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CC BY-NC-ND 4.0 · South Asian J Cancer 2024; 13(03): 191-202
DOI: 10.1055/s-0042-1757556
Original Article
Lung Cancer and Mediastinal Tumor

Histomorphological Spectrum and Diagnostic Challenges in Thymic Epithelial Neoplasms with their Prognostic Significance: A Case Series of 33 Cases at a Regional Cancer Center in Western India

Karthik Dhandapani 
1   Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Jahnavi Gandhi
1   Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Sonali Timaniya
1   Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Krutika Joshi
1   Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Amisha Gami
1   Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Ashini Shah
1   Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
,
Priti Trivedi
1   Department of Onco-pathology, Gujarat Cancer and Research Institute, Ahmedabad, Gujarat, India
› Author Affiliations Funding None.
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Abstract

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Jahnavi Gandhi, DCP

Objective Pathological diagnosis of thymic epithelial neoplasms is challenging due to multiple subtypes, tumor heterogeneity, and variations in inter-observer reproducibility. Very few studies are available on their spectrum in the Indian subcontinent. In this study, we aimed to explore the morphological spectrum and diagnostic difficulties in the classification and subtyping of thymic epithelial neoplasms along with their prognostic significance in the Indian population.

Material and Methods Retrospectively, all surgically resected thymectomy specimens operated at our institute as well as outside review cases during the period were included. Histomorphology and immunohistochemistry (IHC) slides were reviewed and correlated with clinicopathological variables.

Statistical Analysis Microsoft Excel 2019 and SPSS version 20 were used for data analysis.

Results Among the 33 thymic epithelial neoplasms operated during the study period, the commonest subtype was thymoma B2 type followed by AB, B1, A, and B3 types. A single case each of micronodular thymoma, microscopic thymoma, and thymic carcinoma were identified. Six cases of thymomas with more than one pattern (other than ‘A’) were noted. The male:female ratio was 2:1. Stage I in Modified Masaoka staging and pT1a in TNM staging were most common. Seven cases had metastasis, four during initial presentation and three during subsequent follow-up.

Discussion and Conclusion Thymic epithelial neoplasms show morphological overlapping of features. Thorough sampling, morphology, and IHC for exact subtyping of thymoma and diligent search and documenting of lymphovascular invasion (LVI) are vital as both are separate risk factors for metastasis/recurrence and help the clinician in a better follow-up of patients.

Keywords

thymic epithelial neoplasm - thymoma - histomorphology - immunohistochemistry - metastasis

Authors' Contributions

The design of the study was conducted by Jahnavi Gandhi and Sonali Timaniya. Data acquisition was carried out by Karthik Dhandapani, Sonali Timaniya, and Krutika Joshi. The analysis of data involved Jahnavi Gandhi, Sonali Timaniya, Karthik Dhandapani, and Krutika Joshi. The drafting of the manuscript was completed by Jahnavi Gandhi, Sonali Timaniya, Karthik Dhandapani, and Krutika Joshi. Critical revision of the manuscript was performed by Jahnavi Gandhi, Amisha Gami, Ashini Shah, and Priti Trivedi. Statistical analysis was conducted by Karthik Dhandapani, while technical supervision was provided by Jahnavi Gandhi, Amisha Gami, Ashini Shah, and Priti Trivedi.




Publication History

Article published online:
02 December 2022

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  • References

  • 1 Weis CA, Yao X, Deng Y. et al; Contributors to the ITMIG Retrospective Database. The impact of thymoma histotype on prognosis in a worldwide database. J Thorac Oncol 2015; 10 (02) 367-372
    CrossrefPubMedSearch in Google Scholar
  • 2 Marx A, Chan JKC, Chalabreysse L. et al. The 2021 WHO classification of tumors of the thymus and mediastinum: what is new in thymic epithelial, germ cell, and mesenchymal tumors?. J Thorac Oncol 2022; 17 (02) 200-213
    CrossrefPubMedSearch in Google Scholar
  • 3 Detterbeck FC, Nicholson AG, Kondo K, Van Schil P, Moran C. The Masaoka-Koga stage classification for thymic malignancies: clarification and definition of terms. J Thorac Oncol 2011; 6 (7, Suppl 3) S1710-S1716
    CrossrefPubMedSearch in Google Scholar
  • 4 Nicholson AG, Detterbeck F, Marx A. et al. Dataset for reporting of thymic epithelial tumours: recommendations from the International Collaboration on Cancer Reporting (ICCR). Histopathology 2017; 70 (04) 522-538
    CrossrefPubMedSearch in Google Scholar
  • 5 Marx A, Chan JK, Coindre JM. et al. The 2015 World Health Organization classification of tumors of the thymus: continuity and changes. J Thorac Oncol 2015; 10 (10) 1383-1395
    CrossrefPubMedSearch in Google Scholar
  • 6 Sundaram C, Rajagopal P, Rakshak AD, Omprakash G, Das SM, Murthy JMK. Clinicopathological study of thymomas–correlation of histologic subtype to myasthenia gravis and prognosis. Indian J Pathol Microbiol 2003; 46 (03) 378-381
    PubMedSearch in Google Scholar
  • 7 Guleria P, Parshad R, Malik PS, Ray R, Pandey RM, Jain D. Histotyping of Indian thymomas: a clinicopathologic study from north India. Indian J Med Res 2019; 150 (02) 153-160
    CrossrefPubMedSearch in Google Scholar
  • 8 Vaideeswar P, Padmanabhan A, Deshpande JR, Pandit SP. Thymoma: a pathological study of 50 cases. J Postgrad Med 2004; 50 (02) 94-97
    PubMedSearch in Google Scholar
  • 9 Julka PK, Sharma DN, Mallick S. et al. Outcomes of thymoma treated with multimodality approach: a tertiary cancer center experience of 71 patients. Tumori 2017; 103 (06) 572-576
    CrossrefPubMedSearch in Google Scholar
  • 10 Marx A, Ströbel P, Badve SS. et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol 2014; 9 (05) 596-611
    CrossrefPubMedSearch in Google Scholar
  • 11 Roden AC. Evolution of classification of thymic epithelial tumors in the era of Dr Thomas V. Colby. Arch Pathol Lab Med 2017; 141 (02) 232-246
    CrossrefPubMedSearch in Google Scholar
  • 12 Rathod S, Munshi A, Paul S, Ganesh B, Prabhash K, Agarwal JP. Thymoma: first large Indian experience. Indian J Cancer 2014; 51 (02) 109-112
    CrossrefPubMedSearch in Google Scholar
  • 13 Hephzibah J, Shanthly N, Oommen R. Diagnostic utility of PET CT in thymic tumours with emphasis on 68Ga-DOTATATE PET CT in thymic neuroendocrine tumour - experience at a tertiary level hospital in India. J Clin Diagn Res 2014; 8 (09) QC01-QC03
    PubMedSearch in Google Scholar
  • 14 den Bakker MA, Roden AC, Marx A, Marino M. Histologic classification of thymoma: a practical guide for routine cases. J Thorac Oncol 2014; 9 (9, Suppl 2) S125-S130
    CrossrefPubMedSearch in Google Scholar
  • 15 Kumar N, Kumar R, Bera A. et al. Thymoma: clinical experience from a tertiary care institute from North India. J Cancer Res Ther 2013; 9 (02) 235-239
    CrossrefPubMedSearch in Google Scholar
  • 16 Marx A, Willcox N, Leite MI. et al. Thymoma and paraneoplastic myasthenia gravis. Autoimmunity 2010; 43 (5-6): 413-427
    CrossrefPubMedSearch in Google Scholar
  • 17 The WHO Classification of Tumors Editorial Board. Thoracic Tumours. Lyon: IARC; 2021: 319-388
    Search in Google Scholar
  • 18 Fletcher CDM. Diagnostic Histopathology of Tumors 5th ed. Philadelphia: Elsevier; 2020: 1558-1614
    Search in Google Scholar
  • 19 Nishino M, Ashiku SK, Kocher ON, Thurer RL, Boiselle PM, Hatabu H. The thymus: a comprehensive review. Radiographics 2006; 26 (02) 335-348
    CrossrefPubMedSearch in Google Scholar
  • 20 Alkaaki A, Abo Al-Saud A, Di Lena É. et al. Factors predicting recurrence in thymic epithelial neoplasms. Eur J Cardiothorac Surg 2022; 62 (05) ezac274
    CrossrefPubMedSearch in Google Scholar
  • 21 Amin MB, Gress DM, Vega LRM, Edge SB. AJCC Cancer Staging Manual, 8th ed. American College of Surgeons; 2018
    Search in Google Scholar
  • 22 Khandelwal A, Sholl LM, Araki T, Ramaiya NH, Hatabu H, Nishino M. Patterns of metastasis and recurrence in thymic epithelial tumours: longitudinal imaging review in correlation with histological subtypes. Clin Radiol 2016; 71 (10) 1010-1017
    CrossrefPubMedSearch in Google Scholar
  • 23 Utsumi T, Shiono H, Matsumura A. et al. Stage III thymoma: relationship of local invasion to recurrence. J Thorac Cardiovasc Surg 2008; 136 (06) 1481-1485
    CrossrefPubMedSearch in Google Scholar