Thymoma is aggressive and persistent, but does not belong to malignant tumors. In treatments, their optimal treatment protocols still need to be studied and how about the role and the place of use of postoperative radiotherapy is not clear. Some retrospective studies indicate a direction: for the first stage of thymoma, it is adequately treated with complete resection alone. For the second stage of the thymoma, postoperative radiotherapy needs further indications. For the third and fourth stages of thymoma, postoperative radiotherapy plays an important role. A research shows that the radiation dose at 50 Gy is suitable for microscopic tumors, and higher dose of radiation is suitable for macroscopic tumors. With the development of radiotherapy technology, its application scope becomes larger and larger. What kind of the role and the place for radiotherapy in the treatment of thymoma and what is the optimal management of thymoma need to be treated prudently.
Thymoma complicated with polymyositis and myasthenia gravis is a rare case, which can be clearly diagnosed and given symptomatic treatment according to its own diagnostic criteria, imaging and laboratory examinations. This paper reports the clinical data of a thymoma patient with polymyositis and myasthenia gravis admitted to the Seventh Affiliated Hospital of Sun Yat-Sen University, and discusses the possible pathogenesis and treatment methods.
Thymectomy is a major surgical procedure for patients with non-thymomatous myasthenia gravis，and can enhance their symptomatic remission rate and cure rate. There is still much controversy about appropriate surgical approach and extent of resection of thymectomy. The majority of thoracic surgeons believe that the completeness of thymectomy is closely associated with clinical symptom improvement，and perform complete resection of encapsulated thymus and surroun-ding fat tissues via mid-sternotomy. But minimally invasive thymectomies are often more acceptable by patients. On the contrary，in view of common existence of ectopic thymus tissue，some thoracic surgeons advocate a combination of cervical incision and sternotomy in order to further completely remove all thymus tissue.
Abstract: Objective To investigate the clinical characteristics of thymoma and thymoma with myasthenia gravis(MG). Methods From Oct.1979 to July 2004,185 patients with thymoma were surgically treated. Among these patients, comparative analysis was made between 94 cases of thymoma (thymoma group) and 91 cases of thymus tumor with MG(thymoma with MG group).155 patients underwent radical operation (83.8%),16 patients underwent palliative operation (8.6%),and 14 patients underwent exploratory operation (7.6%). Clinical characteristics was analyzed in two groups. The factors affecting prognosis was analyzed by Masaoka’s stage system, with the lifttable method. Results Five patients died after operation, others had complete remission or symptomatic improvement. There was statistically difference of Masaoka’s stage system in two groups (χ2=53.14, P＜0.05). There were no statistically difference in pathological type of thymoma and clinical type of MG and pathologic period (χ2=8.21, P＞0.05). 57 cases of thymoma group were followed up, the duration of follow-up was 1 to 10 years, average follow-up was 40.7 months, and the patients with 1-, 3- and 5-year survival rates were 70.2% (40/57), 66.7% (22/33), 593% (16/27) respectively. 55 cases of thymoma with MG group were followed up. The patients’ survival rates were 98.2% (54/55), 86.4% (38/44), 81.6% (31/38) at 1-, 3-and 5-year respectively. There was no statistically difference of survival rates in two groups (χ2=0.83, P＞0.05). Totally, 112 patients were followed up in two groups, by Masaoka’s stage system, the 5-year survival rates were 93.7% for stage Ⅰ, 79.2% for stageⅡ, 51.4% for stage Ⅲ and 0% for stage Ⅳ respectively. Result of asaoka’s stage system evidence was statistically significant (χ25-year=51.62, P＜0.01). Conclusions Pathological type of thymoma isn’t related to modified Osserman’s classification, prognosis of thymoma is obviously related to Masaoka’s stage and isn’t related to MG. Generalized MG is the major type in MG patients accompanied by thymomas, and the major pathological type is lymphocytic. Chest CT can increase the accuracy early diagnosis of thymoma. The principal treatment is to resect the tumor as completely as possible, and proper administration of postoperative radiotherapy or chemotherapy according to the surgical status. Operative program and tumor stage are the most important prognostic factors.
Objective To investigate and evaluate the clinical manifestation, classification, surgical management and postoperative adjuvant therapy of thymic carcinoid, so as to improve the knowledge of the disease. Methods From January 1980 to January 2006, the outcome of surgery and follow-up of 18 cases of thymic carcinoid surgically intervened were retrospectively analysed. In this series, there were 2? exploratory thoracotomy, 2 partial or incomplete resection and 14 complete resections, which included 2 superior vena cava removal and reconstruction. The survival probabilities were calculated by the life tables, and a multivariable analysis of prognosis factors for thymic carcinoid was carried out using Cox regression model. Results Two patients who underwent exploratory thoracotomy died within one year and two years postoperatively respectively, 2 with partial or incomplete resection obtained temporary symptomatic improvement, 1 of 14 performed complete resections associated with Cushing’s syndrome died of septicemia in two weeks postoperatively, and the other 13 cases were in good condition by follow-up of 5 months to 15 years. The survival rate of 3, 5 and 10 years were 72.6%, 60.5% and 40.3%, respectively. According to Cox regression analysis, the factors of influence upon prognosis included lymph node metastasis(P=0047), pathological type(P=0.000), mode of resection (P=0.000) and postoperative adjuvant treatment(P=0018). Conclusion The thymic carcinoid is different from thymoma or thymic carcinoma, and there exist some difficulty in differential diagnosis. It is divided into typical and atypical thymic carcinoid in pathology, There are obvious differences in clinical manifestation and prognosis between typical and atypical carcinoid. The atypical thymic carcinoid has higher malignancy, frequent recurrence or metastasis, and poor prognosis. Complete resection of tumor with the involved surroundings could improve the long-term survival. The adjuvant radiotheraphy and chemotheraphy postoperatively would be benefit to the patients.
Thymic epithelial tumors represent the most common neoplasms of the anterior mediastinum, while atypical type A thymoma is a rare subtype of thymoma. On the morphological basis of type A thymoma, this tumor exhibits some atypical histological features, such as abundant cells, increased mitotic counts, tumor necrosis, and increased Ki67 index. At present, the clinical and pathological data of this tumor is still available. Since it was formally named, 16 cases have been reported around the world. In order to improve the understanding of the disease, this article reviews the related literature and tries to elaborate the atypical type A thymoma from the aspects of pathological features, clinical manifestations, epidemiology and differential diagnosis.
ObjectiveTo investigate the safety and efficacy of totally no tube three-port thoracoscopic surgery (TNTT) for thymic tumor via lateral thoracic approach. MethodsThe clinical data of patients with thymoma admitted to the Department of Thoracic Surgery of the General Hospital of Northern Theater Command from November 2021 to May 2022 were retrospectively analyzed. The patients were divided into a TNTT group and a single utility port video-assisted thoracic surgery (SVATS) group according to different surgical methods. The clinical data were compared between the two groups. ResultsA total of 111 patients were collected. There were 44 patients in the TNTT group, including 20 males and 24 females, with an average age of 60.11±8.64 years, and 67 patients in the SVATS group, including 30 males and 37 females, with an average age of 62.40±7.92 years. There was no significant difference between the two groups in the baseline data (P>0.05). The postoperative hospital stay and intraoperative blood loss were shorter or less in the TNTT group (P<0.05), and the visual analogue scale score 48 hours after the operation was smaller in the SVATS group (P<0.05). ConclusionTNTT has a good surgical safety, and can shorten postoperative hospital stay, reduce intraoperative blood loss, and has significant advantages in enhanced recovery after surgery, but SVATS can reduce postoperative pain in patients.
