Skip to main content
Log in

The World Health Organization (WHO) Histologic Classification of Thymomas: A Reanalysis

  • Thymoma
  • Published:
Current Treatment Options in Oncology Aims and scope Submit manuscript

Opinion statement

The histologic classification of thymomas has remained for many years an area of conflict. In recent years, the World Health Organization (WHO) presented a proposal for the classification of these tumors, which has been widely adopted in many countries throughout the world. Two successive versions of this classification have been presented in recent years; however, controversy still exists regarding its accuracy and usefulness in clinical practice. We present a review of the current WHO classification of thymomas, with a discussion of some of the inconsistencies and limitations and the possible alternatives to the current approach for the histopathologic classification of these tumors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References and Recommended Reading

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Bernatz PE, Harrison E.G, Claggett OT. Thymoma. A clinicopathologic study. J Thorac Cardiovasc Surg 42:424–444, 1961.

    PubMed  CAS  Google Scholar 

  2. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer 48:2485–2492, 1981. doi:10.1002/1097-0142(19811201)48:11<2485::AID-CNCR2820481123>3.0.CO;2-R.

    Article  PubMed  CAS  Google Scholar 

  3. Marino M, Muller-Hermelink HK. Thymoma and thymic carcinoma: relation of thymoma epithelial cells to the cortical and medullary differentiation of the thymus. Virchows Arch 407:119–149, 1985. doi:10.1007/BF00737071

    Article  CAS  Google Scholar 

  4. Verley JM, Hollmann KH. Thymoma. A comparative clinical study of clinical stages, histologic features, and survival in 200 cases. Cancer 55:1074–1096, 1985. doi:10.1002/1097-0142(19850301)55:5<1074::AID-CNCR2820550524>3.0.CO;2-T

    Article  PubMed  CAS  Google Scholar 

  5. Rosai J: Histological typing of tumors of the thymus. In World Health Organization International Histological Classification of Tumors, 2nd edn. Berlin: Springer-Verlag; 1999

  6. Travis WD, Brambilla E, Muller-Hermelink HK, Harris CC: Pathology and genetics of tumors of the lung, pleura, thymus and heart. In World Health Organization Classification of Tumours. Lyon: IARC Press; 2004

  7. 7) Rieker RJ, Hoegel J, Morresi-Hauf A, Hofmann W, Blaeker H, Penzel R, Otto HF (2002) Histologic classification of thymic epithelial tumors: comparison of established classification schemes. Int J Cancer 98:900–906. doi:10.1002/ijc.10255

    Article  PubMed  CAS  Google Scholar 

  8. 8) Suster S, Moran CA, 2005. Problem areas and inconsistencies in the WHO classification of thymoma. Semin Diagn Pathol 22:189–197.

    Google Scholar 

  9. 9) Suster S, Moran CA, 2006. Thymoma classification: current status and future trends. Am J Clin Pathol 125:542–554.

    PubMed  Google Scholar 

  10. Lattes R. Thymoma and other tumors of the thymus. An analysis of 107 cases. Cancer 15: 1224–1260, 1962. doi:10.1002/1097-0142(196211/12)15:6<1224::AID-CNCR2820150621>3.0.CO;2-V.

    Article  Google Scholar 

  11. Salyer W, Eggleston JC. Thymoma. A clinical and pathological study of 65 cases. Cancer 37: 229–249, 1976. doi:10.1002/1097-0142(197601)37:1<229::AID-CNCR2820370133>3.0.CO;2-2

    Article  PubMed  CAS  Google Scholar 

  12. 12) Sellors TH, Thackaray AC, Thomson AD (1967). Tumors of the thymus. Thorax 22:193–221.

    Article  PubMed  CAS  Google Scholar 

  13. 13) Moran CA, Suster S, 2000. On the histologic heterogeneity of thymic epithelial neoplasms: impact of sampling in subtyping and classification of thymomas. Am J Clin Pathol 114:760–766. doi:10.1309/CYJH-9RXM-P2PK-120J

    Article  PubMed  CAS  Google Scholar 

  14. 14) Chen G, Marx A, Wen-Hu C, Young J, Puppe B, Stroebel P, Mueller-Hermelink HK, 2002. New WHO histologic classification predicts prognosis of thymic epithelial tumors: a clinicopathologic study of 200 thymoma cases from China. Cancer 95:420–429. doi:10.1002/cncr.10665

    Article  PubMed  Google Scholar 

  15. 15) Chalabreysse L, Roy P, Cordier J-F, Loire R, Gamondes J-P, Thivolet-Bejui F, 2002. Correlation of the WHO schema for the classification of thymic epithelial neoplasms with prognosis A retrospective study of 90 tumors. Am J Surg Pathol 26: 1605–1611. doi:10.1097/00000478-200212000-00008

    Article  PubMed  Google Scholar 

  16. Lewis JE, Wick MR, Scheithauer BW. Thymoma: a clinicopathologic review. Cancer 60:2727–2743, 1987. doi:10.1002/1097-0142(19871201)60:11<2727::AID-CNCR2820601125>3.0.CO;2-D

    Article  PubMed  CAS  Google Scholar 

  17. Shimosato Y, Mukai K: Tumors of the mediastinum. Fascicle 21. In Atlas of Tumor Pathology, 3rd series. Washington, DC: Armed Forces Institute of Pathology; 1997:33–157

  18. Suster S, Moran CA, The Mediastinum; in: Modern Surgical Pathology; Weidner N, Cote R, Suster S, Weiss LM (Eds), W.B. Saunders Co, Philadelphia, 2003; pp.439–504.

    Google Scholar 

  19. 19) Marchevsky AM, Gupta R, McKenna RJ, Wick MR, Moran CA, Zakowski M, Suster S, 2008. Evidence-based pathology and the pathologic evaluation of thymomas The World Health Organization classification can be simplified into only 3 categories other than thymic carcinoma. Cancer132: 926–930.

    Google Scholar 

  20. 20) Suster S, Moran CA, 1999. Thymoma, a typical thymoma and thymic carcinoma. A novel conceptual approach to the classification of neoplasms of thymic epithelium. Am J Clin Pathol 111:826–833.

    PubMed  CAS  Google Scholar 

  21. 21) Nakahara K, Ohno K, Hashimoto I, 1988. Thymoma: results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients. J Thorac Cardiovasc Surg 95:1041–1047.

    PubMed  CAS  Google Scholar 

  22. 22) Pescarmona E, Rendina EA, Venuta F, 1995. Recurrent thymoma: evidence for histological progression. Histopathology 27:445–449. doi:10.1111/j.1365-2559.1995.tb00308.x

    Article  PubMed  CAS  Google Scholar 

  23. 23) Suster S, Moran CA, 1996. Primary thymic epithelial neoplasms with combined features of thymoma and thymic carcinoma A clinicopathologic study of 22 cases. Am J Surg Pathol 20:1469–1480. doi:10.1097/00000478-199612000-00006

    Article  PubMed  CAS  Google Scholar 

  24. Suster S, Rosai J: The thymus. In Histology for Pathologists; Sternberg SS (Ed), 3rd. Ed., Raven-Lippincott, Philadelphia, 2006; pp.687–706.

    Google Scholar 

  25. 25) Suster S, Moran CA, 1999. Primary thymic epithelial neoplasms Spectrum of differentiation and histologic features. Semin Diagn Pathol 16:2–17.

    PubMed  CAS  Google Scholar 

  26. 26) Zettl A, Strobel P, Wagner K, et al. 2000. Recurrent genetic aberrations in thymoma and carcinoma. Am J Pathol. 157: 257–266.

    PubMed  CAS  Google Scholar 

  27. 27) Penzel R, Hoegel J, Schmitz W, et al. 2003. Cluster of chromosomal imbalances in thymic epithelial tumors are associated with the WHO classification and the staging system according to Masaoka. Int J Cancer. 105:494–498. doi:10.1002/ijc.11101

    Article  PubMed  CAS  Google Scholar 

  28. 28) Baran JL, Magro CM, King MA et al. 2004. Atypical thymoma: a report of seven patients. Ann Thorac Surg. 78:411–416. doi:10.1016/j.athoracsur.2003.12.052

    Article  PubMed  Google Scholar 

  29. 29) Close PM, Kirchner T, Uys CJ, Muller-Hermelink HK, 1995. Reproducibility of a histogenetic classification of thymic epithelial tumors. Histopathology 26:339–343. doi:10.1111/j.1365-2559.1995.tb00195.x

    Article  PubMed  CAS  Google Scholar 

  30. 30) Tan PH, Sng ITY, 1995. Thymoma—a study of 60 cases in Singapore. Histopathology 26:509–518. doi:10.1111/j.1365-2559.1995.tb00269.x

    Article  PubMed  CAS  Google Scholar 

  31. 31) Schneider PM, Fellbaum C, Fink U, Bollscheiler E, Prauer HW, 1997. Prognostic importance of histomorphologic subclassification for thymic epithelial tumors. Ann Surg Oncol 4:46–56. doi:10.1007/BF02316810

    Article  PubMed  CAS  Google Scholar 

  32. 32) Quintanilla-Martinez L, Wilkins EW, Choi N, Efird J, Hug E, Harris NL, 1994. Thymoma: histologic subclassification is an independent prognostic factor. Cancer 74:606–616. doi:10.1002/1097-0142(19940715)74:2<606::AID-CNCR2820740212>3.0.CO;2-T

    Article  PubMed  CAS  Google Scholar 

  33. 33) Ho FCS, Fu KH, Lam SY, Chiu SW, Chan ACL, Muller-Hermelink HK, 1994. Evaluation of a histogenetic classification for thymic epithelial tumors. Histopathology 25:21–29. doi:10.1111/j.1365-2559.1994.tb00594.x

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Cesar A. Moran MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moran, C.A., Suster, S. The World Health Organization (WHO) Histologic Classification of Thymomas: A Reanalysis. Curr. Treat. Options in Oncol. 9, 288–299 (2008). https://doi.org/10.1007/s11864-009-0084-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11864-009-0084-6

Navigation