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.
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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
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.
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.
Morgenthaler TI, et al. Thymoma. Mayo Clin Proc. 1993;68:1110–23.
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.
Lee JKT, et al. Computed body tomography with MRI correlation. New York: Raven Press; 1989.
Moran CA, Suster S. Thymic carcinoma: current concepts and histologic features. Hematol Oncol Clin North Am. 2008;22:393–407.
Rosai J, et al. Carcinoid tumors and oat cell carcinomas of the thymus. Pathol Annu. 1976;11:201–26.
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.
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.
Lewis JE, et al. Thymoma. A clinicopathologic review. Cancer. 1987;60:2727–43.
Verley JM, et al. Tumors of the mediastinum. Dordrecht: Kluwer Academic; 1992.
Scatarige JC, et al. Transdiaphragmatic extension of invasive thymoma. AJR Am J Roentgenol. 1985;144:31–5.
Yamakawa Y, et al. A tentative tumor-node-metastasis classification of thymoma. Cancer. 1991;68:1984–7.
Travis WD, et al. Pathology and genetics of tumours of the lung, pleura, thymus and heart. Lyon: IARC Press; 2004.
Rieker RJ, et al. Histologic classification of thymic epithelial tumors: comparison of established classification schemes. Int J Cancer. 2002;98:900–6.
Suster S, Moran CA. Histologic classification of thymoma: the World Health Organization and beyond. Hematol Oncol Clin North Am. 2008;22:381–92.
Gamondes JP, et al. Seventeen years of surgical treatment of thymoma: factors influencing survival. Eur J Cardiothorac Surg. 1991;5:124–31.
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.
Masaoka A, et al. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981;48:2485–92.
Huang J, et al. Standard outcome measures for thymic malignancies. J Thorac Oncol. 2010;5:2017–23.
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.
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.
Detterbeck FC, et al. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol. 2011;6:S1710–6.
Regnard JF, et al. Results of re-resection for recurrent thymomas. Ann Thorac Surg. 1997;64:1593–8.
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.
Choyke PL, et al. Thymic atrophy and regrowth in response to chemotherapy: CT evaluation. AJR Am J Roentgenol. 1987;149:269–72.
Inaoka T, et al. Thymic hyperplasia and thymus gland tumors: differentiation with chemical shift MR imaging. Radiology. 2007;243:869–76.
Rosado-de-Christenson ML, et al. Imaging of thymic epithelial neoplasms. Hematol Oncol Clin North Am. 2008;22:409–31.
Batata MA, et al. Thymomas: clinicopathologic features, therapy, and prognosis. Cancer. 1974;34:389–96.
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.
Moran CA, et al. Thymomas presenting as pleural tumors. Report of eight cases. Am J Surg Pathol. 1992;16:138–44.
Tomiyama N, et al. Invasive and noninvasive thymoma: distinctive CT features. J Comput Assist Tomogr. 2001;25:388–93.
Marom EM, et al. Computed tomography findings predicting invasiveness of thymoma. J Thorac Oncol. 2011;6:1274–81.
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.
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.
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.
Maher MM, Shepard JA. Imaging of thymoma. Semin Thorac Cardiovasc Surg. 2005;17:12–9.
Restrepo CS, et al. Imaging findings of expansile lesions of the thymus. Curr Probl Diagn Radiol. 2005;34:22–34.
Sakai S, et al. Differential diagnosis between thymoma and non-thymoma by dynamic MR imaging. Acta Radiol. 2002;43:262–8.
Guidoccio F, et al. Current role of 111In-DTPA-octreotide scintigraphy in diagnosis of thymic masses. Tumori. 2011;97:191–5.
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.
Antoch G, et al. Non-small cell lung cancer: dual-modality PET/CT in preoperative staging. Radiology. 2003;229:526–33.
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.
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.
Endo M, et al. Utility of 18FDG-PET for differentiating the grade of malignancy in thymic epithelial tumors. Lung Cancer. 2008;61:350–5.
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.
Kumar A, et al. Characterization of thymic masses using (18)F-FDG PET-CT. Ann Nucl Med. 2009;23:569–77.
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.
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.
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.
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.
Ambrosini V, et al. 68Ga-DOTA-NOC: a new PET tracer for evaluating patients with bronchial carcinoid. Nucl Med Commun. 2009;30:281–6.
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.
Girard N, et al. Insulin-like growth factor-1 receptor expression in thymic malignancies. J Thorac Oncol. 2010;5:1439–46.
Girard N, et al. Thymoma: a focus on current therapeutic management. J Thorac Oncol. 2009;4:119–26.
Blumberg D, et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg. 1995;60:908–13; discussion 914.
Nakagawa K, et al. Thymoma: a clinicopathologic study based on the new World Health Organization classification. J Thorac Cardiovasc Surg. 2003;126:1134–40.
Falkson CB, et al. The management of thymoma: a systematic review and practice guideline. J Thorac Oncol. 2009;4:911–9.
Casey EM, et al. Clinical management of thymoma patients. Hematol Oncol Clin North Am. 2008;22:457–73.
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.
Elkiran ET, et al. Thymic epithelial neoplasia: a study of 58 cases. Med Oncol. 2007;24:197–201.
Rea F, et al. Chemotherapy and operation for invasive thymoma. J Thorac Cardiovasc Surg. 1993;106:543–9.
Venuta F, et al. Multimodality treatment of thymoma: a prospective study. Ann Thorac Surg. 1997;64:1585–91; discussion 1591–2.
Venuta F, et al. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thorac Surg. 2003;76:1866–72; discussion 1872.
Fuller CD, et al. Radiotherapy for thymoma and thymic carcinoma. Hematol Oncol Clin North Am. 2008;22:489–507.
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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
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DOI: https://doi.org/10.1007/978-3-642-40582-2_8
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