ABSTRACT
Thymic tumor is a relatively rare type of thoracic cancer, which is pathologically-classified as thymic epithelial tumors by World Health Organization (WHO), including thymoma and thymic carcinoma. The incidence of thymic epithelial tumors in China is about 4.09 per million, which is slightly higher than that in European and American countries. For surgically-resectable thymic epithelial tumors, complete resection with or without postoperative radiotherapy or chemotherapy is preferred. For advanced unresectable disease, conventional radiotherapy and chemotherapy is the mainstream treatment but lack of standard first-line and second-line regimens. In recent years, targeted drugs and the immune checkpoint inhibitors have gradually exhibited certain therapeutic prospect in this subset of tumor. Since there was no guideline regarding thymic epithelial tumor released in China, Multidisciplinary Committee on Oncology, Chinese Physicians Association analyze, summarize and discuss the relevant research data for the diagnosis, treatment and prognosis of thymic epithelial tumors, and formulate the "Chinese guidelines for clinical diagnosis and treatment of thymic epithelial tumors (2021 Edition)" for clinicians' reference.
Subject(s)
Humans , China , Neoplasm Staging , Neoplasms, Glandular and Epithelial/therapy , Thymoma/therapy , Thymus Neoplasms/therapyABSTRACT
Thymic epithelial tumors (TETs) are the most common tumors in the anterior mediastinum, and the staging system and histological classification are complex. CT is the most important imaging examination for TETs. MRI has a certain value in the diagnosis of TETs. PET/CT in classification of TETs is progressing rapidly, but the results are controversial. The research progresses of imaging examinations on staging and typing of TETs were reviewed in this article.
ABSTRACT
Thymoma of non-surgical treatment or combined modality therapy must be considered in advanced or unresectable cases, which includes radiotherapy, chemotherapy, targeted therapy and immunotherapy. The first choice of resectable advanced thymoma is surgery followed by adjuvant radiotherapy or chemotherapy. For unresectable advanced thymoma, inducted therapy followed by surgery and adjuvant therapy is a rational pattern. But the best treatment mode is still unclear. We review the effect and prognosis about non-surgical treatment of thymoma recent years, to offer advice about making the best decision in the treatment of thymoma.
ABSTRACT
@#Objective To present the preliminary clinical experience of robot assisted trans-subxiphoid (extended) thymectomy in patients with thymic neoplasms or myasthenia gravis. Methods A total of 62 patients (34 males and 28 females at an average age of 38±11 years) suffering from thymic neoplasms or myasthenia gravis who underwent robotic (extended) thymectomy via subxiphoid approach were included in our department between August 2016 and August 2017. All of the operation were completed through 4 ports. In details, the observation hole was created just below the xiphoid process, two ports for arm 1 and arm 2 were created below bilateral subcostal arch at the midclavicular line, and trocar for arm 3 was placed in the 5th or 6th intercostal space at the anterior axillary line, respectively. Patients with thymic neoplasms received thymectomy. Patients with myasthenia gravis received extended thymectomy. Results All the patients experienced uneventful operations. The mean operative time was 116.0±34.0 min. The mean intraoperative blood loss was 5.6±4.3 ml. The mean postoperative hospital stay was 4.0±2.2 days. There was no intra-operational massive hemorrhage, mortality, conversion or postoperative complication during the postoperative and follow-up period. Conclusion Robotic trans-subxiphoid thymectomy is safe and feasible, which is a promising technique for extensive application.
ABSTRACT
Introducción: la evaluación de un paciente con exacerbación de asma bronquial incluye la búsqueda de enfermedades que pueden simular, complicar o perpetuar esa situación. El dolor retrosternal es un síntoma atípico en pacientes con exacerbación asmática y entre las causas que lo pueden originar están las masas mediastínicas como el timoma. Un tercio de los pacientes con timomas pueden tener síntomas asociados a enfermedades autoinmunes y síndromes paraneoplásicos; sin embargo, aunque el asma bronquial tiene un componente inmunológico importante en su fisiopatología, la asociación del timoma con el asma está poco documentada. Objetivo: ofrecer una enseñanza clínica a través de la presentación de un caso con asociación inusual de timoma y asma bronquial. Presentación del caso: se presenta el caso de una paciente de 50 años que acudió a servicios de urgencias con exacerbación asmática y dolor torácico retrosternal. En tomografía computarizada de alta resolución se observó una masa en mediastino anterosuperior que tras realizar exéresis quirúrgica y estudios inmunohistoquímicos fue diagnosticada como un timoma epitelial tipo IIB. Conclusiones: la presencia de síntomas inusuales en una paciente con exacerbación asmática condujo al diagnóstico de un timoma epitelial, aun cuando no se ha demostrado la asociación entre estas dos enfermedades.
Background: the evaluation of a patient with bronchial asthma exacerbation includes the search for diseases which can simulate, complicate or perpetuate that situation. The retrosternal pain is an atypical symptom in patients with asthmatic exacerbation and among the causes that can originate this symptom are mediastinal masses like thymoma. A third part of patients with thymomas might have symptoms associated with autoimmune diseases and paraneoplastic syndromes; however, although asthma has an important immunologic component in its pathophysiology, association of thymoma with asthma is poorly documented. Objective: to offer a clinical lesson through a presentation of a case with unusual association of thymoma and asthma. Case presentation: a 50 year-old female patient with asthmatic exacerbation and retrosternal thoracic pain came to emergency services. A mass in anterosuperior mediastinum was observed in computed tomographic high-resolution scan and after performing surgical exeresis and immune histochemistry studies an epithelial timoma type IIB was diagnosed. Conclusions: the presence of unusual symptoms in a patient with asthma exacerbation led to an epithelial thymoma, even when there has not been shown association between these two diseases.
Subject(s)
Humans , Chest Pain/complications , Mediastinal Neoplasms/diagnostic imaging , Asthma/complicationsABSTRACT
PURPOSE: Retrospective analyses of patients with stage I-II thymic epithelial tumors (TET) who were treated with either surgery alone (S) or surgery plus postoperative radiation therapy (SRT) were conducted to evaluate the role of adjuvant radiation therapy (RT). MATERIALS AND METHODS: A total of 110 stage I-II TET patients following complete resection were included in this study. Postoperative radiation therapy was recommended for those with aggressive histologic type and/or invasive features according to the surgeons' judgment during the operation. A median dose of 54.0 Gy (range, 44 to 60 Gy) focused on the primary tumor bed was administered to 57 patients (51.8%). RESULTS: In all patients, the rates of overall survival, disease-specific survival, and disease-free survival at 10 years were 91.7%, 97.1%, and 95.8%, respectively. No significant differences in disease-specific survival (100% in the S group and 93.5% in the SRT group at 10 years, p=0.12) and disease-free survival (98.1% in the S group and 94.5% in the SRT group at 10 years, p=0.41) were observed between the treatment groups, although a significantly larger number of World Health Organization (WHO)-type B2-C (p<0.001) and Masaoka stage II (p=0.03) tumors were observed in the SRT group than in the S group. No local recurrence was observed in the SRT group. No grade 2 or greater RT-related toxicities were observed in the SRT group. CONCLUSION: Excellent outcomes were achieved in patients with stage I-II TET who underwent complete resection. Considering excellent local control and low morbidity, adjuvant RT may be considered in high risk patients with WHO-type B2-C histology and Masaoka stage II.