Surgical Treatment Of Thymoma Research Articles

Efficacy of rituximab in thymoma associated minimal change disease: case report

BackgroundThymomas have been associated with a broad spectrum of autoimmune diseases. Minimal change disease (MCD) is the most frequent pathological lesion reported. Pathophysiological mechanisms involved in secondary MCD, and linking MCD to thymoma are not yet fully explained, although the hypothesis of T cell dysfunction has been suggested. The fundamental therapeutic principles are steroids and surgical treatment of thymoma, but failures and relapses often require immunosuppressant combinations.Case presentationA 62-year-old female was admitted in our unit for a nephrotic syndrome associated with a thymoma. The diagnosis of thymoma associated MCD was confirmed by kidney biopsy. After surgical resection of the thymoma and steroid therapy, no remission was observed. Immunosuppressive therapy was then intensified with introduction of rituximab. Here, we report a steroid-resistant nephrotic syndrome secondary to MCD associated thymoma, which achieved complete remission after rituximab therapy. To the best of our knowledge, this is the first report of the use and efficacy of rituximab therapy in this pathology.ConclusionsOur case report suggests that primary and secondary MCD may share similar pathophysiological mechanisms. It does not allow us to draw any conclusions about the mechanism of action of rituximab, but we believe this report argues for the safety and efficacy of rituximab use in thymoma-associated MCD, and therefore constitutes a rationale for future studies.

Tumour size determines both recurrence-free survival and disease-specific survival after surgical treatment for thymoma.

The tumour, node and the metastasis (TNM) staging system for thymic epithelial tumours was adopted by the Union for International Cancer Control (UICC) in 2016. Although the T factor is defined by the invasive nature of a thymoma, tumour size is not considered. The aim of this study was to examine the clinical importance of tumour size using a nationwide retrospective database of cases treated from 1991 to 2010 compiled by the Japanese Association for Research of the Thymus. Tumour size was evaluated by the maximum diameter shown by computed tomography imaging prior to resection. Tumour size was available for 2083 thymoma patients undergoing upfront surgical treatment. The tumour size ranged from 0.6 to 19.4 cm (mean 5.1 cm, median 4.9 cm). Harrell's C-index was adopted to determine the cut-off value of the tumour size in 0.5-cm increments. The highest C-index value (0.7760) was obtained in terms of recurrence-free survival after the complete resection when the cut-off value was set at 5.0 cm. The 10-year recurrence-free survival rate was 93.8% in patients with a tumour ≤5.0 cm and 84.3% in patients with a tumour >5.0 cm (P < 0.0001). The highest C-index value (0.8885) in terms of disease-specific survival was obtained when the cut-off value was set at 8.0 cm. The 10-year disease-specific survival rate was 98.8% in patients with a tumour <8.0 cm and 90.1% in those with a tumour ≥8.0 cm (P < 0.0001). The Cox's proportional hazard model analysis showed that the tumour size and the TNM-based pathological stage were independent factors to determine both recurrence-free survival and disease-specific survival. Tumour size is an important prognostic factor and should be considered when determining the treatment strategy for thymoma patients.

Surgical treatment of thymoma: an 11-year experience with 761 patients.

Thymomas are rare, and information regarding their surgical outcomes and possible prognostic factors is limited. In this study, we aimed to determine the clinicopathological characteristics of thymoma and estimate independent predictors of both overall and disease-free survival in thymoma patients. We carried out a retrospective review of the clinicopathological characteristics and prognostic factors in 761 consecutive patients with pathologically confirmed thymoma treated in Shanghai Chest Hospital between January 2001 and December 2011. Survival was calculated using the Kaplan-Meier method and evaluated with log-rank tests. Multivariable analysis was performed using the Cox regression model. Complete follow-up information was available for 544 patients. The overall survival rate was 92.8% at 5 years and 90.5% at 10 years. The 5- and 10-year disease-free survival was 87.9 and 82.1%, respectively. On multiple Cox regression analysis, the Masaoka-Koga clinical stage [odds ratio (OR), 2.057; 95% confidence interval (CI), 1.454-2.911; P < 0.01] and sex (OR, 2.244; 95% CI, 1.115-4.519; P = 0.02) were found to be independent predictors of overall survival. The Masaoka-Koga clinical stage (OR, 2.127; 95% CI, 1.487-3.042; P < 0.01) and completeness of resection (OR, 2.935; 95% CI, 1.410-6.109; P < 0.01) predicted disease-free survival. The four-tiered Masaoka-Koga clinical stage is the most important prognostic factor, predicting not only overall survival but also disease-free survival after thymoma resection. Completeness of resection predicts disease-free survival, and the World Health Organization histological classification may not have significant prognostic implications.

Chirurgie der Mediastinaltumoren

Thymomas, lymphomas, and germ cell tumors are the most frequent lesions of the anterior mediastinum, whereas endodermal (bronchogenic) cysts and lymphomas are the most frequent lesions of the middle mediastinum. In the posterior mediastinum, neurogenic tumors and soft-tissue sarcomas are the most frequent. Depending on tumor location, mediastinoscopy, mediastinotomy, and thoracoscopy are the preferred diagnostic methods. Surgical treatment of thymoma is the gold standard, and median sternotomy is the most frequently applied approach. The decisive prognostic and therapeutic criteria are Masaoka staging, WHO classification, and R0 status. Thoracoscopy should be performed only in patients with myasthenia gravis and with very small tumors. Surgical treatment is highly recommended in patients with locally recurrent tumors. The importance of surgical treatment of germ cell tumors is determined by a negative concentration of beta-HCG and alpha-fetoprotein and in cases of residual tumor after chemotherapy. Bronchogenic cysts always require resection because of their high complication rate (66%) after conservative treatment. In these cases complete resection is necessary due to the probability of recurrence. Ninety-eight percent of neurogenic tumors in adults are benign and usually resected via thoracoscopy or thoracotomy, depending on location and size.

Surgical treatment of thymoma in cats: 12 cases (1987-1992)

Summary Twelve cats with thymoma were treated hy surgical excision of the tumor alone. None of the cats received radiotherapy or chemotherapy. Two cats died or were euthanatized during the immediate postoperative period: 1 because of postsurgical hemorrhage, and the other because of an associated fungal pleuritis. None of the remaining 10 cats developed evidence of local tumor recurrence or metastases. Six of the cats were alive after follow-up periods ranging from 6 to 36 months (mean, 21 months; median, 21 months). Three cats were euthanatized 18 months, 32 months, and 45 months following surgery for unrelated problems, and 1 cat died as a result of trauma sustained 62 months postoperatively. Myasthenia gravis developed postoperatively in 2 of the cats.

犬の胸腺腫の外科的治験例

犬の胸腺腫の外科的治験例

胸腺腫の手術成積 術後長期観察の重要性について

胸腺腫の手術成積 術後長期観察の重要性について

Surgical treatment for thymoma

Twenty-five patients with thymoma were subjected to surgical treatment in our department from 1972 to 1990. Patients with non-invasive type (stage I), stage III, stage IVa, and stage IVb were 16, 6, 2 and 1, respectively. Twenty-two patients underwent surgical resection and 3 patients underwent exploratory thoracotomy.Histologically, 8 patients were found epithelial cell type, 5 patients lymphocytic type and 12 patients mixed type.The five-year survival rate was 85% in non-invasive type, and 58% in invasive type. Jn non-invasive type, 5-year survival rate was 100% in patients without myasthenia gravis (MG) and 56% in patients with MG. The prognosis of patients with MG was significantly poorer than the one of patients without MG. MG was causes of death in two of three patients who died among patients with MG. 5-year survival rate by histological type was 100% in lymphocytic type, 73% in epithelial cell type and 51% in mixed type.5-year survival rate according to the surgical modalities, were 85% in patients with total resection, 80% in subtotal resection and 33% in exploratory thoracotomy.

Histopathological Changes in Invasive Thymoma in Patients with Recurrence

In the last 20 years, we treated 123 cases of thymoma. In 2 patients histopathological features of the tumors changed during the long-term follow up. In one patient the tumor was resected along with the invaded tissues. Eleven years later, recurring tumor and the invaded organs were extirpated. Hepatic metastasis was detected by abdominal CT scanning 16 years after the first operation. Two years later she died in an accident. Histopathologically, the primary thymoma was lymphoepithelial type and the recurrent tumor was epithelial type. In the other patient, four years after the surgical treatment for thymoma with disseminated lesions, recurrent disseminations were removed. Eight years later, both the disseminated and a metastatic lesion were resected. This patient is currently well without tumor 14 years after initial detection of the disease. Both the primary and recurrent thymoma were lymphoepithelial type and the third tumor was epithelial type. Thus, slow-growing thymomas in patients with long-term survival possibly undergo histological change.

TREATMENT FOR THYMOMAS

Surgical treatment for thymoma is studied by analyzing causes of postoperative recurrences and deaths by stages in 76 patients operated on for thymomas, consisting of 21 in stage I and 55 in stage II, III and IVa. Of the 76 patients, 41 had myasthenia gravis (MG) and 26 received irradiation. Recurrence of the tumor occurred in 4 patients in stage II, 2 of which associated with MG. Of the 4 patients, thymomectomy was carried out in one without postoperative irradiation, and total resection including normal thymus tissues (complete resection) in the remained 3 patients. Death after surgical treatment occurred in 10 patients, one in stage II, 7 in stage III, and 2 in stage IVa, each five of whom underwent complete resection and incomplete resection respectively with irradiation in each 2 of the 5. Causes of the deaths included tumors in 4 patients, MG in 4 and postoperative complications in 2. These findings have suggested that stage I tumors may be treated with thymomectomy or complete resection with or without postoperative radiotherapy; stage II or more advanced tumors, especially those associated with MG, should be treated with complete resection as well as radiotherapy, where the tumor must be resected as complete as possible; and radiotherapy is effective for stage III and IVa tumors.

Results of surgical treatment for thymoma

Ten years' experience with surgical treatment of thymoma in 52 patients is reported, 25 patients with myasthenia gravis and 27 without. Twenty-five patients had noninvasive tumors (Stage I) and 27 had invasive tumors (Stages II and III). Of the 52 patients, 29 had surgical resection as the only treatment and the remaining 23 had surgical resection with adjunctive preoperative or postoperative radiotherapy. Currently, 39 patients are alive (20 with myasthenia and 19 without), 10 are dead (none dying of myasthenia or tumor), and three patients have been lost to follow-up. The mean follow-up time for all patients was 5.6 years. There were no operative deaths in this series. The 5 year cumulative survival rate for the entire group of 52 patients is 81%; for patients with myasthenia it is 92%; and for those without myasthenia, 71%. This series suggests that the prognosis following resection of thymoma relates primarily to the stage of the tumor and is not significantly influenced by the presence or absence of coexisting myasthenia gravis. The improved survival rate, in contrast to a 1973 report, is a reflection of improved long-term medical management of myasthenia gravis and better postoperative supportive care.