Skip to main content

Thymomas and Other Thymic Primary Malignancies of the Chest

  • Chapter
  • First Online:
Functional Imaging in Oncology
  • 1699 Accesses

Abstract

Thymic epithelial tumor is a rare mediastinal neoplasm but is the most common primary neoplasm of the anterior mediastinum. Radiologists and clinicians must be aware of the full spectrum of this rare disease, the standard guidelines for diagnostic evaluation, and how imaging findings affect therapeutic decisions. We present the variable imaging appearance of the normal thymus, the imaging features, and current staging of thymic neoplasms with an emphasis on how imaging interpretation affects management.

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

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 229.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 299.00
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 299.00
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

Institutional subscriptions

Abbreviations

201Tl:

Thallium 201

ACTH:

Adrenocorticotropic hormone

CT:

Computed tomography

FDG:

Fluorodeoxyglucose

ITMIG:

International Thymic Malignancy Interest Group

MRI:

Magnetic resonance imaging

OctreoScan:

Radiolabeled octreotide

PET-CT:

Integrated positron emission tomography

SUVmax:

Standard uptake value

WHO:

World Health Organization

References

  1. Lele SM, et al. The thymus in infancy and childhood. Embryologic, anatomic, and pathologic considerations. Chest Surg Clin N Am. 2001;11:233–53, ix.

    CAS  PubMed  Google Scholar 

  2. Levy Y, et al. Malignant thymoma associated with autoimmune diseases: a retrospective study and review of the literature. Semin Arthritis Rheum. 1998;28:73–9.

    Article  CAS  PubMed  Google Scholar 

  3. Morgenthaler TI, et al. Thymoma. Mayo Clin Proc. 1993;68:1110–23.

    Article  CAS  PubMed  Google Scholar 

  4. Regnard JF, et al. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thorac Cardiovasc Surg. 1996;112:376–84.

    Article  CAS  PubMed  Google Scholar 

  5. Lee JKT, et al. Computed body tomography with MRI correlation. New York: Raven Press; 1989.

    Google Scholar 

  6. Moran CA, Suster S. Thymic carcinoma: current concepts and histologic features. Hematol Oncol Clin North Am. 2008;22:393–407.

    Article  PubMed  Google Scholar 

  7. Rosai J, et al. Carcinoid tumors and oat cell carcinomas of the thymus. Pathol Annu. 1976;11:201–26.

    CAS  PubMed  Google Scholar 

  8. Osserman KE, Genkins G. Studies in myasthenia gravis: review of a twenty-year experience in over 1200 patients. Mt Sinai J Med. 1971;38:497–537.

    CAS  PubMed  Google Scholar 

  9. Davis Jr RD, et al. Primary cysts and neoplasms of the mediastinum: recent changes in clinical presentation, methods of diagnosis, management, and results. Ann Thorac Surg. 1987;44:229–37.

    Article  PubMed  Google Scholar 

  10. Lewis JE, et al. Thymoma. A clinicopathologic review. Cancer. 1987;60:2727–43.

    Article  CAS  PubMed  Google Scholar 

  11. Verley JM, et al. Tumors of the mediastinum. Dordrecht: Kluwer Academic; 1992.

    Book  Google Scholar 

  12. Scatarige JC, et al. Transdiaphragmatic extension of invasive thymoma. AJR Am J Roentgenol. 1985;144:31–5.

    Article  CAS  PubMed  Google Scholar 

  13. Yamakawa Y, et al. A tentative tumor-node-metastasis classification of thymoma. Cancer. 1991;68:1984–7.

    Article  CAS  PubMed  Google Scholar 

  14. Travis WD, et al. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004.

    Google Scholar 

  15. Rieker RJ, et al. Histologic classification of thymic epithelial tumors: comparison of established classification schemes. Int J Cancer. 2002;98:900–6.

    Article  CAS  PubMed  Google Scholar 

  16. Suster S, Moran CA. Histologic classification of thymoma: the World Health Organization and beyond. Hematol Oncol Clin North Am. 2008;22:381–92.

    Article  PubMed  Google Scholar 

  17. Gamondes JP, et al. Seventeen years of surgical treatment of thymoma: factors influencing survival. Eur J Cardiothorac Surg. 1991;5:124–31.

    Article  CAS  PubMed  Google Scholar 

  18. Koga K, 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;44:359–67.

    Article  CAS  PubMed  Google Scholar 

  19. Masaoka A, et al. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48:2485–92.

    Article  CAS  PubMed  Google Scholar 

  20. Huang J, et al. Standard outcome measures for thymic malignancies. J Thorac Oncol. 2010;5:2017–23.

    Article  PubMed  Google Scholar 

  21. Wright CD, et al. Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size. J Thorac Cardiovasc Surg. 2005;130:1413–21.

    Article  PubMed  Google Scholar 

  22. Detterbeck FC, et al. Which way is up? Policies and procedures for surgeons and pathologists of resection specimens of thymic malignancy. J Thorac Oncol. 2011;6(7 Suppl 3):S1730–8.

    Article  PubMed  Google Scholar 

  23. Detterbeck FC, et al. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011;6:S1710–6.

    Article  PubMed  Google Scholar 

  24. Regnard JF, et al. Results of re-resection for recurrent thymomas. Ann Thorac Surg. 1997;64:1593–8.

    Article  CAS  PubMed  Google Scholar 

  25. Strobel P, et al. Tumor recurrence and survival in patients treated for thymomas and thymic squamous cell carcinomas: a retrospective analysis. J Clin Oncol. 2004;22:1501–9.

    Article  PubMed  Google Scholar 

  26. Choyke PL, et al. Thymic atrophy and regrowth in response to chemotherapy: CT evaluation. AJR Am J Roentgenol. 1987;149:269–72.

    Article  CAS  PubMed  Google Scholar 

  27. Inaoka T, et al. Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging. Radiology. 2007;243:869–76.

    Article  PubMed  Google Scholar 

  28. Rosado-de-Christenson ML, et al. Imaging of thymic epithelial neoplasms. Hematol Oncol Clin North Am. 2008;22:409–31.

    Article  PubMed  Google Scholar 

  29. Batata MA, et al. Thymomas: clinicopathologic features, therapy, and prognosis. Cancer. 1974;34:389–96.

    Article  CAS  PubMed  Google Scholar 

  30. Hofmann W, et al. Thymoma. A clinicopathologic study of 98 cases with special reference to three unusual cases. Pathol Res Pract. 1985;179:337–53.

    Article  CAS  PubMed  Google Scholar 

  31. Moran CA, et al. Thymomas presenting as pleural tumors. Report of eight cases. Am J Surg Pathol. 1992;16:138–44.

    Article  CAS  PubMed  Google Scholar 

  32. Tomiyama N, et al. Invasive and noninvasive thymoma: distinctive CT features. J Comput Assist Tomogr. 2001;25:388–93.

    Article  CAS  PubMed  Google Scholar 

  33. Marom EM, et al. Computed tomography findings predicting invasiveness of thymoma. J Thorac Oncol. 2011;6:1274–81.

    Article  PubMed  Google Scholar 

  34. Jeong YJ, et al. Does CT of thymic epithelial tumors enable us to differentiate histologic subtypes and predict prognosis? AJR Am J Roentgenol. 2004;183:283–9.

    Article  PubMed  Google Scholar 

  35. Tomiyama N, et al. Using the World Health Organization Classification of thymic epithelial neoplasms to describe CT findings. AJR Am J Roentgenol. 2002;179:881–6.

    Article  PubMed  Google Scholar 

  36. Sadohara J, et al. Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas. Eur J Radiol. 2006;60:70–9.

    Article  PubMed  Google Scholar 

  37. Maher MM, Shepard JA. Imaging of thymoma. Semin Thorac Cardiovasc Surg. 2005;17:12–9.

    Article  PubMed  Google Scholar 

  38. Restrepo CS, et al. Imaging findings of expansile lesions of the thymus. Curr Probl Diagn Radiol. 2005;34:22–34.

    Article  PubMed  Google Scholar 

  39. Sakai S, et al. Differential diagnosis between thymoma and non-thymoma by dynamic MR imaging. Acta Radiol. 2002;43:262–8.

    Article  CAS  PubMed  Google Scholar 

  40. Guidoccio F, et al. Current role of 111In-DTPA-octreotide scintigraphy in diagnosis of thymic masses. Tumori. 2011;97:191–5.

    PubMed  Google Scholar 

  41. Loehrer Sr PJ, et al. Octreotide alone or with prednisone in patients with advanced thymoma and thymic carcinoma: an Eastern Cooperative Oncology Group Phase II Trial. J Clin Oncol. 2004;22:293–9.

    Article  CAS  PubMed  Google Scholar 

  42. Antoch G, et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology. 2003;229:526–33.

    Article  PubMed  Google Scholar 

  43. Shim SS, et al. Non-small cell lung cancer: prospective comparison of integrated FDG PET/CT and CT alone for preoperative staging. Radiology. 2005;236:1011–9.

    Article  PubMed  Google Scholar 

  44. Jerushalmi J, et al. Physiologic thymic uptake of 18F-FDG in children and young adults: a PET/CT evaluation of incidence, patterns, and relationship to treatment. J Nucl Med. 2009;50:849–53.

    Article  PubMed  Google Scholar 

  45. Endo M, et al. Utility of 18FDG-PET for differentiating the grade of malignancy in thymic epithelial tumors. Lung Cancer. 2008;61:350–5.

    Article  PubMed  Google Scholar 

  46. Sung YM, et al. 18F-FDG PET/CT of thymic epithelial tumors: usefulness for distinguishing and staging tumor subgroups. J Nucl Med. 2006;47:1628–34.

    PubMed  Google Scholar 

  47. Kumar A, et al. Characterization of thymic masses using (18)F-FDG PET-CT. Ann Nucl Med. 2009;23:569–77.

    Article  PubMed  Google Scholar 

  48. Shibata H, et al. 18F-fluorodeoxyglucose and 11C-acetate positron emission tomography are useful modalities for diagnosing the histologic type of thymoma. Cancer. 2009;115:2531–8.

    Article  PubMed  Google Scholar 

  49. Benveniste MF, et al. FDG PET-CT aids in the preoperative assessment of patients with newly diagnosed thymic epithelial malignancies. J Thorac Oncol. 2013;8(4):502–10.

    Article  PubMed  Google Scholar 

  50. El-Bawab HY, et al. Clinical use of combined positron emission tomography and computed tomography in thymoma recurrence. Interact Cardiovasc Thorac Surg. 2010;11:395–9.

    Article  PubMed  Google Scholar 

  51. Kaira K, et al. 18F-FDG uptake on PET helps predict outcome and response after treatment in unresectable thymic epithelial tumors. Ann Nucl Med. 2011;25:247–53.

    Article  PubMed  Google Scholar 

  52. Ambrosini V, et al. 68Ga-DOTA-NOC: a new PET tracer for evaluating patients with bronchial carcinoid. Nucl Med Commun. 2009;30:281–6.

    Article  PubMed  Google Scholar 

  53. Miederer M, et al. Correlation of immunohistopathological expression of somatostatin receptor 2 with standardised uptake values in 68Ga-DOTATOC PET/CT. Eur J Nucl Med Mol Imaging. 2009;36:48–52.

    Article  CAS  PubMed  Google Scholar 

  54. Girard N, et al. Insulin-like growth factor-1 receptor expression in thymic malignancies. J Thorac Oncol. 2010;5:1439–46.

    Article  PubMed  Google Scholar 

  55. Girard N, et al. Thymoma: a focus on current therapeutic management. J Thorac Oncol. 2009;4:119–26.

    Article  PubMed  Google Scholar 

  56. Blumberg D, et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg. 1995;60:908–13; discussion 914.

    Article  CAS  PubMed  Google Scholar 

  57. Nakagawa K, et al. Thymoma: a clinicopathologic study based on the new World Health Organization classification. J Thorac Cardiovasc Surg. 2003;126:1134–40.

    Article  PubMed  Google Scholar 

  58. Falkson CB, et al. The management of thymoma: a systematic review and practice guideline. J Thorac Oncol. 2009;4:911–9.

    Article  PubMed  Google Scholar 

  59. Casey EM, et al. Clinical management of thymoma patients. Hematol Oncol Clin North Am. 2008;22:457–73.

    Article  PubMed  Google Scholar 

  60. Kim ES, et al. Phase II study of a multidisciplinary approach with induction chemotherapy, followed by surgical resection, radiation therapy, and consolidation chemotherapy for unresectable malignant thymomas: final report. Lung Cancer. 2004;44:369–79.

    Article  PubMed  Google Scholar 

  61. Elkiran ET, et al. Thymic epithelial neoplasia: a study of 58 cases. Med Oncol. 2007;24:197–201.

    Article  PubMed  Google Scholar 

  62. Rea F, et al. Chemotherapy and operation for invasive thymoma. J Thorac Cardiovasc Surg. 1993;106:543–9.

    CAS  PubMed  Google Scholar 

  63. Venuta F, et al. Multimodality treatment of thymoma: a prospective study. Ann Thorac Surg. 1997;64:1585–91; discussion 1591–2.

    Article  CAS  PubMed  Google Scholar 

  64. Venuta F, et al. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg. 2003;76:1866–72; discussion 1872.

    Article  PubMed  Google Scholar 

  65. Fuller CD, et al. Radiotherapy for thymoma and thymic carcinoma. Hematol Oncol Clin North Am. 2008;22:489–507.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Marcelo F. K. Benveniste MD .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2014 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Benveniste, M.F.K. (2014). Thymomas and Other Thymic Primary Malignancies of the Chest. In: Luna, A., Vilanova, J., Hygino Da Cruz Jr., L., Rossi, S. (eds) Functional Imaging in Oncology. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-40582-2_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-40582-2_8

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-40581-5

  • Online ISBN: 978-3-642-40582-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics