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Thymic carcinomas: clinicopathologic study of 37 cases from a single institution

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Abstract

Thymic carcinomas represent the rarest and the more aggressive form of thymic epithelial tumors. We retrospectively reviewed a series of 37 consecutive cases seen in our hospital over a 15-year period. The patient group consisted of 14 female and 23 male patients, aged 31 to 80 years (mean = 57). Nineteen patients were smokers (mean 29 PY). Two nonsmokers had undergone radiotherapy for breast cancer, respectively, 9 and 15 years earlier. Twenty-four cases were squamous cell carcinomas (SCCs) expressing CD5 (90 %) and CD117 (87 %) and displaying a c-Kit mutation (n = 3). Ten cases were atypical carcinoids, including four associated with MEN1 and three others with Cushing syndrome. Three cases were undifferentiated large cell carcinomas including one associated with a type A thymoma. Twenty-seven patients had undergone a total (n = 25) or subtotal (n = 2), often extended resection. The overall survival (OS) rate was 66.6 % at 36 months, and median OS was 94 months. Carcinoid tumors (P = 0.007), surgical resection (P = 0.009), and Masaoka–Koga stage II (P = 0.049) were significantly associated with better OS. The TNM and three-grade staging systems were also significantly associated with survival but were not superior to the Masaoka–Koga system. Mediastinal lymph node recurrences treatable by reoperation and pulmonary metastases were the most frequent events in carcinoid tumors and SCCs, respectively. In conclusion, our case series suggests that smoking and radiation might constitute previously unrecognized risk factors. It confirms that SCCs express both CD5 and CD117 and possibly a c-Kit mutation. Lymph node dissection should be systematic when resection is performed, especially for carcinoid tumors.

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References

  1. Travis D, Brambilla E, Müller-Hermelink K, Harris CC (2004) Tumours of the thymus. In: World Health Organization Classification of tumours. Pathology and genetics of tumours of the lung, pleura, thymus and heart. International Agency for Research on Cancer (IARC), Lyon

  2. Venuta F, Anile M, Diso D, Vitolo D, Rendina EA, De Giacomo T et al (2010) Thymoma and thymic carcinoma. Eur J Cardiothorac Surg 37:13–25

    Article  PubMed  Google Scholar 

  3. Thomas de Montpréville V (2010) Thymomes et carcinomes thymiques. Rev Fr Mal Resp 27:1281–1287

    Article  Google Scholar 

  4. Huang J, Rizk NP, Travis WD, Riely GJ, Park BJ, Bains MS et al (2009) Comparison of patterns of relapse in thymic carcinoma and thymoma. J Thorac Cardiovasc Surg 138:26–31

    Article  PubMed  Google Scholar 

  5. Pan CC, Chen PCH, Wang LS, Lee JY, Chiang H (2003) Expression of apoptosis-related markers and HER-2/neu in thymic epithelial tumours. Histopathology 43:165–172

    Article  PubMed  Google Scholar 

  6. Strobel P, Hohenberger P, Marx A (2010) Thymoma and thymic carcinoma. Molecular pathology and targeted therapy. J Thorac Oncol 5:S286–S290

    Article  PubMed  Google Scholar 

  7. Kuhn E, Wistuba II (2008) Molecular pathology of thymic epithelial neoplasms. Hematol Oncol Clin N Am 22:443–455

    Article  Google Scholar 

  8. Hirose Y, Kondo K, Takizawa H, Nagao T, Nakagawa Y, Fujino H et al (2009) Aberrant methylation of tumour-related genes in thymic epithelial tumours. Lung Cancer 64:155–159

    Article  PubMed  Google Scholar 

  9. Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C (2011) The Masaoka–Koga stage classification for thymic malignancies. Clarification and definition of terms. J Thorac Oncol 6:S1710–S1716

    Article  PubMed  Google Scholar 

  10. Kondo K (2010) Tumor-node metastasis staging system for thymic epithelial tumors. J Thorac Oncol 5:S352–S356

    Article  PubMed  Google Scholar 

  11. Weissferdt A, Moran CA (2012) Thymic carcinoma, part 2: a clinicopathologic correlation of 33 cases with a proposed staging system. Am J Clin Pathol 138:115–121

    Article  PubMed  Google Scholar 

  12. Tiffet O, Nicholson AG, Ladas G, Sheppard MN, Goldstraw P (2003) A clinicopathologic study of 12 neuroendocrine tumors arising in the thymus. Chest 124:141–146

    Article  PubMed  Google Scholar 

  13. Kuo TT, Chan JKC (1998) Thymic carcinoma arising in thymoma is associated with alteration in immunohistochemical profile. Am J Surg Pathol 22:1474–1481

    Article  PubMed  CAS  Google Scholar 

  14. Beck F, Guignard R, Richard JB, Wilquin JL, Peretti-Watel P (2011) Augmentation récente du tabagisme en France: principaux résultats du baromètre santé, France, 2010. BEH Institut de Veille Sanitaire 20–21:230–233. http://www.invs.sante.fr/Publications-et-outils/BEH-Bulletin-epidemiologique-hebdomadaire. Accessed 23 Oct 2012

  15. Magois E, Guigay J, Saint Blancard P, Margery J, Milleron B, Lher P et al (2008) Multimodal treatment of thymic carcinoma: report of nine cases. Lung Cancer 59:126–132

    Article  PubMed  Google Scholar 

  16. Yano M, Sasaki H, Yokoyama T, Yukiue H, Kawano O, Suzuki S et al (2008) Thymic carcinoma: 30 cases at a single institution. J Thorac Oncol 3:265–269

    Article  PubMed  Google Scholar 

  17. Hosaka Y, Tsuchida M, Toyabe S, Umezu H, Eimoto T, Hayashi J (2010) Masaoka stage and histologic grade predict prognosis in patients with thymic carcinoma. Ann Thorac Surg 89:912–917

    Article  PubMed  Google Scholar 

  18. Chalabreysse L, Etienne-Mastroianni B, Adeleine P, Cordier JF, Greenland T, Thivolet-Bejui F (2004) Thymic carcinoma: a clinicopathological study of 19 cases. Histopathology 44:367–374

    Article  PubMed  CAS  Google Scholar 

  19. Liu HC, Hsu WH, Chen YJ, Chan YJ, Wu YC, Huang BS et al (2002) Primary thymic carcinoma. Ann Thorac Surg 73:1076–1081

    Article  PubMed  Google Scholar 

  20. Lee CY, Bae MK, Park IK, Kim DJ, Lee JG, Chung KY (2009) Early Masaoka stage and complete resection is important for prognosis of thymic carcinoma: a 20-year experience at a single institution. Eur J Cardiovasc Thorac Surg 36:159–163

    Article  Google Scholar 

  21. Kawaguchi K, Usami N, Okasaka T, Yokoi K (2011) Multiple thymic carcinoids. Ann Thorac Surg 91:1973–1975

    Article  PubMed  Google Scholar 

  22. Ogawa K, Toita T, Uno T, Fuwa N, Kakinohana Y, Kamata M et al (2002) Treatment and prognosis of thymic carcinoma. A retrospective analysis of 40 cases. Cancer 94:3115–3119

    Article  PubMed  Google Scholar 

  23. Nakagawa K, Matsuno Y, Kunitoh H, Maeshima A, Asamura H, Tsuchiya R (2005) Immunohistochemical KIT (CD117) expression in thymic epithelial tumors. Chest 128:140–144

    Article  PubMed  CAS  Google Scholar 

  24. Pan CC, Chen PCH, Chiang H (2004) KIT (CD117) is frequently overexpressed in thymic carcinomas but is absent in thymomas. J Pathol 202:375–381

    Article  PubMed  CAS  Google Scholar 

  25. Tsuchida M, Umezu H, Hashimoto T, Shinohara H, Koike T, Hosaka Y et al (2008) Absence of gene mutations in KIT-positive thymic epithelial tumors. Lung Cancer 62:321–325

    Article  PubMed  Google Scholar 

  26. Butnor KJ, Burchette JL, Sporn TA, Hammar SP, Roggli VL (2004) The spectrum of Kit (CD117) immunoreactivity in lung and pleural tumors. A study of 96 cases using a single-source antibody with review of the literature. Arch Pathol Lab Med 128:538–543

    PubMed  Google Scholar 

  27. Yoh K, Nishiwaki Y, Ishii G, Goto K, Kubota K, Ohmatsu H et al (2008) Mutational status of EGFR and KIT in thymoma and thymic carcinoma. Lung Cancer 62:316–320

    Article  PubMed  Google Scholar 

  28. Girard N (2010) Thymic tumors: relevant molecular data in the clinic. J Thorac Oncol 5:S291–S295

    Article  PubMed  Google Scholar 

  29. Kaira K, Murakami H, Serizawa M, Koh Y, Abe M, Ohde Y et al (2011) MUC1 expression in thymic epithelial tumors: MUC1 may be useful marker as differential diagnosis between type B3 thymoma and thymic carcinoma. Virchows Arch 458:615–620

    Article  PubMed  CAS  Google Scholar 

  30. Kaira K, Endo M, Abe M, Nakagawa K, Ohde Y, Okumura T et al (2010) Biologic correlation of 2-[18F]-fluoro-2-deoxy-D-glucose uptake on positron emission tomography in thymic epithelial tumors. J Clin Oncol 28:3746–3753

    Article  PubMed  CAS  Google Scholar 

  31. Suster S, Moran CA (1995) Thymic carcinoid with prominent mucinous stroma. Report of a distinctive morphologic variant of thymic neuroendocrine neoplasm. Am J Surg Pathol 19:1277–1285

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgments

The authors thank Mrs. Nathalie Beaussart, Mrs. Dominique Gimont, Mrs. Justine Kermarquer, Mrs. Sylvie Planté, and Mr. Nicolas Raymond for their technical assistance, Mrs. Marylaure Legentil and Mrs. Jocelyne Terrible for their secretarial work, and Mrs. Lorna Saint Ange for editing.

Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Pathology, Centre Chirurgical Marie Lannelongue, 133 avenue de la Résistance, Le Plessis Robinson, 92350, Paris, France

    Vincent Thomas de Montpréville, Maria-Rosa Ghigna & Peter Dorfmuller

  2. Department of Pathology and Medical Biology, Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, 94805, Paris, France

    Ludovic Lacroix

  3. Department of Medical Oncology, Institut Gustave Roussy, 114 rue Edouard Vaillant, Villejuif, 94805, Paris, France

    Benjamin Besse

  4. Unité de Santé Publique, Hôpital Paul Brousse, 12 avenue Paul Vaillant Couturier, Villejuif, 94800, Paris, France

    Philippe Broet

  5. Department of Thoracic and Vascular Surgery and Heart–Lung Transplantation, Centre Chirurgical Marie Lannelongue, 133 avenue de la Résistance, Le Plessis Robinson, 92350, Paris, France

    Philippe Dartevelle & Élie Fadel

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  1. Vincent Thomas de Montpréville
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  2. Maria-Rosa Ghigna
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Correspondence to Vincent Thomas de Montpréville.

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Thomas de Montpréville, V., Ghigna, MR., Lacroix, L. et al. Thymic carcinomas: clinicopathologic study of 37 cases from a single institution. Virchows Arch 462, 307–313 (2013). https://doi.org/10.1007/s00428-013-1371-y

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  • DOI: https://doi.org/10.1007/s00428-013-1371-y

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