Sandbox Thymoma staging: Difference between revisions

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Latest revision as of 12:10, 28 August 2015

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2]

Overview

Staging of thymic epithelial tumors was initially proposed by Bergh and his colleagues in 1978,^[1] modified by Wilkins and Castleman in 1979,^[2] and advanced by Masaoka et al. in 1981.^[3]^[4] Modified Masaoka staging grouped with TNM classification is the most widely adopted system for thymic epithelial tumors currently in use.

Modified Masaoka Clinical Staging of Thymoma

*Modified Masaoka Clinical Staging of Thymoma (1994)*^[5]
Stage	Description
I	Macroscopically and microscopically completely encapsulated
II	A. Microscopic transcapsular invasion B. Macroscopic invasion into surrounding fatty tissue or grossly adherent to but not through mediastinal pleura or pericardium
III	Macroscopic invasion into neighboring organs (ie, pericardium, great vessels, lung) A. Without invasion of great vessels B. With invasion of great vessels
IV	A. Pleural or pericardial dissemination B. Lymphogenous or hematogenous metastasis

TNM Classification of Thymic Epithelial Tumors

*TNM Classification of Thymic Epithelial Tumors by Yamakawa and Masaoka (1991)*^[6]
T/N/M Stage		Description
T factor	T1	Macroscopically completely encapsulated and microscopically no capsular invasion
	T2	Macroscopically adhesion or invasion into surrounding fatty tissue or mediastinal pleura, or microscopic invasion into capsule
	T3	Invasion into neighboring organs, such as pericardium, great vessels, and lung
	T4	Pleural or pericardial dissemination
N factor	N0	No lymph node metastasis
	N1	Metastasis to anterior mediastinal lymph nodes
	N2	Metastasis to intrathoracic lymphnodes except anterior mediastinal lymph nodes
	N3	Metastasis to extrathoracic lymphnodes
M factor	M0	No hematogenous metastasis
	M1	Hematogenous metastasis

*Combined Masaoka Staging/TNM Classification (1994)*^[7]
Masaoka Stage	T factor	N factor	M factor
Stage I	T1	N0	M0
Stage II	T2	N0	M0
Stage III	T3	N0	M0
Stage IVa	T4	N0	M0
Stage IVb	Any T	N1, N2, or N3	M0
Stage IVb	Any T	Any N	M1

Previously Reported Staging System

*Masaoka Staging (1981)*^[3]
Stage	Description
I	Macroscopically completely encapsulated and microscopically no capsular invasion
II	1. Macroscopic invasion into surrounding fatty tissue or mediastinal pleura 2. Microscopic invasion into capsule
III	Macroscopic invasion into neighboring organ (ie, pericardium, great vessels, or lung)
IVa	Pleural or pericardial dissemination
IVb	Lymphogenous or hematogenous metastasis

*Clinical Staging by Bergh (1978) and Wilkins (1979)*^[1]^[2]
Author	Stage	Description
Bergh et al.	I	Intact capsule or growth within the capsule
	II	Pericapsular growth into the mediastinal fat tissue
	III	Invasive growth into the surrounding organs and/or intrathoracic metastases
Wilkins et al.	I	Intact capsule or growth within the capsule
	II	Pericapsular growth into the mediastinal fat tissue or adjacent pleura or pericardium
	III	Invasive growth into the surrounding organs and/or intrathoracic metastases

References

↑ ^1.0 ^1.1 Bergh, NP.; Gatzinsky, P.; Larsson, S.; Lundin, P.; Ridell, B. (1978). "Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas". Ann Thorac Surg. 25 (2): 91–8. PMID 626543. Unknown parameter |month= ignored (help)
↑ ^2.0 ^2.1 Wilkins, EW.; Castleman, B. (1979). "Thymoma: a continuing survey at the Massachusetts General Hospital". Ann Thorac Surg. 28 (3): 252–6. PMID 485626. Unknown parameter |month= ignored (help)
↑ ^3.0 ^3.1 Masaoka, A.; Monden, Y.; Nakahara, K.; Tanioka, T. (1981). "Follow-up study of thymomas with special reference to their clinical stages". Cancer. 48 (11): 2485–92. PMID 7296496. Unknown parameter |month= ignored (help)
↑ Kondo, K. (2005). "Invited commentary". Ann Thorac Surg. 80 (6): 2000–1. doi:10.1016/j.athoracsur.2005.08.053. PMID 16305832. Unknown parameter |month= ignored (help)
↑ Masaoka, A.; Yamakawa, Y.; Niwa, H.; Fukai, I.; Saito, Y.; Tokudome, S.; Nakahara, K.; Fujii, Y. (1994). "Thymectomy and malignancy". Eur J Cardiothorac Surg. 8 (5): 251–3. PMID 8043287.
↑ Yamakawa, Y.; Masaoka, A.; Hashimoto, T.; Niwa, H.; Mizuno, T.; Fujii, Y.; Nakahara, K. (1991). "A tentative tumor-node-metastasis classification of thymoma". Cancer. 68 (9): 1984–7. PMID 1913546. Unknown parameter |month= ignored (help)
↑ Tsuchiya, R.; Koga, K.; Matsuno, Y.; Mukai, K.; Shimosato, Y. (1994). "Thymic carcinoma: proposal for pathological TNM and staging". Pathol Int. 44 (7): 505–12. PMID 7921194. Unknown parameter |month= ignored (help)

[Bergh-1978-1] 1.0 ^1.1 Bergh, NP.; Gatzinsky, P.; Larsson, S.; Lundin, P.; Ridell, B. (1978). "Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas". Ann Thorac Surg. 25 (2): 91–8. PMID 626543. Unknown parameter |month= ignored (help)

[Wilkins-1979-2] 2.0 ^2.1 Wilkins, EW.; Castleman, B. (1979). "Thymoma: a continuing survey at the Massachusetts General Hospital". Ann Thorac Surg. 28 (3): 252–6. PMID 485626. Unknown parameter |month= ignored (help)

[Masaoka-1981-3] 3.0 ^3.1 Masaoka, A.; Monden, Y.; Nakahara, K.; Tanioka, T. (1981). "Follow-up study of thymomas with special reference to their clinical stages". Cancer. 48 (11): 2485–92. PMID 7296496. Unknown parameter |month= ignored (help)

[Kondo-2005-4] Kondo, K. (2005). "Invited commentary". Ann Thorac Surg. 80 (6): 2000–1. doi:10.1016/j.athoracsur.2005.08.053. PMID 16305832. Unknown parameter |month= ignored (help)

[Masaoka-1994-5] Masaoka, A.; Yamakawa, Y.; Niwa, H.; Fukai, I.; Saito, Y.; Tokudome, S.; Nakahara, K.; Fujii, Y. (1994). "Thymectomy and malignancy". Eur J Cardiothorac Surg. 8 (5): 251–3. PMID 8043287.

[Yamakawa-1991-6] Yamakawa, Y.; Masaoka, A.; Hashimoto, T.; Niwa, H.; Mizuno, T.; Fujii, Y.; Nakahara, K. (1991). "A tentative tumor-node-metastasis classification of thymoma". Cancer. 68 (9): 1984–7. PMID 1913546. Unknown parameter |month= ignored (help)

[Tsuchiya-1994-7] Tsuchiya, R.; Koga, K.; Matsuno, Y.; Mukai, K.; Shimosato, Y. (1994). "Thymic carcinoma: proposal for pathological TNM and staging". Pathol Int. 44 (7): 505–12. PMID 7921194. Unknown parameter |month= ignored (help)

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[2]

[3]

[4]

[5]

[6]

[7]

@@ Line 5: / Line 5: @@
 ==Overview==
-Staging of thymic epithelial tumors was initially proposed by Bergh and his colleagues in 1978,<ref name="Bergh-1978">{{Cite journal  | last1 = Bergh | first1 = NP. | last2 = Gatzinsky | first2 = P. | last3 = Larsson | first3 = S. | last4 = Lundin | first4 = P. | last5 = Ridell | first5 = B. | title = Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas. | journal = Ann Thorac Surg | volume = 25 | issue = 2 | pages = 91-8 | month = Feb | year = 1978 | doi =  | PMID = 626543 }}</ref> modified by Wilkins and Castleman in 1979,<ref name="Wilkins-1979">{{Cite journal  | last1 = Wilkins | first1 = EW. | last2 = Castleman | first2 = B. | title = Thymoma: a continuing survey at the Massachusetts General Hospital. | journal = Ann Thorac Surg | volume = 28 | issue = 3 | pages = 252-6 | month = Sep | year = 1979 | doi =  | PMID = 485626 }}</ref> and advanced by Masaoka et al. in 1981 and became widely adopted.<ref name="Masaoka-1981">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Monden | first2 = Y. | last3 = Nakahara | first3 = K. | last4 = Tanioka | first4 = T. | title = Follow-up study of thymomas with special reference to their clinical stages. | journal = Cancer | volume = 48 | issue = 11 | pages = 2485-92 | month = Dec | year = 1981 | doi =  | PMID = 7296496 }}</ref><ref name="Kondo-2005">{{Cite journal  | last1 = Kondo | first1 = K. | title = Invited commentary. | journal = Ann Thorac Surg | volume = 80 | issue = 6 | pages = 2000-1 | month = Dec | year = 2005 | doi = 10.1016/j.athoracsur.2005.08.053 | PMID = 16305832 }}</ref> In 1999, World Health Organization (WHO) proposed
+Staging of thymic epithelial tumors was initially proposed by Bergh and his colleagues in 1978,<ref name="Bergh-1978">{{Cite journal  | last1 = Bergh | first1 = NP. | last2 = Gatzinsky | first2 = P. | last3 = Larsson | first3 = S. | last4 = Lundin | first4 = P. | last5 = Ridell | first5 = B. | title = Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas. | journal = Ann Thorac Surg | volume = 25 | issue = 2 | pages = 91-8 | month = Feb | year = 1978 | doi =  | PMID = 626543 }}</ref> modified by Wilkins and Castleman in 1979,<ref name="Wilkins-1979">{{Cite journal  | last1 = Wilkins | first1 = EW. | last2 = Castleman | first2 = B. | title = Thymoma: a continuing survey at the Massachusetts General Hospital. | journal = Ann Thorac Surg | volume = 28 | issue = 3 | pages = 252-6 | month = Sep | year = 1979 | doi =  | PMID = 485626 }}</ref> and advanced by Masaoka et al. in 1981.<ref name="Masaoka-1981">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Monden | first2 = Y. | last3 = Nakahara | first3 = K. | last4 = Tanioka | first4 = T. | title = Follow-up study of thymomas with special reference to their clinical stages. | journal = Cancer | volume = 48 | issue = 11 | pages = 2485-92 | month = Dec | year = 1981 | doi =  | PMID = 7296496 }}</ref><ref name="Kondo-2005">{{Cite journal  | last1 = Kondo | first1 = K. | title = Invited commentary. | journal = Ann Thorac Surg | volume = 80 | issue = 6 | pages = 2000-1 | month = Dec | year = 2005 | doi = 10.1016/j.athoracsur.2005.08.053 | PMID = 16305832 }}</ref> Modified Masaoka staging grouped with TNM classification is the most widely adopted system for thymic epithelial tumors currently in use.
-*There is no universally accepted system; no AJCC staging exists.
-*Historically, a classifiaction system used both histological features and clinical behavior.
-*Masaoka staging is the clinically used staging system, although it may not be predictive for thymic carcinoma.
-*GETT staging is the surgical staging system, and may have better correlation with outcome.
-*A meta-analysis from UCLA suggests that evaluation of transcapsular extension (Stage I vs. Stage IIa) is of no clinical value, as they have same DFS and OS outcomes.
-==GETT Staging==
-*Stage IA - Encapsulated, completely resected.
-*Stage IB - Macroscopically completely resected but suspicion of mediastinal adhesions or potential capsular invasion at surgery.
-*Stage II - Invasive tumor, completely resected.
-*Stage IIIA - Invasive tumor, subtotal resection.
-*Stage IIIB - Invasive tumor, biopsy alone.
-*Stage IVa - Supraclav or pleural met.
-*Stage IVb - Distant metastases.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Seventeen years of surgical treatmen... [Eur J Cardiothorac Surg. 1991] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/2025438 | publisher =  | date =  | accessdate = }}</ref>
-==Previously Reported Staging and Classification==
-WHO Rosai
-<ref>{{Cite book  | last1 = Rosai | first1 = Juan | last2 = Sobin | first2 = L. H. | title = Histological typing of tumours of the thymu | date = 1999 | publisher = Springer | location = Berlin ; New York | isbn = 3-540-65731-2 | pages =  }}</ref>
+==Modified Masaoka Clinical Staging of Thymoma==
 {| style="border: 2px solid #696969;" align="center"
-|+ <SMALL>''Modified Masaoka Clinical Staging of Thymoma (1994)''
+|+ <SMALL>''Modified Masaoka Clinical Staging of Thymoma (1994)''<ref name="Masaoka-1994">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Yamakawa | first2 = Y. | last3 = Niwa | first3 = H. | last4 = Fukai | first4 = I. | last5 = Saito | first5 = Y. | last6 = Tokudome | first6 = S. | last7 = Nakahara | first7 = K. | last8 = Fujii | first8 = Y. | title = Thymectomy and malignancy. | journal = Eur J Cardiothorac Surg | volume = 8 | issue = 5 | pages = 251-3 | month =  | year = 1994 | doi =  | PMID = 8043287 }}</ref></SMALL>
-</SMALL>
 ! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 15px;" | '''Stage'''
 ! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 600px;" | '''Description'''
 |-
-| style="background: #F0F0F0;" align=center | '''I''' || Grossly and microscopically completely encapsulated
+| style="background: #F0F0F0;" align=center | '''I''' || Macroscopically and microscopically completely encapsulated
-|-
-| style="background: #F0F0F0;" align=center | '''II1''' || Microscopic transcapsular invasion
-|-
-| style="background: #F0F0F0;" align=center | '''II2''' || Macroscopic invasion into thymic or surrounding fatty tissue, or grossly adherent to but not breaking <BR> through mediastinal pleura or pericardium
 |-
-| style="background: #F0F0F0;" align=center | '''III''' || Macroscopic invasion of neighboring organ (i.e., pericardium, great vessel, or lung)
+| style="background: #F0F0F0;" align=center | '''II''' || A. Microscopic transcapsular invasion <BR> B. Macroscopic invasion into surrounding fatty tissue or grossly adherent to but not through <BR> mediastinal pleura or pericardium
 |-
-| style="background: #F0F0F0;" align=center | '''IVa''' || Pleural or pericardial dissemination
+| style="background: #F0F0F0;" align=center | '''III''' || Macroscopic invasion into neighboring organs (ie, pericardium, great vessels, lung) <BR> A. Without invasion of great vessels <BR> B. With invasion of great vessels
 |-
-| style="background: #F0F0F0;" align=center | '''IVb''' || Lymphatic or hematogenous metastasis
+| style="background: #F0F0F0;" align=center | '''IV''' || A. Pleural or pericardial dissemination <BR> B. Lymphogenous or hematogenous metastasis
 |-
 |}
-{| style="border: 2px solid #696969;" align="center"
+==TNM Classification of Thymic Epithelial Tumors==
-|+ <SMALL>''Combined Masaoka Staging/TNM Classification (1994)''<ref name="Tsuchiya-1994">{{Cite journal  | last1 = Tsuchiya | first1 = R. | last2 = Koga | first2 = K. | last3 = Matsuno | first3 = Y. | last4 = Mukai | first4 = K. | last5 = Shimosato | first5 = Y. | title = Thymic carcinoma: proposal for pathological TNM and staging. | journal = Pathol Int | volume = 44 | issue = 7 | pages = 505-12 | month = Jul | year = 1994 | doi =  | PMID = 7921194 }}</ref></SMALL>
-! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 150px;" | '''Masaoka Stage'''
-! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 150px;" | '''T factor'''
-! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 150px;" | '''N factor'''
-! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 150px;" | '''M factor'''
-|-
-| style="background: #F0F0F0;" align=center | '''Stage I''' ||align=center| T1 ||align=center| N0 ||align=center| M0
-|-
-| style="background: #F0F0F0;" align=center | '''Stage II''' ||align=center| T2 ||align=center| N0 ||align=center| M0
-|-
-| style="background: #F0F0F0;" align=center | '''Stage III''' ||align=center| T3 ||align=center| N0 ||align=center| M0
-|-
-| style="background: #F0F0F0;" align=center | '''Stage IVa''' ||align=center| T4 ||align=center| N0 ||align=center| M0
-|-
-| style="background: #F0F0F0;" align=center rowspan=2 | '''Stage IVb''' ||align=center| Any T ||align=center| N1, N2, or N3 ||align=center| M0
-|-
-|align=center| Any T ||align=center| Any N ||align=center| M1
-|-
-|}
 {| style="border: 2px solid #696969;" align="center"
-|+ <SMALL>''TNM Classification by Yamakawa and Masaoka (1991)''<ref name="Yamakawa-1991">{{Cite journal  | last1 = Yamakawa | first1 = Y. | last2 = Masaoka | first2 = A. | last3 = Hashimoto | first3 = T. | last4 = Niwa | first4 = H. | last5 = Mizuno | first5 = T. | last6 = Fujii | first6 = Y. | last7 = Nakahara | first7 = K. | title = A tentative tumor-node-metastasis classification of thymoma. | journal = Cancer | volume = 68 | issue = 9 | pages = 1984-7 | month = Nov | year = 1991 | doi =  | PMID = 1913546 }}</ref></SMALL>
+|+ <SMALL>''TNM Classification of Thymic Epithelial Tumors by Yamakawa and Masaoka (1991)''<ref name="Yamakawa-1991">{{Cite journal  | last1 = Yamakawa | first1 = Y. | last2 = Masaoka | first2 = A. | last3 = Hashimoto | first3 = T. | last4 = Niwa | first4 = H. | last5 = Mizuno | first5 = T. | last6 = Fujii | first6 = Y. | last7 = Nakahara | first7 = K. | title = A tentative tumor-node-metastasis classification of thymoma. | journal = Cancer | volume = 68 | issue = 9 | pages = 1984-7 | month = Nov | year = 1991 | doi =  | PMID = 1913546 }}</ref></SMALL>
 ! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px;" colspan=2 | '''T/N/M Stage'''
 ! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 520px;" | '''Description'''
@@ Line 103: / Line 55: @@
 |-
 |}
+{| style="border: 2px solid #696969;" align="center"
+|+ <SMALL>''Combined Masaoka Staging/TNM Classification (1994)''<ref name="Tsuchiya-1994">{{Cite journal  | last1 = Tsuchiya | first1 = R. | last2 = Koga | first2 = K. | last3 = Matsuno | first3 = Y. | last4 = Mukai | first4 = K. | last5 = Shimosato | first5 = Y. | title = Thymic carcinoma: proposal for pathological TNM and staging. | journal = Pathol Int | volume = 44 | issue = 7 | pages = 505-12 | month = Jul | year = 1994 | doi =  | PMID = 7921194 }}</ref></SMALL>
+! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 150px;" | '''Masaoka Stage'''
+! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 150px;" | '''T factor'''
+! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 150px;" | '''N factor'''
+! style="background: #F0F0F0; border: 0px solid #696969; padding: 0 5px; width: 150px;" | '''M factor'''
+|-
+| style="background: #F0F0F0;" align=center | '''Stage I''' ||align=center| T1 ||align=center| N0 ||align=center| M0
+|-
+| style="background: #F0F0F0;" align=center | '''Stage II''' ||align=center| T2 ||align=center| N0 ||align=center| M0
+|-
+| style="background: #F0F0F0;" align=center | '''Stage III''' ||align=center| T3 ||align=center| N0 ||align=center| M0
+|-
+| style="background: #F0F0F0;" align=center | '''Stage IVa''' ||align=center| T4 ||align=center| N0 ||align=center| M0
+|-
+| style="background: #F0F0F0;" align=center rowspan=2 | '''Stage IVb''' ||align=center| Any T ||align=center| N1, N2, or N3 ||align=center| M0
+|-
+|align=center| Any T ||align=center| Any N ||align=center| M1
+|-
+|}
+==Previously Reported Staging System==
@@ Line 144: / Line 121: @@
 ==References==
 {{reflist|2}}
-[[Category:Oncology]]
 [[Category:Types of cancer]]
 [[Category:Rare diseases]]
 [[Category:Disease]]