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1.
Zhongguo Yi Xue Ke Xue Yuan Xue Bao ; 42(4): 431-435, 2020 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-32895093

RESUMO

Objective To investigate the differences in energy spectrum CT findings between anterior mediastinal lymphoma and thymic carcinoma. Methods Twenty-two cases of anterior mediastinal lymphoma and 28 cases of thymic carcinoma confirmed by biopsy in Tangshan People's Hospital were selected.The CT values and changes of iodine content and water content in lesion sites were measured by energy spectrum analysis software.The differences between anterior mediastinal lymphoma and thymic carcinoma were compared. Results The single-energy CT value of 40-80 keV in thymus carcinoma was higher than that in anterior mediastinal lymphoma(P=0.001,P=0.037,P=0.042,P=0.034,P=0.002;P=0.016,P=0.013,P=0.018,P=0.024,P=0.012).The difference in the single-energy CT value of 90-110 keV between anterior mediastinal lymphoma and thymic carcinoma showed no statistical significance(all P>0.05).The concentrations of water in the arterial and venous stages of thymic carcinoma were significantly lower than those in the anterior mediastinal lymphoma(P=0.030,P=0.037),whereas the iodine concentrations were significantly higher(P=0.026,P=0.000). Conclusion Anterior mediastinal lymphoma and thymic carcinoma have remarkably different 40-80 keV single energy CT value and iodine concentration in arterial and venous phases,which may be helpful for the differential diagnosis of these two malignancies.


Assuntos
Linfoma , Neoplasias do Mediastino , Timoma , Neoplasias do Timo , Humanos , Linfoma/diagnóstico por imagem , Neoplasias do Mediastino/diagnóstico por imagem , Timoma/diagnóstico por imagem , Neoplasias do Timo/diagnóstico por imagem , Tomografia Computadorizada por Raios X
2.
Zhonghua Yi Xue Za Zhi ; 100(29): 2297-2302, 2020 Aug 04.
Artigo em Chinês | MEDLINE | ID: mdl-32746602

RESUMO

Objective: To compare the efficacy between thymectomy plus prednisone and prednisone alone in patients with non-thymoma myasthenia gravis (MG). Methods: Thirty generalized MG patients without thymoma who underwent thymectomy were collected as the operation group, and thirty-nine patients without thymectomy who were treated with prednisone alone were matched as the control group. The start point was the enrollment time and the endpoint event was the "clinical remission" (including complete stabilization remission, drug remission, and poor performance). The survival curve was used to analyze the difference of endpoint event time between the two groups. Besides, a 12-month follow-up study was conducted to compare relevant clinical indicators between the two groups. Results: There was no significant difference in the occurrence time of endpoint events between the two groups (P=0.614). After 6-month follow-up, no significant differences were found in clinical remission rate, the dosage of pyridostigmine bromide and prednisone, the peak dosage of prednisone, the use of other immunosuppressive medications and the rate of hospitalization for exacerbation of disease between the two groups (all P>0.05). After 12-month follow-up, the dosage of prednisone and pyridostigmine in the operation group was significantly lower than that in the control group (5(0,10)mg/d vs 7.5(5,10)mg/d and 30(0,105)mg/d vs 90(15,180)mg/d; P=0.038, 0.032). Conclusion: In patients with mild to moderate non-thymoma generalized MG, thymectomy does not achieve faster remission, but it does reduce the long-term dosage of prednisone and bromopyrazine.


Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Seguimentos , Humanos , Timectomia , Resultado do Tratamento
4.
Medicine (Baltimore) ; 99(31): e21531, 2020 Jul 31.
Artigo em Inglês | MEDLINE | ID: mdl-32756201

RESUMO

RATIONALE: Thymic carcinoma with adenoid cystic carcinoma-like features is a special subtype of thymic adenocarcinoma, and the occurrence of this condition is extremely rare. Herein, we report a case of primary thymic carcinoma with adenoid cystic carcinoma-like features in a young man. PATIENT CONCERNS: A 38-year-old man had an incidental finding of space-occupying lesion in the anterior mediastinum during a routine health examination. The patient complained of occasional mild chest tightness during hot weather but had no obvious cough, sputum, chest pain, or fever. Contrast-enhanced computed tomography scan of the chest revealed a space-occupying lesion in the anterior mediastinum, which is likely benign. DIAGNOSIS: The lesion was diagnosed as a primary thymic carcinoma with adenoid cystic carcinoma-like features. INTERVENTION: The patient underwent thoracoscopic resection of left anterior mediastinal mass and enlarged resection of thymectomy and mediastinal fat in our hospital. OUTCOMES: The postoperative course was uneventful. LESSONS: The tissue characteristic of this tumor was extremely similar to that of adenoid cystic carcinoma. A precise pathological examination is extremely important to prevent misdiagnoses of the lesion as adenoid cystic carcinoma or other thymic tumors. Immunohistochemical staining is extremely useful for the pathological and differential diagnoses of this tumor.


Assuntos
Timoma/patologia , Neoplasias do Timo/patologia , Adulto , Carcinoma Adenoide Cístico/patologia , Diagnóstico Diferencial , Humanos , Masculino , Mediastino/patologia , Timoma/diagnóstico , Neoplasias do Timo/diagnóstico
5.
Zhonghua Xue Ye Xue Za Zhi ; 41(6): 506-510, 2020 Jun 14.
Artigo em Chinês | MEDLINE | ID: mdl-32654466

RESUMO

Objective: To investigate secondary factors, laboratory features, treatment options, and prognosis of pure red cell aplastic anemia (PRCA) . Methods: This was a multicenter retrospective clinical study. Patients aged above 18 years newly diagnosed with PRCA between June 1, 2010, and June 1, 2019, were recruited as the main study object. A comparative analysis of remission rate and overall survival rate was made according to different treatment schemes adopted by patients and different drug reduction rates. Results: A total of 67 patients with PRCA were included in this study and the secondary PRCA group accounted for 44.8% (30/67) . The most common secondary factors were thymoma (n=10) and T-cell large lymphocytic leukemia (T-LGLL) (n=6) . The overall response rate of PRCA was 85.7% and the 3-year overall survival rate of PRCA was (74.3±7.5) %. The remission rate of cyclosporine A alone was slightly higher than that of oral glucocorticoid alone or combined with glucocorticoid[90.0% (36/40) vs 75.0% (12/16) , P=0.147]. After patients applied with cyclosporine A treatment reached CR/PR and remained stable for 3-6 months, the dose of cyclosporine A was reduced by 25 mg each time. The cyclosporine A reduction interval of a 25 mg/d reduction in more than 1 month significantly prolonged the median disease-free survival compared with a 25 mg/d reduction in less than 1 month [not reached vs 15 (95% CI 7-23) months, P<0.001]. There were 62.5% (10/16) of patients who responded to the initial or incremental treatment regimen after relapse. Conclusion: PRCA has features of various secondary factors, high overall survival rate, and high remission rate. Treatment with cyclosporine A alone is preferred, and cyclosporine A should be slowly tapered to reduce the risk of later relapse after it takes effect and patients reach a steady state.


Assuntos
Anemia Aplástica , Aplasia Pura de Série Vermelha , Ciclosporina , Humanos , Imunossupressores , Estudos Retrospectivos , Neoplasias do Timo
6.
Medicine (Baltimore) ; 99(27): e20964, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629705

RESUMO

Intraoperative radiotherapy (IORT) has been used to treat different residual solid tumors after tumor removal and has shown many advantages over other treatment methods. However, the use of IORT for invasive thymoma has not been reported. Therefore, in this study, we tried to determine the safety and efficacy of INTRABEAM IORT for the treatment of invasive thymoma.Among the patients admitted to our hospital from September to December 2016 who were diagnosed with invasive thymoma, 14 were selected as study subjects. With medical histories taken beforehand, 8 of these patients were diagnosed with Masaoka stage IIA and 6 with Masaoka stage IIB; furthermore, 5 of the patients were diagnosed with myasthenia gravis (MG). INTRABEAM radiation (8-10 Gy, low energy) was delivered to the postoperative tumor bed of each patient during surgery. The intra- and postoperative complications were observed and evaluated, and the improvement in symptoms was assessed. An additional 23 patients with stage II thymoma undergoing radical surgery from April to August 2016 were chosen as the control group.One month after the operation, only 1 patient in the IORT group had cough, increased levels of leucocytes and neutrophils, and pulmonary inflammation on chest computed tomography. Reactive inflammation and pleural effusion in the 2 groups were similar (P > .05). There was no significant difference between the 2 groups in the improvement of myasthenia gravis (P > .05). Postoperative chest computed tomography and routine blood examination at 3 and 12 months showed that all the patients recovered, with normal hemogram levels and no pulmonary fibrosis around the radiation field. In addition, ultrasonic cardiography and electrocardiography demonstrated no significant difference before or after surgery within the IORT group. At the end of the follow-up, all the patients were alive, no relapse or remote metastasis was observed in the IORT group, and 2 inpatients in the control group had experienced relapse at 24 and 26 months. There was a significant difference in disease-free survival between the 2 groups (P = .00).It is safe to administer low-energy INTRABEAM IORT at a dose of approximately 10 Gy in patients with stage II invasive thymoma. INTRABEAM IORT does not significantly increase operation- or radiation-related complications and has no significant effect on vital organs such as the lungs and heart. Its long-term efficacy is worth expecting.


Assuntos
Timoma/radioterapia , Neoplasias do Timo/radioterapia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Miastenia Gravis/complicações , Dosagem Radioterapêutica , Radioterapia Adjuvante/instrumentação , Radioterapia Adjuvante/métodos , Cirurgia Torácica Vídeoassistida/métodos , Timoma/complicações , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia
8.
Ann Hematol ; 99(7): 1485-1491, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32488602

RESUMO

No agreement had been reached on the treatment of patients with pure red cell aplasia (PRCA) secondary to indolent malignancies. Data was collected from patients with acquired PRCA from May, 2014 to May, 2018 in Peking Union Medical College Hospital. Tumor-associated PRCA and primary PRCA patients were matched at a ratio of 1:2 with compatible baseline characteristics. All patients had been treated with CsA or sirolimus for at least 6 months with the efficacy and adverse events recorded. Twelve tumor-associated PRCA patients (3 thymoma, 8 lymphoproliferative disorders, and 1 smoldering multiple myeloma) with stable underling disease and 24 acquired primary PRCA patients were selected. 83.3% tumor-associated PRCA patients and 100% primary PRCA patients (P = 0.436) responded to immunosuppression therapy (IST) at a median of 2.5 and 3.5 months (P = 0.137), respectively. No different was found in side effects. The ORR at the end of a median of 21.5-month follow-up was 75% and 70.8% (P = 0.795), respectively. No tumor progression was reported except one secondary patient had lymphoma relapse after 2 years of IST and was given chemotherapy again. These results suggested IST had similar effect, safety on patients with tumor-associated, and primary PRCA patients when the tumors were stable.


Assuntos
Imunossupressão , Imunossupressores/uso terapêutico , Neoplasias/complicações , Aplasia Pura de Série Vermelha/tratamento farmacológico , Aplasia Pura de Série Vermelha/etiologia , Adulto , Idoso , Estudos de Casos e Controles , Feminino , Humanos , Imunossupressão/efeitos adversos , Imunossupressão/métodos , Linfoma/complicações , Linfoma/tratamento farmacológico , Linfoma/patologia , Transtornos Linfoproliferativos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Neoplasias/tratamento farmacológico , Neoplasias/patologia , Timoma/complicações , Timoma/tratamento farmacológico , Timoma/patologia , Neoplasias do Timo/complicações , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/patologia , Resultado do Tratamento
9.
J Cancer Res Clin Oncol ; 146(9): 2267-2276, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32514629

RESUMO

BACKGROUND: To investigate the role of intensity-modulated proton therapy (IMPT) compared to volumetric modulated arc therapy (VMAT) for the radiation treatment of thymoma cancer. METHODS: Twenty patients were retrospectively planned for IMPT [with (IMPT_R1 or IMPT_R2 according to the approach adopted) and without robust optimization] and VMAT. The results were compared according to dose-volume metrics on the clinical and planning target volumes (CTV and PTV) and the main organs at risk (heart, breasts, lungs, spinal cord and oesophagus). Estimates of the excess absolute risk (EAR) of secondary cancer induction were determined for the oesophagus, the breasts and the composite lungs. For the heart, the relative risk (RR) of chronic heart failure (CHF) was assessed. RESULTS: IMPT and VMAT plans resulted equivalent in terms of target coverage for both the CTV and the PTV. The CTV homogeneity index resulted in 0.03 ± 0.01 and 0.04 ± 0.01 for VMAT and all IMPT plans, respectively. The conformality index resulted in 1.1 ± 0.1 and 1.2 ± 0.1 for VMAT and all IMPT plans. The mean dose to the breasts resulted in 10.5 ± 5.0, 4.5 ± 3.4, 4.7 ± 3.5 and 4.6 ± 3.4 Gy for VMAT, IMPT, IMPT_R1 and IMPT_R2. For the lungs, the mean dose was 9.6 ± 2.3, 3.5 ± 1.5, 3.6 ± 1.6 and 3.8 ± 1.4 Gy; for the heart: 8.7 ± 4.4, 4.3 ± 1.9, 4.5 ± 2.0 and 4.4 ± 2.4 Gy and for the oesophagus 8.2 ± 3.5, 2.2 ± 3.4, 2.4 ± 3.6 and 2.5 ± 3.5 Gy. The RR for CHF was 1.6 ± 0.3 for VMAT and 1.3 ± 0.2 for IMPT (R1 or R2). The EAR was 3.6 ± 0.v vs 1.0 ± 0.6 or 1.2 ± 0.6 (excess cases/10,000 patients year) for the oesophagus; 17.4 ± 6.5 vs 5.7 ± 3.2 or 6.1 ± 3.8 for the breasts and 24.8 ± 4.3 vs 8.1 ± 2.7 or 8.7 ± 2.3 for the composite lungs for VMAT and IMPT_R, respectively. CONCLUSION: The data from this in-silico study suggest that intensity-modulated proton therapy could be significantly advantageous in the treatment of thymoma patients with particular emphasis to a substantial reduction of the risk of cardiac failure and secondary cancer induction. Robust planning is a technical pre-requisite for the safety of the delivery.


Assuntos
Timoma/radioterapia , Neoplasias do Timo/radioterapia , Esôfago/efeitos da radiação , Feminino , Humanos , Pulmão/efeitos da radiação , Masculino , Terapia com Prótons/métodos , Dosagem Radioterapêutica , Planejamento da Radioterapia Assistida por Computador/métodos , Radioterapia de Intensidade Modulada , Estudos Retrospectivos
10.
Kyobu Geka ; 73(6): 466-470, 2020 Jun.
Artigo em Japonês | MEDLINE | ID: mdl-32475975

RESUMO

A 65-year-old woman presented with mycosis fungoides and an anterior mediastinal tumor. Stage Ⅱa mycosis fungoides was treated with bath psoralen plus ultraviolet A, topical corticosteroids, and oral bexarotene. One month later, a surgical resection was performed for the anterior mediastinal tumor, which was a stage Ⅱ thymoma with membrane invasion. Furthermore, adjuvant radiotherapy was performed for anterior mediastinum. The mycosis fungoides lesion exacerbated after 3 months;thus, chemotherapies were performed. The patient died of respiratory insufficiency due to multiple pulmonary metastases of mycosis fungoides 1 year after the operation.


Assuntos
Micose Fungoide , Timoma , Neoplasias do Timo , Idoso , Feminino , Humanos , Timoma/complicações , Neoplasias do Timo/complicações
11.
Lancet Oncol ; 21(6): 745-746, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32502438
12.
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
13.
Medicine (Baltimore) ; 99(18): e20111, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-32358402

RESUMO

RATIONALE: We report a rare case with ankylosing spondylitis (AS), thymoma, and membranous glomerulonephritis. The pathogenic mechanisms of these 3 diseases may be associated with each other. Here, we discuss the course of diagnosis and treatment. PATIENT CONCERNS: A 64-year-old woman with bilateral pain of the sacroiliac joints for 10 years and anasarca for 10 days. DIAGNOSES: A diagnosis of AS by HLA-B27 and pelvic X-ray tests, thymoma based on computed tomography and pathological diagnosis, and membranous glomerulonephritis based on renal biopsy. INTERVENTIONS: We administered methylprednisolone 500 mg/d for 3 consecutive days, followed by methylprednisolone 40 mg oral QD, for a month. OUTCOMES: The patient was followed up once a month. In the sixth month, the patient's serum creatinine had decreased to 0.96 mg/dL, urine microalbumin/creatinine decreased to 173.3 mg/g, and albumin had risen to 33.1 g/L. Pain and morning stiffness were relieved, and the Bath Ankylosing Spondylitis Disease Activity Index score dropped to 4.0. LESSONS: Although the causal relationship between AS, thymoma, and membranous nephropathy in this patient still needs to be established, the pathogenesis between the 3 diseases may have some association. In clinical practice, patients with AS need to be screened for tumors and renal complications.


Assuntos
Glomerulonefrite Membranosa/complicações , Espondilite Anquilosante/complicações , Timoma/complicações , Neoplasias do Timo/complicações , Anti-Inflamatórios/uso terapêutico , Feminino , Glomerulonefrite Membranosa/diagnóstico , Glomerulonefrite Membranosa/tratamento farmacológico , Antígeno HLA-B27/sangue , Humanos , Metilprednisolona/uso terapêutico , Pessoa de Meia-Idade , Espondilite Anquilosante/diagnóstico , Espondilite Anquilosante/tratamento farmacológico , Timoma/diagnóstico , Timoma/tratamento farmacológico , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/tratamento farmacológico
14.
Acta Cytol ; 64(5): 498-506, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32454502

RESUMO

BACKGROUND: Primary synovial sarcoma (SS) of the thyroid (PSST) is extremely rare. Its differential diagnosis from other neoplasms is essential since it has different management protocols and prognosis. CASE: A 26-year-old man with a 4.5-cm solid lobulated mass was seen at an outside hospital. Fine needle aspiration (FNA) was interpreted as a papillary carcinoma, and a total thyroidectomy was performed. The final histologic diagnosis was spindle epithelial tumor with thymus-like differentiation (SETTLE). No metastases were detected at that time, and the patient received radioactive iodine treatment. Two years post-surgery, he was seen at our hospital with a local recurrence, and FNA was considered as consistent with SETTLE. The mass was resected, and a left modified radical neck dissection was performed. The tumor revealed necrosis and a high mitotic index. Following histologic, immunohistochemical, and molecular studies, the tumor was classified as a PSST. The patient received chemotherapy and targeted immunotherapy, but he died 41 months after the initial presentation. CONCLUSION: The main diagnostic pitfall of PSST is SETTLE. The presence of mitotic figures and basal lamina material, negative staining for smooth muscle actin, and positive staining for transducer-like enhancer of split 1 antibody favor SS over SETTLE. SYT gene rearrangement is essential to establish the definitive diagnosis of PSST.


Assuntos
Carcinoma Papilar/diagnóstico , Neoplasias Epiteliais e Glandulares/diagnóstico , Sarcoma Sinovial/diagnóstico , Neoplasias do Timo/diagnóstico , Neoplasias da Glândula Tireoide/diagnóstico , Adulto , Carcinoma Papilar/terapia , Diagnóstico Diferencial , Evolução Fatal , Humanos , Masculino , Neoplasias Epiteliais e Glandulares/terapia , Sarcoma Sinovial/terapia , Neoplasias do Timo/terapia , Neoplasias da Glândula Tireoide/terapia
15.
Gan To Kagaku Ryoho ; 47(3): 507-509, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32381931

RESUMO

The patient was a 67-year-old man. At the age of 60, he underwent resection of thymic carcinoma with partial resection of the right upper lobe of the lung because of invasive thymic carcinoma. The pathological diagnosis was Masaoka stage Ⅲ squamous cell carcinoma. Follow-up examination 2 years after surgery showed metastases to the mediastinall ymph node and liver. After undergoing radiotherapy of 50 Gy to the mediastinal lymph node metastasis, partial hepatectomy was performed for metastatic liver cancer. Post-operation, he received 4 courses of combination therapy of carboplatin and paclitaxel. Five years post-hepatectomy, the patient developed liver metastasis again and underwent hepatectomy for local control. Postoperative recurrent cases of thymic carcinoma generally have poor prognosis. We describe a patient with thymic carcinoma of postoperative liver and mediastinal lymph node metastases who achieved long-term survival through multidisciplinary treatment.


Assuntos
Timoma , Neoplasias do Timo , Idoso , Terapia Combinada , Humanos , Neoplasias Hepáticas/secundário , Excisão de Linfonodo , Linfonodos , Metástase Linfática , Masculino , Timoma/cirurgia , Neoplasias do Timo/cirurgia
16.
Kyobu Geka ; 73(5): 358-361, 2020 May.
Artigo em Japonês | MEDLINE | ID: mdl-32398393

RESUMO

We report a case of preoperative spontaneous regression of thymoma in a 66-year-old woman who presented chest pain. Chest computed tomography revealed a well-defined tumor in the anterior mediastinum. The long axis of the tumor decreased from 25 to 18 mm during 1 month preoperatively. Video-assisted thoracoscopic thymothymectomy was performed for definitive diagnosis and treatment. Histopathologically, the tumor mainly comprised necrotic components with partially viable cells, and was diagnosed as a thymoma. The occlusion of the feeding artery by organized thrombus was found by pathology and it was considered to be the cause of coagulative necrosis.


Assuntos
Timoma , Neoplasias do Timo , Idoso , Feminino , Humanos , Mediastino , Necrose , Remissão Espontânea , Tomografia Computadorizada por Raios X
17.
Tumori ; 106(4): 306-311, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32366210

RESUMO

BACKGROUND: The immune checkpoint ligand, programmed cell death 1 ligand 1 (PD-L1), is expressed in various tumors and associated with response to drugs that target programmed cell death protein 1. Previous studies have estimated the level of PD-L1 expression among different stages of thymoma and thymic carcinoma to evaluate its potential use as a diagnostic factor; however, its varying expression level has been problematic. We conducted this meta-analysis of published literature to evaluate PD-L1 expression in thymomas and thymic carcinomas. METHODS: We analyzed 12 studies that included 320 patients with type A/AB/B1 thymoma, 225 patients with type B2/B3 thymoma, and 180 patients with thymic carcinoma. RESULTS: No difference in PD-L1 expression level was found between the B2/B3 vs C groups (odds ratio [OR], 0.67; 95% confidence interval [CI], 0.26, 1.76; p = 0.42). However, the heterogeneity was very high (I2 = 78%), and a significant difference was found between groups A/AB/B1 and B2/B3 (OR, 0.22; 95% CI, 0.12, 0.41; p < 0.001), with a relatively low heterogeneity (I2 = 55%). CONCLUSION: PD-L1 positivity might be a useful factor to differentiate type A/AB/B1 thymoma from type B2/B3 and thymic carcinoma. This result might be valuable for potential anti PD-L1 treatment in thymoma and thymic carcinoma.


Assuntos
Antígeno B7-H1/genética , Timoma/genética , Neoplasias do Timo/genética , Adulto , Idoso , Antígeno B7-H1/antagonistas & inibidores , Biomarcadores Tumorais/genética , Feminino , Regulação Neoplásica da Expressão Gênica/genética , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Receptor de Morte Celular Programada 1/genética , Receptor de Morte Celular Programada 1/imunologia , Timoma/imunologia , Timoma/patologia , Timoma/terapia , Neoplasias do Timo/imunologia , Neoplasias do Timo/terapia
18.
Kyobu Geka ; 73(3): 202-205, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32393703

RESUMO

A 79-year-old woman visited a local doctor with a chief complaint of cough. A computed tomography (CT) scan revealed an anterior mediastinal tumor and 20 mm sized ground-glass nodule (GGN) in the right upper lobe. Bronchoscopy was performed, but no definitive diagnosis was made for GGN and follow-up observation was made with an image. The anterior mediastinal tumor was a solid tumor of 50 mm in size, and invasive thymoma was suspected. A total thymectomy with pericardial partial resection was performed through a median sternotomy. Histopathological diagnosis was squamous cell carcinoma, and no pericardial infiltration was observed. On the other hand, GGN of the right upper lobe during follow-up increased in size and thoracoscopic surgery was performed 3 months after surgery for thymic carcinoma. Adenocarcinoma was diagnosed by rapid diagnosis and the upper lobectomy with lymph node dissection were conducted. No signs of recurrence have been observed for 5 years after operation.


Assuntos
Neoplasias Pulmonares , Timoma , Neoplasias do Timo , Idoso , Feminino , Humanos , Recidiva Local de Neoplasia , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia
19.
Kyobu Geka ; 73(3): 233-235, 2020 Mar.
Artigo em Japonês | MEDLINE | ID: mdl-32393709

RESUMO

A 36-year-old man, who had never been detected abnormalities on an annual chest X-ray check up, presented with a sudden onset of right-sided chest pain and fever. Contrast-enhanced computed tomography showed an anterior mediastinal mass with necrosis or hemorrhage and right pleural effusion. Neither computed tomography-guided biopsy nor video-assisted thoracic surgery (VATS) yielded definitive histological diagnosis due to insufficiency of the sample. For diagnosis and treatment, we performed thymectomy. Histopathologically, the tumor was almost entirely necrotic with few viable tumor cells on periphery. A diagnosis of B2 thymoma was rendered.


Assuntos
Timoma , Neoplasias do Timo , Adulto , Humanos , Masculino , Necrose , Cirurgia Torácica Vídeoassistida , Timectomia , Timoma/cirurgia , Neoplasias do Timo/cirurgia
20.
Kyobu Geka ; 73(2): 124-126, 2020 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-32393720

RESUMO

A 67-year-old man had undergone thymectomy with partial resection of the left upper lobe and pericardium for thymic cancer. Four years later, he visited our hospital due to chest pain. Chest computed tomography revealed pneumopericardium. Nine months later, surgical treatment was performed due to the development of the left pneumothorax. Air leak was found from the bulla which was partially incarcerated into the pericardial space.


Assuntos
Pneumopericárdio , Pneumotórax , Neoplasias do Timo , Idoso , Humanos , Pulmão , Masculino , Neoplasias do Timo/cirurgia
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