Tumour-site-dependent expression profile of angiogenic factors in tumour-associated stroma of primary colorectal cancer and metastases.

BACKGROUND: Tumour-associated stroma has a critical role in tumour proliferation. Our aim was to determine a specific protein expression profile of stromal angiogenic cytokines and matrix metalloproteinases (MMPs) to identify potential biomarkers or new therapy targets. METHODS: Frozen tissue of primary colorectal cancer (n=25), liver (n=25) and lung metastases (n=23) was laser-microdissected to obtain tumour epithelial cells and adjacent tumour-associated stroma. Protein expression of nine angiogenic cytokines and eight MMPs was analysed using a multiplex-based protein assay. RESULTS: We found a differential expression of several MMPs and angiogenic cytokines in tumour cells compared with adjacent tumour stroma. Cluster analysis displayed a tumour-site-dependent stromal expression of MMPs and angiogenic cytokines. Univariate analysis identified stromal MMP-2 and MMP-3 in primary colorectal cancer, stromal MMP-1, -2, -3 and Angiopoietin-2 in lung metastases and stromal MMP-12 and VEGF in liver metastases as prognostic markers (P>0.05, respectively). Furthermore, stroma-derived Angiopoietin-2 proved to be an independent prognostic marker in colorectal lung metastases. CONCLUSION: Expression of MMPs and angiogenic cytokines in tumour cells and adjacent tumour stroma is dependent on the tumour site. Stroma-derived MMPs and angiogenic cytokines may be useful prognostic biomarkers. These data can be helpful to identify new agents for a targeted therapy in patients with colorectal cancer.

[Familial pulmonary cysts and papular skin lesions in a 37-year-old woman]. / Familiäre pulmonale Zysten und papulöse Hauteffloreszenzen bei einer 37-jährigen Patientin.

A 37-year-old female patient presented with sudden dyspnea and chest pain. Spontaneous pneumothoraces had been observed several times before in this patient and two members of the patient´s family in the last years. Moreover, she exhibited papular facial skin lesions. Radiomorphologically a pneumothorax apical on the left side and basal accentuated cystic lung destruction on both sides could be seen. Pleurodesis and several wedge resections with insertion of a drainage on the left side were performed therapeutically. Histology disclosed multiple cysts, whereby typical differential diagnoses could be excluded by immunohistochemistry. A molecular genetic investigation detected a heterozygous mutation in the gene coding for follikulin (FLCN). Thereby, Birt-Hogg-Dubé syndrome (BHDS) was diagnosed. BHDS follows autosomal dominant inheritance and is characterized by cystic lung lesions with recurrent pneumothoraces, cutaneous fibrofolliculomas and an increased risk of renal carcinomas. It is based on mutations in the gene coding for the protein FLCN on chromosome 17.

Survival after pulmonary metastasectomy in patients with malignant melanoma.

BACKGROUND: Surgical resection is an important interdisciplinary treatment for pulmonary metastases of metastatic malignant melanoma. The purpose of this study was to determine the clinical course, outcome and prognostic factors in a subset of patients recently treated by metastasectomy. MATERIAL AND METHODS: Between 1995 and 2007, 30 patients (19 men, 11 women) with pulmonary metastases from malignant melanoma underwent pulmonary resection. Exclusion of primary tumor recurrence and other extrapulmonary metastases was mandatory for inclusion in the study. The median follow-up was 93.7 months. These patients' records were subsequently reviewed. RESULTS: Cumulative 5-year survival rate after pulmonary resection was 35.1% with a median survival of 18.3 months. Complete pulmonary resection was achieved in 27 patients who had a median survival of 20.5 months compared to 13.0 months after incomplete resection; however, completeness of resection was not a statistically prognostic factor for survival. Multivariate analysis identified gender as the only significant prognostic parameter for overall survival in the group of patients after complete resection of pulmonary metastases, with 9.4 months versus 25.0 months for the female and male group, respectively ( P = 0.022). CONCLUSIONS: We conclude that pulmonary metastasectomy for metastases of malignant melanoma is a safe treatment modality which may actually be of benefit in selected patients with stage IV malignant melanoma. When pulmonary metastases of malignant melanoma are present, every attempt should be made to completely resect all clinically detected metastases.

Identification of immunohistochemical prognostic markers for survival after resection of pulmonary metastases from colorectal carcinoma.

BACKGROUND: Although aggressive resection of pulmonary metastases prolongs the survival of patients with metastatic colorectal cancer, there is a need for predictive pathologic parameters to understand the key molecular events of metastatic progression. The aim of this study was to verify immunohistochemical markers in addition to established clinical parameters after surgery. METHODS: From our subset of patients undergoing resection of pulmonary metastases from metastatic colorectal carcinoma, we analyzed 39 patients (23 men and 16 women) between 2003 and 2007. Only patients who met the criteria for a potentially curative operation were included. All patients were analyzed with regard to age and sex, primary tumor location, stage of the primary tumor, history of hepatic metastases, number of pulmonary metastases, pre-thoracotomy carcinoembryonic (CEA) serum antigen level, and the presence of thoracic lymph node metastasis. Furthermore, we immunohistochemically investigated the expression of vascular endothelial growth factor (VEGF)-D, FBJ murine osteosarcoma viral oncogene homolog B (FOS-B), and melanoma antigen (MAGE)-A in the surgical specimens of pulmonary metastatic lesions. RESULTS: The overall 3-year survival was 50.6 %. A significantly longer survival was observed with multivariate analysis in patients with a pre-thoracotomy serum carcinoembryonic antigen level of no more than 4.2 ng/mL ( P = 0.001), and Dukes stage A or B primary tumor ( P = 0.001). A significantly longer recurrence-free survival was observed with multivariate analysis in patients without thoracic lymph node involvement compared to patients with pulmonary and/or mediastinal lymph node metastases ( P = 0.006). The stage of the primary tumor remained significant ( P = 0.029), and FOS-B expression in tumor cells showed a trend towards favorable recurrence-free survival after pulmonary metastasectomy ( P = 0.059). No statistically significant difference was found in the overall survival rate or recurrence-free survival rate of patients with expression of VEGF-D or MAGE-A antigen in pulmonary metastatic tumor cells. CONCLUSIONS: Our results suggest that in addition to clinically prognostic factors, FOS-B expression has a debatable impact on patient survival. We conclude that the evaluation of molecular and clinical prognostic parameters at the time of pulmonary metastasectomy offers a greater understanding of the metastatic process and provides important information for patient selection.

[Current surgical management of pulmonary metastases]. / Aktueller Stand in der chirurgischen Therapie von Lungenmetastasen.

Surgical resection has been the first choice for the treatment of isolated pulmonary metastases secondary to extrapulmonary malignancies. Despite recent advances, systemic chemotherapy for metastatic disease without the use of surgery is considered to be merely palliative, as there are rarely long-term survivors. Criteria for resection and prognostic parameters help facilitate patient selection. In addition to the established parameters the most significant factors in selecting patients for operation include the number of pulmonary metastases, disease-free interval, serum tumour marker level, and the question of mediastinal and hilar lymph node metastases. Complete surgical resection is critical to achieving long-term survival and is best accomplished via open thoracotomy accompanied by a systematic mediastinal and hilar lymph node dissection. The recent development of video-assisted thoracoscopic surgery (VATS) and advances in thoracic imaging technique has made the VATS approach more amenable for resection of small pulmonary nodules. However, the oncological radicality of VATS is questionable for pulmonary metastasectomy, thus the VATS approach is mostly limited to diagnostic purposes and in highly selected groups of patients with limited, peripherally located lesions. These operations should be performed preferably within a prospective study setting. All results together demonstrate that resection and re-resection of pulmonary metastases can be beneficial in patients, carefully selected by a multidisciplinary tumour board of thoracic surgeons and medical oncologists.

[Results of N1 and N2 surgery in non-small cell lung cancer]. / Ergebnisse der N1- und N2-Chirurgie beim nichtkleinzelligen Lungenkarzinom.

Lymph node involvement in non-small cell lung cancer shows considerable heterogeneity within the N1 and N2 descriptors with respect to localization, the number of lymph nodes affected and the extent of mass and volume. In an attempt to reflect the different prognostic behavior of lymph node metastases, the 8th classification of the TNM has been published with proposals for further subtyping of the N1 and N2 stages into N1a, N1b, as well as N2a1, N2a2, and N2b. The aim of this article is to discuss the value of surgery of non-small cell lung cancer in the N1 and N2 lymph node metastatic stages. While overall survival benefits were seen after concomitant chemotherapy for patients with N1 metastatic disease and surgery, radiotherapy concepts did not provide any survival benefit in this subgroup. For patients with N2 metastasis, surgical resection is part of a multimodal treatment concept with chemotherapy and radiotherapy. Careful restaging after neoadjuvant therapy is recommended in order to provide surgical treatment to patients deemed suitable for curative (R0) resection. In particular, it should be noted that after inductive chemoradiotherapy, patients should only be treated by pneumonectomy in specialized centers, as resection can be associated with a high risk of postoperative complications. With respect to the new subtyping of the N2 involvement situation in N2a1, N2a2, and N2b, further adapted multimodal treatment concepts are expected in the future. Initial results are reported for stage IIIA patients and the use of video-assisted thoracoscopic surgery (VATS), robotic assisted thoracic surgery (RAST) and thoracotomy for local resection. These indicate that the use of minimally invasive techniques can achieve comparable results to open thoracotomy procedures, at least in specialized treatment centers.

[Treatment of pleural empyema]. / Behandlung des Pleuraempyems.

Pleural empyema remains a frequently encountered clinical problem and is responsible for significant morbidity and mortality worldwide. Its diagnosis may be difficult; delays in diagnosis and treatment may contribute to morbidity, complications, and mortality. The management of parapneumonic effusion and empyema depends on timely, stage-dependent therapy and the underlying etiology. Thoracentesis and antibiotics remain the cornerstones of treatment in stage I disease. In the early fibrinopurulent phase (stage II) thoracoscopic methods should be considered. As treatment strategy for this stage, fibrinopurulent pleural empyema entails thorough debridement of multiloculated collections from the pleural cavity by video-assisted thoracic surgery. After evacuation of multilocular effusions and the removal of fibrin deposits with drainage by two intercostal chest tubes, irrigation treatment helps to achieve clarity of the pleural discharge. Open thoracotomy and decortication are reserved for organized, multiloculated empyema with lung entrapment (stage III disease). Early drain removal may lead to rapid symptomatic recovery and complete resolution.

[Plastic surgical reconstruction of extensive thoracic wall defects after oncologic resection]. / Plastisch-chirurgische Rekonstruktion von Defekten der Thoraxwand nach onkologischen Resektionen. Interdisziplinäre Strategien.

In defect reconstruction following radical oncologic resection of malignant chest wall tumors, adequate soft-tissue reconstruction must be achieved along with function, stability, integrity, and aesthetics of the chest wall. The purpose of this retrospective analysis was to evaluate the oncoplastic concept following radical resection of malignant chest wall infiltration with an interdisciplinary approach. Between 1999 and 2005, 36 consecutive patients (nine males, 27 females, mean age 55 years, range 20-78) were treated with resection for malignant tumors of the chest wall. Indications were locally recurrent breast carcinoma (patient n=22), thymoma (n=1), and desmoid tumor (n=1). Primary lesions of the chest wall were spinalioma (n=1), sarcoma (n=7), and non-small-cell lung cancer (n=2). There were distant metastases of colon and cervical cancer in one patient each. Soft-tissue reconstruction was carried out using primary closure (n=1), external oblique flap (n=1), pectoralis major myocutaneous flap (n=3), latissimus dorsi myocutaneous flap (n=18), vertical or transversal rectus abdominis myocutaneous flap (n=9), free tensor fascia lata- flap (n=6), trapezius flap (n=1), serratus flap (n=1), and one filet flap. In 15 reconstructive procedures microvascular techniques were used. An average of 3.4 ribs were resected. Stability of the chest wall was obtained with synthetic meshes. The latissimus dorsi flap is considered the flap of choice in chest wall reconstruction. However, alternatives such as pectoralis major flap, VRAM/TRAM flap, free TFL flap, and serratus flap must also be considered. Low mortality and morbidity rates allow tumor resection and chest wall reconstruction even in a palliative setting.

Routine intraoperative application of high-dose aprotinin in open heart surgery in adults: antibody formation after first exposure.

High-dose aprotinin is now routinely used in cardiac surgery to reduce postoperative blood loss and transfusion requirements, although several cases of anaphylactic reactions to the proteinase inhibitor have been reported. As part of a multi-centre study to evaluate the immunological response to aprotinin after first exposure 61 cardiac surgical patients were treated with the Hammersmith regimen. Patients with previous aprotinin exposure were excluded from the study. To determine specific IgG and IgE antibodies blood samples were taken pre-operatively, within 3 to 4 weeks and 6 to 7 months after operation. Determinations were made by using Western Blot and ELISA methods. Fifty-six patients were followed up for a 6-month period, 26 (46.4%) of them developed IgG antibodies to aprotinin determined by Western Blot, whereas only 14 (26.8%) patients with IgG antibodies were found by the ELISA. IgE antibodies were not found in any of the patients. On hospital admission and 6 months post-operatively additional intradermal prick tests were performed. No clear-cut positive reaction to the skin test was found in any patient.

Transfontanelle pulsed Doppler measurement of blood flow velocity in the internal jugular vein, straight sinus, and internal cerebral vein in preterm and term neonates.

This paper presents the range of normal blood flow velocity in different cerebral veins in early infancy measured by transfontanelle pulsed Doppler ultrasonography. The blood flow velocity of the internal jugular vein (38 infants), internal cerebral vein (28 infants), and straight sinus (18 infants) in a group of clinically stable neonates and young infants (body weight 1060-3750 g, age 1-86 d, gestational age 28-41 wk) is specified. The time mean of maximum velocity (Vma) of internal jugular vein was 8.4 +/- 4.7 cm/s, of internal cerebral vein 5.5 +/- 1.6 cm/s, and of straight sinus 12.6 +/- 7.8 cm/s. While the variability between infants was high, the reproducibility of the method was in the range of 4.4-10.2% for Vma. This compares well with studies on cerebral arteries and offers a noninvasive approach to the study of the venous cerebral hemodynamics in neonates undergoing intensive care.

Morgagni hernia in adults: results in 7 patients.

OBJECTIVE: Morgagni's hernia is a relatively uncommon diaphragmatic hernia with a potential for considerable morbidity, if the diagnosis is delayed or missed. This review of cases of Morgagni's hernia was undertaken in order to emphasize methods of diagnosis and treatment. METHODS: From 1992 through 2002, seven patients with Morgagni's hernia (5 right, 2 left) were surgically treated at our hospital. We investigated the patients preoperatively including chest roentgenogram, chest CT scan, and contrast studies of the upper gastrointestinal tract. Operative repair was accomplished with the transabdominal or transthoracic approach. Basic spirometric tests had been carried out on patients presented for elective surgery. RESULTS: The majority of patients experienced dyspnea and two patients presented with acute abdomen due to peritonitis. Diagnosis for Morgagni's hernia was made preoperatively in all but one patient. In cases with uncertain diagnosis or peritonitis, a transabdominal approach was preferred. One patient had died of septic multi-organ failure in the early postoperative course. Following elective repair of Morgagni's hernia, improvement in basic spirometric values was seen. CONCLUSIONS: We conclude that repair for Morgagni's hernia can be performed safely and effectively by using different surgical approaches. The risk of progression and incarceration makes clinical awareness, early diagnosis, and surgical treatment warranted. Improvement in lung function can be expected postoperatively.

Surgical treatment of hepatic and pulmonary metastases from non-colorectal and non-neuroendocrine carcinoma.

BACKGROUND: Surgical resection is standard treatment for colorectal and neuroendocrine liver metases provided the tumor can be removed completely. The same is true for isolated pulmonary metastases. To date, only few reports have addressed the value of surgical resection of organ metastases from other solid tumors. METHODS: The literature was searched by Medline, conference proceedings and cross-referencing of published articles for information pertaining to the long-term results of surgical treatment of non-colorectal and non-neuroendocrine (NCNN) liver or lung metastases. RESULTS: Resection of hepatic and pulmonary metastases is increasingly performed in non-colorectal and non-neuroendocrine malignancies. Mortality and morbidity of hepatic and pulmonary resection are low and 5 year survival can be expected to reach some 20-30 percent, irrespective of the histological type of the primary tumor. CONCLUSION: Resection of hepatic or pulmonary metastasis should be considered in all patients with low operative risk provided that complete resection is possible.

[Supra-aortic extracranial revascularization in cerebrovascular disorders with special reference to stage classification]. / Supraaortale extrakranielle Revaskularisation bei zerebralen Durchblutungsstörungen unter besonderer Berücksichtigung der Stadieneinteilung.

The opinions concerning the value of a surgical approach in cerebrovascular insufficiency due to extracranial occlusive arterial disease are still controverse. We analysed a consecutive series of 216 patients after carotid endarterectomy performed in the period of 1980 to 1988. The preoperative symptoms permitted a classification into the clinical groups I to IV according to Vollmar. All operations were done under standard conditions. An intraluminal shunt was used in 194 patients (90%). In 24 patients (11%) a bilateral carotid revascularisation was carried out. The hospital mortality rate in our groups of patients was 5.1%. In order to evaluate the results, Doppler sonographic and clinical examinations with a mean follow-up of 8.1 months (range: 3 to 60 months) were performed. The neurologic examination revealed an unchanged condition in 63 patients (29%). Twelve patients (5.7%) suffered from a progression of the neurologic disorders.

[Development of adenocarcinoma in a retrorectal pre-sacrococcygeal hamartoma]. / Entwicklung eines Adenocarcinomas auf dem Boden eines retrorectalen präsacrococcygealen Hamartoms.

Among the different pathologic structures of the presacrococcygeal space retrorectal cystic hamartomas are uncommon lesions. These cysts are most likely derived from remnants of the embryonic tailgut although an association to teratomas may exist. We describe the clinicopathologic features of a retrorectal cystic hematoma with malignant transformation in a 60 year old female patient. The literature is reviewed and etiology, diagnosis and operative management are discussed.

[Thymus lipoma. A rare entity of the thymus. Case report with special consideration of diagnostic imaging]. / Thymolipom. Eine seltene thymogene Tumorentität. Fallbericht unter besonderer Berücksichtigung der bildgebenden Diagnostik.

This report is on a 37-year-old female patient with an extraordinary large intrapleural tumor on the left, macroscopically originating from mediastinal structures. The tumor was completely removed via transpleural approach without compromising the left lung. It was identified as a thymolipoma with a weight of 2400 g.

[Diaphragmatic ruptures: diagnosis--therapy--results, experiences with 64 patients]. / Zwerchfellrupturen: Diagnostik--Therapie--Ergebnisse, Erfahrungen bei 64 Patienten.

From 1963 to 1993, 64 Patients with traumatic lesions of the diaphragm were treated. 58 Patients were admitted after blunt trauma, 6 Patients after a penetrating trauma. 87.5% of the patients were male with an average age of 37 years. In about 80% of cases other severe traumatic lesions were noted in association. With 64% extremities, 50% abdomen, 47% thoracic cavity and 38% head injuries were concomitant lesions. Due to the association with pelvic fractures (45%) a special diagnostic emphasis on diaphragmatic ruptures is recommended. In 83% the left diaphragm is involved. Over the last years the right-sided rupture of the diaphragm were found in an increasing extent from 3.7% up to 26%. Conventional radiography with gastrographin swallow is still the essential diagnostic tool. Hospital mortality (12%) was mainly influenced by complications of concomitant injuries, i.e. cardio-pulmonary insufficiency, Shock and multi-organ-failure.

Synchronous pulmonary metastases from renal cell carcinoma--a whole nation study on prevalence and potential resectability.

BACKGROUND: At the time of diagnosis, almost one third of patients with renal cell carcinoma (RCC) have metastasis. We studied the prevalence, survival, and potential resectability of synchronous pulmonary metastases (SPMs) in a well-defined cohort of RCC patients. MATERIAL AND METHODS: A retrospective whole nation study including RCC patients with SPM diagnosed 1970-2005 in Iceland. Imaging studies and histology were reviewed, the TNM system used for staging the primary tumors, and disease-specific survival estimated. Eligibility for SPM removal was evaluated using different criteria from the literature on surgical management of SPM, including solitary SPM and SPMs confined to one lung. RESULTS: Altogether, 154 patients (16.9%) had SPMs. In 55 of these patients (35.7%) the lungs were the only site, with detailed information available in 46 cases. Of these 46 patients with SPMs, 15 were unilateral, and of those 11 were solitary. All of these 11 patients were in good physical condition and were deemed eligible for surgical resection; however, only one of them was operated with metastasectomy. Disease-specific survival at five years for patients with solitary SPM was 27.2%, as compared to 12.7%, 7.1%, and 12.0% for patients with unilateral SPMs, all patients with SPMs, and patients with extrapulmonal metastases, respectively (p = 0.33). CONCLUSION: At the time of diagnosis, 16.9% of RCC patients had SPM. In one in three of these SPM patients metastases were confined to the lungs, while one in five had solitary pulmonary metastases. Although the benefit of pulmonary metastasectomy in RCC is still debated and criteria for resection are not well defined, it appears that many RCC patients with SPM are potentially eligible for pulmonary metastasectomy.

Recurrent pleural effusion: who benefits from a tunneled pleural catheter?

Recurrent malignant pleural effusion (MPE) is a common concomitant phenomenon of malignant disease, which can worsen the patient's quality of life and lead to significant morbidity. Tunneled indwelling pleural catheters (TIPC) offer new modalities in patients with recurrent MPE and impaired dilatability of the lung. We report on our experience with 100 consecutive patients suffering from recurrent benign (n = 12) and malignant pleural effusion (n = 88) who were treated with TIPC. The catheter was placed during a VATS procedure or under local anesthesia in an open technique. The median residence time of the TIPC was 70 days; spontaneous pleurodesis was achieved in 29 patients. The rate of complications was low: pleura empyema (n = 4), accidental dislodgement (n = 2), malfunction of the drainage (n = 3). In conclusion, TIPC is a useful method for the palliative treatment of patients with recurrent malignant or nonmalignant pleural effusions and 3 groups of patients seem to benefit most: a) patients with the intraoperative finding of a trapped lung in diagnostic VATS procedure; b) patients after a history of repeated pleuracenteses or previously failed attempts at pleurodesis; c) patients in a reduced condition with a limited lifespan due to underlying disease.

Diagnosis of pulmonary metastases with helical CT: the effect of imaging techniques.

OBJECTIVE: Survival in patients after surgical resection of pulmonary metastases correlates with the complete resection of all metastatic deposits. The purpose of this study was to evaluate the additional value of helical CT to see whether the slice thickness and the reading environment was a factor determining the accuracy of helical scans. METHODS: Between 2004 and 2007, 93 patients (62 men, 31 women) underwent complete resection of pulmonary metastases by open thoracotomy. A total of 125 thoracotomies were performed with manual palpation of the involved lung. We retrospectively examined the helical CT findings obtained using a 5-mm slice thickness in a routine preoperative analysis, and within this study a second reading was performed independently, using 3-mm slice thickness image sets. The CT images were evaluated in a consensus between two radiologists. RESULTS: Computed tomography scanning was performed a median of 12 days before thoracotomy (range 1-121 days). Analysis of helical CT in 5-mm slice thickness detected metastases with a sensitivity of 83.7 % whereas a 3-mm slice thickness had a sensitivity of 88.8 %. There were statistically significantly more lesions using helical CT and a 3-mm slice thickness technique than with the 5-mm slice thickness technique, compared to the surgical results ( P = 0.002). This was also found with regard to nodules which were finally histologically confirmed as lung metastases ( P = 0.014). CONCLUSIONS: We conclude that a reduced slice thickness may have an important positive impact on the treatment and outcome of patients with pulmonary metastases. The use of 3-mm slice thickness helical CT may raise the sensitivity for pulmonary metastases detection compared to 5-mm images, but the rate of false positive results may also increase.

An institutional study on thymomas and thymic carcinomas: experience in 77 patients.

BACKGROUND: Thymomas and thymic carcinomas are rare tumors of the anterior mediastinum. A WHO classification was introduced in 1999, which has been updated in 2004. Meanwhile, several retrospective studies have been carried out which have shown the prognostic significance of this classification together with Masaoka's staging system and the extent of surgery. PATIENTS AND METHODS: Between 1983 and 2000, 77 patients (37 male, 40 female) underwent resection of thymomas and thymic carcinomas in our institution. Complete resection was achieved in 57 patients. The median follow-up was 72.6 months. RESULTS: The overall 5-year survival rate was 71.4 %. The factors "histology" and "extent of resection" had the most important impact on survival. However, even among the patients with complete resection, 12 of them suffered a relapse. Among this patient group, the most important factors for disease-free survival were "tumor stage" and "histology". Patients with an incomplete resection had a 5-year survival rate of only 29 % in spite of adjuvant radiation and/or chemotherapy. Due to the high rate of relapse, the poor survival rate found in incompletely resected patients as well as the failure of classical chemotherapy regimens, especially in type B2 and type B3 thymomas and thymic carcinomas, the search for new chemotherapeutic schemes is mandatory. CONCLUSION: Our study shows that there are still encouraging therapeutic options for thymomas and thymic carinomas. Type B2, type B3 thymomas and thymic carcinomas have worse outcomes in spite of adjuvant chemo- and radiotherapies. Especially in patients with incomplete surgical resection the outcome remains poor.