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1.
Echocardiography ; 41(10): e15947, 2024 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-39418211

RESUMO

Thymoma is a relatively uncommon thoracic solid tumor, and considered to possess malignant potential. Usually, the lung, pleura, and mediastinum are the most frequently affected sites for metastasis in thymoma. However, the thymoma presenting simultaneous intrathoracic and extrathoracic metastases are exceedingly rare. Herein, we present an exceptionally uncommon case of invasive thymoma with multiple metastases. Furthermore, our case underscores the indispensable role of multimodality imaging in confirming the primary diagnosis and guiding treatment decisions.


Assuntos
Timoma , Neoplasias do Timo , Humanos , Timoma/secundário , Timoma/complicações , Timoma/diagnóstico por imagem , Neoplasias do Timo/complicações , Invasividade Neoplásica , Masculino , Tomografia Computadorizada por Raios X/métodos , Pessoa de Meia-Idade , Ecocardiografia/métodos , Diagnóstico Diferencial , Feminino
2.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 46(3): 462-465, 2024 Jun.
Artigo em Chinês | MEDLINE | ID: mdl-38953272

RESUMO

Intraspinal metastasis from malignant carcinomas in other body parts is rarely reported.Intraspinal metastases are often epidural,with primary tumors mostly from the lung and prostate.The extramedullary subdural metastasis of thymic carcinoma is particularly rare and prone to misdiagnosis due to overlapping imaging features with primary intraspinal tumors.This article reports one case of intraspinal metastasis of thymic carcinoma,with the main diagnostic clues including a history of thymic carcinoma,fast growth rate,and irregular shape.


Assuntos
Timoma , Neoplasias do Timo , Humanos , Neoplasias do Timo/patologia , Neoplasias do Timo/diagnóstico por imagem , Masculino , Timoma/patologia , Timoma/diagnóstico por imagem , Timoma/secundário , Neoplasias da Coluna Vertebral/secundário , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Pessoa de Meia-Idade
3.
Acta Med Okayama ; 77(3): 331-334, 2023 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-37357635

RESUMO

Masaoka stage I type A thymomas rarely recur. We report the case of an 82-year-old man who developed endobronchial metastasis after thymothymectomy for Masaoka stage I type A thymoma. Twenty years after surgery, the patient developed bloody sputum, and chest computed tomography revealed a neoplasm obstructing the right upper lobe bronchus of the lung with enlarged mediastinal lymph nodes. He underwent right upper lobectomy and mediastinal lymph node dissection. Although preoperative pathological diagnosis was squamous cell carcinoma of the lung, postoperative histopathology revealed endobronchial metastasis of the thymoma. Nine years later, at age 89, the patient is alive and well.


Assuntos
Neoplasias Pulmonares , Timoma , Neoplasias do Timo , Masculino , Humanos , Idoso de 80 Anos ou mais , Timoma/cirurgia , Timoma/patologia , Timoma/secundário , Neoplasias Pulmonares/patologia , Escarro , Recidiva Local de Neoplasia , Neoplasias do Timo/cirurgia , Neoplasias do Timo/patologia
4.
Cancer Radiother ; 25(2): 119-125, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33676829

RESUMO

PURPOSE: To evaluate the safety and efficacy of Cyberknife® (CK) for the treatment of primary or recurring thymic tumours. MATERIALS AND METHODS: We retrospectively reviewed 12 patients (16 tumour lesions) with primary or recurring thymic tumours who were treated with CK between March 2008 and October 2017. Their data was stored in prospectively collected database. Kaplan-Meier method was used to calculate survival curves. RESULTS: Five patients (41.7%), who had inoperable disease or refused surgery, were treated with CK initially, and 7 patients (58.3%) were treated with CK when they had recurrence diseases. The disease sites treated with CK were primary tumour site (5), regional lymph nodes (4), tumour bed (3), chest wall (2), pleura (1), and bone (1). The median target volume was 43.8 cm3 (range, 13.1-302.5cm3) for the 16 tumour lesions. The median follow-up time was 69.3 months (range, 9.7-124.8 months). The median survival time was 48.2 months, and the 5-year and 10-year OS rates were 68.2% and 45.5%, respectively. A high response rate for the tumour lesions irradiated with CK was obtained. Only one patient (8%) experienced in-field recurrence, and the 5-year local recurrence free survival was 90.9%. A case indicated that CK may induce the abscopal effect, which provides the potential to combine CK and immunotherapy. No severe radiation related toxicities were observed, and no treatment related death occurred. CONCLUSION: CK treatment resulted in good outcomes, particularly local control, with minimal side effects, in highly selected patients with primary and recurring thymic tumours. More studies with larger sample are needed.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Radiocirurgia/métodos , Radioterapia Guiada por Imagem/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Timoma/radioterapia , Neoplasias do Timo/radioterapia , Adulto , Idoso , Feminino , Seguimentos , Humanos , Estimativa de Kaplan-Meier , Neoplasias Pulmonares/radioterapia , Neoplasias Pulmonares/secundário , Irradiação Linfática , Masculino , Neoplasias do Mediastino/radioterapia , Neoplasias do Mediastino/secundário , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/mortalidade , Recidiva Local de Neoplasia/patologia , Radiocirurgia/efeitos adversos , Radioterapia Guiada por Imagem/efeitos adversos , Estudos Retrospectivos , Procedimentos Cirúrgicos Robóticos/efeitos adversos , Segurança , Taxa de Sobrevida , Timoma/mortalidade , Timoma/patologia , Timoma/secundário , Neoplasias do Timo/mortalidade , Neoplasias do Timo/patologia , Fatores de Tempo
5.
Medicine (Baltimore) ; 100(3): e23802, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33545943

RESUMO

BACKGROUND: Thymic carcinoma is a rare malignancy, and platinum-based chemotherapy has not previously been established as a standard treatment for advanced or metastatic thymic carcinoma. With the breakthrough and progress of immunotherapy, the possibility of curing thymic carcinoma has greatly increased. Some clinical trials have reported that compared with traditional platinum-based chemotherapy, the use of programmed death 1 and programmed death ligand 1 inhibitors alone can benefit patients and effectively prolong their overall survival. We compare the efficacy of single immunotherapy with traditional platinum-based chemotherapy in a systematic review and meta-analysis to provide a reliable basis for clinicians. METHODS: Pubmed (Medline), Web of Science, Embase, Cochrane Central Register of Controlled Trials, and Google Scholar will be searched for relevant randomised controlled trials, quasi- randomised controlled trials, and Hi-Q(high quality) prospective cohort trials published or unpublished in any language before March 1, 2021. Subgroup analysis will be performed in tumor pathological stage and ethnicity. INPLASY registration number: INPLASY2020110060. RESULTS: The results of this study will be published in a peer-reviewed journal. CONCLUSION: The results of this systematic review and meta-analysis will provide a basis for clinicians to formulate the best chemotherapy regimen for patients, as well as a research clue for clinical researchers in this field. The results of this study will expand the treatment options for thymic carcinoma, but due to the nature of the disease and intervention, large sample clinical trials are not abundant, so we will include some high-quality small sample trials, which may cause high heterogeneity. INPLASY REGISTRATION NUMBER: INPLASY2020110060.


Assuntos
Antineoplásicos , Imunoterapia , Platina , Timoma , Neoplasias do Timo , Humanos , Antineoplásicos/uso terapêutico , Metanálise como Assunto , Metástase Neoplásica , Platina/uso terapêutico , Ensaios Clínicos Controlados Aleatórios como Assunto , Revisões Sistemáticas como Assunto , Timoma/secundário , Timoma/terapia , Neoplasias do Timo/patologia , Neoplasias do Timo/terapia
6.
J Cardiothorac Surg ; 16(1): 8, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413522

RESUMO

BACKGROUND: This study aimed to retrospectively evaluate the clinical, pathological, and treatment-related factors associated with survival in patients with surgically treated thymomas. METHODS: Sixty patients with thymomas who underwent treatment at our institution between 2004 and 2015 were included. Survival analysis was performed based on curves that were obtained using the Kaplan-Meier method. The Wilcoxon test was used for all comparisons, and p < 0.05 was considered statistically significant. RESULTS: Forty-seven, four, three, four, and two patients presented tumor stages I, II, III, IVa, and IVb (according to the Masaoka classification), respectively, while six, 14, 11, 22, and seven patients had type A, AB, B1, B2, and B3 thymomas, respectively. Furthermore, 53 and eight patients underwent complete resection and required additional resection of adjacent organs, respectively, and no patients died from surgery-related complications. The five-year survival and recurrence-free survival (RFS) rates were 96 and 86%, respectively. The five-year survival rate for all stages was 100% except for those with stage IVb tumors (Masaoka classification); the survival rate for those patients was 0%. Separately, the five-year RFS rates for tumor stages I, II, III, IVa, and IVb were 100, 91, 91, 81, and 71%, respectively. Finally, the five-year survival rates in cases with complete and incomplete resections were 100 and 71%, respectively, indicating that the latter group had a significantly poorer prognosis (p < 0.001). CONCLUSIONS: These findings suggest that complete resection and the Masaoka pathological stage are significant predictors of prognosis in patients with thymomas. Surgery should aim to achieve complete resection; however, advanced cases may require multimodality therapy.


Assuntos
Timoma/secundário , Timoma/cirurgia , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasia Residual , Prognóstico , Estudos Retrospectivos , Taxa de Sobrevida , Timectomia
7.
Int J Radiat Oncol Biol Phys ; 109(3): 775-782, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33039590

RESUMO

PURPOSE: This study aimed to evaluate the efficacy and safety of intensity modulated radiation therapy (IMRT) for pleural recurrence of thymoma that was not suitable for surgery and had progressed after chemotherapy. MATERIALS AND METHODS: From February 2012, consecutive patients with pleural recurrence of thymoma were prospectively enrolled. Due to dose restrictions to normal tissue (lung, liver, and kidney), 3 different levels of radiation doses (30 Gy, 40 Gy, and 50 Gy) were prescribed for pleural lesions of different sizes and locations, with a daily fraction dose of 2 Gy. The objective response rate, local control time (LCT), overall survival time, and toxicity were recorded, respectively. RESULTS: By August 2016, 31 patients had completed the IMRT treatment. There were 21 male and 10 female patients, with a median age of 49 (range, 22-70) years. B3 thymoma was the major (62%) tumor subtype observed. During the median follow-up of 48 (24-70) months, the objective response rate was 97%, and the median LCT was 49 (95% confidence interval, 40.4-58.1) months. However, 29 (93.5%) patients developed out-of-field recurrence, among whom 10 (32%; 30 Gy, n = 7; 40 Gy, n = 3) developed both out-of-field and in-field recurrence. The median progression-free survival was 19 months, and no in-field recurrence occurred in the 50 Gy group. Moreover, a higher dose was related to a longer LCT. No toxicities higher than a grade 4 occurred after IMRT within the normal-tissue dose limitation. The 5-year overall survival of the patients was 81%. CONCLUSIONS: IMRT for pleural recurrence may act as an alternative treatment when surgery is not feasible, with a higher dose resulting in a longer LCT. In this study, out-of-field recurrence was considerably common, but repeated IMRT for new recurrence should be cautiously carried out due to the high risk of radiation-induced pneumonitis.


Assuntos
Recidiva Local de Neoplasia/radioterapia , Neoplasias Pleurais/radioterapia , Radioterapia de Intensidade Modulada/métodos , Timoma/radioterapia , Neoplasias do Timo/patologia , Adulto , Idoso , Intervalos de Confiança , Progressão da Doença , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Neoplasias Pleurais/diagnóstico por imagem , Neoplasias Pleurais/patologia , Neoplasias Pleurais/secundário , Intervalo Livre de Progressão , Estudos Prospectivos , Lesões por Radiação/patologia , Pneumonite por Radiação/etiologia , Dosagem Radioterapêutica , Radioterapia de Intensidade Modulada/efeitos adversos , Radioterapia de Intensidade Modulada/estatística & dados numéricos , Timoma/diagnóstico por imagem , Timoma/tratamento farmacológico , Timoma/secundário , Neoplasias do Timo/tratamento farmacológico , Adulto Jovem
8.
J Cardiothorac Surg ; 15(1): 267, 2020 Sep 25.
Artigo em Inglês | MEDLINE | ID: mdl-32977851

RESUMO

OBJECTIVES: We examine the therapeutic efficacy of extended thymectomy with blood vessel resection and reconstruction in thymic carcinoma patients with great vessel invasion. METHODS: In total 26 patients diagnosed as clinical stage III thymic carcinoma with severe great vessel invasion were enrolled in this retrospective study. Among these patients, 14 cases received adjuvant chemo- and radiotherapy (non-operation subgroup, NOG), the other 12 patients received extended thymectomy with vessel resection and reconstruction followed by the adjuvant treatment (operation subgroup, OG). RESULTS: All surgical procedures went smoothly with no perioperative death. R0 resection was obtained in all surgical cases, and we also observed a lymph node metastasis rate of 38.8%. The overall survival (OS) was 34 months for the whole cohort, 48 and 26 months for the OG and NOG respectively (p = 0.013). The median disease metastasis free survival (DMFS) was 47 months for the OG and 18 months for the NOG (p = 0.019). CONCLUSION: Extended thymectomy with vessel resection is feasible for patients with clinical stage III thymic carcinoma. Surgery significantly improves the overall survival and the prognosis of clinical stage III thymic carcinoma.


Assuntos
Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Neoplasias Vasculares/cirurgia , Procedimentos Cirúrgicos Vasculares , Veia Cava Superior , Adulto , Idoso , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Estudos Retrospectivos , Timoma/mortalidade , Timoma/secundário , Neoplasias do Timo/mortalidade , Neoplasias do Timo/patologia , Neoplasias Vasculares/mortalidade , Neoplasias Vasculares/secundário , Adulto Jovem
9.
Clin Neurol Neurosurg ; 196: 106056, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32622111

RESUMO

OBJECTIVE: Thymomas are rare in clinical practice, and cases of metastatic spinal thymoma are extremely scarce, with only a few case reports or case series described in the literature. In this study, we characterized the clinical features, treatment options and prognostic analysis of patients with metastatic spinal thymomas. PATIENTS AND METHODS: This study included seven patients with metastatic spinal thymoma who underwent open surgery or minimally invasive surgery, and adjuvant treatment in a single center of Peking Union Medical College Hospital from 2010 to 2019. The basic clinical data of the patients were analyzed retrospectively. The possible prognostic factors of progression-free survival (PFS) and overall survival (OS) were studied using the Kaplan-Meier method. RESULTS: This retrospective study included six male patients and one female patient, with a median age of 58.4 (47-75) years. The time from initial diagnosis to detection of spinal metastasis was 54.2 (30-108) months. Kaplan-Meier survival analysis showed the number of spinal metastasis and adjuvant therapies were favorable factors for improving OS and PFS in patients with metastatic spinal thymomas. CONCLUSION: Radiation therapy after the primary operation is an efficient adjuvant therapy, since patients who received postoperative radiation treatment have longer OS and PFS than those who receive chemoradiotherapy. The number of spinal metastases seems to be an effective prognostic factor for longer OS and PFS of patients with spinal metastasis of thymoma.


Assuntos
Neoplasias da Coluna Vertebral/secundário , Timoma/secundário , Neoplasias do Timo/patologia , Idoso , Quimiorradioterapia/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Prognóstico , Intervalo Livre de Progressão , Radioterapia Adjuvante/mortalidade , Estudos Retrospectivos , Neoplasias da Coluna Vertebral/terapia , Procedimentos Cirúrgicos Torácicos , Timoma/terapia , Neoplasias do Timo/terapia
10.
Lancet Oncol ; 21(6): 843-850, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502444

RESUMO

BACKGROUND: Thymic carcinoma is a rare malignant disease and standard treatment for advanced or metastatic thymic carcinoma previously treated with platinum-based chemotherapy has not been established. Lenvatinib is a novel multi-targeted inhibitor of VEGFR, FGFR, RET, c-Kit, and other kinases. The aim of this trial was to assess the activity and safety of lenvatinib as a second-line treatment in thymic carcinoma. METHODS: This single-arm, phase 2 trial done in eight institutions in Japan (five cancer centres, two medical university hospitals, and one public hospital) enrolled patients with pathologically confirmed unresectable advanced or metastatic thymic carcinoma that progressed following at least one platinum-based chemotherapy. Key inclusion criteria were age 20 years or older, at least one measurable lesion as defined by the Response Evaluation Criteria in Solid Tumors version 1.1, and an Eastern Cooperative Oncology Group performance status of 0 or 1. Patients received 24 mg of lenvatinib orally once daily in 4-week cycles until disease progression or occurrence of unacceptable adverse events. The primary endpoint was objective response rate evaluated at the data cutoff date (Feb 22, 2019), by independent central review in the intention-to-treat population. This trial is registered on JMACCT, JMA-IIA00285, and on UMIN-CTR, UMIN000026777. FINDINGS: Between April 21, 2017, and Feb 22, 2018, 42 patients were enrolled and all patients were included in the activity and safety analysis. The median follow-up period was 15·5 months (IQR 13·1-17·5). The objective response rate was 38% (90% CI 25·6-52·0, p<0·0001). 16 (38%) of 42 patients had a partial response and 24 (57%) had stable disease. The most frequent grade 3 treatment-related adverse events were hypertension (27 [64%]) and palmar-plantar erythrodysaesthesia syndrome (three [7%]). No patient died from adverse events. INTERPRETATION: The activity and safety of lenvatinib in patients with advanced or metastatic thymic carcinoma was confirmed. These results suggest that lenvatinib could become a standard treatment option for patients with previously treated advanced or metastatic thymic carcinoma. FUNDING: Center for Clinical Trials, Japan Medical Association.


Assuntos
Antineoplásicos/administração & dosagem , Compostos de Fenilureia/administração & dosagem , Inibidores de Proteínas Quinases/administração & dosagem , Quinolinas/administração & dosagem , Timoma/tratamento farmacológico , Neoplasias do Timo/tratamento farmacológico , Idoso , Antineoplásicos/efeitos adversos , Progressão da Doença , Feminino , Humanos , Japão , Masculino , Pessoa de Meia-Idade , Compostos de Fenilureia/efeitos adversos , Intervalo Livre de Progressão , Inibidores de Proteínas Quinases/efeitos adversos , Quinolinas/efeitos adversos , Timoma/enzimologia , Timoma/mortalidade , Timoma/secundário , Neoplasias do Timo/enzimologia , Neoplasias do Timo/mortalidade , Neoplasias do Timo/patologia , Fatores de Tempo
12.
BMJ Case Rep ; 12(11)2019 Nov 28.
Artigo em Inglês | MEDLINE | ID: mdl-31780618

RESUMO

We report a patient in her 60s with history of end-stage thymoma with bilateral lung metastases on palliative chemotherapy presented to the hospital with sudden shortness of breath initially treated for probable pulmonary embolism (PE) pending CT of the pulmonary arteries which was subsequently negative for PE. During this admission, she developed transient right-sided facial droop and slurred speech which resolved spontaneously; however, the patient became unresponsive and desaturated with severe decompensated type 2 respiratory failure. Patient was supported with non-invasive ventilation (biphasic positive airway pressure) for few days. Myasthenia gravis was suspected due to clinical features and confirmed by the high titre of acetylcholine receptor antibody titre.


Assuntos
Neoplasias Pulmonares/complicações , Insuficiência Respiratória/etiologia , Timoma/complicações , Neoplasias do Timo/complicações , Feminino , Humanos , Neoplasias Pulmonares/secundário , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Insuficiência Respiratória/classificação , Timoma/secundário , Neoplasias do Timo/patologia
14.
Ann Thorac Surg ; 107(2): e157-e160, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30253161

RESUMO

Several surgical procedures, from debulking to extrapleural pneumonectomy, may be applied for stage IVa Masaoka thymomas, but their efficiency is still controversial. Case studies have favored R0 resection as the cornerstone of multimodal therapy for locoregional metastatic extension. This report describes a standardized procedure combining a cytoreductive surgical procedure and intrathoracic chemohyperthermia on a 46-year-old patient presenting with B2 thymoma and synchronous unilateral pleural metastasis.


Assuntos
Antineoplásicos/uso terapêutico , Procedimentos Cirúrgicos de Citorredução/métodos , Hipertermia Induzida/métodos , Neoplasias Pleurais/terapia , Timectomia/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Feminino , Humanos , Pessoa de Meia-Idade , Metástase Neoplásica , Estadiamento de Neoplasias , Pleura/cirurgia , Neoplasias Pleurais/diagnóstico , Neoplasias Pleurais/secundário , Pneumonectomia , Timoma/diagnóstico , Timoma/secundário , Neoplasias do Timo/diagnóstico , Tomografia Computadorizada por Raios X
16.
Medicine (Baltimore) ; 97(51): e13796, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30572538

RESUMO

RATIONALE: Malignant thymoma in the spine is a rare disease without standard curative managements so far. The objective of this article is to report a very rare case of recurrent malignant thymoma with sacrum metastases causing severe lumbosacral pain, which was presented with acute radiculopathy and treated with 2 operations combined with stabilization and cement augmentation. The management of these unique cases is not well-documented. PATIENT CONCERNS: A 75-year-old man presented with lumbosacral pain, radiating pain and numbness of the left extremity. The patient underwent thymectomy in 2008, and posterior spinal cord decompression, tumor resection and a stabilization procedure in 2011. Pathologic results confirmed malignant thymomas of the spine. Imaging studies revealed the density of soft tissues, obvious bony destruction in the sacrum, and significant spinal cord obstruction. DIAGNOSES: We believe this is a less-documented case of metastatic thymoma of the sacral spine presenting with back pain and radiculopathy, and presenting as a giant solid tumor. INTERVENTIONS: The patient underwent osteoplasty via a posterior approach. Pathologic results confirmed malignant thymomas of the sacral spine. OUTCOMES: The patient's neurological deficits improved significantly after the surgery, and the postoperative period was uneventful at the 6-month and 1-year follow-up visit. There were no other complications associated with the operation during the follow-up period. LESSONS: This article emphasizes metastatic thymoma of the spine, although rare, should be part of the differential when the patient presents with back pain and radiculopathy. We recommend the posterior approach for spinal decompression of the metastatic thymoma when the tumor has caused neurological deficits. Osteoplasty by cement augmentation is also a good choice for surgical treatment.


Assuntos
Sacro , Neoplasias da Coluna Vertebral/secundário , Timoma/secundário , Neoplasias do Timo/patologia , Idoso , Humanos , Dor Lombar/etiologia , Imageamento por Ressonância Magnética , Masculino , Sacro/diagnóstico por imagem , Sacro/cirurgia , Neoplasias da Coluna Vertebral/diagnóstico por imagem , Neoplasias da Coluna Vertebral/cirurgia , Timoma/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Imagem Corporal Total
17.
J Thorac Oncol ; 13(12): 1949-1957, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30217490

RESUMO

INTRODUCTION: Surgical resection is a standard treatment for thymic malignancies. However, prognostic significance of nodal metastases and lymph node dissection remains unclear. The aim of this study is to determine prognostic significance of nodal metastases and the role of lymph node dissection (LND) in thymic malignancies. METHODS: Between 2000 and 2013, 1597 patients who underwent thymectomy due to thymic malignancy were included. Predictive factors for nodal metastasis and prognostic significance of LND were evaluated. Patients were divided into two groups: (1) LND+ group, with intentional LND (446 patients, 27.9%); and (2) LND- group, without intentional LND (1151 patients, 72.1%). Propensity score matching was performed between the two groups. RESULTS: Lymph node metastasis was identified in 20 (6.7%) of 298 patients with thymoma and 47 (31.7%) of 148 patients with thymic carcinoma. In multivariable analysis, thymic carcinoma (hazard ratio: 19.2, p < 0.001) and tumor size (hazard ratio: 1.09, p = 0.02) were significant predictive factors for lymph node metastasis. The 10-year freedom from recurrence rate of pN1 and pN2 was significantly worse than that of pN0 (p < 0.001). LND did not increase operative mortality or complication. There was no significant difference in 10-year freedom from recurrence rate between LND+ and LND- groups (82.4% versus 80.9%, p = 0.46 in thymoma; 45.7% versus 44.0%, p = 0.42 in thymic carcinoma). CONCLUSIONS: Lymph node metastasis was a significant prognostic factor in thymic malignancies. Although LND did not improve long-term outcomes in thymic malignancies, LND played a role in accurate staging, and improved prediction of prognosis.


Assuntos
Excisão de Linfonodo/mortalidade , Linfonodos/cirurgia , Recidiva Local de Neoplasia/mortalidade , Timectomia/mortalidade , Timoma/mortalidade , Neoplasias do Timo/mortalidade , Feminino , Seguimentos , Humanos , Linfonodos/patologia , Metástase Linfática , Masculino , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Prognóstico , Pontuação de Propensão , Estudos Retrospectivos , Taxa de Sobrevida , Timoma/secundário , Timoma/cirurgia , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia
18.
J Vet Diagn Invest ; 30(5): 774-778, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30117785

RESUMO

A 12-y-old neutered male Portuguese Water dog was presented because of a 1-y history of persistent hyporexia, diarrhea, and recurrent pyelonephritis. Abdominal ultrasound revealed hepatic nodules and diffuse splenomegaly, and radiographs revealed a mediastinal mass. Fine-needle aspirates of the liver, spleen, and mediastinal mass were suspicious for lymphoma. Flow cytometry identified small T cells that co-expressed CD4 and CD8 at all sites, most suspicious for thymoma, but lymphoma could not be ruled out. PCR for antigen receptor rearrangements analysis identified polyclonal amplification of the T-cell receptor genes, more consistent with thymoma than lymphoma. Histopathology of the liver and thymic mass confirmed thymoma with hepatic metastasis.


Assuntos
Doenças do Cão/diagnóstico , Neoplasias Hepáticas/veterinária , Timoma/veterinária , Neoplasias do Timo/veterinária , Animais , Biópsia por Agulha Fina/veterinária , Diagnóstico Diferencial , Diarreia/etiologia , Diarreia/veterinária , Doenças do Cão/patologia , Cães , Citometria de Fluxo/veterinária , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico , Neoplasias Hepáticas/secundário , Masculino , Metástase Neoplásica , Pielonefrite/etiologia , Pielonefrite/veterinária , Timoma/complicações , Timoma/diagnóstico , Timoma/secundário , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/patologia
19.
J Thorac Oncol ; 13(12): 1940-1948, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30121390

RESUMO

INTRODUCTION: Thymoma and thymic carcinoma (TC) are neoplastic diseases with reported chemosensitivity to a broad range of agents. However, because of the rarity of these diseases, few prospective trials have been conducted in patients with advanced thymic malignancies. We conducted a prospective phase II trial to evaluate the clinical activity of pemetrexed, a multitargeted antifolate agent, in previously treated patients with thymoma and TC. METHODS: A total of 27 previously treated patients (16 with thymoma and 11 with TC) with advanced, unresectable disease were treated with pemetrexed, 500 mg/m2, intravenously every 3 weeks for a maximum of six cycles or until undue toxicity or progressive disease. All patients received folic acid, vitamin B12, and steroid prophylaxis. RESULTS: The median number of cycles administered was 6 (range 1-6). Nine patients with a total of 14 events had grade 3 toxicities; no grade 4 toxicities were noted. In 26 fully evaluable patients, two complete and three partial responses (according to the Response Evaluation Criteria in Solid Tumors) were documented (all in patients with stage IVA thymoma, except for one partial response with stage IVA TC). A total of 14 patients completed the full six cycles of treatment, 7 patients progressed while undergoing therapy, 5 patients discontinued therapy because of intolerance, and 1 patient discontinued therapy because of progressive Morvan syndrome. The median progression-free survival time for all patients was 10.6 months (12.1 months for those with thymoma versus 2.9 months for those with TC). With 23 deaths at data cutoff, the median overall survival time was 28.7 months (46.4 months for those with thymoma versus 9.8 months for those with TC). CONCLUSIONS: Pemetrexed is an active agent in this heavily pretreated population of patients with recurrent thymic malignancies, especially thymoma.


Assuntos
Antineoplásicos/uso terapêutico , Recidiva Local de Neoplasia/tratamento farmacológico , Pemetrexede/uso terapêutico , Terapia de Salvação , Timoma/tratamento farmacológico , Neoplasias do Timo/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Metástase Neoplásica , Recidiva Local de Neoplasia/patologia , Prognóstico , Estudos Prospectivos , Taxa de Sobrevida , Timoma/secundário , Neoplasias do Timo/patologia
20.
Asian Cardiovasc Thorac Ann ; 26(7): 574-576, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30103616

RESUMO

An 81-year-old man underwent thymectomy by video-assisted thoracic surgery for a mediastinal tumor. The pathological diagnosis was Masaoka stage II type B3 thymoma. Thirty-six months later, he presented with a growing mass on his anterior chest wall. Computed tomography showed a lobulated tumor in the sternum with bone destruction. Positron-emission tomography-computed tomography showed a maximal standardized uptake of 12.3 in the tumor. Core needle biopsy confirmed a metastatic sternal tumor from a type B3 thymoma. We partially resected the sternum and reconstructed the defect using an expanded polytetrafluoroethylene sheet. The patient has remained recurrence-free for 3 years after the second surgery.


Assuntos
Neoplasias Ósseas/secundário , Recidiva Local de Neoplasia/diagnóstico , Esterno , Cirurgia Torácica Vídeoassistida/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Idoso de 80 Anos ou mais , Biópsia com Agulha de Grande Calibre , Neoplasias Ósseas/diagnóstico , Neoplasias Ósseas/cirurgia , Humanos , Masculino , Estadiamento de Neoplasias , Tomografia por Emissão de Pósitrons combinada à Tomografia Computadorizada , Período Pós-Operatório , Timectomia/métodos , Timoma/diagnóstico , Timoma/secundário , Neoplasias do Timo/patologia
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