흉선종의 술후 예후판정요인의 분석

박창권 대한흉부심장혈관외과학회 1994 Journal of Chest Surgery (J Chest Surg) Vol.27 No.9

In this study, the authors analyzed the prognostic value of four clinical variables[age and sex of patients, association with myasthenia gravis and clinical stage] and histological type in 30 consecutive patients with thymoma, histologically classified as cortical[10],medullary[5] and mixed[15]type according to Marino and Muller-Hermelink classification. There were significant differences between the histological types in the frequency of the different tumor stages and myasthenia gravis and prognosis.Most of the cortical thymomas were at stage III and all of the medullary and most of the mixed tumors at stage I or II.Myasthenia gravis occurred more commonly in patients with cortical[30%] and mixed thymoma[60%] than in patients with medullary thymoma[10%]. Follow-up was conducted in 30 patients,with follow-up range from 3 months to 120 months[mean,47.3months]. 5 year actuarial survival was 100% for medullary thymoma, 73% for mixed thymoma, and 47% for cortical thymoma.The overall survival curve shows that 87.6% of the patients are alive at 2 years and 72.8% at 5 years. And 7 patients was dead during follow-up periods.By Kaplan-Meier technique, we found that the patients who had myasthenia gravis had better prognosis[P<0.05]. Medullary thymoma is a comparatively rare, benign tumor, and usually not associated with myasthenia gravis. Cortical thymoma must be regarded as malignant. Mixed thymoma is intermediate in its behavior between medullary and cortical thymoma. But these tumors should be considered potentially malignant despite of presence as stage I of II disease. Also, the patients with stageI,II had good prognosis and the patients with total resection had good prognosis[P<0.05].

The Immunoexpression of Ki-67, Bcl-2, p53, and Tyrosine Kinase Receptors in Thymic Epithelial Tumors; Their Correlation with the WHO Histologic Subtypes and the Prognostic Value

김미진 대한병리학회 2008 Journal of Pathology and Translational Medicine Vol.42 No.5

Background : The clinicopathologic features of thymic epithelial tumors are inadequate as predictors of the progression of these tumors because of their heterogeneous histology and varied biological behavior. We attempted to detect the expression of tyrosine kinase receptors and oncogenic markers to determine the correlation between these markers and the WHO classification of the tumors. Methods : Forty-three surgically resected thymic epithelial tumors (37 thymomas and 6 thymic carcinomas) were immunohistochemically assessed on tissue arrays for c-KIT, her-2/neu, epidermal growth factor receptor (EGFR), p53. bcl-2 and Ki-67. Results : The Ki-67 labeling index was significantly increased in thymic carcinoma (p<0.05). The overexpression of p53 protein was observed exclusively in type B3 thymoma (67%) and thymic carcinoma (83%). Bcl-2 was expressed in type A and AB thymomas as well as in thymic carcinoma. C-KIT was only present in thymic carcinoma (p<0.05), whereas the EGFR expression was significantly high in all types of thymomas, except for thymic carcinomas. Her-2/neu was not identified in any type of thymoma. Conclusions : This study suggests that the Ki-67 LI, bcl-2, p53, c-KIT, and EGFR protein expression may be useful markers for the subclassification of thymic epithelial tumors according to WHO schema and WHO classification correlated with the tumor staging. The overexpression of c-KIT in thymic carcinoma reveals that these patients would likely benefit from an anti-c-KIT treatment. Background : The clinicopathologic features of thymic epithelial tumors are inadequate as predictors of the progression of these tumors because of their heterogeneous histology and varied biological behavior. We attempted to detect the expression of tyrosine kinase receptors and oncogenic markers to determine the correlation between these markers and the WHO classification of the tumors. Methods : Forty-three surgically resected thymic epithelial tumors (37 thymomas and 6 thymic carcinomas) were immunohistochemically assessed on tissue arrays for c-KIT, her-2/neu, epidermal growth factor receptor (EGFR), p53. bcl-2 and Ki-67. Results : The Ki-67 labeling index was significantly increased in thymic carcinoma (p<0.05). The overexpression of p53 protein was observed exclusively in type B3 thymoma (67%) and thymic carcinoma (83%). Bcl-2 was expressed in type A and AB thymomas as well as in thymic carcinoma. C-KIT was only present in thymic carcinoma (p<0.05), whereas the EGFR expression was significantly high in all types of thymomas, except for thymic carcinomas. Her-2/neu was not identified in any type of thymoma. Conclusions : This study suggests that the Ki-67 LI, bcl-2, p53, c-KIT, and EGFR protein expression may be useful markers for the subclassification of thymic epithelial tumors according to WHO schema and WHO classification correlated with the tumor staging. The overexpression of c-KIT in thymic carcinoma reveals that these patients would likely benefit from an anti-c-KIT treatment.

갑상선 종괴로 촉지된 흉선종의 세침흡인 세포학적 진단 - 2예 보고 -

김동자,박지영,금윤섭,박태인,손윤경,Kim, Dong-Ja,Park, Ji-Young,Kum, Yoon-Seup,Park, Tae-In,Sohn, Yoon-Kyung 대한세포병리학회 2000 대한세포병리학회지 Vol.11 No.1

Thymoma is the most common anterior mediastinal tumor in adults. Rarely, it is presented as the anterior neck mass, commonly located in the anterolateral aspect of the neck or adjacent to the thyroid. We experienced two cases of fine needle aspiration cytology of thymoma, mimicking thyroid mass. The first case was an ectopoic cervical thymoma in a 31-year-old female. The fine needle aspiration cytology was misinterpreted as reactive hyperplasia of lymph node. But the histologic diagnosis was thymoma, predominantly lymphocytic type. The second case was an invasive thymoma in a 66-year-old female, who complained a large anterior neck mass. The fine needle aspiration cytology revealed biphasic population of some clusters of epithelial cells and scattered lymphocytes. The cytologic diagnosis was thymoma and was confirmed as invasive thymoma after the biopsy. Therefore, when the cytologic feature of anterior neck mass shows the both lymphocyte and epithelial component, the differential diagnosis should Include the possibility of thymoma.

Case Reports : A Case of Pleural Metastasis 6 Years after Complete Surgical Resection of Invasive Thymoma

( Kwang Jin Woo ),( Yang Ki Kim ),( Ki Up Kim ),( Soo Taek Uh ),( Dong Won Kim ),( Jung Hwa Hwang ),( Yong Hoon Kim ),( Choon Sik Park ) 대한결핵 및 호흡기학회 2011 Tuberculosis and Respiratory Diseases Vol.70 No.1

Herein, we report a case of recurrent pleural metastasis after complete resection of invasive thymoma that was successfully treated with surgical resection. Thymoma and thymic carcinoma are uncommon neoplasms derived from the epithelial cells of the thymus. Approximately 30% to 50% of thymomas are asymptomatic at the time of diagnosis. However, these cancers may present with constitutional or local pressure symptoms and sometimes with paraneoplastic syndromes, especially myasthenia gravis. Surgical resection is the mainstay of thymoma treatment and has been shown to remarkably improve long-term survival. Despite complete resection, local recurrences are frequent, and surgery is the cornerstone of therapy even in cases of recurrent thymoma. We experienced a 67-year-old male patient with pleural metastasis that developed 6 years after complete surgical resection of invasive thymoma. The pleural mass was excised by video-assisted thoracoscopic surgery. Histopathological examination revealed an invasive World Health Organization (WHO) type B2 thymoma.

GVHD-like erythroderma associated with aggravation of thymoma

( Ji Hong Lee ),( Jee Bum Lee ),( Seung Chul Lee ),( Young Ho Won ),( Sook Jung Yun ) 대한피부과학회 2019 대한피부과학회 학술발표대회집 Vol.71 No.1

A 76-year-old woman presented with scaly erythema and red papules across the trunk and extremities. She was admitted to internal medicine suspecting meningitis. The initial differential diagnosis for her cutaneous lesions included drug eruption due to antibiotics and viral exanthem. Antibiotics were stopped and she was treated with topical steroid, oral antihistamine. But there was no effect on skin lesion, which then spread rapidly to the whole body during a few days. The patient was diagnosed with invasive thymoma. Because thymoma cells had been disseminated to the pleura, no further treatments could be utilized. And several days before admission, she developed fever and general fatigue. Based on her medical history we suspected that cutaneous lesions may be related to the aggravation of thymoma. The pathologic findings of a biopsy specimen from the abdomen revealed parakeratosis, many apoptotic cells in the epidermal layer, perivascular and interface dermatitis with lymphocytic infiltration. Theses pathologic alterations were similar to those seen in GVHD. Interestingly, she never underwent allogenic stem cell or solid-organ transplantation. And she died of aggravation of thymoma a few days later. Given the presence of GVHD-like skin symptoms and aggravation of thymoma, the diagnosis of thymoma-associated GVHD-like erythroderma, one of the findings in thymoma-associated multiorgan autoimmunity, was made.

Incidence of Thymoma in Myasthenia Gravis: A Systematic Review

Zhi-Feng Mao,Xue-An Mo,Yong-Rong Lai,Maree L. Hackett 대한신경과학회 2012 Journal of Clinical Neurology Vol.8 No.3

Background and Purpose Myasthenia gravis (MG) is usually comorbid with thymoma. More accurate estimates of the incidence thymoma in MG will help inform patients and their physicians, facilitate health policy discussions, provide etiologic clues, and optimize the management of MG. Methods We conducted a systematic review search of relevant English-language studies published between 1960 and 2012 using MEDLINE and Embase. We identified additional studies by reviewing the bibliographies of the retrieved articles and hand searched the main neurology journals. Only incidence studies and case series of unselected MG patients in which information about thymoma were included. Results Out of 2206 potentially relevant studies, 49 met the inclusion criteria. Although there was a considerable degree of heterogeneity, the pooled estimate of the incidence of thymoma in MG was 21% (95% confidence interval, 20-22%). The pooled incidence was significantly higher for surgery-based studies than for population- and hospital-based studies. A large proportion of the reported thymomas were noninvasive. Furthermore, thymoma appears to occur significantly more frequently among male MG patients and those older than 40 years at the onset of MG. Conclusions Thymoma is common in MG patients, but appears to be found more often in male MG patients and those older than 40 years at the onset of MG. Further research is needed to expand our understanding of these association conditions

A Case of Pleural Metastasis 6 Years after Complete Surgical Resection of Invasive Thymoma

Woo, Kwang-Jin,Kim, Yang-Ki,Kim, Ki-Up,Uh, Soo-Taek,Kim, Dong-Won,Hwang, Jung-Hwa,Kim, Yong-Hoon,Park, Choon-Sik The Korean Academy of Tuberculosis and Respiratory 2011 Tuberculosis and Respiratory Diseases Vol.70 No.1

Herein, we report a case of recurrent pleural metastasis after complete resection of invasive thymoma that was successfully treated with surgical resection. Thymoma and thymic carcinoma are uncommon neoplasms derived from the epithelial cells of the thymus. Approximately 30% to 50% of thymomas are asymptomatic at the time of diagnosis. However, these cancers may present with constitutional or local pressure symptoms and sometimes with paraneoplastic syndromes, especially myasthenia gravis. Surgical resection is the mainstay of thymoma treatment and has been shown to remarkably improve long-term survival. Despite complete resection, local recurrences are frequent, and surgery is the cornerstone of therapy even in cases of recurrent thymoma. We experienced a 67-year-old male patient with pleural metastasis that developed 6 years after complete surgical resection of invasive thymoma. The pleural mass was excised by video-assisted thoracoscopic surgery. Histopathological examination revealed an invasive World Health Organization (WHO) type B2 thymoma.

Pathologic Finding of Thymic Carcinoma Accompanied by Myasthenia Gravis

Kim, Se Hoon,Koh, Im Suk,Minn, Yang-Ki 대한신경과학회 2015 Journal of Clinical Neurology Vol.11 No.4

<P><B>Background and Purpose</B></P><P>The World Health Organization (WHO) has classified thymic carcinoma and other thymomas (types A, AB, and B) as different neoplasms. Myasthenia gravis (MG) is an early sign of thymoma and theoretically does not accompany thymic carcinoma; however, cases of thymic carcinoma with MG have been reported. Whether thymic carcinoma can accompany MG has yet to be established.</P><P><B>Methods</B></P><P>The medical records of patients who underwent thymectomy for MG between 1990 and 2011 in a single hospital were reviewed. All cases with the diagnostic code of 'thymic carcinoma' or 'thymoma type C' (old terminology) were selected. A pathologist re-reviewed the pathologic specimens using the new WHO criteria. The rate of thymic carcinoma among these MG patients was then calculated.</P><P><B>Results</B></P><P>A total of 81 patients with MG had thymic tumors, 10 of whom had thymic carcinomas or thymoma type C. Seven cases of well-differentiated thymic carcinomas (type B3) were excluded, leaving three (3.7%) cases of thymic carcinoma with MG. All three of these cases were type B3 thymoma with a focal squamous cell carcinoma component that was very small and well demarcated. In addition, two out of the three tumors were found to be at an early clinical stage. All of the cases survived without recurrence over follow-up periods of at least 5 years.</P><P><B>Conclusions</B></P><P>Thymic carcinoma transformation from thymoma can occur during the early stages of thymoma. The association of this condition with MG is not as rare as was previously thought. Thymic carcinomas accompanying MG had a predominant B3 thymoma component with a focal thymic carcinoma area (squamous cell carcinoma).</P>

흉선종 : 외과적으로 절제된 6예 분석 Muller-Hermelink 분류체계를 중심으로 Analysis of 6 surgically excised cases Centered to Muller-Hermelink Classification

오미혜,임병성,김미영,오삼세 世宗醫學硏究所 2000 世宗醫學 Vol.17 No.1

피질 미성숙 흉선 세포의 특이 항원인 JL1의 흉선종에서의 발현 양상; 새로운 보조적 진단 표지자

박찬식,박영수,김영지,이윤희,허주영 대한병리학회 2008 Journal of Pathology and Translational Medicine Vol.42 No.5

Background : JL1 is a novel antigen that has been reported to be expressed exclusively in immature CD4 CD8 double positive T-cells in the thymic cortex. Thymomas are often infiltrated with lymphocytes that are mostly immature T-cells. Methods : We evaluated 67 cases of surgically resected thymomas and reviewed their histological, surgical, and clinical findings. Representative sections were immunostained using anti-JL1 monoclonal antibody and the immunostaining score was evaluated in each case. Results : JL1 was strongly positive in immature T cells infiltrated in various subtypes of thymomas. The mean value of the immunostaining score was 0 for type A, 0.24 for the A areas of type AB, 2.71 for the B areas of type AB, 3 for type B1, 1.87 for type B2, 0.67 for type B3, and 0.13 for type C. The immunostaining score correlated with the histological subtypes according to the WHO classification, and stages according to the modified Masaoka system. Conclusions : JL1 was specifically detected in immature thymocytes in thymomas. Therefore, JL1 immunostaining can be useful for subtyping thymomas. JL1 can also serve as an adjunctive marker to diagnose thymomas in small biopsy specimens.