Thymic carcinoma classification: Difference between revisions

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:** Squamous cell carcinoma lack of capsule and presents with [[necrosis]] and [[hemorrhage]].
:** Squamous cell carcinoma lack of capsule and presents with [[necrosis]] and [[hemorrhage]].


:* '''Basaloid carcinoma:'''
:** This subtype consists of solid lobules of tumor cells with marginal palisading, without keratinization and a [[basophilic]] pattern due to an elevated [[nuclear]]:[[cytoplasmic]] ratio.


:* '''Mucoepidermoid carcinoma:'''
:** The characteristic features for this rare subtype is the presence of [[squamous cell|squamous c]]<nowiki/>[[squamous cell|ell]]<nowiki/>s and [[mucus]] producing cell<nowiki/>s, with moderate nuclear atypia.
:** It has a mucinous macroscopic appearance.


:* '''Lymphoepithelioma-like carcinoma:'''  
:* '''Lymphoepithelioma-like carcinoma:'''  

Revision as of 04:56, 4 June 2019

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Alejandro Lemor, M.D. [2]; Parminder Dhingra, M.D. [3]

Overview

Thymic carcinomas may be classified according to a histological grading system into either low grade subtypes or high grade subtypes.[1]. Primary thymic carcinomas are rare malignant neoplasms of the mediastinum, and combined thymic carcinomas are even less common. Although tumor stage is the single most important prognostic factor in thymoma, a combination of stage and histologic subtype should be considered in predicting survival.

Classification

  • Thymic carcinomas may be classified according to a histological grading system into either low grade subtypes or high grade subtypes, which include:[1]
  • Squamous cell carcinoma:
    • This subtype of thymic carcinoma is the most common and exhibits atypia with a clear-cut aspect of keratinization with keratin pearls as seen in squamous cell carcinomas.
    • Squamous cell carcinoma lack of capsule and presents with necrosis and hemorrhage.


  • Lymphoepithelioma-like carcinoma:
    • The morphology of this subtype resembles the nasopharingeal lymphoepitelioma, with syncytial growth of undifferentiated malignant cells.
  • Sarcomatoid carcinoma (carcinosarcoma):
    • It is also known as spindle cell thymic carcinoma, is an infiltrative neoplasm with large areas of coagulative necrosis and without a capsule.
    • It is an uncommon tumor that affects patients between 40-80 years old.
  • Papillary adenocarcinoma:
    • It has a tubulopapillary pattern growth with cuboidal cells and psammoma bodies may be present.
    • Type A thymoma may be the origin of this subtype of carcinoma due an expression of malignant transformation.
  • Carcinoma with t(15;19) translocation:
    • It is an aggressive tumor with a translocation t(15;19)(q13:p13.1 ) that has the characteristic presence of undifferentiated cells with high mitotic activity and squamous morphology.
  • Neuroendocrine Carcinomas:
    • The neuroendocrine thymic carcinomas are classified in 4 categories: typical, atypical, small cell, and large cell carcinomas.
      • The typical and atypical are categorized as well differentiated neuroendocrine carcinomas, and the small cell and large cell carcinomas are categorized as poorly differentiated.


  • The table below lists the histological classification of neuroendocrine carcinomas:[2]
Well Differentiated Poorly Differentiated
Typical Carcinoid Atypical Carcinoid Small Cell Large Cell
No necrosis;
<2 mitoses per 2 mm2 (10 HPF)
Necrosis present and/or
2-10 mitoses per 2 mm2 (10 HPF)
Small cell cytology Non-small cell NEC with >10
mitoses per 2 mm2 (10 HPF)
Morphological Variants
Spindle cell type
Pigmented type
With amyloid (extrathyroidal medullary carcinoma)
Oncocytic/oxyphilic type
Mucinous
Angiomatoid type
Combinations of the above variants
Variants
SCNEC combined with Non-NECs

HPF: High power field, SCNEC: Small cell neuroendocrine carcinoma, NEC: Neuroendocrine carcinoma

References

  1. 1.0 1.1 Suster, S.; Rosai, J. (1991). "Thymic carcinoma. A clinicopathologic study of 60 cases". Cancer. 67 (4): 1025–32. PMID 1991250. Unknown parameter |month= ignored (help)
  2. Travis WD, Organization WH, Cancer IA et al. Pathology and Genetics of Tumours of the Lung, Pleura, Thymus and Heart. Diamond Pocket Books (P) Ltd.; 2004.