Thymic carcinoma overview: Difference between revisions
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==Surgery== | ==Surgery== | ||
Surgery is the mainstay of treatment for thymic carcinoma.<ref name=age>National Cancer Institute. General Information About Thymoma and Thymic Carcinoma Treatment. http://www.cancer.gov/types/thymoma/hp/thymoma-treatment-pdq. Accessed on 22nd December, 2015.</ref> | |||
==Primary Prevention== | ==Primary Prevention== | ||
There is no established method for prevention of thymic carcinoma. | There is no established method for prevention of thymic carcinoma. | ||
Revision as of 16:50, 4 January 2016
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Thymic Carcinoma Microchapters |
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Thymic carcinoma overview On the Web |
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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]
Overview
Thymic carcinoma, also known as type C thymoma, is a rare condition (less than 0.13/100,000/year) but should be included in the differential diagnosis of anterior mediastinic masses. It is a tumor of the thymic epithelium, like thymoma, but it is associated with lack of immature lymphocytes and often presents with more invasive or metastatic disease. Thymic carcinomas can metastasize, generally to pleura, kidney, bone, liver or brain
Pathophysiology
The thymic carcinoma is a tumor of the thymic epithelium, but it is associated with lack of immature lymphocytes and often presents with more invasive or metastatic disease.[1] The pathophysiology of thymic carcinoma depends on the histological subtype. On microscopic histopathological analysis, thymic carcinoma is divided into 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.[2] Thymic carcinoma has not been reported in association with myasthenia gravis, in contrast with thymoma[3]
Causes
The cause of thymic carcinoma has not been identified.
Differentiating Thymic carcinoma from other Diseases
The most common differential diagnosis of thymic carcinoma is thymoma, which is the most common pathology of the thymus. Thymic carcinoma must be differentiated from other mediastinal masses such as germ cell tumors, lymphoma, thyroid tumors, and metastatic carcinoma to mediastinal lymph nodes.[4]
Epidemiology and Demographics
The prevalence of thymic carcinoma is approximately 0.00006 per 100,000 individuals worldwide. Males are more commonly affected with thymic carcinoma than females. The male to female ratio is approximately 3 to 1. It is more common in Asians and African Americans than in Caucasians.
Risk Factors
There are no established risk factors for thymic carcinoma.[5]
Natural History, Complications and Prognosis
Thymic carcinomas are generally considered indolent tumors due to long recurrence intervals (median of 68 months). The most common sites of distant recurrence are lung, liver, bone, kidney, brain and bone marrow.[6] *The most important factor for prognosis is the stage and grade of the thymic carcinoma. The 5-year and 10-year overall survival rates in patients with thymic carcinoma are 38% and 28%, respectively. [7] The subtypes squamous cell carcinoma, mucoepidermoid and basaloid carcinoma have a better prognosis than other histological subtypes.
Staging
The staging of thymic carcinoma is based on the Masoka and GETT staging system.[8]
History and Symptoms
Symptoms of thymic carcinoma include dull chest pain, cough, dyspnea, and constitutional symptoms like fatigue, anorexia, weight loss, and malaise.
Physical Examination
The physical examination plays a limited role in the diagnosis of thymic carcinoma.
Laboratory Findings
There are no diagnostic lab findings associated with thymic carcinoma.
Chest X Ray
Chest x ray may be helpful in the diagnosis of thymic carcinoma.
CT
Chest CT scan may be helpful in the diagnosis of thymic carcinoma. On CT scan of the chest, thymic carcinoma is characterized by lobulated mass with irregular borders, heterogeneous attenuation and mediastinal fat invasion with areas of necrosis, haemorrhage, calcification, or cyst formation.
MRI
Chest MRI scan may be diagnostic of thymic carcinoma. Findings on chest MRI suggestive of thymic carcinoma include isointense to slightly hyperintense signal compared to muscle on T1 and heterogeneous signal on T2. On T1 C+ (GD) linear regions of enhancement may be seen coursing through the mass, thought to represent fibrous septae.[9]
Other Imaging Findings
Other imaging studies for thymic carcinoma include FDG PET scan. The standarized uptake value (SUV) in the FDG PET is much higher for the thymic carcinoma than thymoma, with a high sensitivity (84.6%) and specificity (92.3%).[10][11]
Other Diagnostic Studies
Other diagnostic studies for thymic carcinoma include immunohistochemistry.
Medical Therapy
The predominant therapy for thymic carcinoma is surgical resection. Adjunctive cisplatin-basedchemotherapy may be required.[12]
Surgery
Surgery is the mainstay of treatment for thymic carcinoma.[12]
Primary Prevention
There is no established method for prevention of thymic carcinoma.
Secondary Prevention
There are no secondary preventive measures available for thymic carcinoma.
References
- ↑ Thomas CR, Wright CD, Loehrer PJ (1999). "Thymoma: state of the art". Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 17 (7): 2280–9. PMID 10561285. Retrieved 2012-01-18. Unknown parameter
|month=ignored (help) - ↑ 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) - ↑ Harris, C.C (2004), Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart (PDF), Lyon: IARC, retrieved 01/03/2016 Check date values in:
|accessdate=(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.
- ↑ Engels, EA. (2010). "Epidemiology of thymoma and associated malignancies". J Thorac Oncol. 5 (10 Suppl 4): S260–5. doi:10.1097/JTO.0b013e3181f1f62d. PMID 20859116. Unknown parameter
|month=ignored (help) - ↑ "Recurrence of thymoma: clinicopathological feat... [J Surg Oncol. 2001] - PubMed - NCBI".
- ↑ Ogawa, K.; Toita, T.; Uno, T.; Fuwa, N.; Kakinohana, Y.; Kamata, M.; Koja, K.; Kinjo, T.; Adachi, G. (2002). "Treatment and prognosis of thymic carcinoma: a retrospective analysis of 40 cases". Cancer. 94 (12): 3115–9. doi:10.1002/cncr.10588. PMID 12115342. Unknown parameter
|month=ignored (help) - ↑ Masaoka A, Yamakawa Y, Niwa H, Fukai I, Saito Y, Tokudome S; et al. (1994). "Thymectomy and malignancy". Eur J Cardiothorac Surg. 8 (5): 251–3. PMID 8043287.
- ↑ Thymic epithelial tumours. Radiopaedia. http://radiopaedia.org/articles/thymic-epithelial-tumours. Accessed on 3rd January 2016.
- ↑ Template:Citejournal
- ↑ Thymic Carcinoma. Radiopaedia. http://radiopaedia.org/articles/thymic-carcinoma. Accessed on 3rd January 2016.
- ↑ 12.0 12.1 National Cancer Institute. General Information About Thymoma and Thymic Carcinoma Treatment. http://www.cancer.gov/types/thymoma/hp/thymoma-treatment-pdq. Accessed on 22nd December, 2015.