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__NOTOC__
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{{Thymoma}}
{{Thymoma}}
{{CMG}} {{AE}} [[User:K.Nouman|Khuram Nouman, M.D. [4]]]
{{CMG}} {{shyam}} {{AE}} [[User:K.Nouman|Khuram Nouman, M.D. [2]]]  
== Overview ==
== Overview ==
Thymoma can be largely [[Diagnosis|diagnosed]] by using [[Radiology|radiological]] techniques.


== Diagnostic Study of Choice ==
== Diagnostic Study of Choice ==
===Study of Choice===
*[[Anatomical terms of location|Posterior]]-[[Anatomical terms of location|anterior]] (PA) and [[lateral]] [[Chest X-ray|x-ray of the chest]] are helpful in [[Diagnosis|diagnosing]] most of the thymomas.


=== Study of choice ===
* Among the [[Patient|patients]] who present with [[clinical]] signs of [[myasthenia gravis|myasthenia gravis (MG)]], [[Computed tomography|CT scan]] is the test of choice for the [[diagnosis]] of thymoma.
[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
* [[Computed tomography|CT scan]] with [[IV]] [[contrast]] and [[Magnetic resonance imaging|MRI]] are helpful in determining the [[vascularity]] of the thymoma and helps in safe [[Surgery|surgical]] removal of large [[Tumor|tumors]].
*[[Positron emission tomography|PET scan]] is very valuable in [[Diagnosis|diagnosing]] the cases of [[Invasive (medical)|invasive]] [[malignant]] thymoma.<ref name="pmid26273398">{{cite journal| author=Scagliori E, Evangelista L, Panunzio A, Calabrese F, Nannini N, Polverosi R et al.| title=Conflicting or complementary role of computed tomography (CT) and positron emission tomography (PET)/CT in the assessment of thymic cancer and thymoma: our experience and literature review. | journal=Thorac Cancer | year= 2015 | volume= 6 | issue= 4 | pages= 433-42 | pmid=26273398 | doi=10.1111/1759-7714.12197 | pmc=4511321 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26273398  }} </ref>
* Thallium 201 single photon emission [[computed tomography]] is useful to distinguish normal [[Thymus|thymic]] [[Tissue (biology)|tissue]] from [[Hyperplasia|hyperplastic]] [[Tissue (biology)|tissue]] or thymoma
*[[Medical ultrasonography|Ultrasonically]] guided core [[Needle aspiration biopsy|needle biopsy]] is used to obtain larger [[Tissue (biology)|tissue]] specimens for [[histological]] [[examination]].
*Annessi and colleagues were able to [[Diagnosis|diagnose]] thymoma in all [[Patient|patients]] who had undergone [[Anterior mediastinum|anterior mediastinal]] core [[needle biopsy]] by [[Medical ultrasonography|ultrasonic]] guidance with a [[sensitivity]] and [[specificity]] of 100%.


OR
===Staging===
* The thymic epithelial tumor [[Cancer staging|staging]] system was initially proposed by Bergh and his colleagues in 1978, modified by Wilkins and Castleman in 1979, and further developed by Masaoka et al. in 1981.<ref name="Wilkins-1979">{{Cite journal  | last1 = Wilkins | first1 = EW. | last2 = Castleman | first2 = B. | title = Thymoma: a continuing survey at the Massachusetts General Hospital. | journal = Ann Thorac Surg | volume = 28 | issue = 3 | pages = 252-6 | month = Sep | year = 1979 | doi =  | PMID = 485626 }}</ref><ref name="Bergh-1978">{{Cite journal  | last1 = Bergh | first1 = NP. | last2 = Gatzinsky | first2 = P. | last3 = Larsson | first3 = S. | last4 = Lundin | first4 = P. | last5 = Ridell | first5 = B. | title = Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas. | journal = Ann Thorac Surg | volume = 25 | issue = 2 | pages = 91-8 | month = Feb | year = 1978 | doi =  | PMID = 626543 }}</ref><ref name="Masaoka-1981">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Monden | first2 = Y. | last3 = Nakahara | first3 = K. | last4 = Tanioka | first4 = T. | title = Follow-up study of thymomas with special reference to their clinical stages. | journal = Cancer | volume = 48 | issue = 11 | pages = 2485-92 | month = Dec | year = 1981 | doi =  | PMID = 7296496 }}</ref><ref name="Kondo-2005">{{Cite journal  | last1 = Kondo | first1 = K. | title = Invited commentary. | journal = Ann Thorac Surg | volume = 80 | issue = 6 | pages = 2000-1 | month = Dec | year = 2005 | doi = 10.1016/j.athoracsur.2005.08.053 | PMID = 16305832 }}</ref>
* Modified Masaoka staging grouped with [[TNM classification]] is the most widely adopted system for thymic epithelial tumors currently in use.


The following result of [gold standard test] is confirmatory of [disease name]:
====Modified Masaoka Clinical Staging of Thymoma====
* [Result 1]
* [Result 2]


OR
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>'''''Modified Masaoka Clinical Staging of Thymoma (1994)'''''<ref name="Masaoka-1994">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Yamakawa | first2 = Y. | last3 = Niwa | first3 = H. | last4 = Fukai | first4 = I. | last5 = Saito | first5 = Y. | last6 = Tokudome | first6 = S. | last7 = Nakahara | first7 = K. | last8 = Fujii | first8 = Y. | title = Thymectomy and malignancy. | journal = Eur J Cardiothorac Surg | volume = 8 | issue = 5 | pages = 251-3 | month =  | year = 1994 | doi =  | PMID = 8043287 }}</ref></SMALL>
! style="background: #4479BA; color:#FFF;" | '''Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| style="background: #F0F0F0;" align="center" | '''I'''
| style="background: #F0F0F0;" |
* [[Macroscopic|Macroscopically]] and [[Microscopic|microscopically]] completely encapsulated
|-
| style="background: #F0F0F0;" align="center" | '''II'''
| style="background: #F0F0F0;" |
* '''A:''' [[Microscopic]] transcapsular [[Invasive (medical)|invasion]]
* '''B:''' [[Macroscopic]] [[Invasive (medical)|invasion]] into surrounding [[Fat tissue|fatty tissue]] or [[Gross|grossly]] adherent to but not through <BR> [[mediastinal pleura]] or [[pericardium]]
|-
| style="background: #F0F0F0;" align="center" | '''III'''
| style="background: #F0F0F0;" |
* [[Macroscopic]] [[Invasive (medical)|invasion]] into neighboring [[organs]] ([[pericardium]], [[great vessels]], [[lung]])
** '''A:''' Without [[Invasive (medical)|invasion]] of [[great vessels]]
** '''B:''' With [[Invasive (medical)|invasion]] of [[great vessels]]
|-
| style="background: #F0F0F0;" align="center" | '''IV'''
| style="background: #F0F0F0;" |
* '''A:''' [[Pleural]] or [[pericardial]] dissemination
* '''B:''' [[Lymphatic system|Lymphogenous]] or [[Blood|hematogenous]] [[metastasis]]
|-
|}


[Name of the investigation] must be performed when:
====TNM Classification of Thymic Epithelial Tumors====
* The patient presents with [symptom/sign 1], [symptom/sign 2], and [symptom/sign 3].
* A [name of test] is positive for [sign 1], [sign 2], and [sign 3] in the patient.


OR
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>'''''TNM Classification of Thymic Epithelial Tumors by Yamakawa and Masaoka (1991)'''''<ref name="pmid3621939">{{cite journal| author=Sinha Hikim AP, Hoffer AP| title=Quantitative analysis of germ cells and Leydig cells in rat made infertile with gossypol. | journal=Contraception | year= 1987 | volume= 35 | issue= 4 | pages= 395-408 | pmid=3621939 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3621939  }} </ref></SMALL>
! colspan="2" style="background: #4479BA; color:#FFF;" | '''T/N/M Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| rowspan="4" style="background: #F0F0F0; width:75px;" align="center" | '''T'''  || style="background: #F0F0F0; width: 50px;" align="center" |'''T1'''
| style="background: #F0F0F0;" |
* [[Macroscopic|Macroscopically]] completely encapsulated and [[Microscopic|microscopically]] no [[Capsule (anatomy)|capsular]] [[Invasive (medical)|invasion]]
|-
| style="background: #F0F0F0;" align="center" | '''T2'''
| style="background: #F0F0F0;" |
* [[Macroscopic]] adhesion or [[Invasive (medical)|invasion]] into surrounding [[Fat tissue|fatty tissue]] or [[mediastinal pleura]], <BR> '''or''' [[microscopic]] [[Invasive (medical)|invasion]] into the [[Capsule (anatomy)|capsule]]
|-
| style="background: #F0F0F0;" align="center" | '''T3'''
| style="background: #F0F0F0;" |
* [[Invasive (medical)|Invasion]] into neighboring [[Organ (anatomy)|organs]], such as [[pericardium]], [[great vessels]], and [[lung]]
|-
| style="background: #F0F0F0;" align="center" | '''T4'''
| style="background: #F0F0F0;" |
* [[Pleural]] or [[pericardial]] dissemination
|-
| rowspan="4" style="background: #F0F0F0;" align="center" | '''N'''  || style="background: #F0F0F0;" align="center" |'''N0'''
| style="background: #F0F0F0;" |
* No [[lymph node]] [[metastasis]]
|-
| style="background: #F0F0F0;" align="center" | '''N1'''
| style="background: #F0F0F0;" |
* [[Metastasis]] to the [[Anatomical terms of location|anterior]] [[mediastinal lymph nodes]]
|-
| style="background: #F0F0F0;" align="center" | '''N2'''
| style="background: #F0F0F0;" |
* [[Metastasis]] to the [[intrathoracic]] [[Lymph node|lymph nodes]] except [[Anatomical terms of location|anterior]] [[mediastinal lymph nodes]]
|-
| style="background: #F0F0F0;" align="center" | '''N3'''
| style="background: #F0F0F0;" |
* [[Metastasis]] to [[Thoracic|extrathoracic]] [[Lymph node|lymph nodes]]
|-
| rowspan="4" style="background: #F0F0F0;" align="center" | '''M'''  || style="background: #F0F0F0;" align="center" |'''M0'''
| style="background: #F0F0F0;" |
* No [[Blood|hematogenous]] [[metastasis]]
|-
| style="background: #F0F0F0;" align="center" | '''M1'''
| style="background: #F0F0F0;" |
* [[Blood|Hematogenous]] [[metastasis]]
|-
|}


[Name of the investigation] is the gold standard test for the diagnosis of [disease name].
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>'''''Combined Masaoka Staging/TNM Classification (1994)'''''<ref name="pmid7921194">{{cite journal| author=Tsuchiya R, Koga K, Matsuno Y, Mukai K, Shimosato Y| title=Thymic carcinoma: proposal for pathological TNM and staging. | journal=Pathol Int | year= 1994 | volume= 44 | issue= 7 | pages= 505-12 | pmid=7921194 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7921194  }} </ref></SMALL>
! style="background: #4479BA; color:#FFF;" | '''Masaoka Stage'''
! style="background: #4479BA; color:#FFF;" | '''T'''
! style="background: #4479BA; color:#FFF;" | '''N'''
! style="background: #4479BA; color:#FFF;" | '''M'''
|-
| style="background: #F0F0F0;" align="center" | '''Stage I'''
| style="background: #F0F0F0;" align="center" | T1
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage II'''
| style="background: #F0F0F0;" align="center" | T2
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage III'''
| style="background: #F0F0F0;" align="center" | T3
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage IVa'''
| style="background: #F0F0F0;" align="center" | T4
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| rowspan="2" style="background: #F0F0F0;" align="center" | '''Stage IVb'''
| style="background: #F0F0F0;" align="center" | Any T
| style="background: #F0F0F0;" align="center" | N1, N2, or N3
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | Any T
| style="background: #F0F0F0;" align="center" | Any N
| style="background: #F0F0F0;" align="center" | M1
|-
|}


OR
====Previously Reported Staging System====


The diagnostic study of choice for [disease name] is [name of the investigation].
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>'''''Masaoka Staging (1981)'''''<ref name="Masaoka-1981">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Monden | first2 = Y. | last3 = Nakahara | first3 = K. | last4 = Tanioka | first4 = T. | title = Follow-up study of thymomas with special reference to their clinical stages. | journal = Cancer | volume = 48 | issue = 11 | pages = 2485-92 | month = Dec | year = 1981 | doi =  | PMID = 7296496 }}</ref></SMALL>
! style="background: #4479BA; color:#FFF;" | '''Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| style="background: #F0F0F0;" align="center" | '''I'''
| style="background: #F0F0F0;" |
* Macroscopically completely encapsulated and microscopically no capsular invasion
|-
| style="background: #F0F0F0;" align="center" | '''II'''
| style="background: #F0F0F0;" |
* '''1.''' [[Macroscopic]] [[Invasive (medical)|invasion]] into the surrounding [[Fat tissue|fatty tissue]] or [[mediastinal pleura]]
* '''2.''' [[Microscopic]] [[Invasive (medical)|invasion]] into the [[Capsule (anatomy)|capsule]]
|-
| style="background: #F0F0F0;" align="center" | '''III'''
| style="background: #F0F0F0;" |
* [[Macroscopic]] [[Invasive (medical)|invasion]] into the neighboring [[Organ (anatomy)|organs]] ([[pericardium]], [[great vessels]], or [[lung]])
|-
| style="background: #F0F0F0;" align="center" | '''IVa'''
| style="background: #F0F0F0;" |
* [[Pleural]] or [[pericardial]] dissemination
|-
| style="background: #F0F0F0;" align="center" | '''IVb'''
| style="background: #F0F0F0;" |
* [[Lymphatic system|Lymphogenous]] or [[Blood|hematogenous]] [[metastasis]]
|-
|}


OR
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
 
|+ <SMALL>'''''Clinical Staging by Bergh (1978) and Wilkins (1979)'''''<ref name="Bergh-1978">{{Cite journal  | last1 = Bergh | first1 = NP. | last2 = Gatzinsky | first2 = P. | last3 = Larsson | first3 = S. | last4 = Lundin | first4 = P. | last5 = Ridell | first5 = B. | title = Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas. | journal = Ann Thorac Surg | volume = 25 | issue = 2 | pages = 91-8 | month = Feb | year = 1978 | doi =  | PMID = 626543 }}</ref><ref name="Wilkins-1979">{{Cite journal  | last1 = Wilkins | first1 = EW. | last2 = Castleman | first2 = B. | title = Thymoma: a continuing survey at the Massachusetts General Hospital. | journal = Ann Thorac Surg | volume = 28 | issue = 3 | pages = 252-6 | month = Sep | year = 1979 | doi = | PMID = 485626 }}</ref></SMALL>
There is no single diagnostic study of choice for the diagnosis of [disease name].  
! style="background: #4479BA; color:#FFF;" | '''Author'''
 
! style="background: #4479BA; color:#FFF;" | '''Stage'''
OR
! style="background: #4479BA; color:#FFF;" | '''Description'''
 
|-
There is no single diagnostic study of choice for the diagnosis of [disease name], but [disease name] can be diagnosed based on [name of the investigation 1] and [name of the investigation 2].
! rowspan="3" style="background: #F0F0F0;" align="center" | Bergh et al.
 
| style="background: #F0F0F0;" align="center" |'''I''' ||
OR
* Intact [[Capsule (anatomy)|capsule]] or [[growth]] within the [[capsule]]
 
|-
[Disease name] is primarily diagnosed based on the clinical presentation.
| style="background: #F0F0F0;" align="center" | '''II''' ||
 
* [[Capsule (anatomy)|Pericapsular]] [[growth]] into the [[mediastinal]] [[fat tissue]]
OR
|-
 
| style="background: #F0F0F0;" align="center" | '''III''' ||
Investigations:
* [[Invasive (medical)|Invasive]] [[growth]] into the surrounding [[Organ (anatomy)|organs]] and/or [[intrathoracic]] [[Metastasis|metastases]]
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most specific test for the diagnosis.
|-
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most sensitive test for diagnosis.
! rowspan="3" style="background: #F0F0F0;" align="center" | Wilkins et al.
* Among the patients who present with clinical signs of [disease name], the [investigation name] is the most efficient test for diagnosis.
| style="background: #F0F0F0;" align="center" |'''I''' ||
 
* Intact [[capsule]] or [[growth]] within the [[capsule]]
==== The comparison of various diagnostic studies for [disease name] ====
|-
{|
| style="background: #F0F0F0;" align="center" | '''II''' ||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
* [[Capsule|Pericapsular]] [[growth]] into the [[Mediastinum|mediastinal]] [[fat tissue]] or adjacent [[pleura]] or [[pericardium]]
! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
| style="background: #F0F0F0;" align="center" | '''III''' ||
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
* [[Invasive]] [[growth]] into the surrounding [[Organ (anatomy)|organs]] and/or [[intrathoracic]] [[Metastasis|metastases]]
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|-
|-
! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
|}
|}
<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>


===== Diagnostic results =====
==References==
The following finding(s) on performing [investigation name] is(are) confirmatory for [disease name]:
{{reflist|2}}
* [Finding 1]
* [Finding 2]
 
===== Sequence of Diagnostic Studies =====
The [name of investigation] must be performed when:
* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
* A positive [test] is detected in the patient, to confirm the diagnosis.
 
OR
 
The various investigations must be performed in the following order:
* [Initial investigation]
* [2nd investigation]
 
=== Name of Diagnostic Criteria ===
 
'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
 
[Disease name] is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of [disease name].
 
OR
 
There is no single diagnostic study of choice for [disease name], though [disease name] may be diagnosed based on [name of criteria] established by [...].
 
OR
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
 
OR
 
The diagnosis of [disease name] is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
[Disease name] may be diagnosed at any time if one or more of the following criteria are met:
* Criteria 1
* Criteria 2
* Criteria 3
 
OR
 
'''IF there are clear, established diagnostic criteria'''
 
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].


OR
[[Category:Types of cancer]]
 
[[Category:Rare diseases]]
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
[[Category:Disease]]
 
[[Category:Up-To-Date]]
OR
[[Category:Oncology]]
 
[[Category:Medicine]]
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
[[Category:Hematology]]
 
[[Category:Immunology]]
OR
[[Category:Surgery]]
 
'''IF there are no established diagnostic criteria'''
 
There are no established criteria for the diagnosis of [disease name].
 
==References==
{{Reflist|2}}
{{WH}}
{{WS}}

Latest revision as of 17:00, 21 August 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Shyam Patel [2] Associate Editor(s)-in-Chief: Khuram Nouman, M.D. [2]

Overview

Thymoma can be largely diagnosed by using radiological techniques.

Diagnostic Study of Choice

Study of Choice

Staging

  • The thymic epithelial tumor staging system was initially proposed by Bergh and his colleagues in 1978, modified by Wilkins and Castleman in 1979, and further developed by Masaoka et al. in 1981.[2][3][4][5]
  • Modified Masaoka staging grouped with TNM classification is the most widely adopted system for thymic epithelial tumors currently in use.

Modified Masaoka Clinical Staging of Thymoma

Modified Masaoka Clinical Staging of Thymoma (1994)[6]
Stage Description
I
II
III
IV

TNM Classification of Thymic Epithelial Tumors

TNM Classification of Thymic Epithelial Tumors by Yamakawa and Masaoka (1991)[7]
T/N/M Stage Description
T T1
T2
T3
T4
N N0
N1
N2
N3
M M0
M1
Combined Masaoka Staging/TNM Classification (1994)[8]
Masaoka Stage T N M
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
Stage IVa T4 N0 M0
Stage IVb Any T N1, N2, or N3 M0
Any T Any N M1

Previously Reported Staging System

Masaoka Staging (1981)[4]
Stage Description
I
  • Macroscopically completely encapsulated and microscopically no capsular invasion
II
III
IVa
IVb
Clinical Staging by Bergh (1978) and Wilkins (1979)[3][2]
Author Stage Description
Bergh et al. I
II
III
Wilkins et al. I
II
III

References

  1. ↑ Scagliori E, Evangelista L, Panunzio A, Calabrese F, Nannini N, Polverosi R; et al. (2015). "Conflicting or complementary role of computed tomography (CT) and positron emission tomography (PET)/CT in the assessment of thymic cancer and thymoma: our experience and literature review". Thorac Cancer. 6 (4): 433–42. doi:10.1111/1759-7714.12197. PMC 4511321. PMID 26273398.
  2. ↑ 2.0 2.1 Wilkins, EW.; Castleman, B. (1979). "Thymoma: a continuing survey at the Massachusetts General Hospital". Ann Thorac Surg. 28 (3): 252–6. PMID 485626. Unknown parameter |month= ignored (help)
  3. ↑ 3.0 3.1 Bergh, NP.; Gatzinsky, P.; Larsson, S.; Lundin, P.; Ridell, B. (1978). "Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas". Ann Thorac Surg. 25 (2): 91–8. PMID 626543. Unknown parameter |month= ignored (help)
  4. ↑ 4.0 4.1 Masaoka, A.; Monden, Y.; Nakahara, K.; Tanioka, T. (1981). "Follow-up study of thymomas with special reference to their clinical stages". Cancer. 48 (11): 2485–92. PMID 7296496. Unknown parameter |month= ignored (help)
  5. ↑ Kondo, K. (2005). "Invited commentary". Ann Thorac Surg. 80 (6): 2000–1. doi:10.1016/j.athoracsur.2005.08.053. PMID 16305832. Unknown parameter |month= ignored (help)
  6. ↑ Masaoka, A.; Yamakawa, Y.; Niwa, H.; Fukai, I.; Saito, Y.; Tokudome, S.; Nakahara, K.; Fujii, Y. (1994). "Thymectomy and malignancy". Eur J Cardiothorac Surg. 8 (5): 251–3. PMID 8043287.
  7. ↑ Sinha Hikim AP, Hoffer AP (1987). "Quantitative analysis of germ cells and Leydig cells in rat made infertile with gossypol". Contraception. 35 (4): 395–408. PMID 3621939.
  8. ↑ Tsuchiya R, Koga K, Matsuno Y, Mukai K, Shimosato Y (1994). "Thymic carcinoma: proposal for pathological TNM and staging". Pathol Int. 44 (7): 505–12. PMID 7921194.
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