Diagnosis Of Thymoma Research Articles

Application of machine learning for the differentiation of thymomas and thymic cysts using deep transfer learning: A multi-center comparison of diagnostic performance based on different dimensional models.

This study aimed to evaluate the feasibility and performance of deep transfer learning (DTL) networks with different types and dimensions in differentiating thymomas from thymic cysts in a retrospective cohort. Based on chest-enhanced computed tomography (CT), the region of interest was delineated, and the maximum cross section of the lesion was selected as the input image. Five convolutional neural networks (CNNs) and Vision Transformer (ViT) were used to construct a 2D DTL model. The 2D model constructed by the maximum section (n) and the upper and lower layers (n - 1, n + 1) of the lesion was used for feature extraction, and the features were selected. The remaining features were pre-fused to construct a 2.5D model. The whole lesion image was selected for input and constructing a 3D model. In the 2D model, the area under curve (AUC) of Resnet50 was 0.950 in the training cohort and 0.907 in the internal validation cohort. In the 2.5D model, the AUCs of Vgg11 in the internal validation cohort and external validation cohort 1 were 0.937 and 0.965, respectively. The AUCs of Inception_v3 in the training cohort and external validation cohort 2 were 0.981 and 0.950, respectively. The AUC values of 3D_Resnet50 in the four cohorts were 0.987, 0.937, 0.938, and 0.905. The DTL model based on multiple different dimensions can be used as a highly sensitive and specific tool for the non-invasive differential diagnosis of thymomas and thymic cysts to assist clinicians in decision-making.

Hodgkin lymphoma in preexisting thymoma: a case report

Introduction: Thymus is a primary lymphoid organ which has an important role in humoral and cellular immunity. It can be a site for various neoplasms including thymomas. Case presentation: We report a case of a 55-year-old patient presenting with weight loss, night sweats and sensation of heat. After thorough evaluation his histopathology analysis revealed the rare presence of Hodgkin lymphoma in a background of type B2 thymoma. Discussion: Thymoma is one of the well-known thymic tumors that is encountered in clinical practice. It has diverse associations with other autoimmune diseases and malignancies. The concurrent diagnosis of thymoma with thymic Hodgkin lymphoma is extremely rare. Conclusion: Although this association is very rare, it is crucial to distinguish between thymic Hodgkin lymphoma and thymoma and manage them appropriately.

Constitutional Factors and Irradiation as Risk Factors for Thymoma: A European Case-Control Study.

Little is known about the aetiology of thymoma. This study aims to identify medical risk factors for thymoma as a systematic approach to new hypotheses on the aetiology of this disease. A European multi-centre case-control study was conducted from 1995 to 1997, including incident cases aged 35-69 years with thymoma. Altogether, we accepted 85 cases and 3350 controls, of which we interviewed 77 cases and 2071 population controls about constitutional factors, medical examinations, and former diseases. Odds ratios (ORs) with 95% confidence intervals (CI) were calculated. Medical examinations with X-ray or radiotherapy performed >20 times at least one year before the thymoma diagnosis indicated a possible risk factor for thymoma (OR 1.58, 95% CI 0.93-2.69). Having the first radiotherapy treatment at least one year before the thymoma diagnosis yielded an OR for thymoma of 2.39; 95% CI (0.96-5.99), and if it was at least five years before, the OR for thymoma was 2.81; 95% CI (1.03-7.72). Having a red/auburn hair colour was associated with thymoma, (OR 3.6, 95% CI 1.4-9.5) whereas having pigmented skin was slightly associated with thymoma (OR 1.8, 95% CI 0.8-3.8). Over twenty instances of X-ray examinations or radiotherapy were identified as potential risk factors for thymoma, along with certain constitutional factors. The observed correlations between benign tumours and thymoma could stem from an inherent predisposition to tumour development or result from detection bias. Given that this is the initial analytical study examining medical risk factors for thymoma, all of the results should be approached with caution, acknowledging the possibility that some findings might be incidental.

Long term survival and prognostic factors for Thymoma and Thymic carcinoma. Results from a tertiary care center

Background: Thymomas and thymic carcinoma are rare tumors though thymoma is the most common anterior mediastinal neoplasm. We aimed to determine the long-term survival after thymectomy and also to identify the poor prognostic factors of survival. Methods: A retrospective analysis of tumors with the final diagnosis of thymoma or thymic carcinoma (n = 42) was done. Upfront surgery or a multimodality approach was used depending upon Masaoka-Koga stage. Statistical analysis was done using SPSS 26.0 Results: Median survival was 144, 97, 123, 45, 19 and 20 months in Masaoka-Koga stages 1, 2a, 2b, 3, 4a and 4b, respectively (p < 0.001). Median survival and five-year overall survival (OS) were 86 months and 60%, respectively. Median OS was 125, 25 and 24 months for R0, R1 and R2 resections, respectively (p < 0.001). Median OS was 123 months in no-tumor spillage group vs 24 months in tumor spillage group (p < 0.001). Conclusion: Masaoka-Koga stage, resection status and intraoperative tumor spillage are the most important predictors of long-term survival.

Thymoma resection and myasthenia gravis: what is the neurological outcome in patients older than 65years?

To increase the neurological results in patients older than 65years with myasthenia gravis after thymectomy, we retrospectively analysed this outcome in a large bicentric cohort of patients with myasthenia gravis (MG)years, for which surgery was indicated for a concurrent thymoma. From 1/2000 to 2/2022, 502 patients underwent thymectomy for thymic epithelial tumours (TETs) in two high-volume Institutions (167aged more than 65years). Among them, 66 patients were affected by TET and MG, representing our final study group. The mean age for MG onset was 68.3 ± 6years.At surgery, the Osserman score 2 was the most diffuse in our cohort (43, 65.1%), followed by 1 (20, 30.3%). In 11 cases, the MG diagnosis coincided with thymoma diagnosis. In the other cases, the interval between MG diagnosis and surgery was 1.7years ± 1.9. The most common surgical approach was sternotomy (41,62.1%), followed by RATS (14,21.2%). The most frequent TNM stage was T1N0 (75.7%) and most patients had WHO type-B tumour. After radical thymectomy, 58 patients (88%) reported a significant neurological improvement. According to MGFA-PIS, after surgery we had 4 (6%) complete stable remission, 11 (16.7%) pharmacological remission, 43 (65.2%) minimal manifestation, 2 (3%) worsening/death for MG, and 5 (7.6%) unchanged. No association was found between neurological outcome and age of MG onset, kind of pharmacological therapy before surgery, surgical approach (sternotomy vs others), tumour dimension, the ITMIG stage and the preoperative Osserman score. For MG and thymoma-afftected patients over 65years, thymectomy seems to be an effective treatment to improve neurological symptoms. We suggest to set up clinical trials to explore the neurological efficacy of mini-invasive thymectomy in clinically selected MG patients aged over 65years.

A rare case report of accessory thyroid in the superior mediastinum in the form of multinodular goiter

Retrosternal expansion of a goiter is one of the most common types of mass in the upper mediastinum. Although there is no clear definition of retrosternal, substernal, or mediastinal goiter in the literature, it usually refers to an extension of thyroid tissue from the cervical part that continues to the anterior mediastinum of the aortic arch. One of the interesting features of these cervical mediastinal lesions is that they may not be continuous. Such goiter types classically present with compression symptoms such as dyspnea, dysphonia, dysphagia, or sleep apnea, and less frequently, these masses can compress neurovascular structures, leading to superior vena cava (SVC) syndrome and Horner’s syndrome. In our case report, A 47-year-old female from North Karnataka presented to the hospital with history of dyspnea, dysphonia, and dysphagia persisting for the last 3 years. After careful examination and investigation, a diagnosis of thymoma was made initially. However, upon biopsy of the excised tumor, unexpected finding was revealed, it was identified as a multinodular goiter (MNG) rather than a thymoma.

Histogram analysis based on unenhanced CT for identifying thymoma and lymphoma among prevascular mediastinal incidentalomas

ObjectiveTo determine whether histogram analysis based on unenhanced CT can play a role in the differential diagnosis of thymoma and lymphoma from thymic hyperplasia and cyst (mean CT attenuation > 10 HU).Materials and methodsThis retrospective study included consecutive asymptomatic participants who have prevascular mediastinal lesions incidentally detected by unenhanced CT between December 2013 and August 2020, and with definitive diagnosis by pathology or additional radiologic work-ups. A total of thirteen histogram parameters on enhanced CT were calculated for each lesion, then were compared between tumor (thymoma + lymphoma) and non-tumor (hyperplasia + cyst). Receiver operating characteristic analysis was conducted to investigate the performance of histogram parameter for identifying tumor.ResultsThe study population included 192 patients (106 men and 86 women) with a mean age of 50.5 years at the time of CT examination. Of them, 94 patients have tumor (87 thymomas and 7 lymphoma) and 98 have non-tumor (48 thymic hyperplasia and 50 cysts). Nine of the thirteen histogram parameters revealed significant difference between the two groups, including median, minimum, range, 10th percentile, 90th percentile, kurtosis, skewness, uniformity and entropy. No significant difference was observed in the mean CT attenuation between groups. Higher median was found to be independent predictors for distinguishing tumor from non-tumor, and can achieve an area under the curve (AUC) of 0.785 (95% confidence interval [95% IC], 0.720–0.841).ConclusionsHistogram analysis based on unenhanced CT may be able to provide some help in the differential diagnosis of incidental lesions in prevascular mediastinal.Grand supportThis study was sponsored by Natural Science Foundation of Shanghai (No. 21ZR1459700).

Diagnosis, combined treatment, and long-term follow-up of a thymoma patient

Thymic neoplasms account for 20 – 25% of primary mediastinal tumors. Nonspecific clinical symptoms are often associated with delayed diagnosis of thymoma, leading to a distinctive problem of late diagnosis. Nowadays, surgical removal of the tumor is the method of choice for thymoma treatment. Combination treatment is indicated in the case of an unresectable tumor. Modern therapy (various combinations of anticancer drugs) helps reduce neoplasm size, stop metastasis, and maintain good quality of life in patients with thymoma.Aim. The presented clinical case of type B3 thymoma (with invasion into surrounding organs and metastatic pleura) is characterized by a long asymptomatic period of the disease, the onset of symptoms after suffering COVID-19 (COronaVIrus Disease 2019) and successful long-term polychemotherapy. The causes of late diagnosis, as well as insufficient oncologic vigilance in evaluating the results of laboratory and instrumental tests, are discussed based on this clinical case.Conclusion. A correct diagnosis, as well as successful treatment, requires a multidisciplinary approach involving physicians from different specialties – general practitioners, oncologists, surgeons, radiologists, and morphologists.

Thymoma Involved by Small Lymphocytic Lymphoma (SLL): A Rare and Challenging Diagnosis

Abstract Introduction/Objective Thymoma is a malignant neoplasm arising from the epithelial cells of the thymus. It usually affects patients between the fourth and sixth decades of life. There is a strong association of thymoma with myasthenia gravis and other paraneoplastic syndromes Thymic epithelial tumors are the most common tumors of the anterior mediastinum; however, lymphomas frequently present as mediastinal masses. Concurrent thymoma and lymphoma affecting the thymus is very rare. Methods/Case Report A 79-year-old woman with a history of chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) presented with night sweats and weight loss. Chest CT revealed small pulmonary nodules, a 3.3 x cm anterior mediastinal mass and enlarged hilar lymph nodes. Fine needle aspiration (FNA) of the mass revealed a mixture of lymphocytes and epithelial cells. Flow cytometry showed a monoclonal B-cell population, and double CD4/CD8-positive T-cells consistent with thymocytes. Core biopsy showed scattered neoplastic epithelial cells interspersed among densely packed small lymphocytes. Scattered and small clusters of epithelial cells were highlighted by the CK AE1/3 immunostain. CD3 and PAX5 showed the thymocytes and infiltrating B-cells, respectively. Based on cytomorphologic, flow cytometric, histopathologic, and immunohistochemical findings, the diagnosis of thymoma, type B2 involved by SLL was rendered. Results (if a Case Study enter NA) N/A Conclusion A multimodality diagnostic work-up integrating cytomorphology, flow cytometry and immunohistochemistry allowed recognizing this unusual association.

Socioeconomic Factors Associated With Thymoma Survival in the United States

IntroductionThe effects of socioeconomic factors on patients diagnosed with thymomas have not been previously studied. We propose these factors have an important association with survival. Thymoma is the most common tumor of the anterior mediastinum. Compared to other neoplasms which can integrate different therapeutic approaches for treatment, the most effective therapy for local and locally advanced thymoma is complete surgical resection. This study aimed to elaborate on socioeconomic variables and their potential effects on the survival outcomes in patients diagnosed with thymoma. MethodsClinical data from the Surveillance, Epidemiology, and End Results 22 registry from 1975-2019 was used to define overall and cancer-specific survival of thymoma. The unadjusted analysis was followed by fitting a Cox proportional hazards model that included all variables assessed with Kaplan–Meier curves. An unadjusted Kaplan–Meier analysis was performed first comparing time to death by decade, age, race, ethnicity, sex, income, and region separately. The primary outcome was survival measured in months. ResultsWe identified 1821 patients aged 18 y or over from the Surveillance, Epidemiology, and End Results database with a thymoma diagnosis between the years 1975 and 2019. The demographic variables considered were age, race, ethnicity (Hispanic/non-Hispanic), sex (male/female), inflation-adjusted income in 2019 dollars, and community size. We observed a decrease in mortality from thymic neoplasm across the decades. For each subsequent year, mortality risk decreased by 3.5% (P <0.001). The mortality risk of older patients was significantly higher. Compared to the youngest group, the mortality risk was 52.8% higher in the 50-year-old to 65-year-old category (P = 0.021). The mortality risk was 339% times higher in the 65 + age group (P <0.001). Income may be associated with risk reduction. Patients making greater than $75,000 had a 40.1% lower mortality risk than those making less than $50,000 (P = 0.029). The survival rate categorized by race was similar between Blacks and Whites but tended to be higher for the Asian and Pacific Islander groups without reaching statistical significance (P = 0.12). ConclusionsMedical advancements have improved the overall thymoma survival in the past four decades. Yet, demographic, and socioeconomic factors such as age, income, and race may also play a role.

Treatment of Thymoma and Thymic Carcinoma with Proton Beam Therapy: Outcomes from the Proton Collaborative Group Prospective Registry

Given the generally long natural history of thymic malignancies, proton beam therapy (PBT) is advocated to minimize the risk of long-term toxicities to mediastinal organs. Adverse events (AE) and long-term clinical outcomes for this population have not been well-characterized. The Proton Collaborative Group registry (NCT01255748), a multi-institutional prospective database of academic and community proton centers in the US, was queried for patients with thymomas and thymic carcinomas treated with PBT. Patients with recurrent/metastatic disease, non-thymic histology, received either prior or palliative radiotherapy (dose < 40 Gy RBE) were excluded. Overall survival (OS) and local control (LC) were estimated using Kaplan-Meier methods. A total of 97 patients were identified in the PCG registry. After applying relevant exclusion criteria, 70 patients from 12 proton centers treated from 2011-2021 were included for analysis. Median follow-up length was 16 months. Median age was 58.5 years (IQR 46-63), and 60% were female. 81.4% had a diagnosis of thymoma, and 18.6% thymic carcinoma. 59 patients underwent surgical resection. 11 were treated with definitive PBT, of which 5 received concurrent chemotherapy. Median dose was 54 Gy RBE (range 41.4 - 70 Gy RBE), median number of fractions was 30 (range 21 - 38). 73.4% received pencil beam scanning and 23% uniform scanning PBT. Treatment was overall well-tolerated: a single patient developed grade 4 pneumonitis. Grade 3 AEs were seen in 3 patients - dyspnea, anorexia, and heart failure. Highest grade toxicity experienced was grade 2 for 47.1% and grade 1 for 42.9% of patients. 3-year overall survival (OS) was 82.6% for the entire cohort. 3-year OS was 94% for resected/adjuvant cohort and 35.6% in the non-surgical/definitive cohort. 3-year local control (LC) was 91.7% for the entire cohort. By surgery/margin status, 3-year LC was 96.8% in patients with close or negative margins (a single failure in a patient with close margins), whereas 3-year LC was 55.1% for patients with positive margins/unresectable disease. Thymic malignancies treated with PBT appear to have favorable outcomes, especially in the adjuvant setting, in this cohort representing the largest series of such patients.

Locally advanced thymoma; does neoadjuvant chemotherapy make a difference?

BackgroundRegardless of its rare occurrence, Thymoma remains the most frequently encountered primary tumor of the anterior mediastinum comprising about 50% of all masses in the region. Surgical resection, via thymectomy, remains the mainstay treatment modality. In locally advanced and borderline resectable tumors, neoadjuvant chemotherapy (NACT) may be utilized to increase the chance of R0 resection, raising the question of its efficacy and safety.MethodsDemographic and clinical data from patients who presented to a tertiary cancer center between January 2015–October 2021 with a diagnosis of thymoma and underwent curative surgical resection was collected. Computed tomography scan was used to delineate clinical staging, tumor size and to detect post-therapeutic variations in tumor burden. The response evaluation criteria in solid tumors (RECIST) was used to classify the effect of NACT on tumor burden. The pathological response was determined by measuring the percentage of necrotic tissue.ResultsA total of 23 patients were diagnosed with thymoma. Most patients were male with a mean age 46 (± 15) years at diagnosis. The most common clinical stage was stage II with 5 patients (22%). A total of 12 patients had NACT as compared to 11 patients who had upfront surgery. The mean change in tumor volume was 165 cm3 (p = 0.079) and the change in and maximum diameter was 1.53 ± 1.49 cm (p < 0.01). The effect of NACT on tumor burden based on RECIST criteria was minimal as 8 patients had stable disease. Based on pathological findings, the average necrotic portion of the tumor was 39.5% (p = 0.152). The overall survival rate is 95.65%, mean survival was 115 months (4–125). Recurrence occurred in 5 patients. The NACT group had a higher risk for recurrence (4; 33.3%) with a mean survival of 43.8 months compared to 59.6 months in those who did not receive induction therapy.ConclusionsThe exact role of induction chemotherapy in locally advanced thymoma patients remains controversial. NACT effect after utilizing radiological and pathological assessment tools was not found to significantly improve oncological outcomes compared to upfront surgery in locally advanced disease, with minimal radiologic and pathologic effect. To further demonstrate the impact of induction chemotherapy, we recommend multicentric collaborative studies.

Thymic Parenchymal Hyperplasia

Thymic hyperplasia is a rare condition generally caused by lymphoid follicular hyperplasia associated with autoimmune disorders. True thymic parenchymal hyperplasia unassociated with lymphoid follicular hyperplasia is extremely rare and may give rise to difficulties in diagnosis. We have studied 44 patients with true thymic hyperplasia (38 females and 6 males) aged 7 months to 64 years (mean, 36 years). Eighteen patients presented with symptoms of chest discomfort or shortness of breath; in 20 patients, the lesions were discovered incidentally. Imaging studies demonstrated enlargement of the mediastinum by a mass lesion suspicious for malignancy. All patients were treated with complete surgical excision. The tumors measured from 3.5 to 24 cm (median, 10 cm; mean, 10.46 cm). Histologic examination showed lobules of thymic tissue displaying well-developed corticomedullary architecture, with scattered Hassall corpuscles separated by mature adipose tissue and bounded by a thin fibrous capsule. No cases showed evidence of lymphoid follicular hyperplasia, cytologic atypia, or confluence of the lobules. Immunohistochemical studies showed a normal pattern of distribution for keratin-positive thymic epithelial cells against a background rich in CD3/TdT/CD1a+ lymphocytes. Twenty-nine cases had an initial clinical or pathological diagnosis of thymoma or thymoma vs thymic hyperplasia. Clinical follow-up in 26 cases showed that all patients were alive and well between 5 and 15 years after diagnosis (mean, 9 years). Thymic parenchymal hyperplasia causing significant enlargement of the normal thymus that is sufficient to cause symptoms or worrisome imaging findings should be considered in the differential diagnosis of anterior mediastinal masses. The criteria for distinguishing such lesions from lymphocyte-rich thymoma are presented.

Malignant Ectopic Cervical Thymoma in Myasthenia Gravis: A Case Report (P1-8.005)

<h3>Objective:</h3> N/A <h3>Background:</h3> Ectopic cervical thymoma (ECT) is an extremely rare tumor, especially associated with myasthenia gravis (MG). Various locations of ectopic thymoma have been reported, such as the neck, carotid triangle, chest wall, pleura, lung, and heart. Per guidelines, thymectomy is recommended in most MG patients with thymoma, which usually shows an excellent prognosis. <h3>Design/Methods:</h3> N/A <h3>Results:</h3> We report on a 55-year-old woman with MG who was admitted for myasthenic crisis requiring treatment with intravenous immunoglobulin and steroids. The workup suggested acetylcholine-receptor-positive MG and a computed tomography scan found a heterogenous mass arising from or immediately adjacent to the inferior left thyroid lobe extending into the upper mediastinum measuring 40 × 33 × 28 mm and causing right tracheal deviation. This was initially confused for a mass of thyroid or parathyroid origins, however, parathyroid hormone and thyroid-stimulating hormone levels were normal. This multi-lobulated mass was trans-cervically resected from below the left lobe of the thyroid but distinct from it. Histopathological examination revealed a type A thymoma with transcapsular invasion and atypical cells classified as a Masaoka stage II thymoma. During a 3-month follow-up visit, she showed a remarkable improvement in myasthenic symptoms, including dysphagia and dysarthria, with only residual ocular symptoms. Therefore, the prednisone dose was lowered with no need for non-steroidal immunotherapies. The patient was also scheduled to receive radiation therapy to the mediastinum for the malignant thymoma. <h3>Conclusions:</h3> The diagnosis of ECT is challenging due to unusual locations, rare incidence, and inconclusive results of fine needle aspiration cytology (FNAC) that can lead to initial misinterpretation of a thymoma for thyroid or parathyroid lesions, as in our case. A comprehensive search and a timely diagnosis of thymomas for surgical resection are recommended. <b>Disclosure:</b> Dr. Hosseini has nothing to disclose. Dr. Zargar has nothing to disclose.

122 - Retrospective review of patterns of recurrence in patients with a histological diagnosis of thymoma

122 - Retrospective review of patterns of recurrence in patients with a histological diagnosis of thymoma

DNA-Methylation Analysis as a Tool for Thymoma Classification

Thymomas are malignant thymic epithelial tumors that are difficult to diagnose due to their rarity and complex diagnostic criteria. They represent a morphologically heterogeneous class of tumors mainly defined by "organo-typical" architectural features and cellular composition. The diagnosis of thymoma is burdened with a high level of inter-observer variability and the problem that some type-specific morphological alterations are more on the continuum than clear-cut. Methylation pattern-based classification may help to increase diagnostic precision, particularly in borderline cases. We applied array-based DNA methylation analysis to a set of 113 thymomas with stringent histological annotation. Unsupervised clustering and t-SNE analysis of DNA methylation data clearly segregated thymoma samples mainly according to the current WHO classification into A, AB, B1, B2, B2/B3, B3, and micronodular thymoma with lymphoid stroma. However, methylation analyses separated the histological subgroups AB and B2 into two methylation classes: mono-/bi-phasic AB-thymomas and conventional/"B1-like" B2-thymomas. Copy number variation analysis demonstrated methylation class-specific patterns of chromosomal alterations. Our study demonstrates that the current WHO classification is generally well reflected at the methylation level but suggests that B2- and AB-thymomas are (epi)genetically heterogeneous. Methylation-based classifications could help to refine diagnostic criteria for thymoma classification, improve reproducibility, and may affect treatment decisions.

MC-ViT: Multi-path cross-scale vision transformer for thymoma histopathology whole slide image typing.

Accurate histological typing plays an important role in diagnosing thymoma or thymic carcinoma (TC) and predicting the corresponding prognosis. In this paper, we develop and validate a deep learning-based thymoma typing method for hematoxylin & eosin (H&E)-stained whole slide images (WSIs), which provides useful histopathology information from patients to assist doctors for better diagnosing thymoma or TC. We propose a multi-path cross-scale vision transformer (MC-ViT), which first uses the cross attentive scale-aware transformer (CAST) to classify the pathological information related to thymoma, and then uses such pathological information priors to assist the WSIs transformer (WT) for thymoma typing. To make full use of the multi-scale (10×, 20×, and 40×) information inherent in a WSI, CAST not only employs parallel multi-path to capture different receptive field features from multi-scale WSI inputs, but also introduces the cross-correlation attention module (CAM) to aggregate multi-scale features to achieve cross-scale spatial information complementarity. After that, WT can effectively convert full-scale WSIs into 1D feature matrices with pathological information labels to improve the efficiency and accuracy of thymoma typing. We construct a large-scale thymoma histopathology WSI (THW) dataset and annotate corresponding pathological information and thymoma typing labels. The proposed MC-ViT achieves the Top-1 accuracy of 0.939 and 0.951 in pathological information classification and thymoma typing, respectively. Moreover, the quantitative and statistical experiments on the THW dataset also demonstrate that our pipeline performs favorably against the existing classical convolutional neural networks, vision transformers, and deep learning-based medical image classification methods. This paper demonstrates that comprehensively utilizing the pathological information contained in multi-scale WSIs is feasible for thymoma typing and achieves clinically acceptable performance. Specifically, the proposed MC-ViT can well predict pathological information classes as well as thymoma types, which show the application potential to the diagnosis of thymoma and TC and may assist doctors in improving diagnosis efficiency and accuracy.

RARE PRESENTATION OF A THYMOMA AT AN INFREQUENT LOCATION

RARE PRESENTATION OF A THYMOMA AT AN INFREQUENT LOCATION

Analysis of Pulmonary Function in Thymoma Subjects: A 20-Year Retrospective Cohort Study.

Thymoma is the most common tumor of the anterior mediastinum. However, the correlation between thymoma stage and pulmonary function was not assessed. Our objective in this study was to describe the pulmonary function in thymoma subjects stratified with different staging systems. A total of 143 subjects with a diagnosis of thymoma who underwent extended thymectomy for thymoma between January 2001 and December 2019 were reviewed retrospectively. All the subjects experienced pulmonary function tests (PFTs) using Master Screen PFT system and total respiratory resistance measurement. We evaluated 143 subjects with a diagnosis of thymoma; the significant differences were observed in mean values of vital capacity, inspiratory volume (IC), total lung capacity (TLC), ratio of residual volume to total lung capacity (RV/TLC), forced vital capacity, forced expiratory volume in 1 second, ratio of forced expiratory volume in 1 second to forced vital capacity, peak expiratory flow, peak inspiratory flow, maximum ventilation volume, total airway resistance, and diffusing capacity for carbon monoxide (DLCO) across upper airway obstruction classification. PFTs of subjects with varying Masaoka stages are different. RV and RV/TLC of subjects in stages III and IV were higher than those of normal level, while DLCO of subjects in stage IV was lower than the normal level, and the mean level of IC showed significant difference between stage II and stage III. The pulmonary function patterns of thymoma subjects significantly correlate with tumor location and size rather than clinical Masaoka stage.

THYMOMA AS A NECK SWELLING - A SURGICAL DILEMMA

Thymomas are rare neoplasm of Anterior Mediastinum originating within the epithelial cells of the thymus and it is exceedingly uncommon in children and young adults, rises in incidence in middle age, and peaks in the seventh decade of life. One third to one half of patients present with an asymptomatic anterior mediastinal mass on chest radiograph, one third present with local symptoms (cough, chest pain, superior vena cava syndrome, and/or dysphagia), and one third of cases are detected during the evaluation of myasthenia gravis. Myasthenia gravis is a disease of the neuromuscular junction which causes progressive weakness of muscles. Indication of thymectomy for all cases of myasthenia gravis has been a topic of debate but thymectomy is indicated in all cases with thymomas no matter the stage of myasthenia gravis. We present a rare case of Thymoma as 70/Female patient presented with a painful lateral neck swelling on left side with Myasthenia Gravis and Dysphagia. We couldnt find any similar cases in literature. USG Neck was done which showed a 5.3x5.3x4.3cm multilobulated mass in left supraclavicular region inferior to left lobe of thyroid with calcification suspicious of malignancy which possible origin from Thyroid and Parathyroid Gland. On CECT scan there was 4.1x3.4x3.8 cm isodense mass which seems to be arising from lower pole of left thyroid lobe and extending in surrounding structures. FNAC was s/o Thymoma type A. Patient underwent Sternotomy- entire tumor along with thymus was dissected, however posteriorly it was densely adhered to Left Vagus Nerve Giving Suspicion of Neurofibroma. Specimen Sent for Frozen Section which confirmed it to be Type A thymoma. Histopathology Report concluded the diagnosis- Type A Thymoma. Post Operative was Uneventful. Thus, we conclude a rare case of Neck Swelling with series of event to reach to a Final Diagnosis of Thymoma.