Pathology of thymomas and thymic carcinomas

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PATHOLOGY OF THYMOMAS AND THYMIC CARCINOMAS Dr Vincent Thomas de Montpréville Marie Lannelongue Surgical Center LE PLESSIS ROBINSON FRANCE

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Thymic Tumors Classification EPITHELIAL TUMORS:thymomas and thymic carcinomas GERM CELL TUMORS LYMPHOMAS Others :- thymic cysts- thyroid and para-thyroid tumors- miscellaneous

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Thymic Epithelial Tumors THYMOMAS Specific to the thymus Associated with auto-immune diseases Low grade of malignancy Pleural and pericardial metastases CARCINOMAS Similar in other organs No association with Myasthenia Gravis High grade of malignancy Lymphatic and Blood metastases

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THYMOMAS2004 WHO HISTOLOGICAL CLASSIFICATION

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TYPE A THYMOMA (spindle cell) Regular elongated or ovale epithelial cells Sparse lymphocytes

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TYPE A THYMOMA Mesenchymatous tumor ? Keratins

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TYPE A THYMOMA ? Neuroendocrine Tumors ribbons, pseudo-rosettes? neuroendocrine markers

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TYPE AB THYMOMA (mixed) CD 20 + epithelial cells

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TYPE B1 THYMOMA (lymphocyte-rich) Lymphoblastic lymphoma? epithelial markers

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TYPE B2 THYMOMA (cortical)

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TYPE B3 THYMOMA (atypical)

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Micronodular Thymoma Rare ? Lymph node metastasis

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Micronodular Thymoma Keratin CD 20 May be related to type A or type AB thymoma. Frequency: 1.38% Totally encapsulated or only minimally invasive tumors. (Ann Pathol 2002; 22(3): 177-82.)

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Metaplastic Thymoma

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CLINICO-PATHOLOGIC SIGNIFICANCEOF WHO THYMOMAS CLASSIFICATION

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Microscopic Thymomas Single or multiple epithelial nodules, < 1 mm. In cases: of Myasthenia Gravis, of congenital immunodeficiencies (thymic dysplasia) or in involutive thymus. Foci of hyperplasia rather than neoplasic lesions.

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THYMIC CARCINOMAS Squamous cell carcinoma ++ Neuroendocrine : well differentiated (typical or atypical carcinoid) or poorly differentiated (small cell or large cell neuroendocrine carcinoma) Other types: basaloid, mucoepidermoid, lympho-epithelioma like, sarcomatoid, clear cell, undifferentiated, adenocarcinoma. Differential diagnosis: thymic metastasis

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Thymic Carcinoma CD 117 CD 5

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Marie Lannelongue Surgical Center2005-2006 63 cases A:1 AB: 8 9 (14%) B1: 10 B2: 23 B3: 5 Combined: B1/B2: 1 B1/B3: 2 41(65%) Micronodular: 2 Necrotic: 1 3 (5%) Carcinomas: 7 Carcinoids: 3 10(16%)

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Histological Diagnosis / Samples Biopsy: ? Immuno-histochemistry & +/- problems for combined forms Frozen section: Difficult differential diagnosis with lymphoma +++ or seminoma, or between thymoma and carcinoma Surgical specimen: ? Staging

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IMMUNO-HISTOCHEMISTRY THYMOMAS Epithelial Cells: Keratin, EMA, +/-CD20 Lymphocytes: CD99, CD1a, Ki67+++ CARCINOMAS CD5, CD117 (cKit)

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STAGING (Masaoka) Stage I : Totally encapsulated Stage II : 1. Invasion into surrounding fatty tissue or mediastinal pleura 2. Microscopic capsular invasion Stade III : Invasion into neighboring organs : pericardium, great vessels or lung Stade IVa : Pleural or pericardial dissemination Stade IVb : Lymphogenous or hematogenous metastasis

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Capsular invasions(stage II)

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Vena cava invasion(stage III)

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Pleural metastases(stade IVa)

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CONCLUSION Epithelial tumors of the thymus are: rare histologically heterogeneous Their prognosis is related to: histological type clinical staging completeness of resection

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