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{{Thymic carcinoma}}
{{Thymic carcinoma}}
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==Overview==
Thymic carcinomas may be classified according to a histological grading system into either low grade subtypes or high grade subtypes.<ref name="Suster-1991">{{Cite journal  | last1 = Suster | first1 = S. | last2 = Rosai | first2 = J. | title = Thymic carcinoma. A clinicopathologic study of 60 cases. | journal = Cancer | volume = 67 | issue = 4 | pages = 1025-32 | month = Feb | year = 1991 | doi =  | PMID = 1991250 }}</ref>. Primary thymic carcinomas are rare malignant neoplasms of the mediastinum, and combined thymic carcinomas are even less common. Although tumor stage is the single most important prognostic factor in thymoma, a combination of stage and histologic subtype should be considered in predicting survival.
 
==Classification==
 
*Thymic carcinomas may be classified according to a histological grading system into either low grade subtypes or high grade subtypes, which include:<ref name="Suster-1991">{{Cite journal  | last1 = Suster | first1 = S. | last2 = Rosai | first2 = J. | title = Thymic carcinoma. A clinicopathologic study of 60 cases. | journal = Cancer | volume = 67 | issue = 4 | pages = 1025-32 | month = Feb | year = 1991 | doi =  | PMID = 1991250 }}</ref>
 
:* '''Squamous cell carcinoma:''' 
 
:** This subtype of thymic carcinoma is the most common and exhibits atypia with a clear-cut aspect of [[keratinization]]  with [[Keratin 1|keratin]] pearls as seen in squamous cell carcinomas.
:** Squamous cell carcinoma lack of capsule and presents with [[necrosis]] and [[hemorrhage]].
 
:* '''Basaloid carcinoma:'''


==Overview==
:** This subtype consists of solid lobules of tumor cells with marginal palisading, without keratinization and a [[basophilic]] pattern due to an elevated [[nuclear]]:[[cytoplasmic]] ratio.


Thymic carcinomas are categorized in low and high grade histological subtypes, which includes Squamous cell carcinoma, Basaloid carcinoma, Mucoepidermoid carcinoma, Lymphoepithelioma-like carcinoma, Sarcomatoid carcinoma (carcinosarcoma),  Clear cell carcinoma, Papillary adenocarcinoma, Carcinoma with t(15;19) translocation, Neuroendrocrine carcinomas, Undifferentiated carcinoma and Combined thymic epithelial tumors.
:* '''Mucoepidermoid carcinoma:'''


==Classification==
:** The characteristic features for this rare subtype is the presence of [[squamous cell|squamous c]]<nowiki/>[[squamous cell|ell]]<nowiki/>s and [[mucus]] producing cell<nowiki/>s, with moderate nuclear atypia.
:** It has a mucinous macroscopic appearance.




* '''Squamous cell carcinoma:''' This subtype of thymic carcinoma is the most common and exhibits atypia with a clear-cut aspect of keratinization  with keratin pearls as seen in squamous cell carcinomas.  Squamous cell carcinoma lack of capsule and presents with necrosis and hemorrhage.
:* '''Lymphoepithelioma-like carcinoma:'''  
:** The morphology<nowiki/> of this subtype resembles the nasopharingeal lymphoepitelioma, with syncytial growth of undifferentiated malignant cells.


* '''Basaloid carcinoma:''' This subtype consists solid lobules of tumor cells with marginal palisading, without keratinization and a basophilic pattern due to an elevated nucleocytoplasmic ratio.
:* '''Sarcomatoid carcinoma (carcinosarcoma):'''
:** It is also known as [[spindle cell]] thymic carcinoma, is an infiltrative neoplasm with large areas of coagulative necrosis and without a capsule.
:** It is an uncommon  tumor that affects patients between 40-80 years old.


* '''Mucoepidermoid carcinoma:''' The characteristic features for this rare subtype is the presence of squamous and mucus producing cells, with moderate atypia.  It has a mucinous macroscopic appearance.
:* '''Clear cell carcinoma:'''  
:** Consist of cells with minimal nuclear atypia with a characteristic lucent [[cytoplasm]] and a lobulated architecture without sinusoidal [[vasculature]] (in contrast with the [[renal]] [[clear cell carcinoma]])


* '''Lymphoepithelioma-like carcinoma:''' The morphology of this subtype resembles the nasopharingeal lymphoepitelioma, with syncytial growth of undifferentiated malignant cells.
:* '''Papillary adenocarcinoma:'''  
:** It has a tubulopapillary pattern growth with cuboidal cells and [[Psammoma body|psammoma]] bodies may be present.
:** Type A thymoma may be the origin of this subtype of carcinoma due an expression of malignant transformation.


* '''Sarcomatoid carcinoma (carcinosarcoma):''' It is also known as spindle cell thymic carcinoma, is an infiltrative neoplasm with large areas of coagulative necrosis and without a capsule. It is an uncommon  tumor that affects patients between 40-80 years old.
:* '''Carcinoma with t(15;19) translocation:'''  
:** It is an aggressive tumor with a translocation t(15;19)(q13:p13.1 ) that has the characteristic presence of undifferentiated cells with high mitotic activity and squamous morphology.


* '''Clear cell carcinoma:''' Consist of cells with minimal nuclear atypia with a characteristic lucent cytoplasm and a lobulated architecture without sinusoidal vasculature (in contrast with the renal clear cell carcinoma)
:* '''Neuroendocrine Carcinomas:'''  
:** The neuroendocrine thymic carcinomas are classified in 4 categories: typical, atypical, small cell, and large cell carcinomas.
:*** The typical and atypical are categorized as well differentiated neuroendocrine carcinomas, and the small cell and large cell carcinomas are categorized as poorly differentiated.


* '''Papillary adenocarcinoma:''' It has a tubulopapillary pattern growth with cuboidal cells and Psammoma bodies may be present.  Type A thymoma may be the origin of this subtype of carcinoma due an expression of malignant transformation.


* '''Carcinoma with t(15;19) translocation:''' It is an aggressive tumor with a translocation t(15;19)(q13:p13.1 )that has the characteristic presence of undifferentiated cells with high mitotic activity and squamous morphology.
* The table below lists the histological classification of neuroendocrine carcinomas:<ref>Travis WD, Organization WH, Cancer IA et al. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. Diamond Pocket Books (P) Ltd.; 2004.</ref>


* '''Neuroendocrine Carcinomas:''' The neuroendocrine thymic carcinomas are classified in 4 categories: typical, atypical, small cell and large cell carcinomas.  The typical and atypical are categorized as well differentiated neuroendocrine carcinomas, and the small cell and large cell carcinomas are categorized as poor differentiated.
{| class="wikitable" border="1"
|-
! colspan="2" | Well Differentiated || colspan="2" | Poorly Differentiated
|-
| Typical Carcinoid || Atypical Carcinoid  ||  Small Cell || Large Cell 
|-
| No necrosis; <BR> <2 mitoses per 2 mm2 (10 HPF) || Necrosis present and/or <BR> 2-10 mitoses per 2 mm2 (10 HPF) ||  Small cell cytology || Non-small cell NEC with >10 <BR> mitoses per 2 mm2 (10 HPF)
|-
| colspan="2" | '''Morphological Variants''' <BR>  Spindle cell type <BR> Pigmented type <BR> With amyloid (extrathyroidal medullary carcinoma) <BR> Oncocytic/oxyphilic type <BR> Mucinous <BR> Angiomatoid type <BR> Combinations of the above variants || valign="top" |'''Variants''' <BR> SCNEC combined with Non-NECs || valign="top" | —
|-
|}
HPF: High power field, SCNEC: Small cell neuroendocrine carcinoma, NEC: Neuroendocrine carcinoma


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}


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Latest revision as of 18:40, 10 September 2019

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

Overview

Thymic carcinomas may be classified according to a histological grading system into either low grade subtypes or high grade subtypes.[1]. Primary thymic carcinomas are rare malignant neoplasms of the mediastinum, and combined thymic carcinomas are even less common. Although tumor stage is the single most important prognostic factor in thymoma, a combination of stage and histologic subtype should be considered in predicting survival.

Classification

  • Thymic carcinomas may be classified according to a histological grading system into either low grade subtypes or high grade subtypes, which include:[1]
  • Squamous cell carcinoma:
    • This subtype of thymic carcinoma is the most common and exhibits atypia with a clear-cut aspect of keratinization with keratin pearls as seen in squamous cell carcinomas.
    • Squamous cell carcinoma lack of capsule and presents with necrosis and hemorrhage.
  • Basaloid carcinoma:
    • This subtype consists of solid lobules of tumor cells with marginal palisading, without keratinization and a basophilic pattern due to an elevated nuclear:cytoplasmic ratio.
  • Mucoepidermoid carcinoma:
    • The characteristic features for this rare subtype is the presence of squamous cells and mucus producing cells, with moderate nuclear atypia.
    • It has a mucinous macroscopic appearance.


  • Lymphoepithelioma-like carcinoma:
    • The morphology of this subtype resembles the nasopharingeal lymphoepitelioma, with syncytial growth of undifferentiated malignant cells.
  • Sarcomatoid carcinoma (carcinosarcoma):
    • It is also known as spindle cell thymic carcinoma, is an infiltrative neoplasm with large areas of coagulative necrosis and without a capsule.
    • It is an uncommon tumor that affects patients between 40-80 years old.
  • Papillary adenocarcinoma:
    • It has a tubulopapillary pattern growth with cuboidal cells and psammoma bodies may be present.
    • Type A thymoma may be the origin of this subtype of carcinoma due an expression of malignant transformation.
  • Carcinoma with t(15;19) translocation:
    • It is an aggressive tumor with a translocation t(15;19)(q13:p13.1 ) that has the characteristic presence of undifferentiated cells with high mitotic activity and squamous morphology.
  • Neuroendocrine Carcinomas:
    • The neuroendocrine thymic carcinomas are classified in 4 categories: typical, atypical, small cell, and large cell carcinomas.
      • The typical and atypical are categorized as well differentiated neuroendocrine carcinomas, and the small cell and large cell carcinomas are categorized as poorly differentiated.


  • The table below lists the histological classification of neuroendocrine carcinomas:[2]
Well Differentiated Poorly Differentiated
Typical Carcinoid Atypical Carcinoid Small Cell Large Cell
No necrosis;
<2 mitoses per 2 mm2 (10 HPF)		 Necrosis present and/or
2-10 mitoses per 2 mm2 (10 HPF)		 Small cell cytology Non-small cell NEC with >10
mitoses per 2 mm2 (10 HPF)
Morphological Variants
Spindle cell type
Pigmented type
With amyloid (extrathyroidal medullary carcinoma)
Oncocytic/oxyphilic type
Mucinous
Angiomatoid type
Combinations of the above variants		 Variants
SCNEC combined with Non-NECs		 —

HPF: High power field, SCNEC: Small cell neuroendocrine carcinoma, NEC: Neuroendocrine carcinoma

References

  1. ↑ 1.0 1.1 Suster, S.; Rosai, J. (1991). "Thymic carcinoma. A clinicopathologic study of 60 cases". Cancer. 67 (4): 1025–32. PMID 1991250. Unknown parameter |month= ignored (help)
  2. ↑ Travis WD, Organization WH, Cancer IA et al. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. Diamond Pocket Books (P) Ltd.; 2004.
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