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The Mediastinum (including pre-and para-spinal lines, neural tumours, and pneumomediastinum).
Published in Fred W Wright, Radiology of the Chest and Related Conditions, 2022
Thymic carcinoma - is an uncommon tumour of the thymic epithelium; it is aggressive with both local spread and distant metastases, and has a poor prognosis. It may contain areas of necrosis, haemorrhage calcification and cyst formation. Paraneoplastic syndromes are uncommon. One case the author saw was of a young black West Indian athlete with a large irregular anterior mediastinal mass and multiple lung deposits (he was sent by his GP for chest radiography as persistent cough following 'flu).
Mediastinal tumours
Published in Anju Sahdev, Sarah J. Vinnicombe, Husband & Reznek's Imaging in Oncology, 2020
Pathologically, thymic carcinomas are a heterogeneous group of aggressive, invasive epithelial malignancies (7). Histologically, thymic carcinomas are large, firm, infiltrating masses with areas of cystic change and necrosis. The Masaoka staging system used for thymomas is not useful as a prognostic tool in thymic carcinoma. They are classified as low grade or high grade, with squamous cell–like and lymphoepithelioma-like variants being the most common cell types (53). In contrast to thymomas, thymic carcinomas are cytologically malignant, with typical features of cellular necrosis, atypia, and mitoses (50).
Lung cancer and mesothelioma
Published in Peter Hoskin, Peter Ostler, Clinical Oncology, 2020
This arises from the adult remnants of the thymus rather than the lung parenchyma; 90% are found in the anterior mediastinum. They are often detected incidentally when the thorax is surveyed by imaging, such as CT, for another purpose. There is a mixture of lymphocytic and epithelial components. Atypical cells or frank malignant change in the latter alters the diagnosis to thymic carcinoma. Thymomas are often slow-growing tumours with invasion and expansion at the site of origin. Thymomas are associated with paraneoplastic autoimmune syndromes such as myasthenia gravis (50%), polymyositis, lupus erythematosus, rheumatoid arthritis, thyroiditis, Sjögren syndrome and autoimmune pure red cell aplasia. Thymic carcinoma is potentially more aggressive with a tendency to metastasize. Both are best treated by surgical thymectomy. Post-thymectomy radiotherapy is reserved for individuals with more advanced stages of thymic carcinoma. There is an increased risk of second malignancies.
Therapeutic options in thymomas and thymic carcinomas
Published in Expert Review of Anticancer Therapy, 2022
Lenvatinib is also a multikinase inhibitor that blocks VEGFR-1–3, fibroblast growth factor receptor (FGFR) 1–4, PDGFR-α, KIT, RET, and c-KIT. It has already been used in patients with unresectable thyroid cancer and hepatocellular carcinoma. In a Phase 2 study in Japan, the REMORA study, 42 patients with pretreated thymic carcinoma received 24 mg of oral lenvatinib once daily until disease progression or occurrence of unacceptable adverse events [62]. The ORR and disease control rates were 38.1% and 95.2%, respectively. The RR was higher in patients with SCC than in those with non-SCC (46.7% vs. 16.7%). The median PFS was 9.3 months, and the median OS was not reached. The most common Grade 3–4 treatment-related AE was hypertension (64%), followed by hand-foot syndrome (7%). No Grade 5 treatment-related AEs were observed. Although high levels of serum VEGF, soluble VEGFR3, and PDGF-α, as well as low levels of soluble Tie-2, have been reported to be predictors of the therapeutic effect of lenvatinib in patients with thyroid cancer, no biomarker has been detected in patients with thymic carcinoma. The efficacy and safety of multikinase inhibitors in clinical trials are summarized in Table 3. Further studies are needed to determine whether these factors are useful in patients with thymic carcinoma (Figure 1).
Fatal myocarditis and rhabdomyolysis induced by nivolumab during the treatment of type B3 thymoma
Published in Clinical Toxicology, 2018
Qiang Chen, Dang-Sheng Huang, Li-Wei Zhang, Yuan-Qing Li, Hong-Wei Wang, Hong-bin Liu
The biological behavior of type B3 thymoma resembles that of thymic carcinoma, by far a unified therapeutic protocol is lacking due to the rare incidence of less than 1%. It has been proven that the significant expression of PD-L1 on thymoma cells enhanced tumor resistance to T cell-mediated cytotoxicity [4], therefore anti-PD-1 therapies through blocking the combination of PD-1/PD-L1 could be potential methods. A recent case has reported a good response of pembrolizumab in a patient with type2 thymoma [5]; however, few data is available clinically as far as nivolumab is concerned. Our case firstly presented fatal cardiotoxicity and rhabdomyolysis after nivolumab’s treatment of invasive thymoma, besides, a 57-year-old man with type B3 thymoma was reported to developed progressive pneumonitis, a common form of respiratory irAEs, after 4 cycles of nivolumab’s treatment [6], whether an irAEs-related tendency of nivolumab or anti-PD-1 exists in such situation requires further investigation. Of note, compared to other types of malignancies, thymoma is more frequently accompanied by AD such as myasthenia gravis (MG), etc. [7] as a result of pathological T-lymphocytic maturation, whether this feature correlates with irAEs is unknown.
Clinical characteristics, risk factors, and outcomes after adjuvant radiotherapy for patients with thymoma in the United States: analysis of the Surveillance, Epidemiology, and End Results (SEER) Registry (1988–2013)
Published in International Journal of Radiation Biology, 2018
Haibo Mou, Qin Liao, Xuehua Hou, Te Chen, Yuping Zhu
While our analysis of all included patients revealed that CSS was significantly better for patients who received PORT than for those who did not, we found that CSS was significantly shorter for patients in the PORT group with stage I or IIa thymoma. Several factors could account for this finding, which does not agree with the conclusions of other studies (Omasa et al. 2015; Liu et al. 2016). First, when stratifying patients by their tumor’s Masaoka stage, we differentiated between stage IIa, defined as localized disease, and stage IIb, defined as regional disease. Although this grouping might be predicted to lead to a benefit for patients who received PORT, we believe that our data confirm the hypothesis of Forquer et al. (2010). These authors suggested that the use of PORT for a patient with localized thymoma would indicate a poor prognosis and thus create a selection bias for patients with more severe disease. If true, CSS for these patients might be expected to be worse than that of patients with stage I/IIa thymoma who did not receive PORT. Second, we did not include cases of thymic carcinoma (TC). We suspect that including cases of TC would have negated some of the effects of selection bias in the PORT group, which favored the inclusion of patients with a poorer prognosis. Lastly, our use of a national registry with a longer period allowed us not only to include a larger number of patients overall, but also to include more patients with stage I/IIa thymoma who received PORT, identifying the statistically significant role of PORT on CSS.