellitc polymorphism markers and extrated DNA were selected from 9 specmiens of paired thymie squamous cell carcinoma/nor-real tissues. MSI and LOH in the specmiens of thymic carcinoma and relevant pericancerou tissues were detected by polymerase chain reaction (PCR) followed by 6% polyacrylamide gel electrophoresis(PAGE) with silver staining. Results MSI or LOH was detected in 9 thymic carcinoma tissues. The frequency of MSI or LOH was 66.7% (6/9) at loci of D6S1708, 33.3% (3/9) at TP53, 33.3% (3/9)at DM, 33.3% (3/9)at D11S988 and 0% (0/9)at D8S136, LOH at D6S1708 (5/6) was a common genetic alteration. DI1S988 had only LOH alteration. Conclusion D6S1708, TP53, DM, and D11S988 are sensi-tive loci for studying microsatellite DNA imbalance in thymic squamous cell carcinoma. Microsatellite DNA imbalance may play a certain role in occurrence and development of thymic squamous cell carcinoma, and the relationship between MSi or LOH.The linicopathological features of thymic squamous cell carcinoma needs further investigation.

Asymptomatic giant mediastinal mass: a rare case of thymolipoma / Massa mediastinal gigante assintomática: um raro caso de timolipoma

Thymolipoma is a very rare benign neoplasm of the thymus. We present the case of a 42-year-old male with a massive mediastinal tumor discovered on a chest X-ray after a motorcycle accident. The patient had no complaints, and his physical examination was unremarkable. Chest CT scans revealed a lipomatous mass containing areas of soft tissue density. The patient was submitted to median sternotomy expanded to left anterolateral thoracotomy, resulting in the complete excision of the tumor. The pathological diagnosis was thymolipoma. Thymolipoma usually attains enormous dimensions by the time of diagnosis, and the occasional symptoms are related to compression of adjacent structures. Surgical resection is the treatment of choice and offers the only possibility of cure. The airway deserves special care during anesthesia induction.

Timolipoma é uma rara neoplasia benigna do timo. Apresentamos o caso de um paciente do sexo masculino de 42 anos de idade com um volumoso tumor mediastinal, descoberto após a realização de radiografia de tórax devido a um acidente motociclístico. Não apresentava queixas e ao exame físico não havia particularidades. A TC de tórax revelava uma massa lipomatosa entremeada por tecido com densidade de partes moles. O paciente foi submetido a uma esternotomia mediana com extensão para toracotomia ântero-lateral esquerda, permitindo a exérese completa do tumor. O diagnóstico histopatológico foi de timolipoma. O timolipoma geralmente atinge grandes dimensões na época do diagnóstico, sendo os ocasionais sintomas relacionados à compressão de estruturas adjacentes. A ressecção cirúrgica é o tratamento de escolha e a única possibilidade de cura. A via aérea merece atenção especial durante a indução anestésica.