Thymoma diagnostic study of choice: Difference between revisions

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== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
Investigations:
===Study of Choice===
* Posterior-anterior (PA) and lateral [[Chest X-ray|X-ray of the chest]] are helpful in diagnosing most of thymomas.
* Posterior-anterior (PA) and lateral [[Chest X-ray|X-ray of the chest]] are helpful in diagnosing most of thymomas.


Line 14: Line 14:
* Thallium 201 single photon emission computed tomography is useful to distinguish normal thymic tissue from hyperplastic tissue or thymoma  
* Thallium 201 single photon emission computed tomography is useful to distinguish normal thymic tissue from hyperplastic tissue or thymoma  
* Ultrasonically guided core needle biopsy is used to obtain larger tissue specimens for histological examination. Annessi and colleagues were able to diagnose thymoma in all patients that had undergone anterior mediastinal core [[needle biopsy]] by ultrasonic guidance with a [[sensitivity]] and [[specificity]] of 100%.
* Ultrasonically guided core needle biopsy is used to obtain larger tissue specimens for histological examination. Annessi and colleagues were able to diagnose thymoma in all patients that had undergone anterior mediastinal core [[needle biopsy]] by ultrasonic guidance with a [[sensitivity]] and [[specificity]] of 100%.
===Staging===
* The thymic epithelial tumor staging system 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 further developed 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.
====Modified Masaoka Clinical Staging of Thymoma====
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <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>
! style="background: #4479BA; color:#FFF;" | '''Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| style="background: #F0F0F0;" align="center" | '''I'''
| style="background: #F0F0F0;" | Macroscopically and microscopically completely encapsulated
|-
| style="background: #F0F0F0;" align="center" | '''II'''
| style="background: #F0F0F0;" | 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" | '''III'''
| style="background: #F0F0F0;" | 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" | '''IV'''
| style="background: #F0F0F0;" | A. Pleural or pericardial dissemination <BR> B. Lymphogenous or hematogenous metastasis
|-
|}
====TNM Classification of Thymic Epithelial Tumors====
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>''TNM Classification of Thymic Epithelial Tumors by Yamakawa and Masaoka (1991)''<ref name="pmid3621939">{{cite journal| author=Sinha Hikim AP, Hoffer AP| title=Quantitative analysis of germ cells and Leydig cells in rat made infertile with gossypol. | journal=Contraception | year= 1987 | volume= 35 | issue= 4 | pages= 395-408 | pmid=3621939 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3621939  }} </ref></SMALL>
! colspan="2" style="background: #4479BA; color:#FFF;" | '''T/N/M Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| rowspan="4" style="background: #F0F0F0; width:75px;" align="center" | '''T factor''' || style="background: #F0F0F0; width: 50px;" align="center" | '''T1'''
| style="background: #F0F0F0;" | Macroscopically completely encapsulated and microscopically no capsular invasion
|-
| style="background: #F0F0F0;" align="center" | '''T2'''
| style="background: #F0F0F0;" | Macroscopically adhesion or invasion into surrounding fatty tissue or mediastinal pleura, <BR> or microscopic invasion into capsule
|-
| style="background: #F0F0F0;" align="center" | '''T3'''
| style="background: #F0F0F0;" | Invasion into neighboring organs, such as pericardium, great vessels, and lung
|-
| style="background: #F0F0F0;" align="center" | '''T4'''
| style="background: #F0F0F0;" | Pleural or pericardial dissemination
|-
| rowspan="4" style="background: #F0F0F0;" align="center" | '''N factor''' || style="background: #F0F0F0;" align="center" | '''N0'''
| style="background: #F0F0F0;" | No lymph node metastasis
|-
| style="background: #F0F0F0;" align="center" | '''N1'''
| style="background: #F0F0F0;" | Metastasis to anterior mediastinal lymph nodes
|-
| style="background: #F0F0F0;" align="center" | '''N2'''
| style="background: #F0F0F0;" | Metastasis to intrathoracic lymphnodes except anterior mediastinal lymph nodes
|-
| style="background: #F0F0F0;" align="center" | '''N3'''
| style="background: #F0F0F0;" | Metastasis to extrathoracic lymphnodes
|-
| rowspan="4" style="background: #F0F0F0;" align="center" | '''M factor''' || style="background: #F0F0F0;" align="center" | '''M0'''
| style="background: #F0F0F0;" | No hematogenous metastasis
|-
| style="background: #F0F0F0;" align="center" | '''M1'''
| style="background: #F0F0F0;" | Hematogenous metastasis
|-
|}
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>''Combined Masaoka Staging/TNM Classification (1994)''<ref name="pmid7921194">{{cite journal| author=Tsuchiya R, Koga K, Matsuno Y, Mukai K, Shimosato Y| title=Thymic carcinoma: proposal for pathological TNM and staging. | journal=Pathol Int | year= 1994 | volume= 44 | issue= 7 | pages= 505-12 | pmid=7921194 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7921194  }} </ref></SMALL>
! style="background: #4479BA; color:#FFF;" | '''Masaoka Stage'''
! style="background: #4479BA; color:#FFF;" | '''T factor'''
! style="background: #4479BA; color:#FFF;" | '''N factor'''
! style="background: #4479BA; color:#FFF;" | '''M factor'''
|-
| style="background: #F0F0F0;" align="center" | '''Stage I'''
| style="background: #F0F0F0;" align="center" | T1
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage II'''
| style="background: #F0F0F0;" align="center" | T2
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage III'''
| style="background: #F0F0F0;" align="center" | T3
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage IVa'''
| style="background: #F0F0F0;" align="center" | T4
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| rowspan="2" style="background: #F0F0F0;" align="center" | '''Stage IVb'''
| style="background: #F0F0F0;" align="center" | Any T
| style="background: #F0F0F0;" align="center" | N1, N2, or N3
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | Any T
| style="background: #F0F0F0;" align="center" | Any N
| style="background: #F0F0F0;" align="center" | M1
|-
|}
====Previously Reported Staging System====
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>''Masaoka Staging (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></SMALL>
! style="background: #4479BA; color:#FFF;" | '''Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| style="background: #F0F0F0;" align="center" | '''I'''
| style="background: #F0F0F0;" | Macroscopically completely encapsulated and microscopically no capsular invasion
|-
| style="background: #F0F0F0;" align="center" | '''II'''
| style="background: #F0F0F0;" | 1. Macroscopic invasion into surrounding fatty tissue or mediastinal pleura <BR> 2. Microscopic invasion into capsule
|-
| style="background: #F0F0F0;" align="center" | '''III'''
| style="background: #F0F0F0;" | Macroscopic invasion into neighboring organ (ie, pericardium, great vessels, or lung)
|-
| style="background: #F0F0F0;" align="center" | '''IVa'''
| style="background: #F0F0F0;" | Pleural or pericardial dissemination
|-
| style="background: #F0F0F0;" align="center" | '''IVb'''
| style="background: #F0F0F0;" | Lymphogenous or hematogenous metastasis
|-
|}
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>''Clinical Staging by Bergh (1978) and Wilkins (1979)''<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><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></SMALL>
! style="background: #4479BA; color:#FFF;" | '''Author'''
! style="background: #4479BA; color:#FFF;" | '''Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| rowspan="3" style="background: #F0F0F0;" align="center" | Bergh et al. || style="background: #F0F0F0;" align="center" | '''I''' || Intact capsule or growth within the capsule
|-
| style="background: #F0F0F0;" align="center" | '''II''' || Pericapsular growth into the mediastinal fat tissue
|-
| style="background: #F0F0F0;" align="center" | '''III''' || Invasive growth into the surrounding organs and/or intrathoracic metastases
|-
| rowspan="3" style="background: #F0F0F0;" align="center" | Wilkins et al. || style="background: #F0F0F0;" align="center" | '''I''' || Intact capsule or growth within the capsule
|-
| style="background: #F0F0F0;" align="center" | '''II''' || Pericapsular growth into the mediastinal fat tissue or adjacent pleura or pericardium
|-
| style="background: #F0F0F0;" align="center" | '''III''' || Invasive growth into the surrounding organs and/or intrathoracic metastases
|-
|}


==References==
==References==
<references />
{{reflist|2}}
 
[[Category:Types of cancer]]
[[Category:Rare diseases]]
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[[Category:Immunology]]
[[Category:Surgery]]

Revision as of 13:51, 14 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Khuram Nouman, M.D. [2]

Overview

Thymoma can be largely diagnosed by using radiological techniques.

Diagnostic Study of Choice

Study of Choice

  • Posterior-anterior (PA) and lateral X-ray of the chest are helpful in diagnosing most of thymomas.
  • Among the patients who present with clinical signs of myasthenia gravis (MG), the CT Scan is the test of choice for the diagnosis of Thymoma.
  • CT scan with IV contrast and magnetic resonance imaging are helpful in determining the vascularity of the thymoma and helps in safe surgical removal of large tumors.
  • PET scan is very valuable in diagnosing the cases of invasive malignant thymoma.[1]
  • Thallium 201 single photon emission computed tomography is useful to distinguish normal thymic tissue from hyperplastic tissue or thymoma
  • Ultrasonically guided core needle biopsy is used to obtain larger tissue specimens for histological examination. Annessi and colleagues were able to diagnose thymoma in all patients that had undergone anterior mediastinal core needle biopsy by ultrasonic guidance with a sensitivity and specificity of 100%.

Staging

  • The thymic epithelial tumor staging system was initially proposed by Bergh and his colleagues in 1978,[2] modified by Wilkins and Castleman in 1979,[3] and further developed by Masaoka et al. in 1981.[4][5]
  • 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)[6]
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)[7]
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)[8]
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
Any T Any N M1

Previously Reported Staging System

Masaoka Staging (1981)[4]
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)[2][3]
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. ↑ Scagliori E, Evangelista L, Panunzio A, Calabrese F, Nannini N, Polverosi R; et al. (2015). "Conflicting or complementary role of computed tomography (CT) and positron emission tomography (PET)/CT in the assessment of thymic cancer and thymoma: our experience and literature review". Thorac Cancer. 6 (4): 433–42. doi:10.1111/1759-7714.12197. PMC 4511321. PMID 26273398.
  2. ↑ 2.0 2.1 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)
  3. ↑ 3.0 3.1 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)
  4. ↑ 4.0 4.1 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)
  5. ↑ 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)
  6. ↑ 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.
  7. ↑ Sinha Hikim AP, Hoffer AP (1987). "Quantitative analysis of germ cells and Leydig cells in rat made infertile with gossypol". Contraception. 35 (4): 395–408. PMID 3621939.
  8. ↑ 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.
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