Download PDF
Semin Neurol 2004; 24(1): 63-73
DOI: 10.1055/s-2004-829588
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Thymoma: Current Medical and Surgical Management

Kenneth A. Kesler1 , Cameron D. Wright3 , Patrick J. Loehrer2  Sr 
  • 1Professor of Surgery, Thoracic Division, Indiana University School of Medicine, Indianapolis, Indiana
  • 2Kenneth Wiseman Professor of Medicine, Director, Division of Hematology/Oncology, Indiana University School of Medicine, Indianapolis, Indiana
  • 3Associate Professor of Surgery, Thoracic Division, Massachusetts General Hospital, Boston, Massachusetts
Further Information

Publication History

Publication Date:
01 July 2004 (online)

    Permissions and Reprints

Thymoma is a rare neoplasm usually with an indolent growth pattern; however, local invasion and/or dissemination may occur. Surgery has been the standard of care for early stage disease with good to excellent cure rates anticipated. This neoplasm has been found to be relatively sensitive to cisplatinum-based chemotherapy as compared with most other epithelial tumors. Aggressive multimodality therapy therefore can result in long-term disease-free survival for patients presenting with locally advanced or even disseminated disease. This chapter outlines the current medical and surgical treatment options for thymoma.

KEYWORDS

Thymoma - myasthenia gravis - surgery - chemotherapy

REFERENCES

  • 1 Shields T W. Primary lesions of the mediastinum and their investigation and treatment. In: Shields TW General Thoracic Surgery, 4th ed. Baltimore, MD; Williams and Wilkins Publishers 1994: 1724-1796
    Google Scholar
  • 2 Engels E A, Pfeiffer R M. Malignant thymoma in the United States: demographic patterns in incidence and associations with subsequent malignancies.  Int J Cancer. 2003;  105 546-551
    CrossrefPubMedGoogle Scholar
  • 3 Wilkins E W. Thymoma. In: Pearson FG, Deslauriers J, Ginsberg RJ, et al Thoracic Surgery. New York; Churchill Livingstone Publishers 1995: 1419-1427
    Google Scholar
  • 4 Morgenthaler T I, Brown L R, Colby T V et al.. Thymoma.  Mayo Clin Proc. 1993;  68 1110-1123
    PubMedGoogle Scholar
  • 5 Souadjian J V, Enriquez P, Silverstein M N et al.. The spectrum of diseases associated with thymoma: coincidence or syndrome?.  Arch Intern Med. 1974;  134 374-379
    CrossrefPubMedGoogle Scholar
  • 6 Voltz R D, Albrich W E, Nagele A et al.. Paraneoplastic myasthenia gravis: detection of anti-MGT30 (titin) antibodies predicts thymic epithelial tumor.  Neurology. 1997;  49 1454-1457
    PubMedGoogle Scholar
  • 7 Gautel M, Lakey A, Barlow D P et al.. Titin antibodies in myasthenia gravis: identification of a major immunogenic region of titin.  Neurology. 1993;  43 1581-1585
    PubMedGoogle Scholar
  • 8 Ballow M, O'Neil K M. Approach to the patient with recurrent infections. In: Middleton E, Reed CE, Ellis EF, et al Allergy: Principles and Practice, 5th ed. St. Louis, MO; Mosby Publishing 1998: 735-759
    Google Scholar
  • 9 Bulkley G B, Bass K N, Stephenson R et al.. Extended cervicomediastinal thymectomy in the integrated management of myasthenia gravis.  Ann Surg. 1997;  226 324-335
    CrossrefPubMedGoogle Scholar
  • 10 Cumming W JK, Hudgeson P. The role of plasmapheresis in preparing patients with myasthenia for thymectomy.  Muscle Nerve. 1986;  9 S155-S158
    PubMedGoogle Scholar
  • 11 Mulder D M. Extended transsternal thymectomy. In: Shields TW General Thoracic Surgery, 5th ed. Philadelphia, PA; Lippincott Williams and Wilkins Publishers 2000: 2233-2237
    Google Scholar
  • 12 Kesler K A, Rieger K M, Ganjoo K N et al.. Primary mediastinal nonseminomatous germ cell tumors: the influence of postchemotherapy pathology on long-term survival after surgery.  J Thorac Cardiovasc Surg. 1999;  118 692-701
    PubMedGoogle Scholar
  • 13 Kubota K, Yamada S, Kondo T et al.. PET imaging of primary mediastinal tumours.  Br J Cancer. 1996;  73 882-886
    PubMedGoogle Scholar
  • 14 Maggi G, Casadio C, Cavallo A et al.. Thymoma: results of 241 operated cases.  Ann Thorac Surg. 1991;  51 152-156
    CrossrefPubMedGoogle Scholar
  • 15 Morrissey B, Adams H, Gibbs A R et al.. Percutaneous needle biopsy of the mediastinum: review of 94 procedures.  Thorax. 1993;  48 632-637
    CrossrefPubMedGoogle Scholar
  • 16 Bernatz P E, Harrison E G, Clagett O T. Thymoma: a clinicopathologic study.  J West Soc Periodontol Periodontal Abstr. 1961;  42 424-444
    PubMedGoogle Scholar
  • 17 Marino M, Muller-Hermelink H K. Thymoma and thymic carcinoma: relation of thymoma epithelial cells to the cortical and medullary differentiation of thymus.  Virchows Arch A Pathol Anat Histopathol. 1985;  407 119-149
    CrossrefPubMedGoogle Scholar
  • 18 Okumura M, Ohta M, Tateyama H et al.. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients.  Cancer. 2002;  94 624-632
    CrossrefPubMedGoogle Scholar
  • 19 Verley J M, Hollmann K H. Thymoma. A comparative study of clinical stages, histologic features and survival in 200 cases.  Cancer. 1985;  55 1074-1086
    CrossrefPubMedGoogle Scholar
  • 20 Pesamona E, Rendina E A, Veruta F et al.. The prognostic implication of thymoma histologic subtyping. A study of 80 consecutive cases.  Am J Clin Pathol. 1990;  93 190-195
    PubMedGoogle Scholar
  • 21 Masaoka A, Mondem Y, Nakahara K et al.. Follow-up study of thymoma with special reference to their clinical stages.  Cancer. 1981;  48 2485-2492
    CrossrefPubMedGoogle Scholar
  • 22 Masaoka A, Yamakawa Y, Niwa H et al.. Thymectomy and malignancy.  Eur J Cardiothorac Surg. 1994;  8 251-253
    CrossrefPubMedGoogle Scholar
  • 23 Schneider P M, Fellbaum C, Fink U et al.. Prognostic importance of histomorphologic subclassification for epithelial thymic tumors.  Ann Surg Oncol. 1997;  4 46-56
    PubMedGoogle Scholar
  • 24 Nakagawa K, Asamura H, Matsuno Y et al.. Thymoma: a clinicopathologic study based on the new World Health Organization classification.  J Thorac Cardiovasc Surg. 2003;  126 1134-1140
    CrossrefPubMedGoogle Scholar
  • 25 Port J L, Ginsberg R J. Surgery for thymoma.  Chest Surg Clin N Am. 2001;  11 421-437
    PubMedGoogle Scholar
  • 26 Kaiser L R. Thymoma. The use of minimally invasive resection techniques.  Chest Surg Clin N Am. 1994;  4 185-194
    PubMedGoogle Scholar
  • 27 Roviaro G, Rebuffat C, Varonli F et al.. Videothoracoscopic excision of mediastinal masses: indications and techniques.  Ann Thorac Surg. 1994;  58 1679-1684
    CrossrefPubMedGoogle Scholar
  • 28 Landreneau R J, Dowling R D, Castillo W M et al.. Thoracoscopic resection of an anterior mediastinal tumor.  Ann Thorac Surg. 1992;  54 142-144
    CrossrefPubMedGoogle Scholar
  • 29 Acuff T E, Mack M J, Ryan W H et al.. Thoracoscopic thymoma resection.  Ann Thorac Surg. 1993;  55 562-563
    PubMedGoogle Scholar
  • 30 Curran W J, Kornstein F J, Brooks J J et al.. Invasive thymoma: the role of mediastinal irradiation following complete or incomplete surgical resection.  J Clin Oncol. 1988;  6 1722-1727
    PubMedGoogle Scholar
  • 31 Pollack A, Komaki R, Cox J D et al.. Thymoma: treatment and prognosis.  Int J Radiat Oncol Biol Physiol. 1992;  23 1037-1043
    PubMedGoogle Scholar
  • 32 Ogawa K, Uno T, Toita T et al.. Postoperative radiotherapy for patients with completely resected thymoma.  Cancer. 2002;  94 1405-1413
    CrossrefPubMedGoogle Scholar
  • 33 Haniuda M, Morimoto M, Nishimura H et al.. Adjuvant radiotherapy after complete resection of thymoma.  Ann Thorac Surg. 1992;  54 311-315
    CrossrefPubMedGoogle Scholar
  • 34 Mangi A A, Wright C D, Allan J S et al.. Adjuvant radiation therapy for stage II thymoma.  Ann Thorac Surg. 2002;  74 1033-1037
    CrossrefPubMedGoogle Scholar
  • 35 Singhal S, Shrager J B, Rosenthal D I et al.. Comparison of stages: thymoma treated by complete resection with or without adjuvant radiation.  Ann Thorac Surg. 2003;  76 1635-1642
    CrossrefPubMedGoogle Scholar
  • 36 Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan.  Ann Thorac Surg. 2003;  76 878-885
    CrossrefPubMedGoogle Scholar
  • 37 Thomas C R, Wright C D, Loehrer P J. Thymoma: state of the art.  J Clin Oncol. 1999;  17 2280-2289
    CrossrefPubMedGoogle Scholar
  • 38 Macchiarini P, Chella A, Ducci F et al.. Neoadjuvant chemotherapy, surgery and postoperative radiation therapy for invasive thymoma.  Cancer. 1991;  68 706-713
    CrossrefPubMedGoogle Scholar
  • 39 Berruti A, Borasio P, Gerbino A et al.. Primary chemotherapy with adriamycin, cisplatin, vincristine and cyclophosphamide in locally advanced thymomas: a single institution experience.  Br J Cancer. 1999;  81 841-845
    CrossrefPubMedGoogle Scholar
  • 40 Rea F, Sartori F, Loy M et al.. Chemotherapy and operation for invasive thymoma.  J Thorac Cardiovasc Surg. 1993;  106 543-549
    PubMedGoogle Scholar
  • 41 Shin D M, Walsh G L, Komake R et al.. A multidisciplinary approach to therapy for unresectable malignant thymoma.  Ann Intern Med. 1998;  129 100-104
    PubMedGoogle Scholar
  • 42 Kim E S, Putnam J B, Komaki R et al.. A phase II study of a multidisciplinary approach with induction chemotherapy followed by surgical resection, radiation therapy and consolidation chemotherapy for unresectable malignant thymomas: final report.  Proc Am Soc Clin Oncol. 2001;  20 310A
    PubMedGoogle Scholar
  • 43 Loehrer P J, Chen M, Kim K et al.. Cisplatin, doxorubicin and cyclophosphamide plus thoracic radiation therapy for limited-stage unresectable thymoma: an intergroup trial.  J Clin Oncol. 1997;  15 3093-3099
    PubMedGoogle Scholar
  • 44 Loehrer P J, Kim K M, Aisner S C et al.. Cisplatin plus doxorubicin plus cyclophosphamide in metastatic or recurrent thymoma: final results of an Intergroup trial.  J Clin Oncol. 1994;  12 1164-1168
    PubMedGoogle Scholar
  • 45 Yagi K, Hirata T, Fukuse T et al.. Surgical treatment for invasive thymoma, especially when the superior vena cava is invaded.  Ann Thorac Surg. 1996;  61 521-524
    CrossrefPubMedGoogle Scholar
  • 46 Akaogi E, Ohara K, Mitsui K et al.. Preoperative radiotherapy and surgery for advanced thymoma with invasion to the great vessels.  J Surg Oncol. 1996;  63 17-22
    CrossrefPubMedGoogle Scholar
  • 47 Okumura M, Miyoshi S, Takeuchi Y et al.. Results of surgical treatment of thymomas with special reference to the involved organs.  J Thorac Cardiovasc Surg. 1999;  117 605-613
    CrossrefPubMedGoogle Scholar
  • 48 Nakahara K, Ohno K, Hashimoto J et al.. Thymoma: results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients.  J Thorac Cardiovasc Surg. 1988;  95 1041-1047
    PubMedGoogle Scholar
  • 49 Kohman L J. Controversies in the management of malignant thymoma.  Chest. 1997;  112 296S-300S
    PubMedGoogle Scholar
  • 50 Regnard J F, Zinzindohoue F, Magdeleinat P et al.. Results of re-resection for recurrent thymomas.  Ann Thorac Surg. 1997;  64 1593-1598
    CrossrefPubMedGoogle Scholar
  • 51 Kirschner P A. Reoperation for thymoma: report of 23 cases.  Ann Thorac Surg. 1990;  49 550-555
    CrossrefPubMedGoogle Scholar
  • 52 Park H S, Shin D M, Lee J S et al.. Thymoma. A retrospective study of 87 cases.  Cancer. 1994;  73 2491-2498
    PubMedGoogle Scholar
  • 53 Fornasiero A, Daniele O, Ghiotto C et al.. Chemotherapy for invasive thymoma. A 13-year experience.  Cancer. 1991;  68 30-33
    PubMedGoogle Scholar
  • 54 Giaccone G, Ardizzoni A, Kirkpatrick A et al.. Cisplatin and etoposide combination chemotherapy for locally advanced or metastatic thymoma. A phase II study of the European organization for Research and Treatment of Cancer Lung Cancer Cooperative Group.  J Clin Oncol. 1996;  14 814-820
    PubMedGoogle Scholar
  • 55 Lin K, Nguyen B D, Ettinger D S et al.. Somatostatin receptor scintigraphy and somatostatin therapy in the evaluation and treatment of malignant thymoma.  Clin Nucl Med. 1999;  24 24-28
    CrossrefPubMedGoogle Scholar
  • 56 Loehrer P J, Jiroutek M, Aisner S et al.. Combined etoposide, ifosfamide and cisplatin in the treatment of patients with advanced thymoma and thymic carcinoma: an intergroup trial.  Cancer. 2001;  91 2010-2015
    CrossrefPubMedGoogle Scholar
  • 57 Park H S, Shin D M, Lee J S et al.. Thymoma: a retrospective study of 87 cases.  Cancer. 1994;  73 2491-2498
    PubMedGoogle Scholar
  • 58 Budde J M, Morris C D, Gal A A et al.. Predictors of outcome in thymectomy for myasthenia gravis.  Ann Thorac Surg. 2001;  72 197-202
    CrossrefPubMedGoogle Scholar
  • 59 Maggi G, Casadio C, Cavallo A et al.. Thymectomy in myasthenia gravis: results of 662 cases operated upon in 15 years.  Eur J Cardiothorac Surg. 1989;  3 504-511
    CrossrefPubMedGoogle Scholar
  • 60 de Perrot M, Liu J, Bril V et al.. Prognostic significance of thymomas in patients with myasthenia gravis.  Ann Thorac Surg. 2002;  74 1658-1662
    CrossrefPubMedGoogle Scholar
  • 61 Regnard J F, Magdeleinat P, Dromer C et al.. Prognostic factors and long-term results after thymoma resection: a series of 307 patients.  J Thorac Cardiovasc Surg. 1996;  112 376-384
    CrossrefPubMedGoogle Scholar
  • 62 Wilkins Jr E W, Grillo H C, Scannell J G et al.. J. Maxwell Chamberlain Memorial Paper. Role of staging in prognosis and management of thymoma.  Ann Thorac Surg. 1991;  51 888-892
    CrossrefPubMedGoogle Scholar
  • 63 Evoli A, Minisci C, Di Schino C et al.. Thymoma in patients with myasthenia gravis: characteristics and long-term outcome.  Neurology. 2002;  59 1844-1850
    PubMedGoogle Scholar
  • 64 Souadjian J V, Enriquez P, Siverstein M N, Pepin J M. The spectrum of diseases associated with thymoma: coincidence or syndrome?.  Arch Intern Med. 1974;  134 374-379
    CrossrefPubMedGoogle Scholar
  • 65 Wilkins K B, Sheikh E, Green R et al.. Clinical and pathologic predictors of survival in patients with thymoma.  Ann Surg. 1999;  230 562-572
    CrossrefPubMedGoogle Scholar
  • 66 Welsh J S, Wilkins K B, Green R et al.. Association between thymoma and second neoplasms.  JAMA. 2000;  283 1142-1143
    CrossrefPubMedGoogle Scholar

Kenneth A KeslerM.D. 

Professor of Surgery, Thoracic Division, Indiana University School of Medicine

545 Barnhill Drive, EH #212

Indianapolis, IN 46202

Patrick J Loehrer SrM.D. 

Kenneth Wiseman Professor of Medicine, Director, Division of Hematology/Oncology, Indiana University School of Medicine

535 Barnhill Drive, RT #473, Indianapolis, IN 46202

      >