We point out the issue of differential diagnosis regarding the finding of ectopically localised thymic tissue(a thymic cyst)in the neck.Thymic tissue can be found anywhere along its developmental tract of descent,from...We point out the issue of differential diagnosis regarding the finding of ectopically localised thymic tissue(a thymic cyst)in the neck.Thymic tissue can be found anywhere along its developmental tract of descent,from the angle of the mandible to the upper mediastinum.Disruption of the thymic descent can result in ectopically/abnormally localised islets of accessory thymic tissue,which may undergo cystic changes,as described in a case report by Sun et al.This anatomical variation of the thymus may be clinically misinterpreted as a neoplasm or other congenital anomalies as a branchial cyst,lymphatic malformation or cystic hygroma.The present editorial focuses on the challenge of establishing a diagnosis of ectopically localised tissue of thymus often presented as a lateral cervical mass,especially in the case of cystic variation/degeneration of this thymic tissue.We summarise hypotheses on the origin of such congenital cervical thymic cysts from the point of view of evolutionary history and embryology.We also discuss lesser-known facts about the anatomy,histopathology and developmental biology of the thymus as one of the most enigmatic organs in the human body.展开更多
A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,...A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.展开更多
This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tum...This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tumor,resulting in an unnecessary surgical procedure.Both MTCs and thymic tumors are rare conditions that heavily rely on radiological imaging for accurate diagnosis.However,the similarity in their imaging presentations can lead to misinterpretation,resulting in unnecessary surgical procedures.Due to the ongoing lack of comprehensive knowledge about MTCs and thymic tumors,we offer a summary of diagnostic techniques documented in recent literature and examine potential causes of misdiagnosis.When computer tomography(CT)values surpass 20 Hounsfield units and display comparable morphology,there is a risk of misdiagnosing MTCs as thymic tumors.Employing various differential diagnostic methods like biopsy,molecular biology,multi-slice CT,CT functional imaging,positron emission tomography/CT molecular functional imaging,magnetic resonance imaging and radiomics,proves advantageous in reducing clinical misdiagnosis.A deeper understanding of these conditions requires increased attention and exploration by healthcare providers.Moreover,the continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.展开更多
BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with t...BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with transparent liquid.CASE SUMMARY We report on a 39-year-old male with a cystic-solid mass in the anterior mediastinum.Computer tomography(CT)imaging showed that the mass was irregular with unclear boundaries.After injection of contrast agent,there was a slight enhancement of stripes and nodules.According to CT findings,it was diagnosed as thymic cancer.CONCLUSION After surgery,MTC accompanied by bleeding and infection was confirmed by pathological examination.The main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT findings.Caution is necessary in clinical work to avoid misdiagnosis.展开更多
Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients ...Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).展开更多
BACKGROUND Thymic carcinoid(TC)is a rare entity among anterior mediastinal malignancies.TCs are neuroendocrine carcinomas that constitute approximately 2%–5%of all thymic epithelial tumors.CASE SUMMARY The study repo...BACKGROUND Thymic carcinoid(TC)is a rare entity among anterior mediastinal malignancies.TCs are neuroendocrine carcinomas that constitute approximately 2%–5%of all thymic epithelial tumors.CASE SUMMARY The study reported a rare TC with multiple bone metastases.A 77-year-old man presented with a 2-month history of lower back pain and weight loss of 5 kg.Magnetic resonance imaging scans revealed damage to the lumbar spine,sacrocaudal vertebrae and iliac crest,suggesting bone metastasis;computed tomography(CT)scan of the thorax showed a calcified anterior mediastinal mass;positron emission tomography-CT demonstrated multiple abnormal bone signals;and laboratory work-up showed no endocrine abnormalities.Fine-needle aspiration biopsy revealed predominantly single small,round to oval cells with scant cytoplasm and some loose clusters,suggesting endocrine manifestations.The pathological diagnosis was atypical carcinoid,which tend to originate from the thymus and was classified as intermediate-highly invasive.The patient underwent anlotinib-targeted therapy.Anlotinib(12 mg)was administered daily for 2 wk,after which the patient was allowed to rest for 21 d.Follow-up CT after one year demonstrated that the tumor had shrunk by approximately 29%after therapy.Treatment has a long stable disease benefit of more than 2.5 years.CONCLUSION These findings demonstrated that anlotinib is a promising treatment regimen for patients with TC and multiple bone metastases.展开更多
BACKGROUND Thymic lipofibroadenomas are extremely rare.In this study,we investigated the clinicopathological characteristics of thymic lipofibroadenomas.CASE SUMMARY This study included three patients with thymic lipo...BACKGROUND Thymic lipofibroadenomas are extremely rare.In this study,we investigated the clinicopathological characteristics of thymic lipofibroadenomas.CASE SUMMARY This study included three patients with thymic lipofibroadenomas.We retrospectively analyzed the patient data to determine the clinicopathological characteristics of thymic lipofibroadenomas.The study included one man and two women[mean age,43(33–59)years].All patients were non-smokers and presented with well-defined anterior mediastinal tumors.The cut surfaces of the tumors were solid,with a mixture of yellow and white areas.Microscopic evaluation of resected specimens showed scattered cord-like structures of epithelial cells embedded within abundant fibrotic and hyaline stroma admixed with variable quantities of adipose tissue.One patient showed hyperplastic thymic tissue in a part of the tumor.CONCLUSION Thymic lipofibroadenomas are an extremely rare type of benign thymic tumor.Surgical removal of lipofibroadenomas is usually curative.展开更多
Mouse thymic stromal cell line 4 (MTSC4) is one of the stromal cell lines established in our laboratory. While losing the characteristics of epithelial cells, they express some surface markers shared with thymic dendr...Mouse thymic stromal cell line 4 (MTSC4) is one of the stromal cell lines established in our laboratory. While losing the characteristics of epithelial cells, they express some surface markers shared with thymic dendritic cells (TDCs). To further study the biological functions of these cells, we compared the capability of MTSC4 with TDCs in the induction of thymocyte apoptosis, using thymic reaggregation culture system. Apoptosis of thymocytes induced by MTSC4 and TDCs was measured by Annexin V and PI staining and analyzed by flow cytometry. We found that MTSC4 selectively augmented the apoptosis of CD4^+8^+ (DP) thymocytes. This effect was Fas/FasL independent and could not be blocked by antibodies to MHC class Ⅰ and class Ⅱ molecules. In addition, MTSC4 enhanced the apoptosis of DP thymocytes from different strains of mice, which implies that MTSC4-induced thymocyte apoptosis is not mediated by the TCR recognition of self peptide/MHC molecules. In contrast to MTSC4, thymocyte apoptosis induced by TDCs was MHC-restricted. Thus, MHC-independent fashion of stromal-DP thymocyte interaction may be one of the ways to induce thymocyte apoptosis in thymus. Our study has also shown that the interaction of MTSC4 stromal cells and thymocytes is required for the induction of thymocyte apoptosis.展开更多
BACKGROUND Thymic-enteric adenocarcinoma with positive expression of CDX2 and CK20 is rare in adults,with only 16 reported cases.However,standard treatment options for this type of thymic adenocarcinoma has not yet be...BACKGROUND Thymic-enteric adenocarcinoma with positive expression of CDX2 and CK20 is rare in adults,with only 16 reported cases.However,standard treatment options for this type of thymic adenocarcinoma has not yet been established.Therefore,we report a case of stage IV thymic-enteric adenocarcinoma treated with radiotherapy,chemotherapy,and anti-angiogenesis therapy.CASE SUMMARY We report a case of thymic-enteric adenocarcinoma occurring in a 44-year-old woman.The tumor was considered unresectable owing to its invasiveness.The patient was treated with six cycles of oxaliplatin(130 mg/m^(2),day 1)and capecitabine(1000 mg/m^(2) BID,days 1-14).During the first three cycles of chemotherapy,concurrent radiotherapy(60 Gy/30 fractions)and anti-angiogenic therapy using apatinib were recommended.The primary tumor achieved partial remission based on the Response Evaluation Criteria in Solid Tumors.During follow-up,there was no evidence of disease relapse,except a high serum CA19-9 level.The patient is alive and regularly followed.Based on the previous literature and the present case,we believe that early diagnosis of thymic-enteric adenocarcinoma is important.CONCLUSION XELOX(capecitabine plus oxaliplatin)combined with radiotherapy is an optional therapy for inoperable thymic-enteric adenocarcinoma.展开更多
BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are l...BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are lymphoid stromal hyperplasia and nodular arrangement of tumor epithelial cells.This type of tumor is rare;therefore,the corresponding clinical guidelines,histopathological diagnostic criteria,prognostic factors,and therapeutic regimens have not been established.CASE SUMMARY This study covers a novel presentation of MNC in a patient and summarizes the clinicopathological characteristics of this type of tumor by using pooled-analysis methods.Morphologically,this tumor type is a series of benign to malignant pedigrees.We establish the following criteria for the classification of micronodular thymic tumors with lymphoid stroma:(1)Tumor cells with moderate-to-severe dysplasia;(2)Tumor cell mitotic figures>2/10 high-power fields;(3)Appearance of neoplastic necrosis;(4)No terminal deoxynucleotidyl transferase-positive immature T lymphocytes within the tumor;(5)Tumor cells with a Ki-67 index≥10%;and(6)Tumor cells express CD5.Cases that fall into the borders of two categories in terms of morphology are attributed to atypical MNT.It is proposed that the diagnosis of MNT should be established on the diagnostic criteria mentioned above.CONCLUSION Our diagnostic algorithm can effectively distinguish malignant tumors from benign tumors and provides a potent basis for predicting a prognosis,which offers a practical reference for oncologists and pathologists.展开更多
The thymus provides the essential microenvironment for T-cell development and maturation. Thymic epithelial cells （TECs）, which are composed of thymic cortical epithelial cells （cTECs） and thymic medullary epithel...The thymus provides the essential microenvironment for T-cell development and maturation. Thymic epithelial cells （TECs）, which are composed of thymic cortical epithelial cells （cTECs） and thymic medullary epithelial cells （mTECs）, have been well documented to be critical for these tightly regulated processes. It has long been controversial whether the common progenitor cells of TECs could give rise to both cTECs and mTECs. Great progress has been made to characterize the common TEC progenitor cells in recent years. We herein discuss the sole origin paradigm with regard to TEC differentiation as well as these progenitor cells in thymus regeneration.展开更多
Objective: To investigate the expression of both thymic regulatory T cells (CD4+CD25+Foxp3+cells, Treg) and thymic stromal lymphopoietin (TSLP) in thymomas accompanying myasthenia gravis. Methods: We used immunohistoc...Objective: To investigate the expression of both thymic regulatory T cells (CD4+CD25+Foxp3+cells, Treg) and thymic stromal lymphopoietin (TSLP) in thymomas accompanying myasthenia gravis. Methods: We used immunohistochemistry and real-time reverse trancription polymerase chain reaction (real-time RT-PCR) techniques to determine Foxp3+ Treg counts and the expression levels of Foxp3 mRNA and TSLP mRNA in thymomas of 23 MG patients and thymuses of 4 healthy controls. Results: The CD4+ Foxp3+ nTreg (natural regulatory T cells) counts in thymomas were significantly lower than those in normal thymuses (P<0.01), and the expression levels of Foxp3 mRNA and TSLP mRNA were also lower in thymomas(P<0.01). Among the thymoma types, type B1 thymoma had the highest Foxp3+ nTreg count and standard values of Foxp3 mRNA and TSLP mRNA. There was a strong positive correlation between the mRNA transcriptional levels of Foxp3 and TSLP. Conclusion: The insufficient expression of Foxp3 in thymoma, which may be caused by decreased transcription of TSLP, may result in the reduction of Tregs and cause autoimmune disorders.展开更多
Objective: To investigate p53 overexpression and its correlation with neoplastic cell proliferation and apoptosis in 20 thymic carcinomas. Methods: 20 surgical samples of thymic carcinoma were collected randomly durin...Objective: To investigate p53 overexpression and its correlation with neoplastic cell proliferation and apoptosis in 20 thymic carcinomas. Methods: 20 surgical samples of thymic carcinoma were collected randomly during the past 15 years in the Guangzhou area. Immunohistochemical staining was performed using LSAB method with anti-p53 monoclonal antibody (DO-7) and proliferating cell nuclear antigen (clone PC 10) as primary antibodies. The p53 index was indicated by the number of p53 positive cells among 100 carcinoma cells. More than 25 percentage of p53 positive cells found in tissue sections was recognized as p53 overexpression. Carcinoma cell proliferation activity was assayed by PCNA index (PI), and apoptosis degree was evaluated by TUNEL (TdT-mediated dUTP-X nick end labeling) index (TI) using Boehringer MannheimIn Situ Death Detection Kit. Results: P53 positive cells could be found in vast majority of thymic carcinomas (19/20) and the overexpression rate reached 35% (7/20). The median PI (40%) of 7 cases with p53 overexpression was higher than that (31%) of 13 cases without p53 overexpression, but there was no statistical significance that existed between these two data (P>0.05). The median TI (0.5/HPF) of 7 p53 overexpression cases was much lower than that (4.5/HPF) of 13 non-overexpression cases, and there was a significant difference statistically (P<0.05). Conclusion: p53 expression was a frequent finding in thymic carcinoma cells, and the p53 overexpression which might represent p53 inactivation or gene mutation was often involved in thymic carcinogenesis. The median PCNA index of p53 overexpression group was higher than that of non-overexpression group though there existed no statistical difference. This indicates that the inhibiting function of p53 on cell proliferation seemed lost in p53 overexpressed thymic carcinomas. It is worthy to be specially mentioned that the inducing function of p53 on cell apoptosis was markedly lost in p53 overexpressed thymic carcinomas. Taken together, the overexpressed p53 that could represent aberrant p53 protein had not only lost its proliferation-inhibiting but also its apoptosis-inducing function in thymic carcinomas which might play an important role in thymic carcinogenesis.展开更多
BACKGROUND Although the bystander effect and abscopal effect are familiar in medicine,they are relatively rare in clinical practice.Herein,we report the case of a patient who demonstrated an obvious bystander effect a...BACKGROUND Although the bystander effect and abscopal effect are familiar in medicine,they are relatively rare in clinical practice.Herein,we report the case of a patient who demonstrated an obvious bystander effect and abscopal effect response following carbon-ion irradiation for recurrent thymic carcinoma.CASE SUMMARY A 44-year-old female presented with shortness of breath.Eleven years prior,she was diagnosed with athymic tumor located in the anterosuperior mediastinum.She underwent extensive tumor resection,and the postoperative pathologic diagnosis was thymic carcinoma.She was administered 50 Gy/25 Fx of postoperative radiation.In 2019,she was diagnosed with a recurrence of thymic carcinoma,with multiple recurrent nodules and masses in the left thoracic chest and peritoneal cavity,the largest of which was in the diaphragm pleura proximal to the pericardium,with a size of 6.7 cm×5.3 cm×4.8 cm.She received carbonion radiotherapy.After carbon-ion radiotherapy treatment,the treated masses and the untreated masses were observed to have noticeably shrunk on the day of carbon-ion radiotherapy completion and on follow-up imaging.We followed the CARE Guidelines for consensus-based clinical case reporting guideline development and completed the CARE Checklist of information to report this case.CONCLUSION This report is the first of obvious abscopal and bystander effects following carbonion irradiation in a human patient,and further research is needed to better elucidate the mechanisms of bystander and abscopal effects.展开更多
Objective:A high rate of unnecessary thymectomies has been reported.This study aimed to distinguish primary mediastinal lymphomas(PMLs)from thymic epithelial tumors(TETs)by evaluating volumetric and metabolic paramete...Objective:A high rate of unnecessary thymectomies has been reported.This study aimed to distinguish primary mediastinal lymphomas(PMLs)from thymic epithelial tumors(TETs)by evaluating volumetric and metabolic parameters with l8F-FDG PET/CT.Methods:A total of 136 patients who were pathologically diagnosed with TETs or PMLs were enrolled,and 18F-FDG PET/CT was performed before therapy.Volumetric parameters,including the mean SUV(SUVmean),metabolic tumor volume(MTV),total lesion glycolysis(TLG),and SUVmax,were determined and compared between the 2 subtypes.The diagnostic performance of these parameters was evaluated with receiver operating characteristic(ROC)curve analysis.Results:All parameters significantly differed between patients with PMLs and TETs.Patients with lymphomas were younger and had higher SUVmean,SUVmax,TLG,and MTV values than patients with TETs.The MTV and TLG values had similar diagnostic performance.ROC analysis indicated that the areas under the curves of the SUVmean and SUVmax values performed similarly(approximately 0.76)in differentiating patients with PMLs from TETs,and both values were better than the MTV and TLG values.When age was included with the SUVmax in differentiating TETs from PMLs,the AUC was 0.91,and the sensitivity and specificity increased to 80%and 93%,respectively.Conclusions:The SUVmax and volumetric parameters of 18F-FDG PET/CT can be used to distinguish patients with PMLs versus TETs,and thus may aid in preventing unnecessary thymectomies or other invasive operations.展开更多
BACKGROUND Thymic carcinoma is a rare,aggressive tumor arising from the thymus.In less than 7%of patients with thymic carcinoma,extrathoracic metastases occur in the extrathoracic lymph nodes,liver,and bone.Isolated s...BACKGROUND Thymic carcinoma is a rare,aggressive tumor arising from the thymus.In less than 7%of patients with thymic carcinoma,extrathoracic metastases occur in the extrathoracic lymph nodes,liver,and bone.Isolated splenic metastasis can occur but is very uncommon.To date,only 2 cases of splenic metastases from thymic carcinoma have been reported.CASE SUMMARY A 45-year-old man presented with chronic cough,dyspnea,persistent hoarseness and unintentional weight loss 17 kgs in 6 mo.Neck magnetic resonance imaging revealed a large,lobulated,soft-tissue mass measuring 5.4 cm×6.6 cm×3.8 cm which involved the left superior mediastinum and supraclavicular fossa.Chest computed tomography(CT)revealed a confluent and lobulated soft tissue mass encased the right brachiocephalic artery,right and left carotid arteries,and left subclavian artery in the mediastinum.A fluorodeoxyglucose-positron emission tomography was arranged for malignancy survey.The image revealed intense fluorodeoxyglucose avidity in a soft tissue lobulated mass occupying the superior mediastinum,over the cystic lesion in the spleen and in few enlarged nodules over the left supraclavicular fossa.CT-guided biopsy of the thymic mass and the ultrasound-guided biopsy of the splenic lesion were consistent with a thymic carcinoma with splenic metastasis.The patient was diagnosed of thymic carcinoma,cT2N2M1b,stage IVb.CONCLUSION A fluorodeoxyglucose(FDG)-positron emission tomography(PET)scan can provide a useful diagnostic value in conjunction with pathological result in evaluating tumor staging.Our case emphasizes the utility of FDG-PET for metastasis detection in thymic carcinoma.展开更多
Background: We reported our experience with thymic carcinomas and review their clinical features, treatment strategies, and prognoses. Methods: From April 1998 to November 2012, 11 patients pathologically diagnosed wi...Background: We reported our experience with thymic carcinomas and review their clinical features, treatment strategies, and prognoses. Methods: From April 1998 to November 2012, 11 patients pathologically diagnosed with thymic carcinoma and treated in our hospital were investigated. Results: There were 7 men and 4 women, with a median age of 62 years (range, 35 - 72). According to the Masaoka staging system, 3 patients had stage II, 1 stage III disease, 3 stage IVa disease and 4 stage IVb disease. Ten patients had squamous cell carcinoma, whereas 1 had large cell neuroendocrine carcinoma (LCNEC). We performed surgery or multimodality therapy including surgery as the initial therapy for 8 patients. Of the non-surgical cases, 1 patient received chemoradiotherapy and survived for over 6 years without recurrence, whereas 2 received palliative care. Three of 4 patients who underwent complete resection survived without disease recurrence, whereas only 1 patient with LCNEC survived in the incomplete resection group. Multimodality therapy with cisplatin and docetaxel was provided to 3 patients, and recurrence has not been observed in any of the cases. Conclusions: Favorable outcomes could be achieved in patients with thymic carcinoma who underwent intensive treatment. In particular, surgery combined with cisplatin and docetaxel plus thoracic irradiation may be an attractive approach for thymic carcinoma.展开更多
Thymic epithelial tumors(TETs) are uncommon neoplasms with a wide range of anatomical, clinical, histological and molecular malignant entities. To date the management of TETs within clinical practice is based on a mul...Thymic epithelial tumors(TETs) are uncommon neoplasms with a wide range of anatomical, clinical, histological and molecular malignant entities. To date the management of TETs within clinical practice is based on a multimodal therapeutic strategy including surgery, chemotherapy and radiotherapy with a multidisciplinary approach and prognostic evaluation is mainly based on Masaoka staging and World Health Organization classification. Therefore novel strategies are needed, especially for refractory and/or recurrent TETs and for thymic carcinomas that present a poor prognosis. Personalized approaches are currely being developed and molecular targets are emerging from recent integrated genomic analyses. Targeted therapy will represent an important treatment option for TETs with an aggressive histology. To date, data indicate that vascular endothelial growth factor molecules, insulinlike growth factor 1 receptor, cyclin-dependent kinases and mammalian target of rapamycin may be potentially useful as targeted biological therapies.展开更多
Objective: To analyze the influencing factors for radiation-induced heart disease (RIHD) in a panel of cases with malignant thymic tumors treated by radiotherapy. Methods: 52 consecutive patients were treated by radi...Objective: To analyze the influencing factors for radiation-induced heart disease (RIHD) in a panel of cases with malignant thymic tumors treated by radiotherapy. Methods: 52 consecutive patients were treated by radiotherapy for malignant thymic tumor (14 at Masaoka stage II, 23 at stage III and 15 at stage IV). Treatment included radical (in 20), postoperative (in 14), preoperative (in 2) and palliative (in 16) radiotherapy. The conventional two-dimension (2D) radiation therapy was performed in forty-seven patients and three-dimension (3D) conformal radiation therapy has been used in 5 patients since October 2000. The total tumor dose ranged from 10 Gy to 84.5 Gy (median of 55 Gy). Chemotherapy was given in twenty-five patients before or after radiotherapy. The results of following-up could be obtained from the database and updated where appropriated. The dose volume histogram (DVH) of heart in radiotherapy for all patients was analyzed for the effective volume dose of heart. Result: The median following-up was 14 months (ranged from 0.6 to 111.3 months) in the study. RIHD was observed in seven patients. Cardiac toxicity of these seven patients were evaluated as SOMA grade 1-3. The median two-third effective volume dose of heart was 47.2 Gy (ranged from 8.3 Gy to 70.1 Gy) for conventional 2D radiotherapy, which correlated with thymic tumor dose (P<0.0001). The median two-third effective volume dose of heart was 35.3 Gy (ranged from 13 Gy to 38.7 Gy) for 3D conformal radiotherapy. The effective volume doses of heart were decreased by using 3D conformal radiotherapy (P=0.048). A significant association between cardiac toxicity and effective volume dose of heart was found in this study (P<0.0001). Cardiac toxicity accounted for 10.4% and 4.1% of patients receiving and not receiving adjuvant chemotherapy, respectively, and occurred earlier in radiochemotherapy group (P=0.0528). Multivariate analysis suggested that cardiac toxicity was significantly influenced by the effective volume dose of heart and chemotherapy. Conclusion: the results indicate that decreasing the effective volume dose of heart and carefully using chemotherapy drugs that have significant cardiotoxicity may reduce the probability of radiation-induced heart disease.展开更多
Supernatants from human primary thymic epithelial cell culture were collected. The proliferationpromoting effect of the supernatant on mouse thymocyte, as well as on Tcell line 85, Be 13, HDMar, Peer, Loucy, Molt4, R...Supernatants from human primary thymic epithelial cell culture were collected. The proliferationpromoting effect of the supernatant on mouse thymocyte, as well as on Tcell line 85, Be 13, HDMar, Peer, Loucy, Molt4, Reh and Jurkat, were observed. The results demonstrated that the supernatants could increase spontaneous 3 HTdR intake of mouse thymocyte, promote ConAinduced thymocyte proliferation and stimulate the proliferation of 85 cell or the cells of HDMar, Loucy and Jurkat at stationary phase, but did not display any effect on Be13, Peer, Molt4 and Reh cells.展开更多
文摘We point out the issue of differential diagnosis regarding the finding of ectopically localised thymic tissue(a thymic cyst)in the neck.Thymic tissue can be found anywhere along its developmental tract of descent,from the angle of the mandible to the upper mediastinum.Disruption of the thymic descent can result in ectopically/abnormally localised islets of accessory thymic tissue,which may undergo cystic changes,as described in a case report by Sun et al.This anatomical variation of the thymus may be clinically misinterpreted as a neoplasm or other congenital anomalies as a branchial cyst,lymphatic malformation or cystic hygroma.The present editorial focuses on the challenge of establishing a diagnosis of ectopically localised tissue of thymus often presented as a lateral cervical mass,especially in the case of cystic variation/degeneration of this thymic tissue.We summarise hypotheses on the origin of such congenital cervical thymic cysts from the point of view of evolutionary history and embryology.We also discuss lesser-known facts about the anatomy,histopathology and developmental biology of the thymus as one of the most enigmatic organs in the human body.
文摘A recent case report provided a patient scenario,wherein,a 39-year-old male patient presented with occasional palpitations,headache,and fever.Evaluation of tumor markers did not show any abnormal results.Subsequently,a computed tomography(CT)scan was undertaken,and its findings were affirmative of thymic cancer.Finally,the postoperative histopathological assessment of the mass,after its resection,confirmed it as an anterior mediastinal multilocular thymic cyst(MTC),with concurrent acute upper respiratory tract infection and acute myocarditis.Accordingly,this case report advocates the need for a preoperative histopathological examination with CT imaging to minimize the risk of confusing an MTC with a malignant thymic tumor.
基金Project of Special Funds for Science and Technology Cooperation in Guizhou Provinces and Zunyi City,No.Shengshikehe(2015)53.
文摘This editorial provides insights from a case report by Sun et al published in the World Journal of Clinical Cases.The case report focuses on a case where a multilocular thymic cyst(MTC)was misdiagnosed as a thymic tumor,resulting in an unnecessary surgical procedure.Both MTCs and thymic tumors are rare conditions that heavily rely on radiological imaging for accurate diagnosis.However,the similarity in their imaging presentations can lead to misinterpretation,resulting in unnecessary surgical procedures.Due to the ongoing lack of comprehensive knowledge about MTCs and thymic tumors,we offer a summary of diagnostic techniques documented in recent literature and examine potential causes of misdiagnosis.When computer tomography(CT)values surpass 20 Hounsfield units and display comparable morphology,there is a risk of misdiagnosing MTCs as thymic tumors.Employing various differential diagnostic methods like biopsy,molecular biology,multi-slice CT,CT functional imaging,positron emission tomography/CT molecular functional imaging,magnetic resonance imaging and radiomics,proves advantageous in reducing clinical misdiagnosis.A deeper understanding of these conditions requires increased attention and exploration by healthcare providers.Moreover,the continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.continued advancement and utilization of various diagnostic methods are expected to enhance precise diagnoses,provide appropriate treatment options,and improve the quality of life for patients with thymic tumors and MTCs in the future.
文摘BACKGROUND Multilocular thymic cyst(MTC)is a rare mediastinal lesion which is considered to occur in the process of acquired inflammation.It is usually characterized by well-defined cystic density and is filled with transparent liquid.CASE SUMMARY We report on a 39-year-old male with a cystic-solid mass in the anterior mediastinum.Computer tomography(CT)imaging showed that the mass was irregular with unclear boundaries.After injection of contrast agent,there was a slight enhancement of stripes and nodules.According to CT findings,it was diagnosed as thymic cancer.CONCLUSION After surgery,MTC accompanied by bleeding and infection was confirmed by pathological examination.The main lesson of this case was that malignant thymic tumor and MTC of the anterior mediastinum sometimes exhibit similar CT findings.Caution is necessary in clinical work to avoid misdiagnosis.
文摘Cystic lesions of the anterior mediastinum in children suggest a well-known group of benign lesions that are comparatively frequent.Thymic cysts(TCs)are mostly positioned in the anterior mediastinum and some patients in the neck.Benign TCs classified as congenital intra-thoracic mesothelial cysts are commonly asymptomatic and have slight clinical significance.Multilocular TC,which can mimic another anterior mediastinal cystic tumor and is seen in adults,is more clinically important.It is a sporadic mediastinal lesion thought to arise in the course of acquired inflammation.Congenital mediastinal cysts represent 3%-6%of all mediastinal tumors and 10%-18%of radiologically reported mediastinal masses.Mediastinal TCs are uncommon and it is hard to know their true incidence.About 60%of cases with mediastinal TCs are asymptomatic,and the remainder of patients complains of nonspecific symptoms(e.g.,chest pain,dyspnea,or cough).The literature suggests that most cysts are benign,but an indefinite percentage may have a neoplastic process and result in significant compressive symptoms over time.Clinical symptoms of TCs vary depending on the location.In addition,frequent symptoms at the appearance of enlarged benign thymic and mediastinal cysts generally contain compressive symptoms(e.g.,respiratory distress,thymic pain,and symptoms related to Horner syndrome,hoarseness,dysphonia,dyspnea,orthopnea,wheezing,and fever).Many TCs have cystic density and a neat border and are simple to diagnose with radiological imaging.However,some TCs are hard to identify before surgery and may be misidentified as thymomas depending on their site and computed tomography results.Excision by thoracotomy,median sternotomy,or video-assisted techniques is essential for conclusive diagnosis,management,and abolition of relapse of anterior mediastinal masses and TCs.Histopathologic examination may be required after surgery.Considering the extent of the mass and the preliminary inability to make a definitive diagnosis,en bloc excision of the cyst was thought to be preferred to circumvent likely complications(e.g.,perforation,spillage of the contents,or incomplete excision).
基金Supported by Guangxi Guilin Science and Technology Fund,No.20190218-7-6.
文摘BACKGROUND Thymic carcinoid(TC)is a rare entity among anterior mediastinal malignancies.TCs are neuroendocrine carcinomas that constitute approximately 2%–5%of all thymic epithelial tumors.CASE SUMMARY The study reported a rare TC with multiple bone metastases.A 77-year-old man presented with a 2-month history of lower back pain and weight loss of 5 kg.Magnetic resonance imaging scans revealed damage to the lumbar spine,sacrocaudal vertebrae and iliac crest,suggesting bone metastasis;computed tomography(CT)scan of the thorax showed a calcified anterior mediastinal mass;positron emission tomography-CT demonstrated multiple abnormal bone signals;and laboratory work-up showed no endocrine abnormalities.Fine-needle aspiration biopsy revealed predominantly single small,round to oval cells with scant cytoplasm and some loose clusters,suggesting endocrine manifestations.The pathological diagnosis was atypical carcinoid,which tend to originate from the thymus and was classified as intermediate-highly invasive.The patient underwent anlotinib-targeted therapy.Anlotinib(12 mg)was administered daily for 2 wk,after which the patient was allowed to rest for 21 d.Follow-up CT after one year demonstrated that the tumor had shrunk by approximately 29%after therapy.Treatment has a long stable disease benefit of more than 2.5 years.CONCLUSION These findings demonstrated that anlotinib is a promising treatment regimen for patients with TC and multiple bone metastases.
基金Supported by the Natural Science Foundation of Liaoning province,No.2020-MS-179。
文摘BACKGROUND Thymic lipofibroadenomas are extremely rare.In this study,we investigated the clinicopathological characteristics of thymic lipofibroadenomas.CASE SUMMARY This study included three patients with thymic lipofibroadenomas.We retrospectively analyzed the patient data to determine the clinicopathological characteristics of thymic lipofibroadenomas.The study included one man and two women[mean age,43(33–59)years].All patients were non-smokers and presented with well-defined anterior mediastinal tumors.The cut surfaces of the tumors were solid,with a mixture of yellow and white areas.Microscopic evaluation of resected specimens showed scattered cord-like structures of epithelial cells embedded within abundant fibrotic and hyaline stroma admixed with variable quantities of adipose tissue.One patient showed hyperplastic thymic tissue in a part of the tumor.CONCLUSION Thymic lipofibroadenomas are an extremely rare type of benign thymic tumor.Surgical removal of lipofibroadenomas is usually curative.
基金This work was funded by grants from Major State Bascic Research Development Program of China(No.G1999053904)National Natural Science Foundation of China(No.30271200)Young Scentist Cooperation Research Fund(No.39928019).
文摘Mouse thymic stromal cell line 4 (MTSC4) is one of the stromal cell lines established in our laboratory. While losing the characteristics of epithelial cells, they express some surface markers shared with thymic dendritic cells (TDCs). To further study the biological functions of these cells, we compared the capability of MTSC4 with TDCs in the induction of thymocyte apoptosis, using thymic reaggregation culture system. Apoptosis of thymocytes induced by MTSC4 and TDCs was measured by Annexin V and PI staining and analyzed by flow cytometry. We found that MTSC4 selectively augmented the apoptosis of CD4^+8^+ (DP) thymocytes. This effect was Fas/FasL independent and could not be blocked by antibodies to MHC class Ⅰ and class Ⅱ molecules. In addition, MTSC4 enhanced the apoptosis of DP thymocytes from different strains of mice, which implies that MTSC4-induced thymocyte apoptosis is not mediated by the TCR recognition of self peptide/MHC molecules. In contrast to MTSC4, thymocyte apoptosis induced by TDCs was MHC-restricted. Thus, MHC-independent fashion of stromal-DP thymocyte interaction may be one of the ways to induce thymocyte apoptosis in thymus. Our study has also shown that the interaction of MTSC4 stromal cells and thymocytes is required for the induction of thymocyte apoptosis.
文摘BACKGROUND Thymic-enteric adenocarcinoma with positive expression of CDX2 and CK20 is rare in adults,with only 16 reported cases.However,standard treatment options for this type of thymic adenocarcinoma has not yet been established.Therefore,we report a case of stage IV thymic-enteric adenocarcinoma treated with radiotherapy,chemotherapy,and anti-angiogenesis therapy.CASE SUMMARY We report a case of thymic-enteric adenocarcinoma occurring in a 44-year-old woman.The tumor was considered unresectable owing to its invasiveness.The patient was treated with six cycles of oxaliplatin(130 mg/m^(2),day 1)and capecitabine(1000 mg/m^(2) BID,days 1-14).During the first three cycles of chemotherapy,concurrent radiotherapy(60 Gy/30 fractions)and anti-angiogenic therapy using apatinib were recommended.The primary tumor achieved partial remission based on the Response Evaluation Criteria in Solid Tumors.During follow-up,there was no evidence of disease relapse,except a high serum CA19-9 level.The patient is alive and regularly followed.Based on the previous literature and the present case,we believe that early diagnosis of thymic-enteric adenocarcinoma is important.CONCLUSION XELOX(capecitabine plus oxaliplatin)combined with radiotherapy is an optional therapy for inoperable thymic-enteric adenocarcinoma.
文摘BACKGROUND Micronodular thymic tumors with lymphoid stroma include micronodular thymoma with lymphoid stroma(MNT)and micronodular thymic carcinoma with lymphoid hyperplasia(MNC),whose micromorphological features are lymphoid stromal hyperplasia and nodular arrangement of tumor epithelial cells.This type of tumor is rare;therefore,the corresponding clinical guidelines,histopathological diagnostic criteria,prognostic factors,and therapeutic regimens have not been established.CASE SUMMARY This study covers a novel presentation of MNC in a patient and summarizes the clinicopathological characteristics of this type of tumor by using pooled-analysis methods.Morphologically,this tumor type is a series of benign to malignant pedigrees.We establish the following criteria for the classification of micronodular thymic tumors with lymphoid stroma:(1)Tumor cells with moderate-to-severe dysplasia;(2)Tumor cell mitotic figures>2/10 high-power fields;(3)Appearance of neoplastic necrosis;(4)No terminal deoxynucleotidyl transferase-positive immature T lymphocytes within the tumor;(5)Tumor cells with a Ki-67 index≥10%;and(6)Tumor cells express CD5.Cases that fall into the borders of two categories in terms of morphology are attributed to atypical MNT.It is proposed that the diagnosis of MNT should be established on the diagnostic criteria mentioned above.CONCLUSION Our diagnostic algorithm can effectively distinguish malignant tumors from benign tumors and provides a potent basis for predicting a prognosis,which offers a practical reference for oncologists and pathologists.
文摘The thymus provides the essential microenvironment for T-cell development and maturation. Thymic epithelial cells （TECs）, which are composed of thymic cortical epithelial cells （cTECs） and thymic medullary epithelial cells （mTECs）, have been well documented to be critical for these tightly regulated processes. It has long been controversial whether the common progenitor cells of TECs could give rise to both cTECs and mTECs. Great progress has been made to characterize the common TEC progenitor cells in recent years. We herein discuss the sole origin paradigm with regard to TEC differentiation as well as these progenitor cells in thymus regeneration.
文摘Objective: To investigate the expression of both thymic regulatory T cells (CD4+CD25+Foxp3+cells, Treg) and thymic stromal lymphopoietin (TSLP) in thymomas accompanying myasthenia gravis. Methods: We used immunohistochemistry and real-time reverse trancription polymerase chain reaction (real-time RT-PCR) techniques to determine Foxp3+ Treg counts and the expression levels of Foxp3 mRNA and TSLP mRNA in thymomas of 23 MG patients and thymuses of 4 healthy controls. Results: The CD4+ Foxp3+ nTreg (natural regulatory T cells) counts in thymomas were significantly lower than those in normal thymuses (P<0.01), and the expression levels of Foxp3 mRNA and TSLP mRNA were also lower in thymomas(P<0.01). Among the thymoma types, type B1 thymoma had the highest Foxp3+ nTreg count and standard values of Foxp3 mRNA and TSLP mRNA. There was a strong positive correlation between the mRNA transcriptional levels of Foxp3 and TSLP. Conclusion: The insufficient expression of Foxp3 in thymoma, which may be caused by decreased transcription of TSLP, may result in the reduction of Tregs and cause autoimmune disorders.
基金a grant from the National Natural Science Foundation of China!(No.39730200-II and No.39470295).
文摘Objective: To investigate p53 overexpression and its correlation with neoplastic cell proliferation and apoptosis in 20 thymic carcinomas. Methods: 20 surgical samples of thymic carcinoma were collected randomly during the past 15 years in the Guangzhou area. Immunohistochemical staining was performed using LSAB method with anti-p53 monoclonal antibody (DO-7) and proliferating cell nuclear antigen (clone PC 10) as primary antibodies. The p53 index was indicated by the number of p53 positive cells among 100 carcinoma cells. More than 25 percentage of p53 positive cells found in tissue sections was recognized as p53 overexpression. Carcinoma cell proliferation activity was assayed by PCNA index (PI), and apoptosis degree was evaluated by TUNEL (TdT-mediated dUTP-X nick end labeling) index (TI) using Boehringer MannheimIn Situ Death Detection Kit. Results: P53 positive cells could be found in vast majority of thymic carcinomas (19/20) and the overexpression rate reached 35% (7/20). The median PI (40%) of 7 cases with p53 overexpression was higher than that (31%) of 13 cases without p53 overexpression, but there was no statistical significance that existed between these two data (P>0.05). The median TI (0.5/HPF) of 7 p53 overexpression cases was much lower than that (4.5/HPF) of 13 non-overexpression cases, and there was a significant difference statistically (P<0.05). Conclusion: p53 expression was a frequent finding in thymic carcinoma cells, and the p53 overexpression which might represent p53 inactivation or gene mutation was often involved in thymic carcinogenesis. The median PCNA index of p53 overexpression group was higher than that of non-overexpression group though there existed no statistical difference. This indicates that the inhibiting function of p53 on cell proliferation seemed lost in p53 overexpressed thymic carcinomas. It is worthy to be specially mentioned that the inducing function of p53 on cell apoptosis was markedly lost in p53 overexpressed thymic carcinomas. Taken together, the overexpressed p53 that could represent aberrant p53 protein had not only lost its proliferation-inhibiting but also its apoptosis-inducing function in thymic carcinomas which might play an important role in thymic carcinogenesis.
基金Supported by Key R&D Plan of Science and Technology Program of Gansu Province,China,No.19YF3FH001.
文摘BACKGROUND Although the bystander effect and abscopal effect are familiar in medicine,they are relatively rare in clinical practice.Herein,we report the case of a patient who demonstrated an obvious bystander effect and abscopal effect response following carbon-ion irradiation for recurrent thymic carcinoma.CASE SUMMARY A 44-year-old female presented with shortness of breath.Eleven years prior,she was diagnosed with athymic tumor located in the anterosuperior mediastinum.She underwent extensive tumor resection,and the postoperative pathologic diagnosis was thymic carcinoma.She was administered 50 Gy/25 Fx of postoperative radiation.In 2019,she was diagnosed with a recurrence of thymic carcinoma,with multiple recurrent nodules and masses in the left thoracic chest and peritoneal cavity,the largest of which was in the diaphragm pleura proximal to the pericardium,with a size of 6.7 cm×5.3 cm×4.8 cm.She received carbonion radiotherapy.After carbon-ion radiotherapy treatment,the treated masses and the untreated masses were observed to have noticeably shrunk on the day of carbon-ion radiotherapy completion and on follow-up imaging.We followed the CARE Guidelines for consensus-based clinical case reporting guideline development and completed the CARE Checklist of information to report this case.CONCLUSION This report is the first of obvious abscopal and bystander effects following carbonion irradiation in a human patient,and further research is needed to better elucidate the mechanisms of bystander and abscopal effects.
基金the Tianjin Science and Technology Program Fund(grant No.18 PTZWHZ00100 and H2018206600).
文摘Objective:A high rate of unnecessary thymectomies has been reported.This study aimed to distinguish primary mediastinal lymphomas(PMLs)from thymic epithelial tumors(TETs)by evaluating volumetric and metabolic parameters with l8F-FDG PET/CT.Methods:A total of 136 patients who were pathologically diagnosed with TETs or PMLs were enrolled,and 18F-FDG PET/CT was performed before therapy.Volumetric parameters,including the mean SUV(SUVmean),metabolic tumor volume(MTV),total lesion glycolysis(TLG),and SUVmax,were determined and compared between the 2 subtypes.The diagnostic performance of these parameters was evaluated with receiver operating characteristic(ROC)curve analysis.Results:All parameters significantly differed between patients with PMLs and TETs.Patients with lymphomas were younger and had higher SUVmean,SUVmax,TLG,and MTV values than patients with TETs.The MTV and TLG values had similar diagnostic performance.ROC analysis indicated that the areas under the curves of the SUVmean and SUVmax values performed similarly(approximately 0.76)in differentiating patients with PMLs from TETs,and both values were better than the MTV and TLG values.When age was included with the SUVmax in differentiating TETs from PMLs,the AUC was 0.91,and the sensitivity and specificity increased to 80%and 93%,respectively.Conclusions:The SUVmax and volumetric parameters of 18F-FDG PET/CT can be used to distinguish patients with PMLs versus TETs,and thus may aid in preventing unnecessary thymectomies or other invasive operations.
文摘BACKGROUND Thymic carcinoma is a rare,aggressive tumor arising from the thymus.In less than 7%of patients with thymic carcinoma,extrathoracic metastases occur in the extrathoracic lymph nodes,liver,and bone.Isolated splenic metastasis can occur but is very uncommon.To date,only 2 cases of splenic metastases from thymic carcinoma have been reported.CASE SUMMARY A 45-year-old man presented with chronic cough,dyspnea,persistent hoarseness and unintentional weight loss 17 kgs in 6 mo.Neck magnetic resonance imaging revealed a large,lobulated,soft-tissue mass measuring 5.4 cm×6.6 cm×3.8 cm which involved the left superior mediastinum and supraclavicular fossa.Chest computed tomography(CT)revealed a confluent and lobulated soft tissue mass encased the right brachiocephalic artery,right and left carotid arteries,and left subclavian artery in the mediastinum.A fluorodeoxyglucose-positron emission tomography was arranged for malignancy survey.The image revealed intense fluorodeoxyglucose avidity in a soft tissue lobulated mass occupying the superior mediastinum,over the cystic lesion in the spleen and in few enlarged nodules over the left supraclavicular fossa.CT-guided biopsy of the thymic mass and the ultrasound-guided biopsy of the splenic lesion were consistent with a thymic carcinoma with splenic metastasis.The patient was diagnosed of thymic carcinoma,cT2N2M1b,stage IVb.CONCLUSION A fluorodeoxyglucose(FDG)-positron emission tomography(PET)scan can provide a useful diagnostic value in conjunction with pathological result in evaluating tumor staging.Our case emphasizes the utility of FDG-PET for metastasis detection in thymic carcinoma.
文摘Background: We reported our experience with thymic carcinomas and review their clinical features, treatment strategies, and prognoses. Methods: From April 1998 to November 2012, 11 patients pathologically diagnosed with thymic carcinoma and treated in our hospital were investigated. Results: There were 7 men and 4 women, with a median age of 62 years (range, 35 - 72). According to the Masaoka staging system, 3 patients had stage II, 1 stage III disease, 3 stage IVa disease and 4 stage IVb disease. Ten patients had squamous cell carcinoma, whereas 1 had large cell neuroendocrine carcinoma (LCNEC). We performed surgery or multimodality therapy including surgery as the initial therapy for 8 patients. Of the non-surgical cases, 1 patient received chemoradiotherapy and survived for over 6 years without recurrence, whereas 2 received palliative care. Three of 4 patients who underwent complete resection survived without disease recurrence, whereas only 1 patient with LCNEC survived in the incomplete resection group. Multimodality therapy with cisplatin and docetaxel was provided to 3 patients, and recurrence has not been observed in any of the cases. Conclusions: Favorable outcomes could be achieved in patients with thymic carcinoma who underwent intensive treatment. In particular, surgery combined with cisplatin and docetaxel plus thoracic irradiation may be an attractive approach for thymic carcinoma.
文摘Thymic epithelial tumors(TETs) are uncommon neoplasms with a wide range of anatomical, clinical, histological and molecular malignant entities. To date the management of TETs within clinical practice is based on a multimodal therapeutic strategy including surgery, chemotherapy and radiotherapy with a multidisciplinary approach and prognostic evaluation is mainly based on Masaoka staging and World Health Organization classification. Therefore novel strategies are needed, especially for refractory and/or recurrent TETs and for thymic carcinomas that present a poor prognosis. Personalized approaches are currely being developed and molecular targets are emerging from recent integrated genomic analyses. Targeted therapy will represent an important treatment option for TETs with an aggressive histology. To date, data indicate that vascular endothelial growth factor molecules, insulinlike growth factor 1 receptor, cyclin-dependent kinases and mammalian target of rapamycin may be potentially useful as targeted biological therapies.
文摘Objective: To analyze the influencing factors for radiation-induced heart disease (RIHD) in a panel of cases with malignant thymic tumors treated by radiotherapy. Methods: 52 consecutive patients were treated by radiotherapy for malignant thymic tumor (14 at Masaoka stage II, 23 at stage III and 15 at stage IV). Treatment included radical (in 20), postoperative (in 14), preoperative (in 2) and palliative (in 16) radiotherapy. The conventional two-dimension (2D) radiation therapy was performed in forty-seven patients and three-dimension (3D) conformal radiation therapy has been used in 5 patients since October 2000. The total tumor dose ranged from 10 Gy to 84.5 Gy (median of 55 Gy). Chemotherapy was given in twenty-five patients before or after radiotherapy. The results of following-up could be obtained from the database and updated where appropriated. The dose volume histogram (DVH) of heart in radiotherapy for all patients was analyzed for the effective volume dose of heart. Result: The median following-up was 14 months (ranged from 0.6 to 111.3 months) in the study. RIHD was observed in seven patients. Cardiac toxicity of these seven patients were evaluated as SOMA grade 1-3. The median two-third effective volume dose of heart was 47.2 Gy (ranged from 8.3 Gy to 70.1 Gy) for conventional 2D radiotherapy, which correlated with thymic tumor dose (P<0.0001). The median two-third effective volume dose of heart was 35.3 Gy (ranged from 13 Gy to 38.7 Gy) for 3D conformal radiotherapy. The effective volume doses of heart were decreased by using 3D conformal radiotherapy (P=0.048). A significant association between cardiac toxicity and effective volume dose of heart was found in this study (P<0.0001). Cardiac toxicity accounted for 10.4% and 4.1% of patients receiving and not receiving adjuvant chemotherapy, respectively, and occurred earlier in radiochemotherapy group (P=0.0528). Multivariate analysis suggested that cardiac toxicity was significantly influenced by the effective volume dose of heart and chemotherapy. Conclusion: the results indicate that decreasing the effective volume dose of heart and carefully using chemotherapy drugs that have significant cardiotoxicity may reduce the probability of radiation-induced heart disease.
文摘Supernatants from human primary thymic epithelial cell culture were collected. The proliferationpromoting effect of the supernatant on mouse thymocyte, as well as on Tcell line 85, Be 13, HDMar, Peer, Loucy, Molt4, Reh and Jurkat, were observed. The results demonstrated that the supernatants could increase spontaneous 3 HTdR intake of mouse thymocyte, promote ConAinduced thymocyte proliferation and stimulate the proliferation of 85 cell or the cells of HDMar, Loucy and Jurkat at stationary phase, but did not display any effect on Be13, Peer, Molt4 and Reh cells.
