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1.
Ann Surg Oncol ; 29(3): 1829-1837, 2022 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-34657225

RESUMO

BACKGROUND: Thymoma patients with pleural dissemination are difficult to manage, and their treatment strategy remains undefined. This study aimed to investigate the clinicopathologic features of these patients, focusing on the association between the depth of pleural invasion and prognosis. METHODS: Between 2003 and 2019, the study identified 120 disseminated lesions in 20 thymoma patients. Seven patients had de novo stage IVa thymoma and 13 were recurrent cases. Extrapleural pneumonectomy was performed for 8 patients and debulking surgery for 12 patients. Invasion depth of pleural tumors was classified into two groups: when the disseminated tumors invaded the pleura beneath the elastic layer, the tumor was diagnosed as Da, and when the disseminated tumors invaded the pleura beyond the elastic layer, the tumor was diagnosed as Db. RESULTS: Of 120 nodules, 31 (26%), found in eight patients with recurrent malignancies, were classified as Db. The pathologic status of the surgical margin (PSM) was positive in eight patients, seven of whom had Db nodules. The 5-year overall survival (OS) rate was 100% in the Da group and 75% in the Db group (P = 0.02). The 5-year progression-free survival (PFS) rate was 66.7% in the Da group and 25% in the Db group (P = 0.02). Cox univariate analysis showed that PFS was significantly influenced by the depth of invasion (P = 0.04) and PSM (P = 0.03). CONCLUSION: Depth of pleural invasion may influence survival outcomes for thymoma patients with pleural dissemination. The patients in this study with Da-disseminated nodules had an increased probability of a longer OS and PFS and tended to achieve negative PSM compared with the patients with Db.


Assuntos
Neoplasias Pleurais , Timoma , Neoplasias do Timo , Humanos , Recidiva Local de Neoplasia/patologia , Recidiva Local de Neoplasia/cirurgia , Estadiamento de Neoplasias , Pleura/patologia , Pleura/cirurgia , Neoplasias Pleurais/patologia , Neoplasias Pleurais/cirurgia , Estudos Retrospectivos , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/patologia , Neoplasias do Timo/cirurgia , Resultado do Tratamento
2.
Pathol Int ; 71(7): 453-462, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33819365

RESUMO

Micronodular thymoma with lymphoid stroma (MNT) is a rare thymic epithelial neoplasm subtype characterized by a micronodular tumor cell growth pattern and abundant lymphoid stroma. Micronodular thymic carcinoma with lymphoid stroma (MNCA) is considered as a malignant counterpart of MNT and exhibits a growth pattern similar to that of MNT but has histologic features reminiscent of thymic squamous cell carcinoma, such as cytologic atypia and CD5 and CD117 immunoexpression. Although both MNT and MNCA are characterized by abundant lymphoid stroma, it remains unknown whether there are differences in infiltrating lymphocytes between MNT and MNCA. We analyzed the immune microenvironment profile in eight MNT and three MNCA cases. The cell density of CD8-positive T cells was significantly higher in MNT than in MNCA, whereas that of FOXP3-positive T cells was significantly higher in MNCA than in MNT. There was no significant difference in the cell density of programmed death protein 1-positive T cells and programmed death ligand 1 expression between the MNT and MNCA cases. Our findings indicated that the immune microenvironment of MNCA differed from that of MNT and, compared with the T-cell profile of MNT, that of MNCA was more suppressive to patients' antitumor immune response.


Assuntos
Fatores de Transcrição Forkhead/metabolismo , Linfócitos do Interstício Tumoral/patologia , Neoplasias Epiteliais e Glandulares , Timoma , Neoplasias do Timo , Adolescente , Adulto , Linfócitos B/patologia , Antígeno B7-H1/metabolismo , Linfócitos T CD8-Positivos/patologia , Citodiagnóstico , Diagnóstico Diferencial , Humanos , Hiperplasia/patologia , Imuno-Histoquímica , Contagem de Linfócitos , Masculino , Pessoa de Meia-Idade , Neoplasias Epiteliais e Glandulares/diagnóstico , Neoplasias Epiteliais e Glandulares/patologia , Timoma/diagnóstico , Timoma/patologia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/patologia , Microambiente Tumoral
3.
Surg Today ; 49(8): 656-660, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31134370

RESUMO

PURPOSE: We assessed the utility of the tumor doubling time (TDT) for predicting the histological type of thymic epithelial tumors. METHODS: We retrospectively reviewed 130 patients with thymic epithelial tumors who underwent computed tomography two or more times before surgery. The patients were divided into low-risk thymoma (types A, AB and B1), high-risk thymoma (types B2 and B3) and thymic carcinoma (thymic carcinoma and thymic neuroendocrine tumor) groups. In the 96 patients who showed tumor enlargement, the relationship between the histological type and the TDT of the tumor was investigated. RESULTS: The study population included 55 men and 41 women from 26 to 82 years of age. The TDT of the thymic carcinoma group (median 205 days) was significantly shorter in comparison to the low-risk thymoma (median 607 days) and high-risk thymoma (median 459 days) groups. No significant differences were observed between the low-risk thymoma and high-risk thymoma groups. When we set the cutoff time for differentiating thymic carcinoma group from thymoma at 313 days, the sensitivity and specificity were 83.8% and 82.1%, respectively. CONCLUSIONS: The TDT is a useful parameter for differentiating between thymoma and thymic carcinoma group.


Assuntos
Transformação Celular Neoplásica/patologia , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias do Timo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/diagnóstico por imagem , Estudos Retrospectivos , Timoma/diagnóstico por imagem , Timoma/patologia , Neoplasias do Timo/diagnóstico por imagem , Fatores de Tempo , Tomografia Computadorizada por Raios X
5.
Histopathology ; 66(2): 300-7, 2015 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-24702632

RESUMO

AIMS: Micronodular thymoma with lymphoid stroma (MNT) is an uncommon variant of thymoma, characterized by multiple small nodules consisting of type A thymoma-like cells, which are separated by abundant B lymphocytes. The aim of the study was to elucidate the pathogenesis of the stromal lymphoid hyperplasia, which is currently unclear. METHODS AND RESULTS: We retrieved six cases of MNT, and immunohistochemically examined the number and distribution of Langerhans cells (LCs) and mature dendritic cells (DCs), and compared them with those in type A and type AB thymomas. Many LCs were present within the small tumour nests, but LCs were rarely seen in the stroma (75.5/HPF versus 6.1/HPF, P < 0.0001). In contrast, mature DCs were present mainly in the surrounding stroma rather than within the tumour nodules (63.5/HPF versus 6.0/HPF, P < 0.0001), forming clusters with mature T lymphocytes adjacent to lymphoid follicles. In large nodules, as well as in type A and type AB thymomas, a few scattered LCs and DCs were identified. All patients were still alive and well. CONCLUSIONS: Our results suggest that LCs take up tumour antigens and migrate to the stroma, where they mature and form clusters with T lymphocytes to activate them, resulting in lymphoid follicle formation. The favourable clinical behaviour may be attributable to the immune response induced by LCs.


Assuntos
Células Dendríticas/patologia , Centro Germinativo/patologia , Células de Langerhans/patologia , Timoma/patologia , Neoplasias do Timo/patologia , Idoso , Linfócitos B/patologia , Feminino , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Timoma/imunologia , Neoplasias do Timo/imunologia
6.
Virchows Arch ; 2023 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-37953373

RESUMO

Recently, cases of carcinoma showing thymus-like differentiation (CASTLE) occurring in major salivary glands have been identified. To assess the diagnostic value of CD5 immunohistochemistry in distinguishing salivary CASTLE from other types of salivary gland tumors, we evaluated CD5 expression in 109 salivary gland tumors, encompassing 23 different histological types, including salivary CASTLE. In addition, we reviewed 10 previously reported cases of salivary CASTLE. Most salivary CASTLE cases (10/11, 91%) showed strong CD5 expression. In contrast, 104 of 108 (96%) non-salivary CASTLE tumors were negative for CD5, while the remaining four tumors (3.7%), all of which were histologically Warthin tumors, showed focal positivity for CD5 with weak to moderate intensity. In conclusion, the findings in this study support the potential use of CD5 immunohistochemistry for distinguishing salivary CASTLE from other histological types of salivary gland tumors. Aberrant CD5 expression in this tumor may be linked to the tumor microenvironment.

7.
J Thorac Dis ; 14(9): 3245-3254, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36245599

RESUMO

Background: Sarcopenia and its marker, the psoas muscle index (PMI), have attracted attention as prognostic factors for various types of cancers. The fragile X-related 1 (FXR1) gene is highly expressed in myocytes, and FXR1 overexpression is a candidate biomarker for poor survival in several types of cancers. Thymic squamous cell carcinoma (TSQCC) is rare, and no studies assessing its prognostic factors, particularly in terms of skeletal muscle mass and FXR1 expression, are available. Methods: We retrospectively investigated the prognostic significance of PMI in 34 patients who underwent TSQCC resection, considering the status of FXR1 and tumor programmed death-ligand 1 (PD-L1). PMI was calculated from the bilateral psoas muscle using preoperative computed tomography (CT). Patients were divided into two groups: low PMI (<58.2%, n=17) and normal PMI (≥58.2%, n=17). Immunohistochemical analysis was performed to determine the FXR1 and PD-L1 expression levels. Results: Low PMI was significantly associated with worse overall survival (OS) (5-year survival rate; 86% vs. 100%; P=0.026) and marginally associated with worse disease-free survival (DFS) (5-year survival rate; 39% vs. 66%; P=0.090) compared with normal PMI. The immunohistochemical analysis revealed that the FXR1 intensity score (0-1+: 6% vs. 0%; 2+-3+: 94% vs. 100%; P=0.31), median FXR1 distribution (95% vs. 90%; P=0.63), and PD-L1 status (high: 47% vs. 59%; P=0.49) were not significantly different between the two groups. Conclusions: Our findings suggest that PMI might be considered as a potential prognostic factor in TSQCC and that FXR1 is widely expressed regardless of the PMI status. Skeletal muscle mass may play a role in the prognosis of TSQCC.

8.
Thorac Cancer ; 13(17): 2499-2506, 2022 09.
Artigo em Inglês | MEDLINE | ID: mdl-35869676

RESUMO

BACKGROUND: Combination chemotherapy is used to treat advanced thymic carcinoma; however, the effects are insufficient. METHODS: Previously untreated patients with unresectable locally advanced thymic carcinoma received two cycles of 80 mg/m2 /day S-1 orally on days 1-14 plus 60 mg/m2 /day cisplatin intravenously on day 1, and concurrent radiotherapy (60 Gy). RESULTS: Three patients were enrolled into the study. Toxicity and survival were assessable in all patients, but the treatment response was only assessable in one patient. The study was terminated because of poor case recruitment. The patients' characteristics were as follows: male/female = 2/1; PS 0/1 = 2/1; median age (range) = 59 (55-72); and stage III/IV = 2/1. The patient in which the treatment response was assessed exhibited SD (response rate: 0%). In both nonevaluable cases, the second course of chemotherapy was judged to be post-protocol treatment because it was delayed by ≥14 days, but a CR and PR were achieved after the end of the study, respectively. G4 leukopenia/neutropenia and G3 febrile neutropenia occurred in one patient each (33%). The median time to tumor progression was 17.6 months, and the 1-, 2-, 3-, and 4-year survival rates were 67, 33, 33, and 33%, respectively. The median overall survival time was not reached, and the 1-, 2-, 3-, and 4-year survival rates were 100, 67, 67, and 67%, respectively. CONCLUSIONS: Although it was difficult to recruit patients, there was a long-term survivor >4 years who appeared to have achieved a CR, indicating that such chemoradiotherapy may be effective against locally advanced thymic carcinoma.


Assuntos
Timoma , Neoplasias do Timo , Idoso , Quimiorradioterapia/métodos , Cisplatino , Terapia Combinada , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neutropenia , Timoma/tratamento farmacológico , Timoma/patologia , Timoma/radioterapia , Neoplasias do Timo/tratamento farmacológico , Neoplasias do Timo/patologia , Neoplasias do Timo/radioterapia
9.
Clin J Gastroenterol ; 15(1): 228-236, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34694599

RESUMO

A 71-year-old man was receiving follow-up examination because of a retention cyst in the pancreatic body that extended to the dorsal extrahepatic area, but presented to the Emergency Department at our hospital with dyspnea and cough. Chest X-ray showed a large amount of left-sided pleural effusion and abdominal computed tomography (CT) showed reduction in size of the cystic lesion. Biochemical testing of the pleural effusion revealed high levels of pancreatic enzymes. We, therefore, diagnosed rupture of the pancreatic cystic lesion into the chest cavity. Endoscopic retrograde cholangiopancreatography (ERCP) demonstrated stenosis of the pancreatic duct and leakage of contrast medium at the cystic lesion. CT after ERCP revealed leakage of contrast medium from the cystic lesion through the dorsal extrahepatic area into the chest cavity. Endoscopic naso-pancreatic drainage was performed, but the cystic lesion and pleural effusion remained unimproved. Distal pancreatectomy was, therefore, performed. Microscopic examination revealed eosinophilic infiltration of the pancreatic parenchyma, leading to a diagnosis of eosinophilic pancreatitis (EP). Pancreatic retention cyst secondary to chronic pancreatitis associated with eosinophilic infiltration was considered to have ruptured into the chest cavity. EP is a rare etiology of pancreatitis and few cases have been reported. This case was thus considered valuable.


Assuntos
Cisto Pancreático , Pancreatite , Idoso , Colangiopancreatografia Retrógrada Endoscópica , Humanos , Masculino , Pâncreas , Cisto Pancreático/complicações , Ductos Pancreáticos/patologia , Pancreatite/complicações , Pancreatite/patologia
10.
J Thorac Oncol ; 17(2): 200-213, 2022 02.
Artigo em Inglês | MEDLINE | ID: mdl-34695605

RESUMO

This overview of the fifth edition of the WHO classification of thymic epithelial tumors (including thymomas, thymic carcinomas, and thymic neuroendocrine tumors [NETs]), mediastinal germ cell tumors, and mesenchymal neoplasms aims to (1) list established and new tumor entities and subtypes and (2) focus on diagnostic, molecular, and conceptual advances since publication of the fourth edition in 2015. Diagnostic advances are best exemplified by the immunohistochemical characterization of adenocarcinomas and the recognition of genetic translocations in metaplastic thymomas, rare B2 and B3 thymomas, and hyalinizing clear cell carcinomas. Advancements at the molecular and tumor biological levels of utmost oncological relevance are the findings that thymomas and most thymic carcinomas lack currently targetable mutations, have an extraordinarily low tumor mutational burden, but typically have a programmed death-ligand 1high phenotype. Finally, data underpinning a conceptual advance are illustrated for the future classification of thymic NETs that may fit into the classification scheme of extrathoracic NETs. Endowed with updated clinical information and state-of-the-art positron emission tomography and computed tomography images, the fifth edition of the WHO classification of thymic epithelial tumors, germ cell tumors, and mesenchymal neoplasms with its wealth of new diagnostic and molecular insights will be a valuable source for pathologists, radiologists, surgeons, and oncologists alike. Therapeutic perspectives and research challenges will be addressed as well.


Assuntos
Adenocarcinoma , Neoplasias Pulmonares , Neoplasias do Timo , Células Germinativas/patologia , Humanos , Mediastino/patologia , Neoplasias do Timo/patologia , Organização Mundial da Saúde
11.
Surg Today ; 41(10): 1436-8, 2011 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-21922373

RESUMO

Type AB thymomas are considered to be nonaggressive tumors, and the great majority are classified as Masaoka stage I or II. This report presents a case with Masaoka stage I and type AB thymoma, which metastasized to the brain 2 years 5 months after removal of the primary tumor. The original mediastinal lesion was adhesive but not invasive to the lung. The patient is now alive with multiple tiny pulmonary metastases 3 years after complete resection of the brain metastasis. Some reports of recurrent thymomas have suggested that the presence of peritumoral adherence to the adjacent structures might be a risk factor for recurrence in patients with such noninvasive thymomas. During the development of fibrosis which thus causes adhesion, the tumor may have an increased chance to metastasize because of the increased vessels and lymphatics.


Assuntos
Neoplasias Encefálicas/secundário , Lobo Temporal/patologia , Timoma/secundário , Neoplasias do Timo/patologia , Neoplasias Encefálicas/diagnóstico , Feminino , Humanos , Imageamento por Ressonância Magnética , Pessoa de Meia-Idade , Radiografia , Timoma/diagnóstico , Neoplasias do Timo/diagnóstico por imagem
12.
Gen Thorac Cardiovasc Surg ; 69(2): 394-397, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32886276

RESUMO

Thymic lipofibroadenomas are extremely rare; their radiological features have never been reported. We report the first case of a lipofibroadenoma with some largish calcifications mimicking a teratoma. A 28-year-old man had an anterior mediastinal tumor with some calcifications on preoperative computed tomography, which was suspected to be a mature teratoma and resected through robot-assisted thoracic surgery. This tumor had strands of epithelial cells separated by abundant fibrous stroma containing fat cells and was thus diagnosed as a lipofibroadenoma. He was well without any recurrence 6 months postoperatively. Largish calcifications on preoperative computed tomography make distinguishing between teratomas and lipfibroadenomas difficult.


Assuntos
Neoplasias do Mediastino , Teratoma , Timoma , Neoplasias do Timo , Adulto , Humanos , Masculino , Recidiva Local de Neoplasia
13.
Surg Today ; 40(11): 1073-8, 2010 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-21046508

RESUMO

Thymic basaloid carcinoma is an extremely rare tumor type, with only 10 such reports published to date in the English literature. We herein present a new case of thymic basaloid carcinoma with pleural dissemination that developed after a curative resection. A cystic tumor in the anterior mediastinum was observed in a 72-year-old man, and the tumor was completely resected via a median sternotomy with a combined resection of the adjacent structures. One year later, pleural disseminated nodules developed in the right thorax, which were resected through a right thoracotomy. The present case and the review of previous cases indicated that this rare tumor, which had previously been considered to be a low-grade malignant thymic carcinoma, may therefore have a more obstinate and aggressive malignant nature. Histopathologically, a few CD5-positive tumor cells were observed in isolation in the squamous epithelium of the inner cyst wall, thus suggesting that malignant transformation subsequently occurs in a preexisting cyst.


Assuntos
Carcinoma de Células de Transição/patologia , Neoplasias Pleurais/secundário , Neoplasias do Timo/patologia , Idoso , Antígenos CD5/análise , Carcinoma de Células de Transição/secundário , Carcinoma de Células de Transição/cirurgia , Humanos , Imuno-Histoquímica , Masculino , Neoplasias Pleurais/cirurgia , Período Pós-Operatório , Prognóstico , Proteínas Proto-Oncogênicas c-bcl-2/análise , Proteínas Proto-Oncogênicas c-kit/análise , Esternotomia/métodos , Toracotomia/métodos , Neoplasias do Timo/cirurgia
14.
Thorac Cancer ; 11(3): 693-696, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-32020735

RESUMO

Thymic carcinoma is a rare epithelial tumor of the thymus with a poor prognosis, and multimodal approaches are important for its treatment. Recently, a number of studies have indicated that S-1 treatment is effective against thymic carcinoma. S-1 plus cisplatin with concurrent radiotherapy is a commonly used treatment for other malignancies, including non-small cell lung cancer (NSCLC). In addition, its safety has been confirmed, and it has been reported to have a marked effect against thymic carcinoma. Therefore, we conducted a phase II study of S-1 plus cisplatin with concurrent thoracic radiotherapy for locally advanced thymic carcinoma, in which the overall response rate was employed as the primary endpoint. The secondary endpoints were overall survival, progression-free survival, and safety.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/métodos , Timoma/terapia , Neoplasias do Timo/terapia , Adulto , Idoso , Cisplatino/administração & dosagem , Ensaios Clínicos Fase II como Assunto , Combinação de Medicamentos , Humanos , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Ácido Oxônico/administração & dosagem , Prognóstico , Projetos de Pesquisa , Tegafur/administração & dosagem , Timoma/patologia , Neoplasias do Timo/patologia , Adulto Jovem
15.
Surg Case Rep ; 5(1): 194, 2019 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-31823088

RESUMO

BACKGROUND: Primary peritoneal carcinoma (PPC) is a very rare and aggressive type of malignancy with a poor prognosis. CASE PRESENTATION: A 66-year-old woman was referred to our hospital with two pulmonary nodules that developed after PPC resection and postoperative adjuvant chemotherapy administered 5 years earlier. Computed tomography revealed a 1.3-cm-sized nodule in the left lung with a small airspace in the posterior basal segment and a 0.9-cm-sized solid nodule in the apico-posterior segment that grew slightly within a 2-month period. 18F-Fluorodeoxyglucose-positron emission tomography of these lesions revealed respective maximum standardized uptake values of 7.11 and 2.46. Her serum cancer antigen-125 level remained within the normal range, despite elevation before the first surgery. The posterior basal segment and superior division were subjected to anatomical segmentectomy. An intraoperative frozen section examination could not distinguish metastatic PPC from primary lung cancer. Immunopathologically, the two nodules were identified as metastatic PPC. CONCLUSIONS: Our findings suggest that PPC patients may develop late-phase thoracic recurrence that is difficult to diagnose clinically after initial treatment in a potentially resectable setting.

16.
J Thorac Imaging ; 23(1): 47-9, 2008 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-18347521

RESUMO

Diffuse pulmonary ossification most commonly occurs in men in their fifth and sixth decades of life and is usually associated with diffuse and chronic lung disease, cardiac disease, or other systemic disorders. In this report, we describe a case of dendriform pulmonary ossification with a past history of giant cell tumor in the femur that occurred 8 years before. The nodules mimicked calcified pulmonary metastases. The patient was young (30 y old) and had no chronic lung or cardiac diseases. We speculate that the pulmonary ossification might have been due to dissemination of bone cells into the pulmonary circulation during bone curettage.


Assuntos
Neoplasias Ósseas/patologia , Fêmur/patologia , Tumor de Células Gigantes do Osso/patologia , Pneumopatias/diagnóstico , Pulmão/patologia , Ossificação Heterotópica/diagnóstico , Adulto , Neoplasias Ósseas/complicações , Neoplasias Ósseas/cirurgia , Curetagem/efeitos adversos , Diagnóstico Diferencial , Fêmur/cirurgia , Tumor de Células Gigantes do Osso/complicações , Tumor de Células Gigantes do Osso/cirurgia , Humanos , Achados Incidentais , Pulmão/diagnóstico por imagem , Pneumopatias/etiologia , Masculino , Ossificação Heterotópica/etiologia , Doenças Raras , Tomografia Computadorizada por Raios X
17.
Pathol Res Pract ; 202(10): 697-704, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16887284

RESUMO

Hassall's corpuscles are regular structures in the medulla of the normal thymus and in non-neoplastic thymic conditions, e.g. in multilocular thymic cysts. In thymomas, however, they are inconsistently found, and are believed to indicate medullary differentiation of WHO type B1-3 thymomas. We present five organotypical thymomas resembling WHO type B2 and B3 thymomas, but with an abundance of Hassall's corpuscles. We wonder whether this exceedingly rare observation might herald a distinct entity. Four tumors were asymptomatic, incidental findings and of low Masaoka stage (I or II) [20] . One patient suffered from myasthenia gravis which disappeared upon surgical removal of the thymus, while all other patients had no concomitant autoimmune disease. Two patients had a relapse-free follow-up of 12 and 2 years, respectively, upon curative surgery, and another tumor was an autopsy finding; follow-up data of two more recent cases was not yet available. The neoplastic epithelium other than Hassall's corpuscles was arranged either in a cortical type B2 pattern or in type B3 solid cords. In all examples, there was cyst formation, inflammatory reaction and repair, indicative of a long-standing condition. Immature T cells were present in all instances. "Corpuscular thymomas" morphologically resemble WHO type B2 and B3 thymomas, but appear biologically indolent and are rarely associated with myasthenia gravis. Whether they qualify for a separate entity has to be proven by larger series, including genetic studies.


Assuntos
Timoma/patologia , Timo/patologia , Neoplasias do Timo/patologia , Organização Mundial da Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Biomarcadores Tumorais/análise , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Imuno-Histoquímica , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Timectomia , Timoma/química , Timoma/classificação , Timo/química , Neoplasias do Timo/química , Neoplasias do Timo/classificação , Resultado do Tratamento
18.
Eur J Cardiothorac Surg ; 49(2): 574-9, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26547095

RESUMO

OBJECTIVES: The tumour-node-metastasis classification has been widely used as a guide for estimating prognosis, and is the basis for treatment decisions in patients with malignant tumours. The International Association for the Study of Lung Cancer Staging and Prognostic Factors Committee and the International Thymic Malignancy Interest Group have proposed a new staging system for thymic malignancies. However, its validity has not been fully established. In this study, we assessed the system's utilities and drawbacks. METHODS: We reviewed 154 consecutive patients with thymic epithelial tumours who underwent complete resection at our institution, and compared their characteristics and outcomes when classified according to the proposed system with those when classified under the Masaoka-Koga system. RESULTS: The proportion of patients with Stage I disease increased remarkably to 77.3% when using the proposed system because of the reclassification of Masaoka-Koga stages II and III diseases. Among 69 patients with Type A, AB or B1 thymoma, 68 tumours (98%) were reclassified as Stage I disease. Moreover, the proportion of Stage III and IV tumours increased in concordance with Types B2, B3 thymomas and thymic carcinoma. Under the proposed new system, the recurrence-free survival rates showed significant deterioration with increasing stage, while the overall survival curves did not. CONCLUSIONS: The newly proposed classification for thymic malignancies does not serve as a prognostic prediction model for overall survival but served as a significant imbalance of stage distribution in our cohort. However, it appears to be beneficial, especially in clinical settings and recurrence-free survival analysis.


Assuntos
Neoplasias Epiteliais e Glandulares/patologia , Neoplasias do Timo/patologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/mortalidade , Neoplasias Epiteliais e Glandulares/cirurgia , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Timoma/mortalidade , Timoma/patologia , Timoma/cirurgia , Neoplasias do Timo/mortalidade , Neoplasias do Timo/cirurgia
19.
Eur J Cardiothorac Surg ; 50(6): 1068-1074, 2016 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-27999073

RESUMO

OBJECTIVES: The T descriptor of thymic epithelial tumours proposed by the International Association for the Study of Lung Cancer and the International Thymic Malignancy Interest Group as well as the Masaoka-Koga system is defined by the anatomical extent of primary tumours, regardless of their size. However, the prognostic significance of tumour size in thymic epithelial tumours has not been fully elucidated. METHODS: We evaluated the prognostic significance of tumour size in 154 consecutive patients with thymic epithelial tumours including 124 thymomas, 21 thymic carcinomas and 9 neuroendocrine tumours, who underwent complete resection between 2001 and 2014. RESULTS: Among all tumours, the median tumour size was 4.9 cm. The median thymoma, thymic carcinoma and neuroendocrine tumour sizes were 4.8, 5.7 and 5.8, respectively, although the differences were not significant. In survival analysis, the 5- and 10-year overall survival (OS) and recurrence-free survival (RFS) rates for all patients were 91 and 81%, and 80 and 69%, respectively. Under the stratification of tumour size, no trend was observed for OS, whereas RFS showed stepwise deterioration as tumour size increased. For 119 patients with Stage I disease, RFS showed deterioration as tumour size increased. Multivariate analysis revealed that tumour size >4.0 cm was an independent prognostic factor for worsening RFS (P = 0.03). CONCLUSIONS: Patients with tumours >4.0 cm showed significantly worse outcomes in RFS compared with those with smaller tumours. This relationship was also noted in patients with Stage I disease.


Assuntos
Neoplasias Epiteliais e Glandulares/cirurgia , Timo/patologia , Neoplasias do Timo/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias Epiteliais e Glandulares/diagnóstico , Neoplasias Epiteliais e Glandulares/mortalidade , Neoplasias Epiteliais e Glandulares/patologia , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/patologia , Tumores Neuroendócrinos/cirurgia , Prognóstico , Análise de Sobrevida , Timoma/diagnóstico , Timoma/mortalidade , Timoma/patologia , Timoma/cirurgia , Timo/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/mortalidade , Neoplasias do Timo/patologia , Adulto Jovem
20.
Am J Surg Pathol ; 26(2): 249-56, 2002 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-11812948

RESUMO

Serrated adenoma of the colorectum is a recently proposed entity characterized by a saw-toothed structure of hyperplastic polyp and cytologic atypia of tubular adenoma. To clarify the role of apoptosis in morphogenesis of serrated adenoma, we investigated apoptotic indices and expression of apoptosis-related antigens in the tumor cells. Thirty-eight serrated adenomas were examined by the nick-end DNA labeling method and immunostained for CD95 (Fas), bcl-2, bax, and p53. Thirty-seven hyperplastic polyps, 48 tubular adenomas, and 16 sections containing normal colonic mucosa were similarly examined for comparison. The apoptotic indices in the upper and middle zones of the crypts of serrated adenomas and hyperplastic polyps were lower than those of normal colon mucosa and tubular adenomas with statistically significant differences. The CD95 expression was diffusely observed throughout the epithelium of normal crypts and tubular adenomas, whereas it was reduced in serrated adenomas and hyperplastic polyps. The bcl-2 expression was confined to the basal crypts in the latter two lesions but was diffuse throughout the neoplastic epithelium in tubular adenomas. The bax expression was increased in serrated adenomas and tubular adenomas but was decreased in hyperplastic polyps. Overexpression of p53 protein was observed in 50% of serrated adenomas, none of hyperplastic polyps, and 14% of tubular adenomas. These findings suggest that inhibition of apoptosis is caused by reduced CD95 expression in serrated adenomas and hyperplastic polyps, which may induce the characteristic saw-toothed structure in these lesions. Based on the similarities and differences between serrated adenoma and hyperplastic polyp observed in the present study, a progression from the latter to the former lesion may be postulated.


Assuntos
Adenoma/patologia , Apoptose , Neoplasias Colorretais/patologia , Adenoma/química , Adulto , Idoso , Idoso de 80 Anos ou mais , Pólipos do Colo/imunologia , Pólipos do Colo/patologia , Neoplasias Colorretais/química , DNA de Neoplasias/análise , Feminino , Humanos , Hiperplasia/imunologia , Hiperplasia/patologia , Técnicas Imunoenzimáticas , Marcação In Situ das Extremidades Cortadas , Masculino , Pessoa de Meia-Idade , Proteínas Proto-Oncogênicas/análise , Proteínas Proto-Oncogênicas c-bcl-2/análise , Proteína Supressora de Tumor p53/análise , Proteína X Associada a bcl-2 , Receptor fas/análise
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