Chinese guideline for clinical diagnosis and treatment of thymic epithelial tumors (2021 Edition) / 中华肿瘤杂志

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.

Thymoma: First large Indian experience.

BACKGROUND: Thymoma is the most common tumor of the anterior mediastinum. Surgery is mainstay of treatment, with adjuvant radiation recommended for invasive thymoma. Because of rarity, prospective randomized trials may not be feasible even in multicentric settings hence the best possible evidence can be large series. Till date Thymoma has not been studied in Indian settings. MATERIALS AND METHODS: All patients presenting to Thoracic disease management group at our Centre during 2006‑2011 were screened. Sixty two patients’ with histo‑pathological confirmation of thymoma medical records could be retrieved and are presented in this study. Mosaoka staging and WHO classification was used. The clinical, therapeutic factors and follow up parameters were recorded and survival was calculated. Effects of prognostic factors were compared. RESULTS: Sixty two patients were identified (36M, 26F; age 22‑84, median 51.5 years) and majorities (57%) of thymoma were stage I‑II. WHO pathological subtype B was most common 30 (49%). Mean tumor size was smaller in patients with myasthenia (5.3cm) than the entire group (7.6cm). Neoadjuvant therapy was offered to five unresectable stages III or IV a patient’s with 40% resectability rates. Median overall survival was 60 months (Inter quartile‑range 3‑44 months) with overall survival rate (OS) at three year being 90%. Resectable tumors had better outcomes (94%) than non resectable (81%) at three years. Mosaoka Stage was the only significant (P = 0.03) prognostic factor on multivariate analysis. CONCLUSION: This is first thymoma series from India with large number of patients where staging is an important prognostic factor and surgery is the mainstay of therapy. In Indian context aggressive multimodality treatment should be offered to advanced stage patients and which yields good survival rates and comparable.

Isaac's syndrome associated with myasthenia gravis and thymoma.

A 65-year-old male developed fatigable weakness of ocular and bulbar muscle and positive anti-acetyl cholinesterase antibodies suggesting the diagnosis of myasthenia gravis. His condition responded to anticholinesterase and immunotherapy. However, 18 months later, he developed painful paresthesiae, muscle cramps with hyperhiderosis, and was diagnosed as having Isaac's syndrome (neuromyotonia, continuous muscle fibre activity). Computed tomography of the chest revealed a thymic mass, which was confirmed after surgery and histopathology as thymic cell carcinoma. The co-occurrence of myasthenia gravis and continuous muscle fiber activity should prompt the consideration of the occurrence of these disorders as one of the paraneoplastic manifestations, most often due to a thymic neoplasm. Both these conditions respond to treatment of underlying thymoma. This case is a very rare presentation worth reporting.

Asociación entre bronquiectasias, timoma e hipogammaglobulinemia: síndrome de good / Association between bronchiectasis, thymona and hypogammaglobulinemia: good's a syndrome

Se presenta el caso de un paciente con bronquiectasias, hipogamaglobulinemia y timoma, entidad denominada Sindrome de Good. Mostranmos los aspectos clínicosde laboratorio, radiológicos y funcionales de este caso. Se revisa en la literatura la descripción de casos similares

Aplasia pura roja : infrecuente manifestación hematológica de mielopatía autoinmune / Pure red aplasia : infrequent hematological manifestation of autoimmune myelopathy

Se presenta una paciente de 65 años de edad, con imagen tomográfica tumoral en lóbulo anterosuperior de pulmón izquierdo, que al resecarse se comprobó que era un nódulo de mediastino de 5 cm de diámetro, sin atipías, pero con infiltración linfoide. A continuación presentó linfocitosis de 10 meses de evolución seguida de anemia hemolítica. Luego de 2 años de remisión clínica se presentó con anemia aguda diagnosticada como Aplasia Pura Roja. Sus patologías revirtieron con corticosteroides. Se hace una actualización acerca de los vínculos entre las enfermedades de la médula ósea y la inmunopatología.

Tumores tímicos epiteliales: a propósito de 40 casos / Thymic epithelial tumors: apropos of 40 cases

Cuarenta casos de Tumores Tímicos Epiteliales tratados en el Instituto Gustave-Roussy, IGR, Villejuif y en la Clínica Médico-Quirúrgica de la Puerta de Choisy, Francia, entre 1951 y 1982, fueron evaluados retrospectivamente. Se empleó la clasificación anátomo-quirúrgica por estadios propuesta por el Grupo de Estudio sobre los Tumores Tímicos, GETT, IGR. El tratamiento fue quirúrgico en los estadios I, II y IIIA, radioterapia en los estadios II, III y IV, quimioterapia en los estadios III y IV. Se constataron recidivas locales en 20% de los estadios I y en 44% de los otros estadios, metástasis a distancia en 30% de los casos. La sobrevida a 10 años fue de 81% en el estadio I y de 37% en los otros estadios. La causa más frecuente de muerte fue la progresión tumoral