Skip to main content

Thymic Neoplasm

  • Chapter
  • First Online:
  • 601 Accesses

Part of the book series: Current Clinical Pathology ((CCPATH))

Abstract

The variety of tumors originating in the thymus partially reflects the main cellular types present in the organ, i.e., epithelial and lymphoid cells. However, in the anterior mediastinum along with the thymus, several other structures and ectopic tissues are located, giving rise to a variety of other tumors. The clinical, pathological, and genetic features of thymic epithelial tumors are described, together with the key imaging features supporting the diagnosis. A review of current surgical options is provided, as well as current chemotherapeutic and targeted agent treatment options. The added value of international networks (ERN, European reference networks) is discussed with respect to patient care.

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

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   79.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   99.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD   109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

References

  1. Castleman B, Iverson L, Menendez VP. Localized mediastinal lymphnode hyperplasia resembling thymoma. Cancer. 1956;9(4):822–30.

    Article  CAS  PubMed  Google Scholar 

  2. Kligerman SJ, Auerbach A, Franks TJ, Galvin JR. Castleman disease of the thorax: clinical, radiologic, and pathologic correlation: from the radiologic pathology archives. Radiographics. 2016;36(5):1309–32.

    Article  PubMed  Google Scholar 

  3. Suster S, Moran C. Diagnostic pathology: thoracic. 1st ed. In: Hammond E, editor. Canada: Amirsys Publishing, Inc.; 2012.

    Google Scholar 

  4. Grandhomme F. Über Tumoren des vorderen Mediastinums und ihre Beziehungen zu der Thymusdrüse. Heidelberg: Inaug Diss; 1900.

    Google Scholar 

  5. Ewing J. Thymus and its tumors. Report of 3 cases of thymoma. Surg Gynec Obst. 1916;22:461–72.

    Google Scholar 

  6. Ewing J. Neoplastic diseases: a treatise on tumors. 3rd ed. Philadelphia: Saunders, WB; 1928.

    Google Scholar 

  7. Symmers D. Malignant tumors and tumor-like growths of the thymic region. Ann Surg. 1932;95(4):544–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Bell E. Tumors of the thymus in myasthenia gravis. J Nerv Ment Dis. 1917;42:130.

    Article  Google Scholar 

  9. Levine GD, Rosai J, Bearman RM, Polliack A. The fine structure of thymoma, with emphasis on its differential diagnosis. A study of ten cases. Am J Pathol. 1975;81(1):49–86.

    CAS  PubMed  PubMed Central  Google Scholar 

  10. Weigert C. Pathologisch-anatomischer Beitrag zur Erb’schen Krankheit [Myasthenia gravis]. In: Mendel E, editor. Neurologisches Zentralblatt. Leipzig: Verlag von Veit & Comp.; 1901. p. 597–601.

    Google Scholar 

  11. Blalock A, Mason M, Morgan H, Riven S. Myasthenia gravis and tumors of the thymic region: Report of a case in which the tumor was removed. Ann Surg. 1939;110(4):544–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  12. Iverson L. Thymoma; a review and reclassification. Am J Pathol. 1956;32(4):695–719.

    CAS  PubMed  PubMed Central  Google Scholar 

  13. Rosai J, Levine G. Tumors of the thymus. Second series ed. Washington, DC: Armed Forces Institute of Pathology; 1976.

    Google Scholar 

  14. Bernatz PE, Harrison EG, Clagett OT. Thymoma: a clinicopathologic study. J Thorac Cardiovasc Surg. 1961;42:424–44.

    Article  CAS  PubMed  Google Scholar 

  15. Lattes R. Thymoma and other tumors of the thymus: an analysis of 107 cases. Cancer. 1962;15:1224–60.

    Article  Google Scholar 

  16. Miller J. Immunological function of the thymus. Lancet. 1961;278(7205):748–9.

    Article  Google Scholar 

  17. Good R, Maclean L, Varco R, ZAK S. Thymic tumor and acquired agammaglobulinemia : a clinical and experimental study of the immune response. Surgery. 1956;40(6):1010–7.

    CAS  PubMed  Google Scholar 

  18. Thomson AD, Jelliffe AM, Smithers DW. Discussion on the possible significance of the thymic origin of Hodgkin’s disease. Proc R Soc Med. 1956;49(2):97–104.

    CAS  PubMed  Google Scholar 

  19. Keynes G. The physiology of the thymus gland. Br Med J. 1954;2(4889):659–63.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  20. Keynes G. The history of myasthenia gravis. Med Hist. 1961;5:313–26.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. von Gaudecker B. The development of the human thymus microenvironment. Curr Top Pathol. 1986;75:1–41.

    Google Scholar 

  22. Van Ewijk W. Immunohistology of lymphoid and non-lymphoid cells in the thymus in relation to T lymphocyte differentiation. Am J Anat. 1984;170(3):311–30.

    Article  PubMed  Google Scholar 

  23. van de Wijngaert FP, Kendall MD, Schuurman HJ, Rademakers LH, Kater L. Heterogeneity of epithelial cells in the human thymus. An ultrastructural study. Cell Tissue Res. 1984;237(2):227–37.

    Article  PubMed  Google Scholar 

  24. Engels EA. Epidemiology of thymoma and associated malignancies. J Thorac Oncol. 2010;5(10 Suppl 4):S260–5.

    Article  PubMed  PubMed Central  Google Scholar 

  25. Iorio R, Evoli A, Lauriola L, Batocchi AP. A B3 type-thymoma in a 7-year-old child with myasthenia gravis. J Thorac Oncol. 2012;7(5):937–8.

    Article  PubMed  Google Scholar 

  26. Fonseca AL, Ozgediz DE, Christison-Lagay ER, Detterbeck FC, Caty MG. Pediatric thymomas: report of two cases and comprehensive review of the literature. Pediatr Surg Int. 2014;30(3):275–86.

    Article  PubMed  Google Scholar 

  27. Stachowicz-Stencel T, Orbach D, Brecht I, Schneider D, Bien E, Synakiewicz A, et al. Thymoma and thymic carcinoma in children and adolescents: a report from the European Cooperative Study Group for Pediatric Rare Tumors (EXPeRT). Eur J Cancer. 2015;51(16):2444–52.

    Article  PubMed  Google Scholar 

  28. Siesling S, van der Zwan JM, Izarzugaza I, Jaal J, Treasure T, Foschi R, et al. Rare thoracic cancers, including peritoneum mesothelioma. Eur J Cancer. 2012;48(7):949–60.

    Article  PubMed  Google Scholar 

  29. Weissferdt A, Moran CA. The spectrum of ectopic thymomas. Virchows Arch. 2016;469(3):245–54.

    Article  PubMed  Google Scholar 

  30. Chung SR, Kim IS, Kim J. Thymoma of the middle mediastinum. Korean J Thorac Cardiovasc Surg. 2012;45(4):267–8.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Marandino F, Zoccali C, Salducca N, Marino M, Visca P. Ectopic primary type A thymoma located in two thoracic vertebras: a case report. BMC Cancer. 2010;10:322.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Weissferdt A, Kalhor N, Petersson F, Moran CA. Ectopic hamartomatous thymoma-new insights into a challenging entity: a clinicopathologic and immunohistochemical study of 9 cases. Am J Surg Pathol. 2016;40(11):1571–6.

    Article  PubMed  Google Scholar 

  33. Yan B, Lim D, Petersson F. Ectopic cervical thymoma: a report of two cases of a rare entity frequently misdiagnosed on fine needle aspiration cytology and frozen section. Head Neck Pathol. 2010;4(2):152–6.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Amodeo G, Cipriani O, Orsini R, Scopelliti D. A rare case of ectopic laterocervical thymoma. J Craniomaxillofac Surg. 2013;41(1):7–9.

    Article  PubMed  Google Scholar 

  35. Venuta F, Rendina EA, Anile M, de Giacomo T, Vitolo D, Coloni GF. Thymoma and thymic carcinoma. Gen Thorac Cardiovasc Surg. 2012;60(1):1–12.

    Article  PubMed  Google Scholar 

  36. Shimosato Y, Mukai K. Tumors of the mediastinum, Atlas of tumor pathology. Washington, DC: Armed Forces Institute of Pathology; 1997.

    Google Scholar 

  37. Carter BW, Marom EM, Detterbeck FC. Approaching the patient with an anterior mediastinal mass: a guide for clinicians. J Thorac Oncol. 2014;9(9 Suppl 2):S102–9.

    Article  PubMed  Google Scholar 

  38. Moran CA, Suster S, Fishback NF, Koss MN. Primary intrapulmonary thymoma. A clinicopathologic and immunohistochemical study of eight cases. Am J Surg Pathol. 1995;19(3):304–12.

    Article  CAS  PubMed  Google Scholar 

  39. Marino M, Lattanzio R, Pescarmona E. Mediastinal tumor markers, Ch 151. In: LoCicero J, Feins R, Rocco G, Colson Y, Meyers B, editors. Shield’s general thoracic surgery. 8th ed. Wolters Kluwer Health; 2018. ISBN/ISSN9781451195224, Publication Date June 1, 2018.

    Google Scholar 

  40. Priola AM, Priola SM, Di Franco M, Cataldi A, Durando S, Fava C. Computed tomography and thymoma: distinctive findings in invasive and noninvasive thymoma and predictive features of recurrence. Radiol Med. 2010;115(1):1–21.

    Article  CAS  PubMed  Google Scholar 

  41. Carter BW, Benveniste MF, Truong MT, Marom EM. State of the art: MR imaging of thymoma. Magn Reson Imaging Clin N Am. 2015;23(2):165–77.

    Article  PubMed  Google Scholar 

  42. Tomiyama N, Honda O, Tsubamoto M, Inoue A, Sumikawa H, Kuriyama K, et al. Anterior mediastinal tumors: diagnostic accuracy of CT and MRI. Eur J Radiol. 2009;69(2):280–8.

    Article  PubMed  Google Scholar 

  43. Rosado-de-Christenson ML, Strollo DC, Marom EM. Imaging of thymic epithelial neoplasms. Hematol Oncol Clin North Am. 2008;22(3):409–31.

    Article  PubMed  Google Scholar 

  44. Regnard JF, Zinzindohoue F, Magdeleinat P, Guibert L, Spaggiari L, Levasseur P. Results of re-resection for recurrent thymomas. Ann Thorac Surg. 1997;64(6):1593–8.

    Article  CAS  PubMed  Google Scholar 

  45. Yabuuchi H, Matsuo Y, Abe K, Baba S, Sunami S, Kamitani T, et al. Anterior mediastinal solid tumours in adults: characterisation using dynamic contrast-enhanced MRI, diffusion-weighted MRI, and FDG-PET/CT. Clin Radiol. 2015;70(11):1289–98.

    Article  CAS  PubMed  Google Scholar 

  46. Han J, Lee KS, Yi CA, Kim TS, Shim YM, Kim J, et al. Thymic epithelial tumors classified according to a newly established WHO scheme: CT and MR findings. Korean J Radiol. 2003;4(1):46–53.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Abdel Razek AA, Khairy M, Nada N. Diffusion-weighted MR imaging in thymic epithelial tumors: correlation with World Health Organization classification and clinical staging. Radiology. 2014;273(1):268–75.

    Article  PubMed  Google Scholar 

  48. Seline TH, Gross BH, Francis IR. CT and MR imaging of mediastinal hemangiomas. J Comput Assist Tomogr. 1990;14(5):766–8.

    Article  CAS  PubMed  Google Scholar 

  49. Okasaka T, Iwano S, Usami N, Uchiyama M, Sato N, Ito S, et al. [Usefulness of dynamic computed tomography for the diagnosis of mediastinal hemangioma]. Kyobu Geka. 2007;60(11):1031–4.

    Google Scholar 

  50. Shin KE, Yi CA, Kim TS, Lee HY, Choi YS, Kim HK, et al. Diffusion-weighted MRI for distinguishing non-neoplastic cysts from solid masses in the mediastinum: problem-solving in mediastinal masses of indeterminate internal characteristics on CT. Eur Radiol. 2014;24(3):677–84.

    Article  PubMed  Google Scholar 

  51. Takahashi K, Al-Janabi NJ. Computed tomography and magnetic resonance imaging of mediastinal tumors. J Magn Reson Imaging. 2010;32(6):1325–39.

    Article  PubMed  Google Scholar 

  52. Marom EM. Advances in thymoma imaging. J Thorac Imaging. 2013;28(2):69–80; quiz 1–3.

    Article  PubMed  Google Scholar 

  53. Evoli A, Lancaster E. Paraneoplastic disorders in thymoma patients. J Thorac Oncol. 2014;9(9 Suppl 2):S143–7.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Marx A, Willcox N, Leite MI, Chuang WY, Schalke B, Nix W, et al. Thymoma and paraneoplastic myasthenia gravis. Autoimmunity. 2010;43(5-6):413–27.

    Article  CAS  PubMed  Google Scholar 

  55. Vitiello L, Masci AM, Montella L, Perna F, Angelini DF, Borsellino G, et al. Thymoma-associated immunodeficiency: a syndrome characterized by severe alterations in NK, T and B-cells and progressive increase in naïve CD8+ T Cells. Int J Immunopathol Pharmacol. 2010;23(1):307–16.

    Article  CAS  PubMed  Google Scholar 

  56. Means RT. Pure red cell aplasia. Blood. 2016;128(21):2504–9.

    Article  CAS  PubMed  Google Scholar 

  57. Shelly S, Agmon-Levin N, Altman A, Shoenfeld Y. Thymoma and autoimmunity. Cell Mol Immunol. 2011;8(3):199–202.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. Kon T, Mori F, Tanji K, Miki Y, Kimura T, Wakabayashi K. Giant cell polymyositis and myocarditis associated with myasthenia gravis and thymoma. Neuropathology. 2013;33(3):281–7.

    Article  PubMed  Google Scholar 

  59. Evoli A, Minisci C, Di Schino C, Marsili F, Punzi C, Batocchi AP, et al. Thymoma in patients with MG: characteristics and long-term outcome. Neurology. 2002;59(12):1844–50.

    Article  CAS  PubMed  Google Scholar 

  60. Fang W, Chen W, Chen G, Jiang Y. Surgical management of thymic epithelial tumors: a retrospective review of 204 cases. Ann Thorac Surg. 2005;80(6):2002–7.

    Article  PubMed  Google Scholar 

  61. Wang F, Pang L, Fu J, Shen Y, Wei Y, Tan L, et al. Postoperative survival for patients with thymoma complicating myasthenia gravis-preliminary retrospective results of the ChART database. J Thorac Dis. 2016;8(4):711–7.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Mao ZF, Mo XA, Qin C, Lai YR, Hackett ML. Incidence of thymoma in myasthenia gravis: a systematic review. J Clin Neurol. 2012;8(3):161–9.

    Article  PubMed  PubMed Central  Google Scholar 

  63. Ruffini E, Filosso PL, Mossetti C, Bruna MC, Novero D, Lista P, et al. Thymoma: inter-relationships among World Health Organization histology, Masaoka staging and myasthenia gravis and their independent prognostic significance: a single-centre experience. Eur J Cardiothorac Surg. 2011;40(1):146–53.

    Article  PubMed  Google Scholar 

  64. Filosso PL, Venuta F, Oliaro A, Ruffini E, Rendina EA, Margaritora S, et al. Thymoma and inter-relationships between clinical variables: a multicentre study in 537 patients. Eur J Cardiothorac Surg. 2014;45(6):1020–7.

    Article  PubMed  Google Scholar 

  65. Girard N, Ruffini E, Marx A, Faivre-Finn C, Peters S, Committee EG. Thymic epithelial tumours: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(Suppl 5):v40–55.

    Article  PubMed  Google Scholar 

  66. Detterbeck FC, Parsons AM. Management of stage I and II thymoma. Thorac Surg Clin. 2011;21(1):59–67, vi–vii.

    Article  PubMed  Google Scholar 

  67. Ried M, Guth H, Potzger T, Diez C, Neu R, Schalke B, et al. Surgical resection of thymoma still represents the first choice of treatment. Thorac Cardiovasc Surg. 2012;60(2):145–9.

    Article  CAS  PubMed  Google Scholar 

  68. Ackman JB, Verzosa S, Kovach AE, Louissaint A, Lanuti M, Wright CD, et al. High rate of unnecessary thymectomy and its cause. Can computed tomography distinguish thymoma, lymphoma, thymic hyperplasia, and thymic cysts? Eur J Radiol. 2015;84(3):524–33.

    Article  PubMed  Google Scholar 

  69. Ruffini E, Van Raemdonck D, Detterbeck F, Rocco G, Thomas P, Venuta F, et al. Management of thymic tumors: a survey of current practice among members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2011;6(3):614–23.

    Article  PubMed  Google Scholar 

  70. Priola AM, Priola SM, Ciccone G, Evangelista A, Cataldi A, Gned D, et al. Differentiation of rebound and lymphoid thymic hyperplasia from anterior mediastinal tumors with dual-echo chemical-shift MR imaging in adulthood: reliability of the chemical-shift ratio and signal intensity index. Radiology. 2015;274(1):238–49.

    Article  PubMed  Google Scholar 

  71. Yue J, Gu Z, Yu Z, Zhang H, Ma Z, Liu Y, et al. Pretreatment biopsy for histological diagnosis and induction therapy in thymic tumors. J Thorac Dis. 2016;8(4):656–64.

    Article  PubMed  PubMed Central  Google Scholar 

  72. Kent MS, Wang T, Gangadharan SP, Whyte RI. What is the prevalence of a “nontherapeutic” thymectomy? Ann Thorac Surg. 2014;97(1):276–82; discussion 82.

    Article  PubMed  Google Scholar 

  73. Wang H, Sima CS, Beasley MB, Illei P, Saqi A, Nonaka D, et al. Classification of thymic epithelial neoplasms is still a challenge to thoracic pathologists: a reproducibility study using digital microscopy. Arch Pathol Lab Med. 2014;138(5):658–63.

    Article  PubMed  Google Scholar 

  74. Falkson CB, Bezjak A, Darling G, Gregg R, Malthaner R, Maziak DE, et al. The management of thymoma: a systematic review and practice guideline. J Thorac Oncol. 2009;4(7):911–9.

    Article  PubMed  Google Scholar 

  75. Davenport E, Malthaner RA. The role of surgery in the management of thymoma: a systematic review. Ann Thorac Surg. 2008;86(2):673–84.

    Article  PubMed  Google Scholar 

  76. Margaritora S, Cesario A, Cusumano G, Meacci E, D’Angelillo R, Bonassi S, et al. Thirty-five-year follow-up analysis of clinical and pathologic outcomes of thymoma surgery. Ann Thorac Surg. 2010;89(1):245–52; discussion 52.

    Article  PubMed  Google Scholar 

  77. Girard N, Mornex F, Van Houtte P, Cordier JF, van Schil P. Thymoma: a focus on current therapeutic management. J Thorac Oncol. 2009;4(1):119–26.

    Article  PubMed  Google Scholar 

  78. Detterbeck FC, Moran C, Huang J, Suster S, Walsh G, Kaiser L, et al. Which way is up? Policies and procedures for surgeons and pathologists regarding resection specimens of thymic malignancy. J Thorac Oncol. 2011;6(7 Suppl 3):S1730–8.

    Article  PubMed  Google Scholar 

  79. Jurado J, Javidfar J, Newmark A, Lavelle M, Bacchetta M, Gorenstein L, et al. Minimally invasive thymectomy and open thymectomy: outcome analysis of 263 patients. Ann Thorac Surg. 2012;94(3):974–81; discussion 81–2.

    Article  PubMed  Google Scholar 

  80. Yu L, Zhang XJ, Ma S, Li F, Zhang YF. Thoracoscopic thymectomy for myasthenia gravis with and without thymoma: a single-center experience. Ann Thorac Surg. 2012;93(1):240–4.

    Article  PubMed  Google Scholar 

  81. Pennathur A, Qureshi I, Schuchert MJ, Dhupar R, Ferson PF, Gooding WE, et al. Comparison of surgical techniques for early-stage thymoma: feasibility of minimally invasive thymectomy and comparison with open resection. J Thorac Cardiovasc Surg. 2011;141(3):694–701.

    Article  PubMed  Google Scholar 

  82. Weksler B, Tavares J, Newhook TE, Greenleaf CE, Diehl JT. Robot-assisted thymectomy is superior to transsternal thymectomy. Surg Endosc. 2012;26(1):261–6.

    Article  PubMed  Google Scholar 

  83. Rueckert J, Swierzy M, Badakhshi H, Meisel A, Ismail M. Robotic-assisted thymectomy: surgical procedure and results. Thorac Cardiovasc Surg. 2015;63(3):194–200.

    Article  PubMed  Google Scholar 

  84. Marulli G, Rea F, Melfi F, Schmid TA, Ismail M, Fanucchi O, et al. Robot-aided thoracoscopic thymectomy for early-stage thymoma: a multicenter European study. J Thorac Cardiovasc Surg. 2012;144(5):1125–30.

    Article  PubMed  Google Scholar 

  85. Scott WJ, Allen MS, Darling G, Meyers B, Decker PA, Putnam JB, et al. Video-assisted thoracic surgery versus open lobectomy for lung cancer: a secondary analysis of data from the American College of Surgeons Oncology Group Z0030 randomized clinical trial. J Thorac Cardiovasc Surg. 2010;139(4):976–81; discussion 81–3.

    Article  PubMed  Google Scholar 

  86. Lacin T, Swanson S. Current costs of video-assisted thoracic surgery (VATS) lobectomy. J Thorac Dis. 2013;5(Suppl 3):S190–3.

    PubMed  PubMed Central  Google Scholar 

  87. Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. WHO classification of tumours of the lung, pleura, thymus and heart. 4th ed. In: Cancer IAfRo, editor. Lyon: International Agency for Research on Cancer-IARC Press; 2015.

    Google Scholar 

  88. Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC. WHO classification of tumours of the lung, pleura, thymus and heart. In: Kleihues P, Sobin LH, editors. Lyon: IARC Press; 2004.

    Google Scholar 

  89. Rosai J, Sobin LH. Histological typing of tumours of the thymus. World Health Organization. Springer-Verlag H, editor; 1999.

    Google Scholar 

  90. Marino M, Müller-Hermelink HK. Thymoma and thymic carcinoma. Relation of thymoma epithelial cells to the cortical and medullary differentiation of thymus. Virchows Arch A Pathol Anat Histopathol. 1985;407(2):119–49.

    Article  CAS  PubMed  Google Scholar 

  91. Hayashi A, Fumon T, Miki Y, Sato H, Yoshino T, Takahashi K. The evaluation of immunohistochemical markers and thymic cortical microenvironmental cells in distinguishing thymic carcinoma from type b3 thymoma or lung squamous cell carcinoma. J Clin Exp Hematop. 2013;53(1):9–19.

    Article  PubMed  Google Scholar 

  92. Ströbel P, Hartmann E, Rosenwald A, Kalla J, Ott G, Friedel G, et al. Corticomedullary differentiation and maturational arrest in thymomas. Histopathology. 2014;64(4):557–66.

    Article  PubMed  Google Scholar 

  93. Marx A, Ströbel P, Badve SS, Chalabreysse L, Chan JK, Chen G, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol. 2014;9(5):596–611.

    Article  CAS  PubMed  Google Scholar 

  94. Marx A, Chan JK, Coindre JM, Detterbeck F, Girard N, Harris NL, et al. The 2015 World Health Organization classification of tumors of the thymus: continuity and changes. J Thorac Oncol. 2015;10(10):1383–95.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  95. Wu J, Fang W, Chen G. The enlightenments from ITMIG Consensus on WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Dis. 2016;8(4):738–43.

    Article  PubMed  PubMed Central  Google Scholar 

  96. Meurgey A, Girard N, Merveilleux du Vignaux C, Maury JM, Tronc F, Thivolet-Bejui F, et al. Assessment of the ITMIG statement on the WHO histological classification and of the eighth TNM staging of thymic epithelial tumors of a series of 188 thymic epithelial tumors. J Thorac Oncol. 2017;12(10):1571–81.

    Article  PubMed  Google Scholar 

  97. Suster S, Moran CA. Primary thymic epithelial neoplasms: spectrum of differentiation and histological features. Semin Diagn Pathol. 1999;16(1):2–17.

    CAS  PubMed  Google Scholar 

  98. Suster S, Moran CA. Thymoma, atypical thymoma, and thymic carcinoma. A novel conceptual approach to the classification of thymic epithelial neoplasms. Am J Clin Pathol. 1999;111(6):826–33.

    Article  CAS  PubMed  Google Scholar 

  99. Moran CA, Suster S. The World Health Organization (WHO) histologic classification of thymomas: a reanalysis. Curr Treat Options Oncol. 2008;9(4–6):288–99.

    Article  PubMed  Google Scholar 

  100. Chilosi M, Castelli P, Martignoni G, Pizzolo G, Montresor E, Facchetti F, et al. Neoplastic epithelial cells in a subset of human thymomas express the B cell-associated CD20 antigen. Am J Surg Pathol. 1992;16(10):988–97.

    Article  CAS  PubMed  Google Scholar 

  101. Nonaka D, Rosai J. Is there a spectrum of cytologic atypia in type a thymomas analogous to that seen in type B thymomas? A pilot study of 13 cases. Am J Surg Pathol. 2012;36(6):889–94.

    Article  PubMed  Google Scholar 

  102. Vladislav IT, Gökmen-Polar Y, Kesler KA, Loehrer PJ, Badve S. The role of histology in predicting recurrence of type A thymomas: a clinicopathologic correlation of 23 cases. Mod Pathol. 2013;26(8):1059–64.

    Article  PubMed  Google Scholar 

  103. Bürger T, Schaefer IM, Küffer S, Bohnenberger H, Reuter-Jessen K, Chan JK, et al. Metastatic type A thymoma: morphological and genetic correlation. Histopathology. 2017;70(5):704–10.

    Article  PubMed  Google Scholar 

  104. Chilosi M, Doglioni C, Yan Z, Lestani M, Menestrina F, Sorio C, et al. Differential expression of cyclin-dependent kinase 6 in cortical thymocytes and T-cell lymphoblastic lymphoma/leukemia. Am J Pathol. 1998;152(1):209–17.

    CAS  PubMed  PubMed Central  Google Scholar 

  105. Weis CA, Yao X, Deng Y, Detterbeck FC, Marino M, Nicholson AG, et al. The impact of thymoma histotype on prognosis in a worldwide database. J Thorac Oncol. 2015;10(2):367–72.

    Article  PubMed  PubMed Central  Google Scholar 

  106. Snover DC, Levine GD, Rosai J. Thymic carcinoma. Five distinctive histological variants. Am J Surg Pathol. 1982;6(5):451–70.

    Article  CAS  PubMed  Google Scholar 

  107. Suster S, Moran CA. Thymic carcinoma: spectrum of differentiation and histologic types. Pathology. 1998;30(2):111–22.

    Article  CAS  PubMed  Google Scholar 

  108. Suster S, Moran CA. Spindle cell thymic carcinoma: clinicopathologic and immunohistochemical study of a distinctive variant of primary thymic epithelial neoplasm. Am J Surg Pathol. 1999;23(6):691–700.

    Article  CAS  PubMed  Google Scholar 

  109. Suster S, Moran CA. Primary thymic epithelial neoplasms showing combined features of thymoma and thymic carcinoma. A clinicopathologic study of 22 cases. Am J Surg Pathol. 1996;20(12):1469–80.

    Article  CAS  PubMed  Google Scholar 

  110. Jiang Y, Liu Y, Shi X, Mao X, Zhao Y, Fan C. An unusual combined thymic carcinoma composed of squamous cell carcinoma and type AB thymoma: a rare case report. Diagn Pathol. 2017;12(1):9.

    Article  PubMed  PubMed Central  Google Scholar 

  111. Rosai J, Higa E. Mediastinal endocrine neoplasm, of probable thymic origin, related to carcinoid tumor. Clinicopathologic study of 8 cases. Cancer. 1972;29(4):1061–74.

    Article  CAS  PubMed  Google Scholar 

  112. Ströbel P, Zettl A, Shilo K, Chuang WY, Nicholson AG, Matsuno Y, et al. Tumor genetics and survival of thymic neuroendocrine neoplasms: a multi-institutional clinicopathologic study. Genes Chromosomes Cancer. 2014;53(9):738–49.

    Article  PubMed  CAS  Google Scholar 

  113. Teh BT, Zedenius J, Kytölä S, Skogseid B, Trotter J, Choplin H, et al. Thymic carcinoids in multiple endocrine neoplasia type 1. Ann Surg. 1998;228(1):99–105.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  114. Gibril F, Chen YJ, Schrump DS, Vortmeyer A, Zhuang Z, Lubensky IA, et al. Prospective study of thymic carcinoids in patients with multiple endocrine neoplasia type 1. J Clin Endocrinol Metab. 2003;88(3):1066–81.

    Article  CAS  PubMed  Google Scholar 

  115. Moran CA, Suster S. Primary neuroendocrine carcinoma (thymic carcinoid) of the thymus with prominent oncocytic features: a clinicopathologic study of 22 cases. Mod Pathol. 2000;13(5):489–94.

    Article  CAS  PubMed  Google Scholar 

  116. Suster S, Moran CA. Neuroendocrine neoplasms of the mediastinum. Am J Clin Pathol. 2001;115(Suppl):S17–27.

    PubMed  Google Scholar 

  117. Hekimgil M, Hamulu F, Cagirici U, Karabulut B, Ozgen AG, Soydan S, et al. Small cell neuroendocrine carcinoma of the thymus complicated by Cushing’s syndrome. Report of a 58-year-old woman with a 3-year history of hypertension. Pathol Res Pract. 2001;197(2):129–33.

    CAS  PubMed  Google Scholar 

  118. den Bakker MA, Oosterhuis JW. Tumours and tumour-like conditions of the thymus other than thymoma; a practical approach. Histopathology. 2009;54(1):69–89.

    Article  Google Scholar 

  119. Pomplun S, Wotherspoon AC, Shah G, Goldstraw P, Ladas G, Nicholson AG. Immunohistochemical markers in the differentiation of thymic and pulmonary neoplasms. Histopathology. 2002;40(2):152–8.

    Article  CAS  PubMed  Google Scholar 

  120. Marchevsky A, Marx A, Ströbel P, Suster S, Venuta F, Marino M, et al. Policies and reporting guidelines for small biopsy specimens of mediastinal masses. J Thorac Oncol. 2011;6(7 Suppl 3):S1724–9.

    Article  PubMed  Google Scholar 

  121. Weissferdt A, Moran CA. Pax8 expression in thymic epithelial neoplasms: an immunohistochemical analysis. Am J Surg Pathol. 2011;35(9):1305–10.

    Article  PubMed  Google Scholar 

  122. Jevremovic D, Roden AC, Ketterling RP, Kurtin PJ, McPhail ED. LMO2 is a specific marker of T-lymphoblastic leukemia/lymphoma. Am J Clin Pathol. 2016;145(2):180–90.

    Article  CAS  PubMed  Google Scholar 

  123. Zhang K, Deng H, Cagle PT. Utility of immunohistochemistry in the diagnosis of pleuropulmonary and mediastinal cancers: a review and update. Arch Pathol Lab Med. 2014;138(12):1611–28.

    Article  PubMed  Google Scholar 

  124. Marx A, Weis C, Tzankov A, Ströbel P. Thymic epithelial tumors and benign thymic lesions. In: Roden A, Moreira A, editors. Mediastinal lesions: diagnostic pearls for interpretation of small biopsies and citology. Cham: Springer Internarional AG; 2017. p. 87–148.

    Chapter  Google Scholar 

  125. Nicholson AG, Detterbeck F, Marx A, Roden AC, Marchevsky AM, Mukai K, et al. Dataset for reporting of thymic epithelial tumours: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology. 2017;70(4):522–38.

    Article  PubMed  Google Scholar 

  126. Marx A, Pfister F, Schalke B, Saruhan-Direskeneli G, Melms A, Ströbel P. The different roles of the thymus in the pathogenesis of the various myasthenia gravis subtypes. Autoimmun Rev. 2013;12(9):875–84.

    Article  CAS  PubMed  Google Scholar 

  127. Melzer N, Ruck T, Fuhr P, Gold R, Hohlfeld R, Marx A, et al. Clinical features, pathogenesis, and treatment of myasthenia gravis: a supplement to the Guidelines of the German Neurological Society. J Neurol. 2016;263(8):1473–94.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  128. Marx A, Porubsky S, Belharazem D, Saruhan-Direskeneli G, Schalke B, Ströbel P, et al. Thymoma related myasthenia gravis in humans and potential animal models. Exp Neurol. 2015;270:55–65.

    Article  PubMed  Google Scholar 

  129. Filosso PL, Evangelista A, Ruffini E, Rendina EA, Margaritora S, Novellis P, et al. Does myasthenia gravis influence overall survival and cumulative incidence of recurrence in thymoma patients? A retrospective clinicopathological multicentre analysis on 797 patients. Lung Cancer. 2015;88(3):338–43.

    Article  PubMed  Google Scholar 

  130. Willcox N, Schluep M, Ritter MA, Schuurman HJ, Newsom-Davis J, Christensson B. Myasthenic and nonmyasthenic thymoma. An expansion of a minor cortical epithelial cell subset? Am J Pathol. 1987;127(3):447–60.

    CAS  PubMed  PubMed Central  Google Scholar 

  131. Filosso PL, Ruffini E, Lausi PO, Lucchi M, Oliaro A, Detterbeck F. Historical perspectives: the evolution of the thymic epithelial tumors staging system. Lung Cancer. 2014;83(2):126–32.

    Article  PubMed  Google Scholar 

  132. Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48(11):2485–92.

    Article  CAS  PubMed  Google Scholar 

  133. Koga K, Matsuno Y, Noguchi M, Mukai K, Asamura H, Goya T, et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int. 1994;44(5):359–67.

    Article  CAS  PubMed  Google Scholar 

  134. Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011;6(7 Suppl 3):S1710–6.

    Article  PubMed  Google Scholar 

  135. Detterbeck FC, Stratton K, Giroux D, Asamura H, Crowley J, Falkson C, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposal for an evidence-based stage classification system for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9(9 Suppl 2):S65–72.

    Article  PubMed  Google Scholar 

  136. Nicholson AG, Detterbeck FC, Marino M, Kim J, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the T component for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9(9 Suppl 2):S73–80.

    Article  PubMed  Google Scholar 

  137. Kondo K, Van Schil P, Detterbeck FC, Okumura M, Stratton K, Giroux D, et al. The IASLC/ITMIG Thymic Epithelial Tumors Staging Project: proposals for the N and M components for the forthcoming (8th) edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9(9 Suppl 2):S81–7.

    Article  PubMed  Google Scholar 

  138. Bhora FY, Chen DJ, Detterbeck FC, Asamura H, Falkson C, Filosso PL, et al. The ITMIG/IASLC Thymic Epithelial Tumors Staging Project: a proposed lymph node map for thymic epithelial tumors in the forthcoming 8th edition of the TNM classification of malignant tumors. J Thorac Oncol. 2014;9(9 Suppl 2):S88–96.

    Article  PubMed  Google Scholar 

  139. Lee GY, Yang WI, Jeung HC, Kim SC, Seo MY, Park CH, et al. Genome-wide genetic aberrations of thymoma using cDNA microarray based comparative genomic hybridization. BMC Genomics. 2007;8:305.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  140. Girard N, Shen R, Guo T, Zakowski MF, Heguy A, Riely GJ, et al. Comprehensive genomic analysis reveals clinically relevant molecular distinctions between thymic carcinomas and thymomas. Clin Cancer Res. 2009;15(22):6790–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  141. Rajan A, Girard N, Marx A. State of the art of genetic alterations in thymic epithelial tumors. J Thorac Oncol. 2014;9(9 Suppl 2):S131–6.

    Article  PubMed  Google Scholar 

  142. Gökmen-Polar Y, Cook RW, Goswami CP, Wilkinson J, Maetzold D, Stone JF, et al. A gene signature to determine metastatic behavior in thymomas. PLoS One. 2013;8(7):e66047.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  143. Petrini I, Meltzer PS, Kim IK, Lucchi M, Park KS, Fontanini G, et al. A specific missense mutation in GTF2I occurs at high frequency in thymic epithelial tumors. Nat Genet. 2014;46(8):844–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  144. Huang B, Belharazem D, Li L, Kneitz S, Schnabel PA, Rieker RJ, et al. Anti-apoptotic signature in thymic squamous cell carcinomas—functional relevance of anti-apoptotic BIRC3 expression in the thymic carcinoma cell line 1889c. Front Oncol. 2013;3:316.

    PubMed  PubMed Central  Google Scholar 

  145. Radovich M, Solzak JP, Hancock BA, Conces ML, Atale R, Porter RF, et al. A large microRNA cluster on chromosome 19 is a transcriptional hallmark of WHO type A and AB thymomas. Br J Cancer. 2016;114(4):477–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  146. Ganci F, Vico C, Korita E, Sacconi A, Gallo E, Mori F, et al. MicroRNA expression profiling of thymic epithelial tumors. Lung Cancer. 2014;85(2):197–204.

    Article  PubMed  Google Scholar 

  147. Bellissimo T, Ganci F, Gallo E, Sacconi A, Tito C, De Angelis L, et al. Thymic Epithelial Tumors phenotype relies on miR-145-5p epigenetic regulation. Mol Cancer. 2017;16(1):88.

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  148. Radovich M, Pickering C, Felau I. The integrated genomic landscape of thymic epithelial tumors. Cancer Cell. 2018;33(2):244–258.e10.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  149. Ruffini E, Detterbeck F, Van Raemdonck D, Rocco G, Thomas P, Weder W, et al. Tumours of the thymus: a cohort study of prognostic factors from the European Society of Thoracic Surgeons database. Eur J Cardiothorac Surg. 2014;46(3):361–8.

    Article  PubMed  PubMed Central  Google Scholar 

  150. Omasa M, Date H, Sozu T, Sato T, Nagai K, Yokoi K, et al. Postoperative radiotherapy is effective for thymic carcinoma but not for thymoma in stage II and III thymic epithelial tumors: the Japanese Association for Research on the Thymus Database Study. Cancer. 2015;121(7):1008–16.

    Article  PubMed  Google Scholar 

  151. Forquer JA, Rong N, Fakiris AJ, Loehrer PJ, Johnstone PA. Postoperative radiotherapy after surgical resection of thymoma: differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys. 2010;76(2):440–5.

    Article  PubMed  Google Scholar 

  152. Patel S, Macdonald OK, Nagda S, Bittner N, Suntharalingam M. Evaluation of the role of radiation therapy in the management of malignant thymoma. Int J Radiat Oncol Biol Phys. 2012;82(5):1797–801.

    Article  PubMed  Google Scholar 

  153. Ahmad U, Yao X, Detterbeck F, Huang J, Antonicelli A, Filosso PL, et al. Thymic carcinoma outcomes and prognosis: results of an international analysis. J Thorac Cardiovasc Surg. 2015;149(1):95–100, 1.e1–2.

    Article  PubMed  Google Scholar 

  154. Ruffini E, Detterbeck F, Van Raemdonck D, Rocco G, Thomas P, Weder W, et al. Thymic carcinoma: a cohort study of patients from the European society of thoracic surgeons database. J Thorac Oncol. 2014;9(4):541–8.

    Article  PubMed  Google Scholar 

  155. Korst RJ, Kansler AL, Christos PJ, Mandal S. Adjuvant radiotherapy for thymic epithelial tumors: a systematic review and meta-analysis. Ann Thorac Surg. 2009;87(5):1641–7.

    Article  PubMed  Google Scholar 

  156. Rimner A, Yao X, Huang J, Antonicelli A, Ahmad U, Korst RJ, et al. Postoperative radiation therapy is associated with longer overall survival in completely resected stage II and III thymoma—an analysis of the international thymic malignancies interest group retrospective database. J Thorac Oncol. 2016;11(10):1785–92.

    Article  PubMed  PubMed Central  Google Scholar 

  157. Detterbeck F, Youssef S, Ruffini E, Okumura M. A review of prognostic factors in thymic malignancies. J Thorac Oncol. 2011;6(7 Suppl 3):S1698–704.

    Article  PubMed  Google Scholar 

  158. Rimner A, Gomez DR, Wu AJ, Shi W, Yorke ED, Moreira AL, et al. Failure patterns relative to radiation treatment fields for stage II-IV thymoma. J Thorac Oncol. 2014;9(3):403–9.

    Article  PubMed  Google Scholar 

  159. Gomez D, Komaki R, Yu J, Ikushima H, Bezjak A. Radiation therapy definitions and reporting guidelines for thymic malignancies. J Thorac Oncol. 2011;6(7 Suppl 3):S1743–8.

    Article  PubMed  Google Scholar 

  160. Girard N, Lal R, Wakelee H, Riely GJ, Loehrer PJ. Chemotherapy definitions and policies for thymic malignancies. J Thorac Oncol. 2011;6(7 Suppl 3):S1749–55.

    Article  PubMed  Google Scholar 

  161. Girard N, Merveilleux du Vignaux C. Systemic treatment for thymic malignancies. Curr Opin Oncol. 2017;29(2):112–7.

    Article  PubMed  Google Scholar 

  162. Mizuno T, Okumura M, Asamura H, Yoshida K, Niwa H, Kondo K, et al. Surgical management of recurrent thymic epithelial tumors: a retrospective analysis based on the Japanese nationwide database. J Thorac Oncol. 2015;10(1):199–205.

    Article  PubMed  Google Scholar 

  163. Lattanzio R, La Sorda R, Facciolo F, Sioletic S, Lauriola L, Martucci R, et al. Thymic epithelial tumors express vascular endothelial growth factors and their receptors as potential targets of antiangiogenic therapy: a tissue micro array-based multicenter study. Lung Cancer. 2014;85(2):191–6.

    Article  PubMed  Google Scholar 

  164. Thomas A, Rajan A, Szabo E, Tomita Y, Carter CA, Scepura B, et al. A phase I/II trial of belinostat in combination with cisplatin, doxorubicin, and cyclophosphamide in thymic epithelial tumors: a clinical and translational study. Clin Cancer Res. 2014;20(21):5392–402.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  165. Zucali PA, De Pas TM, Palmieri G, et al. Phase II study of everolimus in patients with thymoma and thymic carcinoma previously treated with cisplatin-based chemotherapy. J Clin Oncol. 2014;32(15 suppl 5s):7527 Abs.

    Article  Google Scholar 

  166. Giaccone G, Thompson J, Crawford J, Et A. A phase II study of pembrolizumab in patients with recurrent thymic carcinoma. J Clin Oncol. 2016;34(15 Suppl):8517 Abs.

    Article  Google Scholar 

  167. Girard N, Merveilleux du Vignaux C. How large databases may impact clinical practices for rare tumors-postoperative chemotherapy in thymic malignancies. J Thorac Dis. 2016;8(8):1863–4.

    Article  PubMed  PubMed Central  Google Scholar 

  168. Huang J, Ahmad U, Antonicelli A, Catlin AC, Fang W, Gomez D, et al. Development of the international thymic malignancy interest group international database: an unprecedented resource for the study of a rare group of tumors. J Thorac Oncol. 2014;9(10):1573–8.

    Article  PubMed  Google Scholar 

  169. Detterbeck F. The impact of ChART on the science of thymic malignancies. J Thorac Dis. 2016;8(8):1921.

    Article  PubMed  PubMed Central  Google Scholar 

  170. Okumura M. Trends and current status of general thoracic surgery in Japan revealed by review of nationwide databases. J Thorac Dis. 2016;8(Suppl 8):S589–95.

    Article  PubMed  PubMed Central  Google Scholar 

  171. Chalabreysse L, Thomas De Montpreville V, De Muret A, Hofman V, Lantuejoul S, Parrens M, et al. [Rythmic-pathology: the French national pathology network for thymic epithelial tumours]. Ann Pathol. 2014;34(1):87–91.

    Google Scholar 

  172. Remon J, Girard N, Mazieres J, Dansin E, Pichon E, Grellier L, et al. Sunitinib in patients with advanced thymic malignancies: cohort from the French RYTHMIC network. Lung Cancer. 2016;97:99–104.

    Article  PubMed  Google Scholar 

  173. Basse C, Thureau S, Bota S, Dansin E, Thomas PA, Pichon E, et al. Multidisciplinary tumor board decision making for postoperative radiotherapy in thymic epithelial tumors: insights from the RYTHMIC prospective cohort. J Thorac Oncol. 2017;12(11):1715–22.

    Article  PubMed  Google Scholar 

  174. Serpico D, Trama A, Haspinger ER, Agustoni F, Botta L, Berardi R, et al. Available evidence and new biological perspectives on medical treatment of advanced thymic epithelial tumors. Ann Oncol. 2015;26(5):838–47.

    Article  CAS  PubMed  Google Scholar 

  175. Rami-Porta R, Editor E. Staging manual in thoracic oncology. In: IASLC, AJCC, UICC, editors. North Fort Myers, FL: Editorial Rx Press; 2016.

    Google Scholar 

Download references

Acknowledgments

The authors want to thank Pr G. Palmieri (Naples, Italy) for her longstanding collaboration and Dr. Enzo Gallo for his photographical and editorial overview.

The authors are also grateful to Dr. T. Merlino for English language editing.

No funding was received for this work.

Conflict of Interest Statement

MM, FF, YS, and GA declare no conflict of interest. Nicolas Girard has received research support and travel grants from Novartis, Bristol-Myers Squibb, MSD, and Pfizer.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mirella Marino .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2018 Springer International Publishing AG, part of Springer Nature

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Marino, M., Facciolo, F., Shen, Y., Alessandrini, G., Girard, N. (2018). Thymic Neoplasm. In: Franco, R., Zito Marino, F., Giordano, A. (eds) The Mediastinal Mass. Current Clinical Pathology. Humana, Cham. https://doi.org/10.1007/978-3-319-90368-2_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-90368-2_9

  • Published:

  • Publisher Name: Humana, Cham

  • Print ISBN: 978-3-319-90367-5

  • Online ISBN: 978-3-319-90368-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics