Thymic epithelial neoplasms: a comprehensive review of diagnosis and treatment
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Format: | Buch |
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Sprache: | English |
Veröffentlicht: |
Philadelphia [u.a.]
Saunders
2008
|
Schriftenreihe: | Hematology, oncology clinics of North America
22,3 |
Schlagworte: | |
Online-Zugang: | Inhaltsverzeichnis |
Beschreibung: | XII S., S. 381 - 580 Ill., graph. Darst. |
ISBN: | 9781416061021 1416061029 |
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adam_text | CONTENTS VOLUME 22 » NUMBER 3 • JUNE 2008
Preface xi
Cesar A. Moran and Saul Suster
Histologic Classification of Thymoma: The World
Health Organization and Beyond 381
Saul Suster and Cesar A. Moran
Thymoma classification has remained for many years a troubled and
contentious field. In recent years, the World Health Organization
(WHO) presented a proposal for the histopathologic classification of
thymic epithelial neoplasms that has been adopted as the standard by
many pathologists throughout the world. Yet, controversy still exists re¬
garding its validity, accuracy, usefulness, and reproducibility in routine
clinical practice. This article reviews the basic criteria of the current
WHO classification of thymoma, along with its weaknesses and limita¬
tions, and presents alternate proposals for the histopathologic approach
to the classification of thymic epithelial neoplasms.
Thymic Carcinoma: Current Concepts and
Histologic Features 393
Cesar A. Moran and Saul Suster
Thymic carcinoma is a rare tumor that has traditionally posed a signif¬
icant challenge for diagnosis to clinicians and histopathologists. No re¬
liable histopathologic features have yet been identified that can permit
reliable distinction of these tumors from a metastasis to the mediasti¬
num. Histologically, the tumors are characterized by morphologic fea¬
tures that are indistinguishable from those arising from a variety of
other epithelial organs. A large number of histologic variants have
been described. In general, these tumors remain a diagnosis of exclusion
and, as a group, represent high-grade neoplasms with a very aggressive
clinical behavior and an often-ominous prognosis.
Imaging of Thymic Epithelial Neoplasms 409
Melissa L. Rosado-de-Christenson, Diane C. Strollo,
and Edith M. Marom
Thymic epithelial neoplasms are uncommon lesions. Affected patients
may be asymptomatic or may present with thoracic complaints or para-
neoplastic syndromes. Asymptomatic lesions may be discovered
CONTENTS continued
incidentally during chest radiography or during other chest imaging
studies. This article addresses the imaging evaluation of patients who
have thymic epithelial neoplasms, specifically covering the use of chest
radiography, CT, MRI, and positron emission tomography.
Fine Needle Aspiration in the Diagnosis of Thymic
Epithelial Neoplasms 433
PaulE. Wakleyjr
Fine-needle aspiration (FNA) biopsy of thymoma is a demanding diag¬
nostic exercise by the cytopathologist because of an overwhelming,
often obscuring population of benign lymphocytes in many cases. Diag¬
nosis requires the presence of a dual population of unequivocal epithe¬
lial cells and lymphocytes in the correct clinical-radiologic context.
Cytologic examination alone is not insufficient to discriminate among
the various subtypes of thymoma, nor can capsular invasion or invasion
of adjacent structures be determined using FNA. The cytopathology of
various thymic carcinomas (including neuroendocrine carcinoma)
imitate their appearance in extra-thymic sites, and are generally recog¬
nizable using FNA. Separation of moderately differentiated neuroendo¬
crine carcinoma from poorly differentiated small cell neuroendocrine
carcinomas is generally not possible.
Molecular Pathology of Thymic Epithelial Neoplasms 443
Elisabetta Kuhn and Ignacio I. Wistuba
The etiology and molecular pathogenesis of thymic tumors are un¬
known. However, during the last two decades there has been some
progress on elucidating the genetic abnormalities present and molecular
pathways altered in thymic tumors. These abnormalities, while bearing
distinctions and similarities to those described in other tumors, can be
f organized under the hallmarks of cancer, as proposed by Hanahan
and Weinberg. These changes include self-sufficiency in growth signal¬
ing, insensitivity to antigrowth signals, ability to evade apoptosis, limit¬
less replicative potential, ability to sustain angiogenesis, and tissue
invasion and metastasis. However, this progress is still limited and
has not led to better tumor classifications, prognostication of outcome,
and design of molecular targeted therapy.
Clinical Management of Thymoma Patients 457
Erin M. Casey, Patrick J. Kiel, and Patrick J. Loehrer, Sr
Thymoma and thymic carcinomas are rare epithelial tumors that arise
from the thymus gland. Current management depends on staging, with
surgery being the mainstay of therapy for stages I and II disease. Com¬
bined modality therapy, including radiation and chemotherapy, is rec¬
ommended for patients who have invasive and metastatic disease.
Relapse has been documented decades after initial therapy with options
CONTENTS continued
for treating recurrent advanced stage disease. Prospective studies have
been limited, and current studies aim to evaluate novel treatment
options.
Surgical Treatment of Thymic Epithelial Neoplasms 475
Larry R. Kaiser
Resection continues to be the mainstay of treatment for epithelial le¬
sions of the thymus. This has never been in doubt for encapsulated
stage I and II lesions, but we recently have come to a greater apprecia¬
tion of the role of preoperative therapy for locally advanced lesions, par¬
ticularly stage III disease. For any lesion that presents in the anterior
mediastinum and on CT scan does not appear to be eminently resect-
able, a biopsy should be performed to rule out lymphoma after serum
germ cell markers have been obtained to rule out the rare primary me-
diastinal or metastatic germ cell tumor.
Radiotherapy for Thymoma and Thymic Carcinoma 489
Clifton David Fuller, Douglas M. Housman, and
Charles R. Thomas
The role of radiodierapy for patients who have thymic neoplasms re¬
mains unclear. The low incidence of thymic malignancies, excellent out¬
come with complete resection, and limited body of evidence obfuscate
the role of radiation therapy within the current multidisciplinary man¬
agement of disease. Nonetheless, existing literature reports and novel
radiotherapy techniques show increasing potential for integration of
radiotherapy into the standard therapeutic milieu for carefully selected
patient subpopulations.
Thymoma, Myasthenia Gravis, and Other
Paraneoplastic Syndromes 509
Laura M. Tormoehlen and Robert M. Pascuzzi
The relationship between myasthenia gravis and thymic pathology, in¬
cluding thymoma, is well known. Approximately 10% to 15% of pa¬
tients who have myasthenia gravis are observed to have a thymoma.
Myasthenia gravis may be considered as the most common of the para¬
neoplastic syndromes in patients who have thymoma. This article sum¬
marizes the clinical aspects of myasthenia gravis, followed by a review
of the less often recognized paraneoplastic disorders noted to occur in
patients who have thymoma.
Prognostic Factors for Thymic Epithelial Neoplasms,
with Emphasis on Tumor Staging 527
Mark R. Wick
The prognosis of thymic epithelial tumors depends on their separation
into thymoma and thymic carcinoma, as well as the extent to which
they involve adjacent tissues and organs. To formalize evaluations of
CONTENTS continued
the latter attribute, several staging systems have been developed over the
past 30 years. These include the Masaoka, Bergh, Wilkins-Castleman,
Groupe d Etudes des Tumeurs Thymiques, and tumor-nodal-
metastasis schemes. The first of those formulations is most commonly
employed in clinical practice, at least in the United States. The author
believes that surgical-padiologic staging is the most powerful and reli¬
able prognosticator for thymoma, as compared with histologic subtype-
related prediction of behavior for that tumor type. Those topics, as
well as affiliated issues concerning tissue sampling and staging tech¬
niques, are discussed in this article.
Thymic Epithelial Neoplasms: A Review of Current
Concepts Using an Evidence-Based Pathology Approach 543
Alberto M. Marchevsky, Robert J. McKenna, Jr,
and Ruta Gupta
Evidence-based pathology promotes the critical evaluation of current
clinical information and the development of evidence-based diagnostic
and prognostic guidelines. No randomized clinical trials of patients
who have thymomas or diymic carcinomas are available to evaluate
the validity of the current World Health Organization (WHO) histo¬
logic classification or the widely used Masaoka staging system. A
meta-analysis of over 2000 diymoma patients estimated that only three
WHO histologic types of thymomas are associated with significant sur¬
vival differences. Prospective randomized clinical trials and aninterna-
tional registry of patients who have Thymic epithelial neoplasms are
needed to stratify patients who may benefit from neoadjuvant chemo¬
therapy, postoperative radiation therapy, and other nonsurgical
modalities.
The Foundation for Thymic Cancer Research: Scope
and Contributions 563
Alan Neibauer
This article addresses the history and purpose of the Foundation for
Thymic Cancer Research. It discusses the thymic cancer experiences
of the founders—the author and his wife Barbara Neibauer—and die
role the Foundation plays in providing physical, emotional, and re¬
search support to victims of this disease, their families, and their
physicians.
Index 575
|
adam_txt |
CONTENTS VOLUME 22 » NUMBER 3 • JUNE 2008
Preface xi
Cesar A. Moran and Saul Suster
Histologic Classification of Thymoma: The World
Health Organization and Beyond 381
Saul Suster and Cesar A. Moran
Thymoma classification has remained for many years a troubled and
contentious field. In recent years, the World Health Organization
(WHO) presented a proposal for the histopathologic classification of
thymic epithelial neoplasms that has been adopted as the standard by
many pathologists throughout the world. Yet, controversy still exists re¬
garding its validity, accuracy, usefulness, and reproducibility in routine
clinical practice. This article reviews the basic criteria of the current
WHO classification of thymoma, along with its weaknesses and limita¬
tions, and presents alternate proposals for the histopathologic approach
to the classification of thymic epithelial neoplasms.
Thymic Carcinoma: Current Concepts and
Histologic Features 393
Cesar A. Moran and Saul Suster
Thymic carcinoma is a rare tumor that has traditionally posed a signif¬
icant challenge for diagnosis to clinicians and histopathologists. No re¬
liable histopathologic features have yet been identified that can permit
reliable distinction of these tumors from a metastasis to the mediasti¬
num. Histologically, the tumors are characterized by morphologic fea¬
tures that are indistinguishable from those arising from a variety of
other epithelial organs. A large number of histologic variants have
been described. In general, these tumors remain a diagnosis of exclusion
and, as a group, represent high-grade neoplasms with a very aggressive
clinical behavior and an often-ominous prognosis.
Imaging of Thymic Epithelial Neoplasms 409
Melissa L. Rosado-de-Christenson, Diane C. Strollo,
and Edith M. Marom
Thymic epithelial neoplasms are uncommon lesions. Affected patients
may be asymptomatic or may present with thoracic complaints or para-
neoplastic syndromes. Asymptomatic lesions may be discovered
CONTENTS continued
incidentally during chest radiography or during other chest imaging
studies. This article addresses the imaging evaluation of patients who
have thymic epithelial neoplasms, specifically covering the use of chest
radiography, CT, MRI, and positron emission tomography.
Fine Needle Aspiration in the Diagnosis of Thymic
Epithelial Neoplasms 433
PaulE. Wakleyjr
Fine-needle aspiration (FNA) biopsy of thymoma is a demanding diag¬
nostic exercise by the cytopathologist because of an overwhelming,
often obscuring population of benign lymphocytes in many cases. Diag¬
nosis requires the presence of a dual population of unequivocal epithe¬
lial cells and lymphocytes in the correct clinical-radiologic context.
Cytologic examination alone is not insufficient to discriminate among
the various subtypes of thymoma, nor can capsular invasion or invasion
of adjacent structures be determined using FNA. The cytopathology of
various thymic carcinomas (including neuroendocrine carcinoma)
imitate their appearance in extra-thymic sites, and are generally recog¬
nizable using FNA. Separation of moderately differentiated neuroendo¬
crine carcinoma from poorly differentiated small cell neuroendocrine
carcinomas is generally not possible.
Molecular Pathology of Thymic Epithelial Neoplasms 443
Elisabetta Kuhn and Ignacio I. Wistuba
The etiology and molecular pathogenesis of thymic tumors are un¬
known. However, during the last two decades there has been some
progress on elucidating the genetic abnormalities present and molecular
pathways altered in thymic tumors. These abnormalities, while bearing
distinctions and similarities to those described in other tumors, can be
f organized under the "hallmarks of cancer," as proposed by Hanahan
and Weinberg. These changes include self-sufficiency in growth signal¬
ing, insensitivity to antigrowth signals, ability to evade apoptosis, limit¬
less replicative potential, ability to sustain angiogenesis, and tissue
invasion and metastasis. However, this progress is still limited and
has not led to better tumor classifications, prognostication of outcome,
and design of molecular targeted therapy.
Clinical Management of Thymoma Patients 457
Erin M. Casey, Patrick J. Kiel, and Patrick J. Loehrer, Sr
Thymoma and thymic carcinomas are rare epithelial tumors that arise
from the thymus gland. Current management depends on staging, with
surgery being the mainstay of therapy for stages I and II disease. Com¬
bined modality therapy, including radiation and chemotherapy, is rec¬
ommended for patients who have invasive and metastatic disease.
Relapse has been documented decades after initial therapy with options
CONTENTS continued
for treating recurrent advanced stage disease. Prospective studies have
been limited, and current studies aim to evaluate novel treatment
options.
Surgical Treatment of Thymic Epithelial Neoplasms 475
Larry R. Kaiser
Resection continues to be the mainstay of treatment for epithelial le¬
sions of the thymus. This has never been in doubt for encapsulated
stage I and II lesions, but we recently have come to a greater apprecia¬
tion of the role of preoperative therapy for locally advanced lesions, par¬
ticularly stage III disease. For any lesion that presents in the anterior
mediastinum and on CT scan does not appear to be eminently resect-
able, a biopsy should be performed to rule out lymphoma after serum
germ cell markers have been obtained to rule out the rare primary me-
diastinal or metastatic germ cell tumor.
Radiotherapy for Thymoma and Thymic Carcinoma 489
Clifton David Fuller, Douglas M. Housman, and
Charles R. Thomas
The role of radiodierapy for patients who have thymic neoplasms re¬
mains unclear. The low incidence of thymic malignancies, excellent out¬
come with complete resection, and limited body of evidence obfuscate
the role of radiation therapy within the current multidisciplinary man¬
agement of disease. Nonetheless, existing literature reports and novel
radiotherapy techniques show increasing potential for integration of
radiotherapy into the standard therapeutic milieu for carefully selected
patient subpopulations.
Thymoma, Myasthenia Gravis, and Other
Paraneoplastic Syndromes 509
Laura M. Tormoehlen and Robert M. Pascuzzi
The relationship between myasthenia gravis and thymic pathology, in¬
cluding thymoma, is well known. Approximately 10% to 15% of pa¬
tients who have myasthenia gravis are observed to have a thymoma.
Myasthenia gravis may be considered as the most common of the para¬
neoplastic syndromes in patients who have thymoma. This article sum¬
marizes the clinical aspects of myasthenia gravis, followed by a review
of the less often recognized paraneoplastic disorders noted to occur in
patients who have thymoma.
Prognostic Factors for Thymic Epithelial Neoplasms,
with Emphasis on Tumor Staging 527
Mark R. Wick
The prognosis of thymic epithelial tumors depends on their separation
into thymoma and thymic carcinoma, as well as the extent to which
they involve adjacent tissues and organs. To formalize evaluations of
CONTENTS continued
the latter attribute, several staging systems have been developed over the
past 30 years. These include the Masaoka, Bergh, Wilkins-Castleman,
Groupe d'Etudes des Tumeurs Thymiques, and tumor-nodal-
metastasis schemes. The first of those formulations is most commonly
employed in clinical practice, at least in the United States. The author
believes that surgical-padiologic staging is the most powerful and reli¬
able prognosticator for thymoma, as compared with histologic subtype-
related prediction of behavior for that tumor type. Those topics, as
well as affiliated issues concerning tissue sampling and staging tech¬
niques, are discussed in this article.
Thymic Epithelial Neoplasms: A Review of Current
Concepts Using an Evidence-Based Pathology Approach 543
Alberto M. Marchevsky, Robert J. McKenna, Jr,
and Ruta Gupta
Evidence-based pathology promotes the critical evaluation of current
clinical information and the development of evidence-based diagnostic
and prognostic guidelines. No randomized clinical trials of patients
who have thymomas or diymic carcinomas are available to evaluate
the validity of the current World Health Organization (WHO) histo¬
logic classification or the widely used Masaoka staging system. A
meta-analysis of over 2000 diymoma patients estimated that only three
WHO histologic types of thymomas are associated with significant sur¬
vival differences. Prospective randomized clinical trials and aninterna-
tional registry of patients who have Thymic epithelial neoplasms are
needed to stratify patients who may benefit from neoadjuvant chemo¬
therapy, postoperative radiation therapy, and other nonsurgical
modalities.
The Foundation for Thymic Cancer Research: Scope
and Contributions 563
Alan Neibauer
This article addresses the history and purpose of the Foundation for
Thymic Cancer Research. It discusses the thymic cancer experiences
of the founders—the author and his wife Barbara Neibauer—and die
role the Foundation plays in providing physical, emotional, and re¬
search support to victims of this disease, their families, and their
physicians.
Index 575 |
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title | Thymic epithelial neoplasms a comprehensive review of diagnosis and treatment |
title_auth | Thymic epithelial neoplasms a comprehensive review of diagnosis and treatment |
title_exact_search | Thymic epithelial neoplasms a comprehensive review of diagnosis and treatment |
title_exact_search_txtP | Thymic epithelial neoplasms a comprehensive review of diagnosis and treatment |
title_full | Thymic epithelial neoplasms a comprehensive review of diagnosis and treatment guest ed. Cesar A. Moran ... |
title_fullStr | Thymic epithelial neoplasms a comprehensive review of diagnosis and treatment guest ed. Cesar A. Moran ... |
title_full_unstemmed | Thymic epithelial neoplasms a comprehensive review of diagnosis and treatment guest ed. Cesar A. Moran ... |
title_short | Thymic epithelial neoplasms |
title_sort | thymic epithelial neoplasms a comprehensive review of diagnosis and treatment |
title_sub | a comprehensive review of diagnosis and treatment |
topic | Tumor (DE-588)4078460-5 gnd Thymus (DE-588)4060010-5 gnd |
topic_facet | Tumor Thymus Aufsatzsammlung |
url | http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&local_base=BVB01&doc_number=016596205&sequence=000002&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA |
volume_link | (DE-604)BV000625446 |
work_keys_str_mv | AT morancesara thymicepithelialneoplasmsacomprehensivereviewofdiagnosisandtreatment |