Thymic carcinoma classification: Difference between revisions
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==Classification== | ==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> | * 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 pearls as seen in squamous cell carcinomas. Squamous cell carcinoma lack of capsule and presents with necrosis and hemorrhage. | :* '''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:''' This subtype consists of solid lobules of tumor cells with marginal palisading, without keratinization and a basophilic pattern due to an elevated | :* '''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 and mucus producing cells, with moderate atypia. It has a mucinous macroscopic appearance. | :* '''Mucoepidermoid carcinoma:''' The characteristic features for this rare subtype is the presence of [[squamous cell]]<nowiki/>s 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. | :* '''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. | :* '''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. | ||
:* '''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) | :* '''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]]) | ||
:* '''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. | :* '''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. | ||
:* '''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. | :* '''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. | ||
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* 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> | * 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> | ||
{|class="wikitable" border="1" | {| class="wikitable" border="1" | ||
|- | |- | ||
! colspan=2 | Well Differentiated || colspan=2 | Poorly Differentiated | ! colspan="2" | Well Differentiated || colspan="2" | Poorly Differentiated | ||
|- | |- | ||
| Typical Carcinoid || Atypical Carcinoid || Small Cell || Large Cell | | Typical Carcinoid || Atypical Carcinoid || Small Cell || Large Cell | ||
| Line 35: | Line 35: | ||
| 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) | | 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 | — | | 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" | — | ||
|- | |- | ||
|} | |} | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Parminder Dhingra, M.D. [3]
Overview
Thymic carcinomas may be classified according to a histological grading system into either low grade subtypes or high grade subtypes.[1]
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.
- 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)
- 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
- ↑ 1.0 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) - ↑ 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.