Journal of Pathology and Translational Medicine

Case Study

Thymoma and Synchronous Primary Mediastinal Seminomas with Florid Follicular Lymphoid Hyperplasia in the Anterior Mediastinum: A Case Report and Review of the Literature: Hyang-im Lee, In-seok Jang, Kyung Nyeo Jeon, Gyung Hyuck Ko, Jong Sil Lee, Dong Chul Kim, Dae Hyun Song, Jeong-Hee Lee; J Pathol Transl Med. 2017;51(2):165-170. Published online February 2, 2017; DOI: https://doi.org/10.4132/jptm.2016.08.24

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Thymoma is the most common neoplasm of the anterior mediastinum and has malignant potential. Germ cell tumors (GCTs) found in the anterior mediastinum are usually benign, and malignant GCTs, such as seminomas, are rare. Histologically, mediastinal seminoma is indistinguishable from testicular seminoma except for site-associated morphological features such as lymphoid follicular hyperplasia. Therefore, excluding metastasis is very important. Recently, we treated a young adult patient with multiple thymic masses that occurred simultaneously. The patient underwent a thymectomy for the removal of the mediastinal masses, one of which was diagnosed as type B2 invasive thymoma, and two of which were diagnosed as primary mediastinal seminomas with massive follicular hyperplasia. The patient received adjuvant chemotherapy after surgical resection. To our knowledge, this is the first description of a thymoma and a mediastinal seminoma occurring simultaneously in the thymus. We present this case along with a literature review.

Citations

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Alexander Fichtner, Alexander Marx, Philipp Ströbel, Felix Bremmer
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Combined type A thymoma and yolk sac tumour of the mediastinum
Dong Sheng, Yu-Chen Han
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Combined Thymic Epithelial Neoplasms – a Review
Annikka Weissferdt
International Journal of Surgical Pathology.2023; 31(6): 917. CrossRef
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Chelsey M. Williams, Derek B. Allison, Adam B. Coleman, Roshmita Bardhan, Jordan D. Miller, Zin W. Myint
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Brief Case Report

A Rare Case of Mesothelioma Showing Micropapillary and Small Cell Differentiation with Aggressive Behavior: Yoon Jin Cha, Binnari Kim, Joungho Han, Chin A Yi, Jae Ill Zo; Korean J Pathol. 2014;48(6):466-468. Published online December 31, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.6.466

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Small cell mesothelioma: A rare entity and diagnostic pitfall mimicking small cell lung carcinoma on fine‐needle aspiration
Yanhong Zhang, Alaa Afify, Regina F. Gandour‐Edwards, John W. Bishop, Eric C. Huang
Diagnostic Cytopathology.2016; 44(6): 526. CrossRef
A Biphasic Pleural Tumor with Features of an Epithelioid and Small Cell Mesothelioma: Morphologic and Molecular Findings
Sarah Hackman, Richard D. Hammer, Lester Layfield
Case Reports in Pathology.2016; 2016: 1. CrossRef

Case Studies

Alveolar Soft Part Sarcoma of the Uterine Cervix: A Case Report and Review of the Literature: Hyun Ju Lee; Korean J Pathol. 2014;48(5):361-365. Published online October 27, 2014; DOI: https://doi.org/10.4132/KoreanJPathol.2014.48.5.361

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Abstract PDF

Alveolar soft part sarcoma (ASPS) of the uterine cervix is a rare malignancy, and 21 cases have been reported the literature from every language (including our case). Herein, we describe a 17-yearold female patient who presented with active vaginal bleeding. Pelvic examination revealed a 1.6 ×1.0×0.5-cm-sized soft mass protruding from the uterine cervix. The final pathological diagnosis was ASPS of the uterine cervix. Immunohistochemically, tumor cells were strongly nuclear positive for transcription factor E3. The patient remained disease free for 24 months without adjuvant therapy. The prognosis of ASPS in the cervix is considerably better than that of ASPS in soft tissues due to early clinical detection, small size, and resectability. ASPS should be considered in the differential diagnosis of an unusual epithelioid neoplasm showing organoid appearance with mild cytologic atypia and no/rare mitotic figures, particularly in young women. Pathologists should be aware of those unusual locations where ASPS may originate.

Citations

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Primary Uterine Alveolar Soft Part Sarcoma in a Postmenopausal Woman: Histopathologic and Immunohistochemical Characteristics of a Rare Case
Anjali Gupta, Parikshaa Gupta, Amarjot Kaur, Snigdha Kumari, Gupta Nalini, Shalini Gainder
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International Journal of Women's Health.2024; Volume 16: 17. CrossRef
Alveolar soft part sarcoma: a clinicopathological and immunohistochemical analysis of 26 cases emphasizing risk factors and prognosis
Yi Zhang, Yuchen Huang, Yanzi Qin, Ningning Yang, Panpan Yang, Nan Li, Zhenzhong Feng
Diagnostic Pathology.2024;[Epub] CrossRef
Epithelioid and clear‐cell variant of Kaposi sarcoma: A rare histopathologic subtype
Kaitlyn M. Yim, Tom Liang, Esteban Gnass, Brittney DeClerck
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A Case of TFE3-positive Non-neoplastic Pseudodecidualized Endometrium Presenting as a Cervical Mass
Serenella Serinelli, Dana Hariri, Gustavo de la Roza, Daniel J. Zaccarini
Applied Immunohistochemistry & Molecular Morphology.2022; 30(6): e50. CrossRef
Alveolar Soft Part Sarcoma of the Uterus: Clinicopathological and Molecular Characteristics
Yurimi Lee, Kiyong Na, Ha Young Woo, Hyun-Soo Kim
Diagnostics.2022; 12(5): 1102. CrossRef
Alveolar soft part sarcoma in childhood and adolescence: Report of three cases and review of literature
Yudi Zhang, Ying Wang, Hao Wang, Chuan Wen, Xiaochuan Wu
Frontiers in Pediatrics.2022;[Epub] CrossRef
Exploring the Histogenesis and Diagnostic Strategy Using Immunoassay and RT-PCR in Alveolar Soft Part Sarcoma
Xinxin Ju, Kunming Sun, Ruixue Liu, Shugang Li, Gulinaer Abulajiang, Hong Zou, Jiaojiao Lan, Yan Ren, Jinfang Jiang, Weihua Liang, Lijuan Pang, Feng Li
Pathology & Oncology Research.2018; 24(3): 593. CrossRef
Alveolar Soft Part Sarcoma of the Female Genital Tract
J. Kenneth Schoolmeester, Joseph Carlson, Gary L. Keeney, Karen J. Fritchie, Esther Oliva, Robert H. Young, Marisa R. Nucci
American Journal of Surgical Pathology.2017; 41(5): 622. CrossRef
Recurrent alveolar soft part sarcoma of the uterine cervix
Aeli Ryu, Seong Taek Mun, Hyun Ju Lee, Nan-Seol Kim
Journal of Obstetrics and Gynaecology.2017; 37(8): 1099. CrossRef

Micronodular Thymoma with Lymphoid Stroma in a Multilocular Thymic Cyst: A Case Study: Na Rae Kim, Jae Ik Lee, Seung Yeon Ha; Korean J Pathol. 2013;47(4):392-394. Published online August 26, 2013; DOI: https://doi.org/10.4132/KoreanJPathol.2013.47.4.392

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Abstract PDF

Herein, we report a case of micronodular thymoma with lymphoid stroma in a previously healthy 73-year-old male. Thymectomy was performed. The solid and macrocystic masses were encapsulated with focal invasion. The solid portion consisted of nodules of bland-looking spindle or round epithelial cells in lymphoid stroma containing prominent germinal centers. The epithelial cells had moderate amount of cytoplasm and occasional mucin production. The cystic portion was lined with cuboidal epithelium. According to World Health Organization (WHO) classification, the mass was diagnosed as a micronodular thymoma with lymphoid stroma accompanied by a pre-existing multilocular thymic cyst. Micronodular thymoma with lymphoid stroma, a possible variant of type A thymoma, is an extremely rare tumor. This so-called "unusual" variant may imply the schematic weakness of the current WHO classification that cannot cover all morphologic types. Further study is recommended for clarification of this variant and its incorporation into the current classification.

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GTF2Imutation in micronodular thymoma with lymphoid stroma
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Jan von der Thüsen
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Minimally invasive thoracoscopic resection of a micronodular thymoma with lymphoid stroma via a subxiphoid single-incision approach: A case report
Qiang Wu, Kun Qiao, Xiaoming Zhang, Zizi Zhou
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Micronodular Thymomas With Prominent Cystic Changes: A Clinicopathological and Immunohistochemical Study of 25 Cases
Diana M. Oramas, Cesar A. Moran
International Journal of Surgical Pathology.2021; 29(4): 352. CrossRef
Two cases of resection of micronodular thymoma with lymphoid stroma
Seiji Omura, Kyohei Masai, Kaoru Kaseda, Keisuke Asakura, Tomoyuki Hishida, Hisao Asamura
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Two surgical cases of micronodular thymoma with lymphoid stroma
Yusuke Kita, Yoshimasa Tokunaga, Taku Okamoto
The Journal of the Japanese Association for Chest Surgery.2020; 34(2): 166. CrossRef
Thoracoscopic Thymectomy for Large Thymic Cyst: Myasthenia Gravis With Thymoma Concealed by Thymic Cyst
Motoki Yano, Hiroki Numanami, Takashi Akiyama, Rumiko Taguchi, Chihiro Furuta, Akari Iwakoshi, Masayuki Haniuda
Surgical Laparoscopy, Endoscopy & Percutaneous Techniques.2019; 29(3): e34. CrossRef
A resected case of micronodular thymoma with lympoid stroma
Hiromitsu Domen, Yasuhiro Hida, Yasunari Takakuwa, Yuki Iijima, Kazuomi Ichinokawa, Hidehisa Yamada
The Journal of the Japanese Association for Chest Surgery.2019; 33(5): 504. CrossRef
Thymoma and thymic carcinoma associated with multilocular thymic cyst: a clinicopathologic analysis of 18 cases
Xuxia Shen, Yan Jin, Lei Shen, Yihua Sun, Haiquan Chen, Yuan Li
Diagnostic Pathology.2018;[Epub] CrossRef
Micronodular thymoma with lymphoid stroma: Two cases, one in a multilocular thymic cyst, and literature review
Linlin Qu, Yan Xiong, Qian Yao, Bo Zhang, Ting Li
Thoracic Cancer.2017; 8(6): 734. CrossRef
Cystic Micronodular Thymoma. Report of a Case
Mlika M
Journal of Clinical, Medical and Experimental Images.2017; 1(1): 001. CrossRef
A Rare Case of Mixed Type A Thymoma and Micronodular Thymoma with Lymphoid Stroma
Yoon Jin Cha, Joungho Han, Jimin Kim, Kyung Soo Lee, Young Mog Shim
Journal of Pathology and Translational Medicine.2015; 49(1): 75. CrossRef
Micronodular thymic neoplasms: case series and literature review with emphasis on the spectrum of differentiation
Wadad S Mneimneh, Yesim Gökmen-Polar, Kenneth A Kesler, Patrick J Loehrer Sr, Sunil Badve
Modern Pathology.2015; 28(11): 1415. CrossRef

Case Reports

Cytologic Findings of Thyroid Carcinoma Showing Thymus-like Differentiation: A Case Report: Sunhee Chang, Mee Joo, Hanseong Kim; Korean J Pathol. 2012;46(3):302-305. Published online June 22, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.3.302

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Abstract PDF

Carcinoma showing thymus-like differentiation (CASTLE) is a rare carcinoma of the thyroid or adjacent soft tissue of the neck with a histologic resemblance to thymic epithelial tumors. Although the fine-needle aspiration (FNA) plays a central role in the initial evaluation of thyroid nodules, few reports about the cytologic findings of CASTLE have been found according to a review of literatures. We report cytologic findings of a case of CASTLE. A 34-year-old woman presented with a 2-month history of sore throat. The FNA showed that the smear was composed of three dimensional clusters and sheets. The tumor cells were round to ovoid with high nuclear : cytoplasmic ratios. The nuclei were vesicular with small nucleoli. There were some tumor cells showing keratinization. Some lymphocytes were found on the background and within clusters. The presence of poorly-differentiated tumor cells with a focal keratinization and a lymphocytic background on the FNA is suggestive of CASTLE.

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Coexistence of intrathyroid thymic carcinoma and papillary thyroid carcinoma: a case report and literature review
Maryam Vajihinejad, Ali Ataei, Mohammad Pashmchi, Ali Aledavoud, Vahid Zand, Mohammad Ali Broomand, Mohammad Mohammadi, Niloofar Zare Reshkuiyeh
Frontiers in Oncology.2024;[Epub] CrossRef
Intrathyroidal Thymic Carcinoma: A Retrospective Case Series Study
Jinhui Liang, Mei Huang, Helang Huang, Li Li, Hailin Luo, Weidong Mao, Shan Gao, Haoxiang Xu
Ear, Nose & Throat Journal.2023; 102(9): 584. CrossRef
Carcinoma showing thymus‐like differentiation of the parotid gland: The brief report of cytomorphology and review of the literature
Tomoko Uchiyama, Chiyoko Terada, Yuma Tachibana, Hirokazu Nishiura, Maiko Takeda, Tomomi Fujii, Takahiro Kimura, Masahiro Tsutsumi, Chiho Ohbayashi
Diagnostic Cytopathology.2023;[Epub] CrossRef
A case of concurrent occurrence of carcinoma showing thymus-like differentiation and follicular variant of papillary thyroid cancer in the same thyroid
Takahito Kimura, Keisuke Enomoto, Masamitsu Kono, Masanobu Hiraoka, Saori Takeda, Naoko Kumashiro, Shun Hirayama, Eri Kimura, Shunji Tamagawa, Makiko Ohtani, Shin-Ichi Murata, Muneki Hotomi
Journal of Surgical Case Reports.2022;[Epub] CrossRef
Ultrasonographic Features of Intrathyroidal Thymic Carcinoma: Review and Analysis of 10 Cases
Wang, MD Yanhai, Yang, MD Hua, Liu, MD Hanqing, Luo, MD Xiaoli, Liu, BS Luying, Zhou, BS Pingting
ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY.2022; 6(2): 58. CrossRef
Thyroid carcinoma with thymus-like differentiation (CASTLE) tumor: а сase report
A. A. Ilyin, V. V. Polkin, P. A. Isaev, F. E. Sevrukov, N. Yu. Dvinskych, M. I. Ryzhenkova, S. A. Ivanov, A. D. Kaprin
Head and Neck Tumors (HNT).2021; 11(2): 64. CrossRef
Metastatic Renal Cell Neoplasm Within a Papillary Thyroid Carcinoma as Incidental Finding in an Asymptomatic Patient: a Case Report
Maria-Rosa Bella-Cueto, Mireia Pascua-Solé, Albert Cano-Palomares, M. Àngels Cabezuelo-Hernandez, Maria-Rosa Escoda-Giralt, Santiago Barcons-Vilaplana, Paula Serret-Miralles, Carmen Caral-Vanaclocha, Xavier Guirao-Garriga, Joan Prats-Lopez, Meritxell Meda
SN Comprehensive Clinical Medicine.2020; 2(7): 978. CrossRef
Intrathyroidal thymic carcinoma exhibiting neuroendocrine differentiation: Case report with cytomorphology, immunocytochemistry, and review of the literature focusing on cytology
Wen‐hao Ren, Kun Dong, Xiao‐zheng Huang, Yan‐li Zhu
Diagnostic Cytopathology.2019; 47(11): 1197. CrossRef
Management and Prognostic Factors for Thyroid Carcinoma Showing Thymus-Like Elements (CASTLE): A Case Series Study
Rui Gao, Xi Jia, Ting Ji, Jinteng Feng, Aimin Yang, Guangjian Zhang
Frontiers in Oncology.2018;[Epub] CrossRef
Multiple squamous cells in thyroid fine needle aspiration: Friends or foes?
Heather Gage, Elizabeth Hubbard, Laurentia Nodit
Diagnostic Cytopathology.2016; 44(8): 676. CrossRef
Clinical analysis of 82 cases of carcinoma showing thymus-like differentiation of the thyroid
WEI GE, YONG-ZHONG YAO, GANG CHEN, YI-TAO DING
Oncology Letters.2016; 11(2): 1321. CrossRef
Carcinoma Showing Thymus-Like Differentiation (CASTLE): Cytopathological Features and Differential Diagnosis
Jennifer A. Collins, Bo Ping, Justin A. Bishop, Syed Z. Ali
Acta Cytologica.2016; 60(5): 421. CrossRef
Carcinoma Showing Thymus-Like Elements of the Thyroid Gland: Report of Three Cases Including One Case with Breast Cancer History
Guanjun Zhang, Xi Liu, Wei Huang, Xiaofeng Li, Marianne Johnstone, Yuan Deng, Yongqiang Ke, Quentin M. Nunes, Hongyan Wang, Yili Wang, Xuebin Zhang
Pathology & Oncology Research.2015; 21(1): 45. CrossRef
Potential Role of Adjuvant Radiation Therapy in Cervical Thymic Neoplasm Involving Thyroid Gland or Neck
Jae Myoung Noh, Sang Yun Ha, Yong Chan Ahn, Dongryul Oh, Seung Won Seol, Young Lyun Oh, Joungho Han
Cancer Research and Treatment.2014; 47(3): 436. CrossRef

Metaplastic Thymoma: Report of 4 Cases: Guhyun Kang, Nara Yoon, Joungho Han, Young Eun Kim, Tae Sung Kim, Kwhanmien Kim; Korean J Pathol. 2012;46(1):92-95. Published online February 23, 2012; DOI: https://doi.org/10.4132/KoreanJPathol.2012.46.1.92

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Abstract PDF

Metaplastic thymoma (MT), accepted in the World Health Organization 2004 scheme, is a circumscribed tumor of the thymus exhibiting biphasic morphology. We herein describe the clinicopathologic features of four MTs and the differential diagnoses of this unusual tumor. There were three women and one man with mean age of 49.5 years. The patients were found to have mediastinal masses, and underwent surgical excision. One exhibited symptoms of myasthenia gravis, and the serum titer for anti-acetylcholine receptor antibody was positive. Grossly, the tumors were encapsulated, and showed vaguely multinodular, solid, tan-white to yellow cut surfaces. Histologically, they comprised epithelial islands intertwining with bundles of delicate spindle cells. The patients remained well after surgical excision at 5-55 months. Because of the distinctive histological appearance and benign clinical course, MT should be distinguished from other more aggressive mediastinal neoplasms displaying biphasic feature.

Citations

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A Rare Case of Metaplastic Thymoma Presenting With Myasthenia Gravis
Ilianne Vega Prado, John Shymansky, Anisha Apte, Keith Mortman, Henry J. Kaminski, Stephanie Barak
International Journal of Surgical Pathology.2024; 32(1): 155. CrossRef
Thymic epithelial tumours: histopathological classification and differential diagnosis
Jan von der Thüsen
Histopathology.2024; 84(1): 196. CrossRef
Epigenetics of Thymic Epithelial Tumors
Vanessa Nicolì, Fabio Coppedè
Cancers.2023; 15(2): 360. CrossRef
Expanding the Clinicopathologic Spectrum of YAP1::MAML2–Rearranged Thymic Neoplasm
Eric Eunshik Kim, Ye Yoon Suh, Sang Won Lee, Jeong Mo Bae, Kyoungbun Lee, Sungyoung Lee, Hongseok Yun, Kyeong Cheon Jung, Jiwon Koh
Modern Pathology.2023; 36(2): 100048. CrossRef
Significance of YAP1–MAML2 rearrangement and GTF2I mutation in the diagnosis and differential diagnosis of metaplastic thymoma
Minghao Wang, Hongtao Xu, Qiang Han, Liang Wang
Annals of Medicine.2023;[Epub] CrossRef
Loss of YAP1 C‐terminus expression as an ancillary marker for metaplastic thymoma: a potential pitfall in detecting YAP1::MAML2 gene rearrangement
Xuan Wang, Lei‐lei Liu, Qing Li, Qiu‐yuan Xia, Rui Li, Sheng‐bing Ye, Ru‐song Zhang, Ru Fang, Hui Chen, Nan Wu, Qiu Rao
Histopathology.2023; 83(5): 798. CrossRef
A Case of Metaplastic Thymoma
Ryoichi TAKENAKA, Kenji NEZU, Daijiro TAKEMOTO, Tatsuya HAYASHI, Hisato YAMAMOTO, Shoichi MATSUKAGE
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2023; 84(4): 538. CrossRef
Malignant Transformation of Metaplastic Thymoma into High-Grade Sarcomatoid Carcinoma: A Case Report
Zheng Hua Piao, Jin Ping Chen, Hai Ren Chen, Xin Cheng Zhou
International Journal of Surgical Pathology.2022; 30(5): 564. CrossRef
YAP1-MAML2 Fusion as a Diagnostic Biomarker for Metaplastic Thymoma
Jikai Zhao, Ruiying Zhao, Chan Xiang, Jinchen Shao, Lianying Guo, Yuchen Han
Frontiers in Oncology.2021;[Epub] CrossRef
Metaplastic thymoma: a distinctive thymic neoplasm characterized by YAP1-MAML2 gene fusions
Marina Vivero, Phani Davineni, Valentina Nardi, John K.C. Chan, Lynette M. Sholl
Modern Pathology.2020; 33(4): 560. CrossRef
Metaplastic thymoma: Report of two cases
Yoshikazu Shinohara, Mariko Tanaka, Kentaro Kitano, Kazuhiro Nagayama, Masaaki Sato, Jun Nakajima
The Journal of the Japanese Association for Chest Surgery.2020; 34(7): 733. CrossRef
Type AB thymoma is not a mixed tumor of type A and type B thymomas, but a distinct type of thymoma
Yukari Miki, Kana Hamada, Tadashi Yoshino, Katsuya Miyatani, Kiyoshi Takahashi
Virchows Archiv.2014; 464(6): 725. CrossRef
Potential Role of Adjuvant Radiation Therapy in Cervical Thymic Neoplasm Involving Thyroid Gland or Neck
Jae Myoung Noh, Sang Yun Ha, Yong Chan Ahn, Dongryul Oh, Seung Won Seol, Young Lyun Oh, Joungho Han
Cancer Research and Treatment.2014; 47(3): 436. CrossRef
A Case of Metaplastic Thymoma
Eiji MIYAHARA, Tomoko ITAGAKI, Masaki KUWAHARA, Akira KAMEDA, Yoshihiro MIYATA, Kazuhiro SENTANI, Wataru YASUI
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2014; 75(2): 360. CrossRef

Original Articles

Cytologic Study of Thymoma.: Gu Kong, Se Jin Jang, Jung Dal Lee; Korean J Cytopathol. 1990;1(1):36-42.

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Abstract PDF: The fluoroscopy-guided fine needle aspiration biopsy has been gaining widespread acceptance as a rapid and effective method to make a pre-operative diagnosis of mediastinal tumors including thymoma, malignant lymphoma, and metastatic carcinoma. Although thymoma is a most common tumor of the superior mediastinum, most cytopathologists are not experted in cytologic diagnosis of this tumor because of limited experience. In order to define the diagnostic cytologic features of thymoma, we have retrospectively reviewed imprinting smears and corresponding tissue sections from four cases of this tumor. All cases revealed an apparent biphasic pattern of epithelial cell clusters and lymphocytes with occasional branching capillary fronds extending from three dimensional epithelial cell clusters. Epithelial cell clusters predominated in one case and lymphocytes in two cases. Mixed epithelial cell and lymphocyte type represented in one of four cases. In the lymphocyte predominant type, the presence of epithelial cell clusters and small mature lymphocytes are helpful features to differentiate from a malignent lymphoma.

Fine needle aspiration cytology of malignant thymoma: two cases of invasive thymoma and thymic carcinoma.: Mee Yon Cho, Young Nyun Park, Kwang Gil Lee; Korean J Cytopathol. 1991;2(1):36-42.

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Abstract PDF: We report 4 cases of malignant thymoma which were composed of 2 cases of invasive thymoma and 2 cases of thymic carcinoma. The cytologic findings of invasive thymoma were similar to those of benign thymoma. The distinctive cytologic features of thymic carcinoma were necrotic background, irregular clusters and individually scattered arrangement of anaplastic epithelial cells, and some scattered mature small lymphocytes. These findings may be found in the Hodgkin'slymphoma, seminoma, and metastatic squamous cell carcinoma, undifferentiated carcinoma, and large cell carcinoma of the. lung. But, the feature of irregular clustering of anaplastic epithelial cell having scanty cytoplasm was different from Hodgkin'slymphoma and seminoma. Clinical and radiologic findings as well as cytologic finding were helpful in differential diagnosis of thymic carcinoma from metastatic carcinoma.

Case Reports

Localized Primary Thymic Amyloidosis Presenting as a Mediastinal Mass: A Case Report.: Sang Yun Ha, Jae Jun Lee, Heejung Park, Joungho Han, Hong Kwan Kim, Kyung Soo Lee; Korean J Pathol. 2011;45:S41-S44.; DOI: https://doi.org/10.4132/KoreanJPathol.2011.45.S1.S41

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Abstract PDF

We herein describe a case of a 55-year-old healthy woman with localized primary thymic amyloidosis presented as a mediastinal mass, found incidentally by chest radiography. Computed tomography revealed a 4.1 cm soft tissue lesion with nodular calcification in the left anterior mediastinum. The resected specimen was a well-defined lobulating mass with calcification. Microscopically, the mass was consisted of amorphous eosinophilc hyalinized substances involving the thymus and intrathymic lymph nodes. These eosinophilic substances showed apple-green bi-refringence under polarized light after staining with Congo red. In immunohistochemical study, they were positive for kappa and lambda light chains and negative for amyloid A. There was no evidence of systemic amyloidosis in clinical investigations. A final diagnosis of localized primary thymic amyloidosis was made.

Citations

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EBUS-TBNA diagnosis of localised amyloidosis presenting as mediastinal lymphadenopathy
Avnee Kumar, Barathi Sivasailam, Ellen Marciniak, Janaki Deepak
BMJ Case Reports.2018; 11(1): e226619. CrossRef
Ocular Myasthenia Gravis Associated With Thymic Amyloidosis
Kristin O. Chapman, Debra M. Beneck, Marc J. Dinkin
Journal of Neuro-Ophthalmology.2016; 36(1): 50. CrossRef
Localized Thymic Amyloidosis Presenting with Myasthenia Gravis: Case Report
Seung-Myoung Son, Yong-Moon Lee, Si Wook Kim, Ok-Jun Lee
Journal of Korean Medical Science.2014; 29(1): 145. CrossRef

Aspiration Cytology of Cervical Thymoma: A Case Report.: Xian Ji Jin, Ju Young Song, Suk Jin Choi, Lucia Kim, In Suh Park, Jee Young Han, Joon Mee Kim, Young Chae Chu; Korean J Pathol. 2010;44(4):444-447.; DOI: https://doi.org/10.4132/KoreanJPathol.2010.44.4.444

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Abstract PDF

An ectopic cervical thymoma is an uncommon tumor of the neck displaying the same histologic features as a mediastinal thymoma. Because of its unusual location, this mass is often confused as originating from the thyroid. In this report we describe a case of cervical type AB thymoma. Aspiration cytologic smears were highly cellular and revealed irregular tissue fragments, cohesive sheets, and clusters of crowded epithelial cells intermingled with many small lymphocytes. The epithelial cells had oval and spindle shaped bland-looking nuclei and scant cytoplasm with indistinct cell borders. Mitosis, nuclear atypia, and necrosis were not observed. The cells were focally arranged in a nesting pattern. Many small lymphocytes, a few activated lymphocytes, and lymphoid tangles were seen in the background. A cytologic misdiagnosis of "possible carcinoma" was rendered. Therefore, ectopic thymoma should also be considered in fine needle aspiration cytology of a neck mass when the smear shows epithelial and lymphoid components.

Citations

Citations to this article as recorded by

Aspiration cytology of an ectopic cervical thymoma misinterpreted as a lymphoproliferative lesion of the thyroid: A case report
YI-YING LEE, WEN-CHING WANG, CHIEN-FENG LI
Oncology Letters.2015; 10(3): 1255. CrossRef

Original Article

Histopathologic Re-evaluation of Thymoma with Immunonhistochemical Study for bcl-2 and MIC-2 Protein.: Kyung Moo Yang, Mee Yon Cho, Soon Won Hong, Tae Seung Kim, Chan Il Park, Woo Ick Yang; Korean J Pathol. 1997;31(5):446-461.

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Abstract PDF: We reviewed 86 thymic epithelial tumors and reclassified them according to the Kirchner and Muller- Hermelink classification. They were subtyped as medullary, mixed, predominantly cortical (organoid), cortical, well differentiated thymic carcinoma, and poorly differentiated thymic carcinoma. The frequency of each subtype was determined and histologic findings were related to stage and myasthenia gravis. Immunohistochemical stains for bcl-2 protein as a marker for medullary thymocytes and MIC-2 protein as a marker for cortical thymocytes were performed in each case. The stages and association of myasthenia gravis was significantly different in each subtypes. The results of this study demonstrate that this histogenetic classification is clinically applicable. The bcl-2 protein was specifically demonstrated in lymphocytes within areas of medullary differentiation and MIC-2 protein in cortical differentiation. The expression of bcl-2 and MIC-2 proteins lend histogenetic support for this new classification of thymoma. Bcl-2 protein is strongly expressed in tumor epithelial cells of every case of poorly differentiated thymic carcinoma whereas the other types of thymic epithelial tumors do not show epithelial expression of this protein. The strong expression of bcl-2 protein in tumor epithelium may be considered as a predictor of aggressive behavior in thymic epithelial tumors.

Case Reports

Malignant Thymoma Diagnosed by Fine Needle Aspiration Cytology: A case Report.: ung Ha Kang, Jin Hee Sohn, Duck Hwan Kim, Sung Suk Pang, Seong Eun Yang, Jung Il Suh; Korean J Cytopathol. 1994;5(2):189-193.

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Abstract PDF: Malignant thymoma is usually manifested as a mediastinal mass. Occasiomally, these tumors may be associated with a variety of systemic syndromes, such as myasthenia gravis, pure red cell aplasia or hypogammaglobulinemia. However, it is generally accepted that thymomas rarely metastasize and the frequency of extrathoracic metastasis has been reported as 1 to 15%. In general, nuclear changes of tumor cells such as enlarged size, irregular shape and altered textures are determining feactors in the assessment of the grade of malignancy. We experienced a case of malignant thymoma of anterior mediastinum in a 35-year-old woman. After 3 years, she developed recurrent malignant thymoma in the right supraclavicular area, diagnosed by aspiration biopsy cytology.

Cytologic Features of Metastatic Thymoma in the Liver: A Cese Report.: Ji Young Kim, Kwang Gil Lee; Korean J Cytopathol. 1996;7(1):92-96.

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Abstract PDF: Extrathoracic metastases of thymomas are extremely rare, occurring in less than 2% of cases. We present a case of metastatic thymoma in the liver diagnosed by aspiration biopsy. A fine-needle aspirate from a hepatic mass of a 65-year old man who had a history of malignant thymoma locally invading pericardium was examined. Nests of epithelial cells with few scattered lymphocytes were present. The nuclei of the epithelial cells were round to oval and appeared retatively uniform and regular, with fine chromatin pattern. They had one or two, small but rather conspicuous nucleoli. Unlike previous reports on the findings of the aspiration cytology of thymomas, the charactristic biphasic pattern was not present in this case.

Original Articles

Fine Needle Aspiration Cytologic Diagnosis of Thymoma Presenting as a Thyroid Nodule: A Report of Two Cases.: Dong Ja Kim, Ji Young Park, Yoon Seup Kum, Tae In Park, Yoon Kyung Sohn; Korean J Cytopathol. 2000;11(1):41-46.

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Abstract PDF: Thymoma is the most common anterior mediastinal tumor in adults. Rarely, it is presented as the anterior neck mass, commonly located in the anterolateral aspect of the neck or adjacent to the thyroid. We experienced two cases of fine needle aspiration cytology of thymoma, mimicking thyroid mass. The first case was an ectopoic cervical thymoma in a 31-year-old female. The fine needle aspiration cytology was misinterpreted as reactive hyperplasia of lymph node. But the histologic diagnosis was thymoma, predominantly lymphocytic type. The second case was an invasive thymoma in a 66-year-old female, who complained a large anterior neck mass. The fine needle aspiration cytology revealed biphasic population of some clusters of epithelial cells and scattered lymphocytes. The cytologic diagnosis was thymoma and was confirmed as invasive thymoma after the biopsy. Therefore, when the cytologic feature of anterior neck mass shows the both lymphocyte and epithelial component, the differential diagnosis should include the possibility of thymoma.

The Immunoexpression of Ki-67, Bcl-2, p53, and Tyrosine Kinase Receptors in Thymic Epithelial Tumors; Their Correlation with the WHO Histologic Subtypes and the Prognostic Value.: Mi Jin Kim; Korean J Pathol. 2008;42(5):277-286.

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Abstract PDF: BACKGROUND
The clinicopathologic features of thymic epithelial tumors are inadequate as predictors of the progression of these tumors because of their heterogeneous histology and varied biological behavior. We attempted to detect the expression of tyrosine kinase receptors and oncogenic markers to determine the correlation between these markers and the WHO classification of the tumors. METHODS: Forty-three surgically resected thymic epithelial tumors (37 thymomas and 6 thymic carcinomas) were immunohistochemically assessed on tissue arrays for c-KIT, her-2/neu, epidermal growth factor receptor (EGFR), p53. bcl-2 and Ki-67.
RESULTS
The Ki-67 labeling index was significantly increased in thymic carcinoma (p<0.05). The overexpression of p53 protein was observed exclusively in type B3 thymoma (67%) and thymic carcinoma (83%). Bcl-2 was expressed in type A and AB thymomas as well as in thymic carcinoma. C-KIT was only present in thymic carcinoma (p<0.05), whereas the EGFR expression was significantly high in all types of thymomas, except for thymic carcinomas. Her-2/neu was not identified in any type of thymoma. CONCLUSION: This study suggests that the Ki-67 LI, bcl-2, p53, c-KIT, and EGFR protein expression may be useful markers for the subclassification of thymic epithelial tumors according to WHO schema and WHO classification correlated with the tumor staging. The overexpression of c-KIT in thymic carcinoma reveals that these patients would likely benefit from an anti-c-KIT treatment.

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