Invasive Thymoma Research Articles

Long term outcomes from the early days of minimally invasive thymoma surgery for Myasthenia Gravis patients: a follow-up of 19 years

BackgroundLong-term survival outcomes are crucial for accurately determining the effectiveness of treatment in an indolent disease like thymoma. We aimed to analyze the clinical findings in terms of survival and relapse patterns with a median follow up of 105 months (8.7 years) in patients with thymoma and myasthenia gravis who underwent minimally invasive surgery between 2002 and 2015.MethodsA total of 59 pathologically confirmed Masaoka Stage I and II thymoma patients with Myasthenia Gravis (MG) who underwent minimally invasive thymoma resection were included in this study. Primary aim of this study is to evaluate recurrences, overall and disease free survival in patients with a thymoma and MG in the long run. We also aimed to study the changes in Myasthenia Gravis medication during the follow-up.ResultsThe mean age of the patients was 47.6 +/13.5 years. Seventeen patients were at Masaoka Stage I and 42 were at Masaoka Stage II. The median follow-up time was 105 months. The mean size of the tumor was 3.6 cm +/16.2 cm. Twenty-one patients (35%) received adjuvant radiotherapy. There was no postoperative mortality and median length of hospital stay was 4 days. Two patients developed recurrences both presented with pleural metastases. Eight patients died because of non-oncologic pathologies. 10-year disease free survival and overall survival rates were calculated to 96.6% and 86.4% respectively.ConclusionThe 10-year survival analysis and current myasthenic status of stage I-II thymoma patients with myasthenia gravis who underwent minimally invasive surgery demonstrate that these procedures are both safe and effective.

Thymoma and Crohn's Disease: A Case Report

Thymoma is often associated with other diseases, including autoimmune diseases and endocrine disorders. Crohn's disease is a nonspecific inflammatory disease and is considered an immune-mediated disorder; However, the coincidence of thymoma and Crohn's disease is rare. We report the observation of a 63-year-old woman with invasive thymoma and Crohn's disease. Following radio-chemotherapy, the digestive symptoms disappeared.

Efficacy and safety of low-dose rituximab in the treatment of myasthenia gravis: a systemic review and meta-analysis.

Rituximab (RTX) is a monoclonal antibody that has been increasingly used in the treatment of myasthenia gravis (MG). In most studies, the therapeutic protocol of RTX has been similar to that adopted for B cell lymphoma, with an increasing number of studies aimed at exploring the efficacy of low-dose RTX in MG. However, the beneficial effects of low-dose RTX in MG remain a subject of critical debate. This study was conducted following the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. Two reviewers (Xishuai Yang and Bingxia Li) independently conducted searches across multiple databases, including PubMed, MEDLINE, EMBASE, Web of Science, Cochrane Library, and China National Knowledge Infrastructure (CNKI). A meta-analysis, utilizing representative forest plots, was performed to assess "Improved clinical status" and changes in the Quantitative Myasthenia Gravis (QMG) score before and after treatment. A total of 17 studies involving 292 patients were included in the meta-analysis. A noticeable improvement in clinical status was observed in 91% of patients at the final follow-up after therapy (95% CI: 84-96%, P < 0.001). The QMG score showed a significant reduction following the treatment, with a standardized mean difference (SMD) of -1.69 (95% CI: -2.21 to -1.16, Z = 6.29, P < 0.001). In the acetylcholine receptor antibody-positive myasthenia gravis (AChR-MG) group, 90% of patients achieved improved clinical status (95% CI: 80-97%, P < 0.001) and the QMG score significantly decreased after low-dose RTX treatment, with an SMD of -1.51 (95% CI: -0.80 to -2.21, Z = 4.50, P < 0.001). In the muscle-specific kinase antibody-positive myasthenia gravis (MuSK-MG) group, 97% of patients achieved improved clinical status (95% CI: 89-100%, P < 0.001). The QMG score also significantly decreased following low-dose RTX treatment, with an SMD of -2.31 (95% CI: -2.99 to -1.62, Z = 6.60, P < 0.001). Adverse effects were reported in 29 out of 207 patients (14%, including infusion reactions in 22 patients (10.1%), infections in three patients (1.45%), cytopenia in two patients (0.96%), eosinophilia in one patient (0.48%), and hemiplegia in one patient (0.48%). Additionally, one patient (0.48%) succumbed to complications from invasive thymoma. Our meta-analysis shows that low-dose RTX is both effective and safe for treating MG. PROSPERO, identifier: CRD42024509951.

Surgical outcomes of patients with locally advanced thymic epithelial tumor undergoing induction therapy followed by surgery: a narrative review.

Thymic epithelial tumors (TETs), including thymomas and thymic cancers, are relatively rare malignancies originating from the thymus. Although complete surgical resection is the cornerstone of treatment for these tumors, the optimal management strategy for locally advanced cases remains uncertain. Neoadjuvant therapies, with their potential to improve the likelihood of complete resection, are promising, particularly in marginally operable cases. However, the current evidence supporting this approach is lacking. This review of the existing literature on the efficacy of induction therapy followed by surgical resection for stage III or IV locally advanced TETs aimed to provide an up-to-date perspective and highlighting directions for future clinical research. PubMed was searched using the keywords "surgery," "survival", "thymoma", "thymic cancer", and "induction therapy". Relevant articles including case series, retrospective studies, prospective studies, and review articles were reviewed and selected for this comprehensive narrative review. This review included primarily revealed retrospective studies and a limited number of prospective phase II trials on induction therapy followed by surgery for stage III or IV locally advanced TETs. No randomized phase III studies were identified, indicating that a comprehensive evaluation of the benefits of induction therapy on overall survival (OS) has not yet been conducted. Induction therapies for both invasive thymoma and thymic cancer included chemotherapy, radiotherapy, and chemoradiotherapy, with anthracycline-based combination chemotherapies being the primary option. For exclusively invasive thymomas, the median rate of complete surgical resection and the 5-year OS rate were reported as 76% and 85%, respectively. Literature focusing on induction therapy for TETs, which includes both thymoma and thymic cancers, indicates that the rates of complete resection and 5-year OS are 76% and 70%, respectively. Our narrative review of retrospective and prospective studies highlighted promising long-term OS rates in patients with advanced TETs who underwent induction therapy followed by surgical resection. These findings support this multimodal treatment strategy in selected patients with stage III and IV TETs.

Kiosk 3Q-TA-09 - Rare Case of Cardiac Invasive Metastatic Thymoma Utilizing High Accuracy CMR Tissue Characterization Techniques

Kiosk 3Q-TA-09 - Rare Case of Cardiac Invasive Metastatic Thymoma Utilizing High Accuracy CMR Tissue Characterization Techniques

Germinal centers are associated with postthymectomy myasthenia gravis in patients with thymoma.

Germinal centers (GCs) can be observed in the thymic tissues of patients with thymoma-associated myasthenia gravis (MG). Although an association between thymic GCs and MG has been suggested, it is unknown whether the presence of GCs could predict the development of MG after the resection of thymoma, known as postthymectomy MG. We conducted a retrospective analysis of previously nonmyasthenic patients who underwent surgical removal of the thymoma. All available thymic tissue slides were rereviewed by a pathologist to assess for GCs. Patients were classified into GC-positive and GC-negative groups based on the presence of GCs. The incidence of postthymectomy MG was compared between the two groups, and the risk factors for postthymectomy MG were assessed. Of the 196 previously nonmyasthenic patients who underwent thymoma resection, 21 were GC-positive, whereas 175 were GC-negative. Postthymectomy MG developed in 11 (5.6%) patients and showed a higher incidence in the GC-positive group than in the GC-negative group (33.3% vs. 2.3%, p < 0.001). No postoperative radiotherapy and the presence of GCs were risk factors for postthymectomy MG in the univariate analysis. In multivariate analysis, invasive thymoma (hazard ratio [HR] = 9.835, 95% confidence interval [CI] = 1.358-105.372), postoperative radiotherapy (HR = 0.160, 95% CI = 0.029-0.893), and presence of GCs (HR = 15.834, 95% CI = 3.742-67.000) were significantly associated with postthymectomy MG. Thymic GCs may be a significant risk factor for postthymectomy MG. Even in patients with thymoma who do not show clinical symptoms of MG, postthymectomy MG should be considered, especially if thymic GCs are observed.

Abstract CT177: A phase I, first in human study of CBA-1205, glycoengineered humanized anti-DLK-1 monoclonal antibody in patients with advanced solid tumors

Abstract Background: CBA-1205 is a novel humanized anti-delta-like 1 homolog (DLK-1) antibody. It is a glycoengineered antibody by GlymaxX® technology to potentiate antibody-dependent cellular cytotoxicity activity. DLK-1 is a membrane protein with 6 tandem EGF-like motifs in extracellular region. Overexpression of DLK-1 has been reported in variety of cancer types including hepatocellular carcinoma (HCC), suggesting that DLK-1 could be an ideal target for cancer therapy. Methods: This is a first in human, multicenter, open-label Phase I study. The purpose of part 1 is to evaluate the safety and tolerability in patients with advanced solid tumors who had no standard therapy or were refractory or intolerant to standard therapies and to determine the starting dose for part 2 in HCC patients. The standard 3+3 dose escalation design was utilized in seven cohorts (0.1, 0.3, 1, 3, 10, 20, 30 mg/kg). CBA-1205 was administered at 2-week intervals in a 28-day cycle. If the patient had no Dose Limiting Toxicity (DLT) during 28 days after the first two doses, CBA-1205 administration will be continued for further cycles unless any of the criteria for discontinuation. Serum DLK-1 concentration before the start of CBA-1205 administration was analyzed using the Human Pref-1/DLK1/FA1 DuoSet ELISA (R&amp;D Systems, Inc.). Immunohistochemical analysis of DLK-1 expression in the archival tumor specimen was determined in FFPE tissue sections using mouse anti-hDLK-1 antibody (clone DI-2-20, Chiome Bioscience). Results: 22 patients with advanced solid tumors were enrolled. CBA-1205 was well tolerated in these patients and no DLT was observed even at the highest dose tested. No ≥ Grade 3 treatment related adverse events was observed throughout the study periods. The serum concentration of CBA-1205 increased dose-proportionally. The exposure to CBA-1205 exceeded the effective concentrations observed in a mouse xenograft model. No serum anti-CBA-1205 antibody was detected. The disease control was seen in 8 patients (38.1%, all with SD). Especially, long SD was observed in 3 patients with invasive thymoma, malignant melanoma, and pancreatic carcinoma, where progression free survival (PFS) was 39, 72(ongoing, at data cutoff), and 41 weeks, respectively. The serum concentration of soluble DLK-1 was detected in 6 out of 22 patients. Patients with SD by the best overall response had a higher rate of detectable serum DLK-1 concentration and a higher mean concentration than patients with PD. No DLK-1 expression in tumor was detected by IHC method, in 14 patients who consented to use the archival tumor specimens. Conclusions: CBA-1205 was well tolerated without any severe toxicity in patients with advanced solid tumors.Part 2 of this Phase I study with two cohorts (20, 30 mg/kg) in patients with unresectable advanced/recurrent HCC refractory or intolerable to the standard therapy has been initiated. Citation Format: Masafumi Ikeda, Nobuaki Matsubara, Chihiro Kondoh, shose taoka, Yuki Katsuya, Takafumi Koyama, Noboru Yamamoto. A phase I, first in human study of CBA-1205, glycoengineered humanized anti-DLK-1 monoclonal antibody in patients with advanced solid tumors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2023; Part 2 (Clinical Trials and Late-Breaking Research); 2023 Apr 14-19; Orlando, FL. Philadelphia (PA): AACR; Cancer Res 2023;83(8_Suppl):Abstract nr CT177.

Evaluation of the role of postoperative radiotherapy in locally invasive thymoma: A propensity-matched study based on the SEER database.

No consensus was reached on the efficacy of postoperative radiotherapy (PORT) in locally invasive thymomas because of the rarity of the thymic epithelial and the variations of study results. Therefore, we aimed to explore the efficacy of PORT in locally invasive thymomas using the Surveillance, Epidemiology, and End Results (SEER) database. Patients diagnosed with thymomas from 2004 to 2016 were identified using the SEER database. Prognostic factors of cancer-specific survival (CSS) and overall survival (OS) were identified using univariate and multivariate Cox regression analyses.Propensity score matching (PSM) was performed to balance the baseline characteristics. A total of 700 eligible patients were identified. After PSM, 262 paired patients were selected from the two groups, those who received or did not receive PORT. Receiving PORT improved CSS and OS before and after PSM. In the matched population, the multivariate analyses showed that tumour invasion into adjacent organs/structures and non-utilisation of PORT were independent poor prognostic factors for CSS, whereas age ≥62 years,tumour invasion into adjacent organs/structures, and non-utilisation of PORT were independently associated with poorer OS. The subgroup analysis revealed that PORT improved CSS and OS in Masaoka-Koga stage III thymoma, but showed no OS benefit in Masaoka-Koga stage IIB thymoma. Based on the SEER database, we found that PORT provides a significant survival benefit in Masaoka-Koga stage III thymoma with complete or incomplete resection. The role of PORT in thymoma requires further evaluation.

TCTAP C-150 Combined Thrombectomy and Stent Placement for Superior Vena Cava Syndrome Due to Invasive Thymoma

TCTAP C-150 Combined Thrombectomy and Stent Placement for Superior Vena Cava Syndrome Due to Invasive Thymoma

Radiologic and clinicopathologic evaluation of invasive thymoma in a domestic shorthair cat

Radiologic and clinicopathologic evaluation of invasive thymoma in a domestic shorthair cat

SUPERIOR VENA CAVA SYNDROME DUE TO A MEDIASTINAL MASS WITH RIGHT ATRIAL INVOLVEMENT

SUPERIOR VENA CAVA SYNDROME DUE TO A MEDIASTINAL MASS WITH RIGHT ATRIAL INVOLVEMENT

Modified subcostal arch xiphoid thoracoscopic expanded thymectomy for thymic carcinoma: a case report and review of literature

Thymic neoplasms are a relatively uncommon tumor, with the anterior mediastinum being the most common. Median sternotomy is the procedure of choice for the treatment of thymomas. With the advent of thoracoscopy, an increasing number of countries are adopting the right thoracic approach for the treatment of thymomas, but there are still no clear surgical standards or modalities to treat thymic carcinoma. We propose a modified subxiphoid subcostal arch thoracoscopic enlarged thymectomy to treat thymic carcinoma based on various reviews. We have also reviewed the relevant literature on the subject of evidence-based medicine. The evaluation of CD70 in combination with CD5 and CD117 or preferentially expressed antigen in melanoma in combination with CD5 and CD117 may help to diagnose thymic squamous cell carcinoma (TSCC) more accurately. The modified thoracoscopic expanded thymic resection under the costal arch of the xiphoid process is not only suitable for TSCC but also for thymic cyst, thymoma, locally invasive thymoma, and thymic carcinoma.

Immunodeficiency in patients with thymoma-associated myasthenia gravis

Thymoma with immunodeficiency is sometimes accompanied by myasthenia gravis (MG), but the clinical characteristics have not been elucidated. This study aimed to characterize its clinical and immunological features. Of the 132 thymoma-associated MG patients, 9 patients presented with immunodeficiency. All suffered from severe pneumonia, and most had invasive thymoma and autoimmune disorders. DRB1*08:03 and DQB1*06:01 alleles were frequently detected. Compared to group without immunodeficiency, they showed no significant differences in the severity of MG, significantly lower IgG concentrations and higher mortality rate. Thymoma-associated MG with immunodeficiency is a distinct subset requiring special attention to prevent infection during the follow-up period.

Characteristics of cause of death and triggers for crisis in patients with myasthenia gravis

AbstractIntroductionImproving our knowledge on the cause of death and triggers of crisis in myasthenia gravis (MG) patients may have a patient be careful in the daily life.MethodsWe selected 233 MG patients with regular visits to our hospital between 1st May 2006 and 31 December 2018. We investigated the cause of death and trigger of crisis at our hospital.ResultsEight MG patients were confirmed to die during the observation period, and the causes of death were four cases of cancer (breast cancer, pancreatic cancer, stomach cancer, and cancer of an unknown primary site) and two cases of sudden death (sudden cardiac arrest and cardiac arrest from choking), invasive thymoma, and vertebral artery dissection. Fourteen patients experienced crisis, and the most common trigger of crisis was respiratory infection, followed by cholinergic and intravenous methylprednisolone.ConclusionThe most common cause of death was cancer, and the most common trigger of crisis was respiratory infection. Sudden death was characteristic of MG patients. Respiratory infection and malignancy should be considered in MG patients regularly to prevent crisis and death. Further research on sudden death in MG patients should be performed.

Successful resection of invasive thymoma directly invading the superior vena cava and right atrium with a pulmonary artery tumor embolus

Successful resection of invasive thymoma directly invading the superior vena cava and right atrium with a pulmonary artery tumor embolus

The Anesthesia Management of Thymoma Invading the Heart, Great Vessels, and Main Bronchi Undergoing Radical Resection

Thymomas are rare mediastinum tumors with a low incidence rate, distinguished into types A, AB, B (B1, B2, B3), and C. Surgery is the essential treatment for patients with invasive thymoma. It is rare for thymoma to invade the right atrium (RA), the central airway, and the superior vena cava (SVC) simultaneously. Radical resection and Masaoka staging are the main prognostic factors for patients' long-term survival, and the survival rate is positively correlated with the degree of the thymoma resection. To ensure the patient's safety and a favorable prognosis. Adequate preparations and anesthesia management are indispensable. We would report the anesthetic management of a 20-year-old female student (166cm, 48kg, NYHA class III) with complaints of sudden palpitations accompanied by profuse sweating. The thymoma, located in the thymus area, with a vast invasion, was about 10cm*6cm*4cm. It had invaded the SVC, epicardium, part of the brachiocephalic trunk, transverse jugular vein, and main bronchi (squeezed and deformed), and the right lung and hilum were slightly affected on the upper and right side of the pericardium. This giant thymoma was entirely resected under general anesthesia and cardiopulmonary bypass (CPB). As a result, the anesthesia management of the giant thymoma undergoing radical resection was successful.

A case of concomitant surgery for invasive thymoma with myasthenia gravis and severe mitral valve regurgitation

A case of concomitant surgery for invasive thymoma with myasthenia gravis and severe mitral valve regurgitation

Invasive thymoma - Which patients benefit from post-operative radiotherapy?

The aim of this study is to identify patients with thymoma who should receive post-operative radiotherapy. The Surveillance, Epidemiology, and End Results database was queried for stage IIB-IV thymoma patients diagnosed during 1988-2015. We analyzed the prognostic implications of various clinical-pathological factors by comparing the outcomes of those who received surgery with and without post-operative radiotherapy. A total of 1120 patients were identified; 62% received post-operative radiotherapy and 38% underwent surgery alone. In a propensity-matched cohort of 812 patients, no survival difference was seen in World Health Organization A, AB, B1, B2, or B3 tumors with the addition of post-operative radiotherapy to surgery (p>0.05). Post-operative radiotherapy also did not improve survival over surgery alone for tumors ≥ or < less than the 4 cm, 7 cm, 10 cm, and 13 cm cutoffs, all p>0.05. Post-operative radiotherapy was an independent, positive prognostic indicator only in the subgroup with stage III disease and in those receiving chemotherapy in addition to post-operative radiotherapy, both p<0.05. Patients with stage III thymoma are most likely to benefit from the addition of post-operative radiotherapy to surgical treatments. Tumor size or World Health Organization histology alone should not be criteria for determining the need for post-operative radiotherapy in locally advanced thymoma. Masaoka-Koga stage, which has traditionally been used to help make such decisions, appears to be the most reliable determinant of the use of post-operative radiotherapy.

Mediastinal diffuse large B-cell lymphoma mimicking invasive thymoma on 68Ga-FAPI PET/CT

Mediastinal diffuse large B-cell lymphoma mimicking invasive thymoma on 68Ga-FAPI PET/CT

Iatrogenic Iliac Vein Injury Following Extracorporeal Membrane Oxygenation Cannulation in a Patient with May-Thurner Syndrome: A Case Report and Literature Review

A 53-year-old woman presented with dyspnea. She had undergone extended thymectomy for an invasive thymoma two months prior. CT revealed numerous small nodules in the lung. After that, she deteriorated owing to acute respiratory distress syndrome (ARDS), and the vascular surgeon planned veno-venous extracorporeal membrane oxygenation (ECMO). During percutaneous cannulation through the left femoral vein, a vascular injury was suspected, and the patient's vital signs became unstable. Diagnostic angiography showed a ruptured left common iliac vein, and the bleeding was stopped by placement of a stent-graft. May-Thurner syndrome was diagnosed on abdominal CT. Here, we report a rare case of ECMO-related vascular injury in a patient with an unrecognized anatomical variant, May-Thurner syndrome.