| Thymic carcinoma | |
|---|---|
 | |
| Thymic carcinoma seen on CT. | |
| Specialty | Oncology |
Thymic carcinoma, or type C thymoma, is a malignancy of the thymus. It is a rare cancer that is often diagnosed at advanced stages. Recurrence following treatment is common, and thymic carcinoma is associated with a poor prognosis. [1]
A study examining cases of thymic carcinoma in the United States from 2001 to 2015 found a peak incidence from 70 to 74 years old and a higher incidence in males compared to females. After thymoma, thymic carcinoma is the second most common type of thymus cancer. [2]
Early-stage thymic carcinoma is generally asymptomatic, and the development of symptoms is indicative of an advanced stage cancer. [3] Signs and symptoms are non-specific and include chest pain, persistent cough, and difficulty breathing, which are related to progressive tumor compression of anterior chest wall structures. [4] Superior vena cava syndrome may be associated with thymic carcinoma. [3] Thymic carcinoma is rarely associated with paraneoplastic syndromes, unlike thymoma which has a strong association with myasthenia gravis. [5]
Both thymoma and thymic carcinoma originate from thymic epithelial cells; however, the epithelial cells in thymic carcinoma appear abnormal histologically, as they are infiltrative and not arranged in a lobular pattern as seen in the normal thymus. [6] Thymic carcinoma represents 20% of tumors derived from thymic epithelial cells. Compared to thymoma, the cells of thymic carcinoma behave aggressively; they are fast growing and have a higher likelihood of systemic spread. [4]
The World Health Organization separates thymoma into categories from type A to C based on histology, with type C thymoma representing the equivalent of thymic carcinoma. [3] Thymic carcinoma can be further divided into subtypes based on histopathological features. Though the genetic and molecular profile of thymic carcinoma has been shown to be different from that of thymoma, [7] immunohistochemical cell markers specific for thymic carcinoma have not yet been identified. [5]
Diagnosis of thymic carcinoma is based on a combination of clinical, radiologic, and biopsy findings. Most early cases are asymptomatic and found incidentally on chest radiographs as a mass in the anterior mediastinum. Further evaluation consists of additional imaging, such as CT, MRI, and PET, and tumor biopsy, which is the gold standard and provides the definitive diagnosis. [5] Biopsy may be done prior to surgery by fine needle aspiration or during the surgery with concomitant evaluation by the pathologist. [8] Other carcinomas with malignant spread to the thymus are on the differential diagnosis and must be excluded, as they may appear similar to thymic carcinoma on histopathological examination. [3]
There is no consensus staging protocol for thymic carcinoma. [3] Both the Masaoka staging system, designed for thymoma staging, and the TNM staging system have been proposed and used for thymic carcinoma, but consensus has been limited. The Masaoka staging system has been more commonly used, but it has been suggested to have limited applicability as most thymic carcinoma patients present at an advanced stage. [5] The TNM system predicts prognosis if lymph node spread is observed; [5] however, cancer spread to lymph nodes is uncommon. [3] At the time of diagnosis, cancer spread outside of the chest cavity is estimated at less than 7%. [6]
Treatment of thymic carcinoma depends on the stage, [3] though initial resection of the entire tumor or surgical debulking is standard. Patients with complete resection of the tumor may undergo subsequent radiation therapy and may also require chemotherapy. [4] For those with incomplete tumor resection, chemotherapy with or without radiation therapy followed by repeat surgical resection may be warranted. [4] Other treatment options include hormone therapy, targeted therapy, and experimental immunotherapy. [4] [8]
As thymic carcinoma tends to be diagnosed at later stages, prognosis tends to be poor, with some studies estimating 30 to 55% of patients survive 5 years following diagnosis. [2] [3] Recurrence following complete resection is common, with one case series finding a recurrence rate as high as 50%. [3]
Lung cancer, also known as lung carcinoma, is a malignant lung tumor characterized by uncontrolled cell growth in tissues of the lung. Lung carcinomas derive from transformed, malignant cells that originate as epithelial cells, or from tissues composed of epithelial cells. Other lung cancers, such as the rare sarcomas of the lung, are generated by the malignant transformation of connective tissues, which arise from mesenchymal cells. Lymphomas and melanomas can also rarely result in lung cancer.
Carcinoma is a malignancy that develops from epithelial cells. Specifically, a carcinoma is a cancer that begins in a tissue that lines the inner or outer surfaces of the body, and that arises from cells originating in the endodermal, mesodermal or ectodermal germ layer during embryogenesis.
Kidney cancer, also known as renal cancer, is a group of cancers that starts in the kidney. Symptoms may include blood in the urine, lump in the abdomen, or back pain. Fever, weight loss, and tiredness may also occur. Complications can include spread to the lungs or brain.
Ovarian cancer is a cancerous tumor of an ovary. It may originate from the ovary itself or more commonly from communicating nearby structures such as fallopian tubes or the inner lining of the abdomen. The ovary is made up of three different cell types including epithelial cells, germ cells, and stromal cells. When these cells become abnormal, they have the ability to divide and form tumors. These cells can also invade or spread to other parts of the body. When this process begins, there may be no or only vague symptoms. Symptoms become more noticeable as the cancer progresses. These symptoms may include bloating, vaginal bleeding, pelvic pain, abdominal swelling, constipation, and loss of appetite, among others. Common areas to which the cancer may spread include the lining of the abdomen, lymph nodes, lungs, and liver.
The TNM Classification of Malignant Tumors (TNM) is a globally recognised standard for classifying the extent of spread of cancer. It is a classification system of the anatomical extent of tumor cancers. It has gained wide international acceptance for many solid tumor cancers, but is not applicable to leukaemia and tumors of the central nervous system. Most common tumors have their own TNM classification. Sometimes also described as the AJCC system.
A thymoma is a tumor originating from the epithelial cells of the thymus that is considered a rare malignancy. Thymomas are frequently associated with neuromuscular disorders such as myasthenia gravis; thymoma is found in 20% of patients with myasthenia gravis. Once diagnosed, thymomas may be removed surgically. In the rare case of a malignant tumor, chemotherapy may be used.
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Invasive carcinoma of no special type (NST) is also referred to as invasive ductal carcinoma or infiltrating ductal carcinoma(IDC) and invasive ductal carcinoma, not otherwise specified (NOS). Each of these terms represents to the same disease entity, but for international audiences this article will use invasive carcinoma NST because it is the preferred term of the World Health Organization (WHO).
Merkel-cell carcinoma (MCC) is a rare and aggressive skin cancer occurring in about 3 people per 1,000,000 members of the population. It is also known as cutaneous APUDoma, primary neuroendocrine carcinoma of the skin, primary small cell carcinoma of the skin, and trabecular carcinoma of the skin. Factors involved in the development of MCC include the Merkel cell polyomavirus, a weakened immune system, and exposure to ultraviolet radiation. Merkel-cell carcinoma usually arises on the head, neck, and extremities, as well as in the perianal region and on the eyelid. It is more common in people over 60 years old, Caucasian people, and males. MCC is less common in children.
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A mediastinal tumor is a tumor in the mediastinum, the cavity that separates the lungs from the rest of the chest. It contains the heart, esophagus, trachea, thymus, and aorta. The most common mediastinal masses are neurogenic tumors, usually found in the posterior mediastinum, followed by thymoma (15–20%) located in the anterior mediastinum. Lung cancer typically spreads to the lymph nodes in the mediastinum.
Papillary thyroid cancer or papillary thyroid carcinoma is the most common type of thyroid cancer, representing 75 percent to 85 percent of all thyroid cancer cases. It occurs more frequently in women and presents in the 20–55 year age group. It is also the predominant cancer type in children with thyroid cancer, and in patients with thyroid cancer who have had previous radiation to the head and neck. It is often well-differentiated, slow-growing, and localized, although it can metastasize.
Lung cancer staging is the assessment of the extent to which a lung cancer has spread from its original source. As with most cancers, staging is an important determinant of treatment and prognosis. In general, more advanced stages of cancer are less amenable to treatment and have a worse prognosis.
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Combined small cell lung carcinoma is a form of multiphasic lung cancer that is diagnosed by a pathologist when a malignant tumor, arising from transformed cells originating in lung tissue, contains a component of;small cell lung carcinoma (SCLC), admixed with one components of any histological variant of non-small cell lung carcinoma (NSCLC) in any relative proportion.
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