Background: Thymoma is an uncommon tumor without a widely accepted standard care to date. We aimed to investigate the clinicopathologic variables of patients with thymoma and identify possible predictors of survival a...Background: Thymoma is an uncommon tumor without a widely accepted standard care to date. We aimed to investigate the clinicopathologic variables of patients with thymoma and identify possible predictors of survival and recurrence after initial resection.Methods: We retrospectively selected 307 patients with thymoma who underwent complete resection at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College(Beijing, China) between January 2003 and December 2014. The associations of patients' clinical characteristics with prognosis were estimated using Cox regression and Kaplan–Meier survival analyses.Results: During follow?up(median, 86 months; range, 24–160 months), the 5? and 10?year disease?free survival(DFS) rates were 84.0% and 73.0%, respectively, and the 5? and 10?year overall survival(OS) rates were 91.0% and 74.0%, respectively. Masaoka stage(P < 0.001), World Health Organization(WHO) histological classification(P < 0.001), and postoperative radiotherapy after initial resection(P = 0.006) were associated with recurrence(52/307, 16.9%). Multivariate analysis revealed that, after initial resection, WHO histological classification and Masaoka stage were independent predictors of DFS and OS. The pleura(25/52, 48.0%) were the most common site of recurrence, and locoregional recurrence(41/52, 79.0%) was the most common recurrence pattern. The recurrence pattern was an independent predictor of post?recurrence survival. Patients with recurrent thymoma who underwent repeated resec?tion had increased post?recurrence survival rates compared with those who underwent therapies other than surgery(P = 0.017).Conclusions: Masaoka stage and WHO histological classification were independent prognostic factors of thymoma after initial complete resection. The recurrence pattern was an independent predictor of post?recurrence survival. Locoregional recurrence and repeated resection of the recurrent tumor were associated with favorable prognosis.展开更多
Thymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic"(types A, AB, B1, B2, and B3) and "non-o...Thymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic"(types A, AB, B1, B2, and B3) and "non-organotypic"(thymic carcinomas) thymomas. Type B3 thymomas are aggressive tumors, which can metastasize. Due to the rarity of these lesions, only 7 cases of extradural metastasis are described in the literature. We report the first and unique case of a man with cervical intradural B3 thymoma metastasis. A 46-year-old man underwent thymoma surgical removal. The year after the procedure he was treated for a parietal pleura metastasis. In 2006 he underwent cervical-dorsal extradural metastasis removal and C5-Th1 stabilization. Seven years after he came to our observation complaining left cervicobrachialgia and a reduction of strength of the left arm. He underwent a cervical spine magnetic resonance imaging, which showed a new lesion at the C5-C7 level. The patient underwent a surgery for the intradural B3 thymoma metastasis. Neurological symptoms improved although the removal was subtotal. He went through postoperative radiation therapy with further mass reduction. Spinal metastases are extremely rare. To date, only 7 cases of spinal extradural metastasis have been described in the literature. This is the first case of spinal intradural metastasis. Early individuation of these tumors and surgical treatment improve neurological outcome in patients with spinal cord compression. A multimodal treatment including neoadjuvant chemotherapy, surgery and postoperative radiation therapy seems to improve survival in patients with metastatic thymoma.展开更多
Bleeding resulting from spontaneous rupture of the liver is an infrequent but potentially life threatening complication that may be associated with an underlying liver disease. A hepatocellular carcinoma or hepatic ad...Bleeding resulting from spontaneous rupture of the liver is an infrequent but potentially life threatening complication that may be associated with an underlying liver disease. A hepatocellular carcinoma or hepatic adenoma is frequently reported is such cases. However, hemoperitoneum resulting from a hepatic metastatic thymoma is extremely rare. Here, we present a case of a 62-year-old man with hypovolemic shock induced by ruptured hepatic metastasis from a thymoma. At the first hospital admission, the patient had a 45-mm anterior mediastinal mass that was eventually diagnosed as a type A thymoma. The mass was excised, and the patient was disease-free for 6 years. He experienced sudden-onset right upper quadrant pain and was again admitted to our hospital. We noted large hemoperitoneum with a 10-cm encapsulated mass in S5/8 and a 2.3-cm nodular lesion in the right upper quadrant of the abdomen. He was diagnosed with hepatic metastasis from the thymoma, and he underwent chemotherapy and surgical excision.展开更多
Objective: Evaluation the role of neoadjuvant chemotherapy in invasive thymoma. Methods: 14 patients with invasive thymoma(Masaoka stage Ⅲ in 12 and Ⅳa in 2) were treated with neoadjuvant chemotherapy by CAVP for 3-...Objective: Evaluation the role of neoadjuvant chemotherapy in invasive thymoma. Methods: 14 patients with invasive thymoma(Masaoka stage Ⅲ in 12 and Ⅳa in 2) were treated with neoadjuvant chemotherapy by CAVP for 3-4 cycles (cyclophosphamide 600mg/m2 D1, adramycin 30mg/m2 or epi-adramycin 40mg/m2 D1, vincristine 0.6mg/m2 D1 or vindestine 3mg/m2 D1、D8, cisplatin 30mg/m2 D1、2、3)。After chemotherapy, all patients underwent operation in 1-3 months. We performed 10 sternotomies and 4 anterolateral thoracotomies. Radiotherapy was administrated with total dose 50-60Gy in all patients except for those who were pathologically complete remission. The group was followed up by 6 months to 3 years. Results :After chemotherapy, 5 patients(35.7%) had a complete remission(CR) and 9 patients(64.3%) had a partial remission(PR)。At operation, 9 patients had radical resection and 5 had partial resection. Postoperative pathological examination found only fibrosis in 5 patients with CR by chemotherapy. All patients were still alive except 2 patients died from visceral metastasis after 18 months and 2 years respectively. Conclusion: Neoadjuvant chemotherapy can increase the resectability of stage Ⅲ and Ⅳa invasive thymoma. A longer follow-up and a larger number of patients are needed to determine the impact of this treatment on long-term survival.展开更多
Ectopic hamartomatous thymoma is a rare,generally benign neoplasm that mainly arises in the lower neck region and is yet to be completely understood.Herein,we describe a case with two separate and sequential growing n...Ectopic hamartomatous thymoma is a rare,generally benign neoplasm that mainly arises in the lower neck region and is yet to be completely understood.Herein,we describe a case with two separate and sequential growing neoplasms for the first time,distinguished from other reported solitary cases.A 58-year-old Chinese male presented with a 6-month history of two nontender,self-palpated masses in the suprasternal region of his neck.Physical examination revealed two masses with diameters of 5 cm and 2 cm.Ultrasound examination 2 years ago revealed a hyperechoic mass with a fat-derived possibility.These two neoplasms were clinically diagnosed as lipomas without other radiological examinations and were completely excised.Microscopically,they were well circumscribed and characterized by admixture with spindle cells,epithelial nests,and adipocytes in variable amounts,without atypia or mitotic activity.Immunohistochemical staining revealed that both neoplasms showed a biphasic pattern,with an epithelial nature with strong and diffuse positive expression of cytokeratin(CK)and myoepithelial differentiation with CK5/6 and p63 positivity in the spindle cells.There was no evidence of recurrence after a 28-month follow-up period.In this report,we present a unique case of ectopic hamartomatous thymoma to show the existence of multiple tumors in this rare disease.We hope to raise the awareness of the possibility of this disease when the tumor rises in typical lower neck regions,especially when mixed soft tissue or fat components are shown by imaging examination.展开更多
Thymoma is the most common neoplasm of the anterior mediastinum and accounts for one quarter of all mediastinal tumours and half of all anterior mediastinal masses. Pericardial effusion may be present in approximately...Thymoma is the most common neoplasm of the anterior mediastinum and accounts for one quarter of all mediastinal tumours and half of all anterior mediastinal masses. Pericardial effusion may be present in approximately 20% of cases. This report presents a patient with a previously diagnosed thymoma without surgical indication and with poor response to chemotherapy and radiotherapy who had a pericardial effusion that likely resulted from the malignancy dissemination to pericardium.展开更多
The myasthenia gravis is an autoimmune disease which can be associated frequently with a thymoma and also with autoimmune pathologies. We report the case of a 64-year-old man affected an overlap syndrome corresponding...The myasthenia gravis is an autoimmune disease which can be associated frequently with a thymoma and also with autoimmune pathologies. We report the case of a 64-year-old man affected an overlap syndrome corresponding to the association of autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). He also presented concomitant myasthenia gravis and thymoma. The physical examination notes only a disturbed voice. The liver tests showed: alkaline phosphatase 600 U/l, alanine aminotransferase 1280 U/l, and aspartate aminotransferase 985 U/l. Viral serologies of hepatitis were all negative, as well as antinuclear, antimitochondrial and antismooth muscle antibodies. The diagnosis of an overlap syndrome was posed according to the biological and hepatic histhological results. An associated myasthenia was confirmed by the results of the EMG and the positivity of the anti-acetylcholine receptor antibody. A chest CT revealed a thymoma. The treatment consisted of ursodeoxycholic acid, prednisone, azathioprine and pyridostigmine. And the patient improved his voice and the liver function. Thymectomy was practiced without incidents.展开更多
Background: Age is an important prognostic factor for thymoma;however, few studies have specifically focused on age-related survival outcomes in thymoma patients. This study explored the effect of age on the clinicopa...Background: Age is an important prognostic factor for thymoma;however, few studies have specifically focused on age-related survival outcomes in thymoma patients. This study explored the effect of age on the clinicopathological features and survival outcomes of thymoma patients. Methods: We reviewed the clinical data of 1984 chest thymoma patients from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. In accordance with the World Health Organization age brackets, the patients were divided into young (group A, 0 - 44-year-old);middle-aged (group B, 45 - 59-year-old);old (group C, 60 - 74-year-old);and seniors (group D 75 - 84-year-old). Single-factor and multivariate analysis were performed using the Kaplan-Meier method, and a multivariate Cox regression model was generated to assess patient prognosis. Results: In total, 1984 patients were included. The median follow-up time was 156.0 months (range: 0 - 492 months). Group C (60 - 74-year-old) had the most patients (35.1%), and Group D had the fewest patients (12.3%). Among all age groups, the proportion of white people and men with thymoma increased with age, while the proportion of black people and women showed a downward trend. Univariate and multivariate analyses showed that the overall survival rate of thymoma patients was negatively correlated with age. The overall survival times of the four groups were significantly different (p Conclusion: Age is an important prognostic factor for survival in thymoma patients, and younger patients have a survival advantage over older patients.展开更多
A Pleural mass biopsy was performed showing an invasive thymoma. Computed tomography (CT) scan of the chest performed on admission revealed a left sided pleural mass, anterior mediastinal mass, lymphadenopathy and per...A Pleural mass biopsy was performed showing an invasive thymoma. Computed tomography (CT) scan of the chest performed on admission revealed a left sided pleural mass, anterior mediastinal mass, lymphadenopathy and pericardial effusion. Pleural mass biopsy showed an invasive thymoma. Due to her clinical presentation, a complete work-up was performed revealing paraneoplastic systemic lupus erythematous (SLE), myasthenia gravis (MG) and hypogammaglobulinemia. We reviewed the literature regarding thymoma and its relationship with paraneoplastic SLE, MG and hypogammaglobulinemia.展开更多
The congenital thymic cysts are rare. They have a congenital origin and they are benign. The differential diagnosis of acquired cysts, cystic thymoma and thymic malignancies in cystic degeneration can be particularly ...The congenital thymic cysts are rare. They have a congenital origin and they are benign. The differential diagnosis of acquired cysts, cystic thymoma and thymic malignancies in cystic degeneration can be particularly difficult. Rarely, they assume clinical relevance for the appearance of symptoms of compression, more typical of malignant lesions, and the association with thymoma was reported in very few cases in literature. For all these features, treatment strategy remains controversial and in particular surgical approach. We report a case of a huge symptomatic congenital thymic cyst, surgically removed with histological finding of microscopic thymoma.展开更多
Thymomas are the most common neoplasms of the mediastinum. It is common that thymoma invades neighboring structures in the thorax, but direct polypoid tumor growth into the airway is extremely rare. We report a rare c...Thymomas are the most common neoplasms of the mediastinum. It is common that thymoma invades neighboring structures in the thorax, but direct polypoid tumor growth into the airway is extremely rare. We report a rare case of invasive thymoma with polypoid endobronchial growth in a 66-year-old woman. Computed tomography demonstrated an anterior mediastinal tumor which extended into the right upper lobe. Endoscopic examination revealed a polypoid tumor which occluded the right upper bronchus. A biopsy specimen obtained from the intraluminal mass was very suggestive of thymoma. The patient had no parathymic syndrome. The tumor was resected with the right upper lobe. The final post-operative tissue findings confirmed a type B2 thymoma of the World Health Organisation classification.展开更多
Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage Ⅰ and Ⅱ thymoma using the trans-sternal technique.Whether this is appropriate for minimally invasive approach is not yet c...Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage Ⅰ and Ⅱ thymoma using the trans-sternal technique.Whether this is appropriate for minimally invasive approach is not yet clear.We evaluated the feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of Masaoka stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis,compared to conventional trans-sternal thymectomy.We summarized 33 patients with Masaoka stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis between April 2006 and September 2011.Of these,15 patients underwent right-sided complete VATS (the VATS group) by using adjuvant pneuomomediastinum,comparing with 18 patients using the trans-sternal approach (the T3b group).No intraoperative death was found and no VATS case required conversion to median sternotomy.Significant differences between the two groups regarding duration of surgery and volume of intraoperative blood loss (P=0.001 and P < 0.001,respectively) were observed.Postoperative morbidities were 26.7% and 33.3% for the VATS and T3b groups,respectively.All 33 patients were followed up for 12 to 61 months in the study.The cumulative probabilities of reaching complete stable remission and effective rate were 26.7% (4/15) and 93.3% (14/15) in the VATS group,which had a significantly higher complete stable remission and effective rate than those in the T3b group (P=0.026 and P=0.000,respectively).We conclude that VATS thymectomy utilizing adjuvant pneuomomediastinum for the treatment of stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis is technically feasible but deserves further investigation in a large series with long-term follow-up.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: β-catenin is closely associated with proliferation, differentiation, invasion and metastasis of tumor cells. C-myc is proved to be abnormally expressed in various kinds of malignant neoplasmas. This study ...Objective: β-catenin is closely associated with proliferation, differentiation, invasion and metastasis of tumor cells. C-myc is proved to be abnormally expressed in various kinds of malignant neoplasmas. This study is aimed to investigate the features of β-catenin and C-myc expressions in thymoma and the corresponding clinical significance. Method: Immunochemistry was used to detect the features of expressions of β-catenin and C-myc in thymoma and normal thymus. Of the 105 samples, according to Beratz classification, there were: epithelial type 34; lymphocyte type 35; mixed type 31 and shuttle cell type 5. According to Masaoka classification, there were: stage 1: 38; stage 2: 32; stage 3: 20 and stage 4: 15. According to WHO classification, there were: type A 20; type AB 19; type B1 21; type B2 17; type B3 13 and type C 15. Results: Different ways of expression was revealed in different stages of thymomas. With the progress of thymoma, the expression of β-catenin on cell membrane decreased, while increased in cytoplasma and nucleus, even with nucleus shift. The expression of C-myc increased in invasive thymoma. Abnormal expression of β-catenin and C-myc increased, with significant difference(P<0.05). Conclusion: The different ways of expression and diversity of expression level may indicate the biological characters of thymoma, and could be used as an objective index for invasive thymoma.展开更多
Autoimmune hepatitis(AIH) has rarely been described as an autoimmune paraneoplastic syndrome of thymoma.This case is the seventh case of AIH revealed by cholestasis few years after the diagnosis of thymoma and the fir...Autoimmune hepatitis(AIH) has rarely been described as an autoimmune paraneoplastic syndrome of thymoma.This case is the seventh case of AIH revealed by cholestasis few years after the diagnosis of thymoma and the first case treated with chemotherapy alone.We report in this paper a new approach to this rare severe condition.A 29 year-old man presented with chest pain and dyspnea with a history of thymoma surgically removed 4 years ago.CT scan showed the recurrence of an anterior mediastinal mass.Biology showed elevated liver enzymes and profound cholestasis.No sign of viral or toxic hepatitis or bile duct abnormalities were observed.Autoimmune antibodies,except for the anti-nuclear antibody,were negative.Liver biopsy showed active chronic AIH.The patient was diagnosed with recurrent thymoma with AIH and underwent 6 cycles of chemotherapy.A complete response on thymoma and cholestasis was obtained after 10 months of follow-up.Steroids and immunosuppressors are the standard treatment for AIH.The effect of chemotherapy as a specific treatment of this paraneoplastic syndrome needs to be considered.展开更多
THYMOMA,a relatively rare epithelial neoplasm with unique clinical and pathologic features,is the most usual diagnosis for a mass located in the mediastinum.It is often associated with autoimmune disorders.The myasthe...THYMOMA,a relatively rare epithelial neoplasm with unique clinical and pathologic features,is the most usual diagnosis for a mass located in the mediastinum.It is often associated with autoimmune disorders.The myasthenia gravis and pure red cell aplasia are the most common disorders,with the incidences of 40%and 5%,respectively,while the incidence of aplastic anemia is only about 0-1.4%.1Thymectomy is hard to perform on patients with severe aplastic anemia展开更多
Objective: To explore the prognostic factors influencing the long term survival rate of thymoma after resection. Methods: Sixty nine patients with thymoma surgically treated in our department from 1973 to 2000 were re...Objective: To explore the prognostic factors influencing the long term survival rate of thymoma after resection. Methods: Sixty nine patients with thymoma surgically treated in our department from 1973 to 2000 were retrospectively studied. The possible prognostic factors were analyzed by univariate analysis and multivariate analysis with Kaplan Meiter method and Cox proportional hazard model respectively. Results: Overall patients survival rates were 83.3%, 67.4%, 48.3% at 5, 10, 15 years. The significant prognostic factors ( P <0 05) demonstrated by univariate analysis included age, Masaoka staging, WHO histological classification, resection method and Rosai/Levine classification. According to multivariate analysis, the independent prognostic factors included Masaoka stage ( P <0 01), resection method ( P <0 05) and age ( P <0 05). Conclusion: Complete surgical resection of thymomas helps increase the long term survival rate.展开更多
Objective: To explore the postoperative clinical characteristics and outcomes of myasthenia gravis with and without thymoma. Methods: Two hundred and forty-three patients with myasthenia gravis(MG) surgically treated ...Objective: To explore the postoperative clinical characteristics and outcomes of myasthenia gravis with and without thymoma. Methods: Two hundred and forty-three patients with myasthenia gravis(MG) surgically treated in our department from 1978 to 2003 were studied retrospectively. The clinical characteristics, complication, remissions and survival rates were compared between MG with and without thymoma. Results: The patients of MG with thymoma were significantly older (P<0.01), had shorter duration of symptom(P<0.01), and higher myasthenia crisis rates after operation(P<0.01) than those without thymoma. No difference of Osserman classification was found between the 2 groups. The complete remission rates and partial remission rates of MG with thymoma were significantly lower than those without thymoma at 1 and 3 years(P=0.049, P=0.000, P=0.015, P=0.010), but no differences at 5 years(P=0.457, P=0.699). The survival rates were lower in MG with thymoma than without thymoma(Log rank=18.58,P=0.000). Conclusion: The clinical characteristics are different between MG with and without thymoma. The remission of symptom of MG with thymoma is worse than that of MG without thymoma in the near future, but similar in the long future. In a long-term, the death rate of MG with thymoma is significantly higher than that of MG without thymoma.展开更多
Objective:To study the expressions and clinical significances of PCNA, EGFR, Bcl-2 and Bax in thymoma. Methods: The expressions of EGFR, PCNA, Bcl-2 and Bax in 46 cases of thymoma and 11 cases of normal thymus were de...Objective:To study the expressions and clinical significances of PCNA, EGFR, Bcl-2 and Bax in thymoma. Methods: The expressions of EGFR, PCNA, Bcl-2 and Bax in 46 cases of thymoma and 11 cases of normal thymus were detected with S-P immunohistochemistry. The results were analyzed with the pathologic indexes. Results: The positive rates of EGFR, Bcl-2 and Bax in normal thymus were 18. 2%, 9. 1%,and 18.2% respectively, while in thymoma were 71.7%, 41.3%, and 15.2% separately. The expression of EGFR in thymoma was significantly correlated with Masaoka staging and Levine classification. The survival rate of EGFR negative patients was significantly higher thanthat of EGFR positive patients (P＜0. 01). PCNA labelling index was significantly higher in thymoma as (4.00±1.87)% than in normal thymus, (2.68±0. 62)% , which was significantly correlated with Levine classification. The expression of Bcl-2 in thymoma was also significantly correlated with Levine classification. The survival rate of Bcl-2 negative patients was significantly higher than that of Bcl-2 positive patients (P＜0. 01). The expression of PCNA, EGFR, Bcl-2and Bax in thymoma had no correlation with histologic type and myasthenia gravis (MG) (P＞0. 05). Conclusion: The expression of EGFR may be involved in the occurrence and development of thymoma. EGFR can be regarded as a supplementary predictor for Masaoka staging so as to predict the progression accurately.The expression of Bcl-2 may contribute to the occurrence of thymic carcinoma and Bcl-2 can be used as a biomarker identifying thymic carcinoma.展开更多
Background Manual segmentation of thymoma is an onerous,labor-intensive,and subjective task for radiologists.Accordingly,the development of an automatic and efficient method for thymoma segmentation can be valuable fo...Background Manual segmentation of thymoma is an onerous,labor-intensive,and subjective task for radiologists.Accordingly,the development of an automatic and efficient method for thymoma segmentation can be valuable for the early detection and diagnosis of this malignancy.Methods Three hundred and ten subjects were enrolled in this retrospective study and all underwent CECT scans.All the scans were manually labeled by four experienced radiologists.The successful application of convolution neural networks(CNNs)and Transformer in computer vision led us to propose a hybrid CNN–Transformer architecture,named transformer attention Net(TA-Net),that would allow the utilization of both local information from CNN features and the global information encoded by Transformers.U-Net was used as the basic structure and Transformers were inserted into convolution blocks in the encoder.In addition,attention gates were embedded in skip connections to highlight salient features.Comparison of the accuracy,intersection over Union(IoU),Dice score,and Boundary F1 contour matching score(BFScore)between the predicted segmentation and the manual labels were utilized to evaluate segmentation performance.Results For thymoma segmentation using TA-Net,the accuracy,Dice score,IoU,and BFScore were 92.49%,89.92%,83.80%,and 0.8945,respectively,and no significant differences were detected among tumor types and enhanced phases.Our proposed method achieved the best performance when compared with state-of-the-art methods.Conclusion The proposed method,which combines CNNs with Transformer,achives outstanding performance in thymoma segmentation compared with previous methods.TA-Net may provide consistent and reproducible delineation,thereby assisting radiologists in clinical applications.展开更多
文摘Background: Thymoma is an uncommon tumor without a widely accepted standard care to date. We aimed to investigate the clinicopathologic variables of patients with thymoma and identify possible predictors of survival and recurrence after initial resection.Methods: We retrospectively selected 307 patients with thymoma who underwent complete resection at the Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College(Beijing, China) between January 2003 and December 2014. The associations of patients' clinical characteristics with prognosis were estimated using Cox regression and Kaplan–Meier survival analyses.Results: During follow?up(median, 86 months; range, 24–160 months), the 5? and 10?year disease?free survival(DFS) rates were 84.0% and 73.0%, respectively, and the 5? and 10?year overall survival(OS) rates were 91.0% and 74.0%, respectively. Masaoka stage(P < 0.001), World Health Organization(WHO) histological classification(P < 0.001), and postoperative radiotherapy after initial resection(P = 0.006) were associated with recurrence(52/307, 16.9%). Multivariate analysis revealed that, after initial resection, WHO histological classification and Masaoka stage were independent predictors of DFS and OS. The pleura(25/52, 48.0%) were the most common site of recurrence, and locoregional recurrence(41/52, 79.0%) was the most common recurrence pattern. The recurrence pattern was an independent predictor of post?recurrence survival. Patients with recurrent thymoma who underwent repeated resec?tion had increased post?recurrence survival rates compared with those who underwent therapies other than surgery(P = 0.017).Conclusions: Masaoka stage and WHO histological classification were independent prognostic factors of thymoma after initial complete resection. The recurrence pattern was an independent predictor of post?recurrence survival. Locoregional recurrence and repeated resection of the recurrent tumor were associated with favorable prognosis.
文摘Thymoma and thymic carcinoma are rare epithelial tumors, which originate from the thymus gland. According to the World Health Organization there are "organotypic"(types A, AB, B1, B2, and B3) and "non-organotypic"(thymic carcinomas) thymomas. Type B3 thymomas are aggressive tumors, which can metastasize. Due to the rarity of these lesions, only 7 cases of extradural metastasis are described in the literature. We report the first and unique case of a man with cervical intradural B3 thymoma metastasis. A 46-year-old man underwent thymoma surgical removal. The year after the procedure he was treated for a parietal pleura metastasis. In 2006 he underwent cervical-dorsal extradural metastasis removal and C5-Th1 stabilization. Seven years after he came to our observation complaining left cervicobrachialgia and a reduction of strength of the left arm. He underwent a cervical spine magnetic resonance imaging, which showed a new lesion at the C5-C7 level. The patient underwent a surgery for the intradural B3 thymoma metastasis. Neurological symptoms improved although the removal was subtotal. He went through postoperative radiation therapy with further mass reduction. Spinal metastases are extremely rare. To date, only 7 cases of spinal extradural metastasis have been described in the literature. This is the first case of spinal intradural metastasis. Early individuation of these tumors and surgical treatment improve neurological outcome in patients with spinal cord compression. A multimodal treatment including neoadjuvant chemotherapy, surgery and postoperative radiation therapy seems to improve survival in patients with metastatic thymoma.
文摘Bleeding resulting from spontaneous rupture of the liver is an infrequent but potentially life threatening complication that may be associated with an underlying liver disease. A hepatocellular carcinoma or hepatic adenoma is frequently reported is such cases. However, hemoperitoneum resulting from a hepatic metastatic thymoma is extremely rare. Here, we present a case of a 62-year-old man with hypovolemic shock induced by ruptured hepatic metastasis from a thymoma. At the first hospital admission, the patient had a 45-mm anterior mediastinal mass that was eventually diagnosed as a type A thymoma. The mass was excised, and the patient was disease-free for 6 years. He experienced sudden-onset right upper quadrant pain and was again admitted to our hospital. We noted large hemoperitoneum with a 10-cm encapsulated mass in S5/8 and a 2.3-cm nodular lesion in the right upper quadrant of the abdomen. He was diagnosed with hepatic metastasis from the thymoma, and he underwent chemotherapy and surgical excision.
文摘Objective: Evaluation the role of neoadjuvant chemotherapy in invasive thymoma. Methods: 14 patients with invasive thymoma(Masaoka stage Ⅲ in 12 and Ⅳa in 2) were treated with neoadjuvant chemotherapy by CAVP for 3-4 cycles (cyclophosphamide 600mg/m2 D1, adramycin 30mg/m2 or epi-adramycin 40mg/m2 D1, vincristine 0.6mg/m2 D1 or vindestine 3mg/m2 D1、D8, cisplatin 30mg/m2 D1、2、3)。After chemotherapy, all patients underwent operation in 1-3 months. We performed 10 sternotomies and 4 anterolateral thoracotomies. Radiotherapy was administrated with total dose 50-60Gy in all patients except for those who were pathologically complete remission. The group was followed up by 6 months to 3 years. Results :After chemotherapy, 5 patients(35.7%) had a complete remission(CR) and 9 patients(64.3%) had a partial remission(PR)。At operation, 9 patients had radical resection and 5 had partial resection. Postoperative pathological examination found only fibrosis in 5 patients with CR by chemotherapy. All patients were still alive except 2 patients died from visceral metastasis after 18 months and 2 years respectively. Conclusion: Neoadjuvant chemotherapy can increase the resectability of stage Ⅲ and Ⅳa invasive thymoma. A longer follow-up and a larger number of patients are needed to determine the impact of this treatment on long-term survival.
文摘Ectopic hamartomatous thymoma is a rare,generally benign neoplasm that mainly arises in the lower neck region and is yet to be completely understood.Herein,we describe a case with two separate and sequential growing neoplasms for the first time,distinguished from other reported solitary cases.A 58-year-old Chinese male presented with a 6-month history of two nontender,self-palpated masses in the suprasternal region of his neck.Physical examination revealed two masses with diameters of 5 cm and 2 cm.Ultrasound examination 2 years ago revealed a hyperechoic mass with a fat-derived possibility.These two neoplasms were clinically diagnosed as lipomas without other radiological examinations and were completely excised.Microscopically,they were well circumscribed and characterized by admixture with spindle cells,epithelial nests,and adipocytes in variable amounts,without atypia or mitotic activity.Immunohistochemical staining revealed that both neoplasms showed a biphasic pattern,with an epithelial nature with strong and diffuse positive expression of cytokeratin(CK)and myoepithelial differentiation with CK5/6 and p63 positivity in the spindle cells.There was no evidence of recurrence after a 28-month follow-up period.In this report,we present a unique case of ectopic hamartomatous thymoma to show the existence of multiple tumors in this rare disease.We hope to raise the awareness of the possibility of this disease when the tumor rises in typical lower neck regions,especially when mixed soft tissue or fat components are shown by imaging examination.
文摘Thymoma is the most common neoplasm of the anterior mediastinum and accounts for one quarter of all mediastinal tumours and half of all anterior mediastinal masses. Pericardial effusion may be present in approximately 20% of cases. This report presents a patient with a previously diagnosed thymoma without surgical indication and with poor response to chemotherapy and radiotherapy who had a pericardial effusion that likely resulted from the malignancy dissemination to pericardium.
文摘The myasthenia gravis is an autoimmune disease which can be associated frequently with a thymoma and also with autoimmune pathologies. We report the case of a 64-year-old man affected an overlap syndrome corresponding to the association of autoimmune hepatitis (AIH) and primary biliary cirrhosis (PBC). He also presented concomitant myasthenia gravis and thymoma. The physical examination notes only a disturbed voice. The liver tests showed: alkaline phosphatase 600 U/l, alanine aminotransferase 1280 U/l, and aspartate aminotransferase 985 U/l. Viral serologies of hepatitis were all negative, as well as antinuclear, antimitochondrial and antismooth muscle antibodies. The diagnosis of an overlap syndrome was posed according to the biological and hepatic histhological results. An associated myasthenia was confirmed by the results of the EMG and the positivity of the anti-acetylcholine receptor antibody. A chest CT revealed a thymoma. The treatment consisted of ursodeoxycholic acid, prednisone, azathioprine and pyridostigmine. And the patient improved his voice and the liver function. Thymectomy was practiced without incidents.
文摘Background: Age is an important prognostic factor for thymoma;however, few studies have specifically focused on age-related survival outcomes in thymoma patients. This study explored the effect of age on the clinicopathological features and survival outcomes of thymoma patients. Methods: We reviewed the clinical data of 1984 chest thymoma patients from the Surveillance, Epidemiology, and End Results (SEER) database of the National Cancer Institute. In accordance with the World Health Organization age brackets, the patients were divided into young (group A, 0 - 44-year-old);middle-aged (group B, 45 - 59-year-old);old (group C, 60 - 74-year-old);and seniors (group D 75 - 84-year-old). Single-factor and multivariate analysis were performed using the Kaplan-Meier method, and a multivariate Cox regression model was generated to assess patient prognosis. Results: In total, 1984 patients were included. The median follow-up time was 156.0 months (range: 0 - 492 months). Group C (60 - 74-year-old) had the most patients (35.1%), and Group D had the fewest patients (12.3%). Among all age groups, the proportion of white people and men with thymoma increased with age, while the proportion of black people and women showed a downward trend. Univariate and multivariate analyses showed that the overall survival rate of thymoma patients was negatively correlated with age. The overall survival times of the four groups were significantly different (p Conclusion: Age is an important prognostic factor for survival in thymoma patients, and younger patients have a survival advantage over older patients.
文摘A Pleural mass biopsy was performed showing an invasive thymoma. Computed tomography (CT) scan of the chest performed on admission revealed a left sided pleural mass, anterior mediastinal mass, lymphadenopathy and pericardial effusion. Pleural mass biopsy showed an invasive thymoma. Due to her clinical presentation, a complete work-up was performed revealing paraneoplastic systemic lupus erythematous (SLE), myasthenia gravis (MG) and hypogammaglobulinemia. We reviewed the literature regarding thymoma and its relationship with paraneoplastic SLE, MG and hypogammaglobulinemia.
文摘The congenital thymic cysts are rare. They have a congenital origin and they are benign. The differential diagnosis of acquired cysts, cystic thymoma and thymic malignancies in cystic degeneration can be particularly difficult. Rarely, they assume clinical relevance for the appearance of symptoms of compression, more typical of malignant lesions, and the association with thymoma was reported in very few cases in literature. For all these features, treatment strategy remains controversial and in particular surgical approach. We report a case of a huge symptomatic congenital thymic cyst, surgically removed with histological finding of microscopic thymoma.
文摘Thymomas are the most common neoplasms of the mediastinum. It is common that thymoma invades neighboring structures in the thorax, but direct polypoid tumor growth into the airway is extremely rare. We report a rare case of invasive thymoma with polypoid endobronchial growth in a 66-year-old woman. Computed tomography demonstrated an anterior mediastinal tumor which extended into the right upper lobe. Endoscopic examination revealed a polypoid tumor which occluded the right upper bronchus. A biopsy specimen obtained from the intraluminal mass was very suggestive of thymoma. The patient had no parathymic syndrome. The tumor was resected with the right upper lobe. The final post-operative tissue findings confirmed a type B2 thymoma of the World Health Organisation classification.
文摘Complete resection could be achieved in virtually all myasthenic patients with Masaoka stage Ⅰ and Ⅱ thymoma using the trans-sternal technique.Whether this is appropriate for minimally invasive approach is not yet clear.We evaluated the feasibility of complete video-assisted thoracoscopic surgery (VATS) thymectomy for the treatment of Masaoka stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis,compared to conventional trans-sternal thymectomy.We summarized 33 patients with Masaoka stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis between April 2006 and September 2011.Of these,15 patients underwent right-sided complete VATS (the VATS group) by using adjuvant pneuomomediastinum,comparing with 18 patients using the trans-sternal approach (the T3b group).No intraoperative death was found and no VATS case required conversion to median sternotomy.Significant differences between the two groups regarding duration of surgery and volume of intraoperative blood loss (P=0.001 and P < 0.001,respectively) were observed.Postoperative morbidities were 26.7% and 33.3% for the VATS and T3b groups,respectively.All 33 patients were followed up for 12 to 61 months in the study.The cumulative probabilities of reaching complete stable remission and effective rate were 26.7% (4/15) and 93.3% (14/15) in the VATS group,which had a significantly higher complete stable remission and effective rate than those in the T3b group (P=0.026 and P=0.000,respectively).We conclude that VATS thymectomy utilizing adjuvant pneuomomediastinum for the treatment of stage Ⅰ and Ⅱ thymoma-associated myasthenia gravis is technically feasible but deserves further investigation in a large series with long-term follow-up.
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This work was supported by a grant from the Scientific Foundation of Liaoning Province(No. 20042088).
文摘Objective: β-catenin is closely associated with proliferation, differentiation, invasion and metastasis of tumor cells. C-myc is proved to be abnormally expressed in various kinds of malignant neoplasmas. This study is aimed to investigate the features of β-catenin and C-myc expressions in thymoma and the corresponding clinical significance. Method: Immunochemistry was used to detect the features of expressions of β-catenin and C-myc in thymoma and normal thymus. Of the 105 samples, according to Beratz classification, there were: epithelial type 34; lymphocyte type 35; mixed type 31 and shuttle cell type 5. According to Masaoka classification, there were: stage 1: 38; stage 2: 32; stage 3: 20 and stage 4: 15. According to WHO classification, there were: type A 20; type AB 19; type B1 21; type B2 17; type B3 13 and type C 15. Results: Different ways of expression was revealed in different stages of thymomas. With the progress of thymoma, the expression of β-catenin on cell membrane decreased, while increased in cytoplasma and nucleus, even with nucleus shift. The expression of C-myc increased in invasive thymoma. Abnormal expression of β-catenin and C-myc increased, with significant difference(P<0.05). Conclusion: The different ways of expression and diversity of expression level may indicate the biological characters of thymoma, and could be used as an objective index for invasive thymoma.
文摘Autoimmune hepatitis(AIH) has rarely been described as an autoimmune paraneoplastic syndrome of thymoma.This case is the seventh case of AIH revealed by cholestasis few years after the diagnosis of thymoma and the first case treated with chemotherapy alone.We report in this paper a new approach to this rare severe condition.A 29 year-old man presented with chest pain and dyspnea with a history of thymoma surgically removed 4 years ago.CT scan showed the recurrence of an anterior mediastinal mass.Biology showed elevated liver enzymes and profound cholestasis.No sign of viral or toxic hepatitis or bile duct abnormalities were observed.Autoimmune antibodies,except for the anti-nuclear antibody,were negative.Liver biopsy showed active chronic AIH.The patient was diagnosed with recurrent thymoma with AIH and underwent 6 cycles of chemotherapy.A complete response on thymoma and cholestasis was obtained after 10 months of follow-up.Steroids and immunosuppressors are the standard treatment for AIH.The effect of chemotherapy as a specific treatment of this paraneoplastic syndrome needs to be considered.
基金Supported by the Key Provincial Talents Program of Jiangsu Province(H201126)the Natural Science Fund for Colleges and Universities of Jiangsu Province(09KJB320015)+1 种基金Key Projects in the National Science&Technology Pillar Program(2008BAI61B02 and 2008ZX09312-026)the Priority Academic Program Development of Jiangsu Higher Education Institutions
文摘THYMOMA,a relatively rare epithelial neoplasm with unique clinical and pathologic features,is the most usual diagnosis for a mass located in the mediastinum.It is often associated with autoimmune disorders.The myasthenia gravis and pure red cell aplasia are the most common disorders,with the incidences of 40%and 5%,respectively,while the incidence of aplastic anemia is only about 0-1.4%.1Thymectomy is hard to perform on patients with severe aplastic anemia
文摘Objective: To explore the prognostic factors influencing the long term survival rate of thymoma after resection. Methods: Sixty nine patients with thymoma surgically treated in our department from 1973 to 2000 were retrospectively studied. The possible prognostic factors were analyzed by univariate analysis and multivariate analysis with Kaplan Meiter method and Cox proportional hazard model respectively. Results: Overall patients survival rates were 83.3%, 67.4%, 48.3% at 5, 10, 15 years. The significant prognostic factors ( P <0 05) demonstrated by univariate analysis included age, Masaoka staging, WHO histological classification, resection method and Rosai/Levine classification. According to multivariate analysis, the independent prognostic factors included Masaoka stage ( P <0 01), resection method ( P <0 05) and age ( P <0 05). Conclusion: Complete surgical resection of thymomas helps increase the long term survival rate.
文摘Objective: To explore the postoperative clinical characteristics and outcomes of myasthenia gravis with and without thymoma. Methods: Two hundred and forty-three patients with myasthenia gravis(MG) surgically treated in our department from 1978 to 2003 were studied retrospectively. The clinical characteristics, complication, remissions and survival rates were compared between MG with and without thymoma. Results: The patients of MG with thymoma were significantly older (P<0.01), had shorter duration of symptom(P<0.01), and higher myasthenia crisis rates after operation(P<0.01) than those without thymoma. No difference of Osserman classification was found between the 2 groups. The complete remission rates and partial remission rates of MG with thymoma were significantly lower than those without thymoma at 1 and 3 years(P=0.049, P=0.000, P=0.015, P=0.010), but no differences at 5 years(P=0.457, P=0.699). The survival rates were lower in MG with thymoma than without thymoma(Log rank=18.58,P=0.000). Conclusion: The clinical characteristics are different between MG with and without thymoma. The remission of symptom of MG with thymoma is worse than that of MG without thymoma in the near future, but similar in the long future. In a long-term, the death rate of MG with thymoma is significantly higher than that of MG without thymoma.
文摘Objective:To study the expressions and clinical significances of PCNA, EGFR, Bcl-2 and Bax in thymoma. Methods: The expressions of EGFR, PCNA, Bcl-2 and Bax in 46 cases of thymoma and 11 cases of normal thymus were detected with S-P immunohistochemistry. The results were analyzed with the pathologic indexes. Results: The positive rates of EGFR, Bcl-2 and Bax in normal thymus were 18. 2%, 9. 1%,and 18.2% respectively, while in thymoma were 71.7%, 41.3%, and 15.2% separately. The expression of EGFR in thymoma was significantly correlated with Masaoka staging and Levine classification. The survival rate of EGFR negative patients was significantly higher thanthat of EGFR positive patients (P＜0. 01). PCNA labelling index was significantly higher in thymoma as (4.00±1.87)% than in normal thymus, (2.68±0. 62)% , which was significantly correlated with Levine classification. The expression of Bcl-2 in thymoma was also significantly correlated with Levine classification. The survival rate of Bcl-2 negative patients was significantly higher than that of Bcl-2 positive patients (P＜0. 01). The expression of PCNA, EGFR, Bcl-2and Bax in thymoma had no correlation with histologic type and myasthenia gravis (MG) (P＞0. 05). Conclusion: The expression of EGFR may be involved in the occurrence and development of thymoma. EGFR can be regarded as a supplementary predictor for Masaoka staging so as to predict the progression accurately.The expression of Bcl-2 may contribute to the occurrence of thymic carcinoma and Bcl-2 can be used as a biomarker identifying thymic carcinoma.
基金supported by the National Natural Science Foundation of China (Grant No.82172023)the Natural Science Basic Research Program of Shaanxi (Grant Nos.2022JC-44 and 2022JQ-622)+1 种基金the National Clinical Research Center for Digestive Diseases (Grant No.2015BAI13B07)the Intramural Research Program of the National Institute on Alcoholism and Alcohol Abuse (Grant Nos.Y1AA3009 to P.M.,D.T.,N.D.V.,and G.J.W.).
文摘Background Manual segmentation of thymoma is an onerous,labor-intensive,and subjective task for radiologists.Accordingly,the development of an automatic and efficient method for thymoma segmentation can be valuable for the early detection and diagnosis of this malignancy.Methods Three hundred and ten subjects were enrolled in this retrospective study and all underwent CECT scans.All the scans were manually labeled by four experienced radiologists.The successful application of convolution neural networks(CNNs)and Transformer in computer vision led us to propose a hybrid CNN–Transformer architecture,named transformer attention Net(TA-Net),that would allow the utilization of both local information from CNN features and the global information encoded by Transformers.U-Net was used as the basic structure and Transformers were inserted into convolution blocks in the encoder.In addition,attention gates were embedded in skip connections to highlight salient features.Comparison of the accuracy,intersection over Union(IoU),Dice score,and Boundary F1 contour matching score(BFScore)between the predicted segmentation and the manual labels were utilized to evaluate segmentation performance.Results For thymoma segmentation using TA-Net,the accuracy,Dice score,IoU,and BFScore were 92.49%,89.92%,83.80%,and 0.8945,respectively,and no significant differences were detected among tumor types and enhanced phases.Our proposed method achieved the best performance when compared with state-of-the-art methods.Conclusion The proposed method,which combines CNNs with Transformer,achives outstanding performance in thymoma segmentation compared with previous methods.TA-Net may provide consistent and reproducible delineation,thereby assisting radiologists in clinical applications.
