RESUMO
Thymic epithelial tumors are a group of rare neoplasms of the mediastinum. When resectable, complete resection is considered the gold standard for any stage. The primary endpoint was to evaluate overall survival and disease-free survival of patients with thymus epithelial tumors who underwent surgical treatment. The secondary endpoint was to evaluate and compare the overall survival according to: resection type (complete vs. incomplete), Masaoka-Koga stage and tumor histology according to WHO classification. This is a descriptive observational study from January 2004 to December 2020, in which 42 patients with a postoperative histopathological diagnosis of thymic epithelial tumours were included. Thirty-nine were thymomas (92.9%) and 3 were thymic carcinomas (7.1%). In all patients a total thymectomy was performed. The median follow-up was 63.5 months (IQR 32-97.5). The estimated overall survival at five and ten years was 87% (95% CI, 0.69-0.95) and 78% (95% CI, 0.5-0.92), respectively. Estimated diseasefree survival at five and ten years was 90% (95% CI, 0.74-0.96). Patients who underwent complete resection and with early Masaoka-Koga stages had superior overall survival compared to incomplete resections and advanced Masaoka-Koga stages (p = 0.0097 and p = 0.0028, respectively). We found no differences in terms of survival between histological subtypes due to a low number of patients in the thymic carcinoma group.
Las neoplasias epiteliales del timo (NET) son tumores infrecuentes. El manejo inicial de las mismas se basa en el análisis de la resecabilidad del tumor en los estudios por imágenes, siendo la resección completa el tratamiento estándar para cualquier estadio. El objetivo principal fue evaluar la supervivencia global y la supervivencia libre de enfermedad de los pacientes con diagnóstico de NET sometidos a tratamiento quirúrgico. El objetivo secundario fue comparar la supervivencia global de acuerdo al tipo de resección quirúrgica, el estadio de Masaoka-Koga y subtipo histológico. Estudio observacional descriptivo realizado en el Hospital Británico de Buenos Aires desde 2004 a 2020. Se incluyeron 42 pacientes operados de tumores en mediastino anterior con diagnóstico histopatológico definitivo de NET. Treinta y nueve eran timomas y 3 carcinomas tímicos. La cirugía realizada en todos los pacientes fue una timectomia total. La mediana de seguimiento fue de 63.5 meses (RIQ 32-97.5). La supervivencia global estimada a los cinco y diez años fue del 87% (95% IC, 0.69-0.95) y 78% (95% IC, 0.5-0.92), respectivamente. La supervivencia libre de enfermedad estimada a cinco y diez años fue del 90% (95% IC, 0.74-0.96). Los pacientes a los que se le realizó una resección completa y que tenían estadios tempranos de Masaoka-Koga presentaron una supervivencia global superior en comparación con las resecciones incompletas y estadios avanzados (p = 0.0097 y p = 0.0028, respectivamente). Al contar con un bajo número de pacientes en el grupo de carcinomas tímicos, no pudimos sacar conclusiones en cuanto a supervivencia entre éstos y los timomas.
Assuntos
Neoplasias Epiteliais e Glandulares , Timoma , Neoplasias do Timo , Humanos , Estadiamento de Neoplasias , Neoplasias Epiteliais e Glandulares/patologia , Neoplasias Epiteliais e Glandulares/cirurgia , Estudos Retrospectivos , Timoma/cirurgia , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgiaRESUMO
BACKGROUND: Thymic tumors are unusual neoplasms, representing 0.2 to 1.5% of tumors in humans, but correspond to 20% of mediastinal tumors and 50% of those that occur in the anterior mediastinum. They tend to appear around the fourth and fifth decades of life without gender predilection. Up to 30% of patients are asymptomatic, therefore many are incidentally diagnosed. Radical thymectomy is the treatment of choice with high survival rates when detected in the early stages. METHODS: This was a retrospective descriptive study, including 18 adult patients' diagnosis of thymic neoplasm, who were managed with surgical resection from 2011 to 2019. Information about demographics, clinical characteristics, imaging findings, surgical and medical management, plus histological findings was obtained and reported. RESULTS: 18 patients with thymic tumors were included, of which specific histologic studies reveled thymomas, carcinomas, neuroendocrine tumors, thymolipoma and thymic cyst. Mean age was 52.7 years, with a predominance of male population. The main symptom was dyspnea, followed by cough and chest pain. Paraneoplastic syndromes such as myasthenia gravis, aplastic anemia and Cushing syndrome were reported. 89% of cases were treated by radical thymectomy alone, while only 2 cases required chemotherapy and radiotherapy. There were no surgical complications. Mean hospital stay length was 11. 9 days, with only 1 mortality during hospital admission. 5-year survival rate was 81%. CONCLUSIONS: The treatment of choice is radical thymectomy, which has been shown to positively impact patient mortality. Early detection is key to improve patient outcomes.
Assuntos
Síndromes Paraneoplásicas/epidemiologia , Timectomia , Timo/patologia , Neoplasias do Timo/cirurgia , Idoso , Carcinoma/complicações , Carcinoma/diagnóstico , Carcinoma/mortalidade , Carcinoma/cirurgia , Colômbia/epidemiologia , Feminino , Humanos , Tempo de Internação/estatística & dados numéricos , Lipoma/complicações , Lipoma/diagnóstico , Lipoma/mortalidade , Lipoma/cirurgia , Masculino , Pessoa de Meia-Idade , Tumores Neuroendócrinos/complicações , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/mortalidade , Tumores Neuroendócrinos/cirurgia , Síndromes Paraneoplásicas/etiologia , Estudos Retrospectivos , Taxa de Sobrevida , Timoma/complicações , Timoma/diagnóstico , Timoma/mortalidade , Timoma/cirurgia , Timo/diagnóstico por imagem , Timo/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/mortalidadeRESUMO
The intrathyroidal thymic carcinoma is a rare neoplasm. The probable origin of this neoplasm is the presence of ectopic thymic tissue or remnants of the third and fourth branchial arch. The case of a 49-year-old female with an initial diagnosis of medullary thyroid cancer is presented. When she was operated for regional recurrence, 16 years later, the pathology report demonstrates the presence of a intrathyroidal thymic carcinoma. Intrathyroidal thymic carcinoma is considered an independent type of thyroid carcinoma because this entity has specific clinical-pathological characteristics similar to thymic carcinomas and different prognosis than known thyroid carcinomas. We present the case of a patient initially treated as having a medullary thyroid carcinoma who, upon presenting recurrence, the presence of intrathyroidal thymic carcinoma was demonstrated.
El carcinoma tímico intratiroideo es una neoplasia rara. El origen probable de esta neoplasia es la presencia de tejido tímico ectópico o de restos del tercer y cuarto arcos branquiales. Se presenta el caso de una mujer de 49 años con diagnóstico inicial de cáncer medular de tiroides. Cuando fue operada por recurrencia regional, 16 años después, se demostró la presencia de un carcinoma tímico intratiroideo, que se considera un tipo independiente de carcinoma tiroideo debido a que tiene características clínico-patológicas específicas similares a los carcinomas tímicos y un pronóstico diferente a los carcinomas de tiroides conocidos. Este caso se trató inicialmente como carcinoma medular de tiroides y al presentar recurrencia se demostró la presencia de un carcinoma tímico intratiroideo.
Assuntos
Timoma , Neoplasias do Timo , Neoplasias da Glândula Tireoide , Erros de Diagnóstico , Feminino , Humanos , Pessoa de Meia-Idade , Recidiva Local de Neoplasia , Timoma/diagnóstico por imagem , Timoma/cirurgia , Neoplasias do Timo/diagnóstico por imagem , Neoplasias do Timo/cirurgia , Neoplasias da Glândula Tireoide/diagnóstico , Neoplasias da Glândula Tireoide/cirurgiaRESUMO
OBJECTIVE: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. METHODS: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. RESULTS: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. CONCLUSIONS: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.
Assuntos
Procedimentos Cirúrgicos Robóticos/métodos , Procedimentos Cirúrgicos Torácicos/métodos , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Resultado do TratamentoRESUMO
BACKGROUND: The association between myasthenia gravis (MG) and thymoma is a frequent finding; however, the post-thymectomy MG is rare. The pathogenic mechanisms are poorly understood and include thymoma recurrence, surgical exposure and activation of peripheral lymphocytes after surgery. CLINICAL CASE: 39-year-old male patient who 6 months after surgical treatment of B1 thymoma presented a clinical picture, characterized by dysphagia, global weakness, diplopia and respiratory failure. The antibodies against acetylcholine receptor were positive (16.10 nmol/L). Electromyography was not performed due to technical problems. With these results, the patient's clinic was attributed due to MG Osserman IV crisis. The patient had medical management with parasympathomimetics, ventilatory support and plasmapheresis, with favorable clinical evolution. CONCLUSIONS: The late onset of MG and other autoimmune disorders should be considered as possible complications of the surgical treatment of thymomas. Therefore, after the resection of a thymoma, follow-up care with post-operative MG consideration is necessary.
INTRODUCCIÓN: La asociación entre miastenia grave (MG) y timoma es un hallazgo frecuente; sin embargo, la MG posterior a una timectomía es rara. Los mecanismos patogénicos son poco entendidos e incluyen recurrencia del timoma, exposición quirúrgica y activación de los linfocitos periféricos después de la cirugía. CASO CLÍNICO: Varón de 39 años, quien 6 meses después del tratamiento quirúrgico de un timoma B1 cursó con cuadro clínico caracterizado por disfagia, debilidad global, diplopía y dificultad respiratoria. Los anticuerpos contra el receptor de acetilcolina fueron positivos (16.10 nmol/l). No se realizó electromiografía por problemas técnicos. Con estos resultados se atribuyó que la clínica del paciente fue compatible con crisis de MG Osserman IV. El paciente tuvo manejo médico con parasimpaticomiméticos, soporte ventilatorio y plasmaféresis, con una evolución clínica favorable. CONCLUSIONES: El inicio tardío de la MG y otros trastornos autoinmunitarios deben ser considerados como posibles complicaciones del tratamiento quirúrgico de los timomas. Por lo tanto, después de la resección de un timoma es necesario el cuidado de seguimiento con consideración de la MG posoperatoria.
Assuntos
Miastenia Gravis , Timoma , Neoplasias do Timo , Adulto , Humanos , Masculino , Miastenia Gravis/diagnóstico , Miastenia Gravis/etiologia , Recidiva Local de Neoplasia , Timectomia , Timoma/complicações , Timoma/diagnóstico , Timoma/cirurgia , Neoplasias do Timo/complicações , Neoplasias do Timo/diagnóstico , Neoplasias do Timo/cirurgiaRESUMO
ABSTRACT Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.
RESUMO Objetivo: Avaliar os resultados da ressecção de tumores tímicos por cirurgia torácica robótica, verificando a radicalidade da ressecção, complicações pós-operatórias, tempo de cirurgia e tempo de internação. Métodos: Estudo retrospectivo a partir de um banco de dados envolvendo pacientes com diagnóstico de tumor tímico e submetidos à cirurgia torácica robótica em sete hospitais no Brasil entre outubro de 2015 e junho de 2018. Resultados: Durante o período estudado, houve 18 casos de ressecção de tumores tímicos (timomas, em 12; carcinoma tímico, em 2; e tumor carcinoide tímico, sarcoma tímico de alto grau, teratoma tímico e timolipoma, em 1 cada). A média do tamanho das lesões foi de 60,1 ± 32,0 mm. Tumores tímicos foram ressecados com margens livres em 17 casos. As medianas (intervalos interquartis) de tempo de dreno pleural e de internação, em dias, foram 1 (1-3) e 2 (2-4), respectivamente. Não houve necessidade de conversão cirúrgica nem complicações maiores. Conclusões: A cirurgia torácica robótica para a ressecção de tumores tímicos demonstrou ser factível e segura, com baixo risco de complicações e desfechos pós-operatórios comparáveis aos de outras técnicas.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Timoma/cirurgia , Neoplasias do Timo/cirurgia , Procedimentos Cirúrgicos Torácicos/métodos , Procedimentos Cirúrgicos Robóticos/métodos , Tomografia Computadorizada por Raios X , Estudos Retrospectivos , Resultado do TratamentoRESUMO
Background: Thymomas are epithelial neoplasms of the thymus, although lymphocyte infiltration is common. Histological features are not sufficient to define its biological behaviour, which is dependent of clinical criteria of invasiveness and resectability. Myasthenia gravis may happen as a paraneoplastic syndrome in up to 47% of canine thymomas. This article aims at reporting a case of thymoma associated with myasthenia gravis in a dog, emphasizing the morphological, phenotypical and therapeutical aspects.Case: A 7-year-old, male Labrador, was presented with a history of acute dyspnea and exercise intolerance. The physical examination revealed a red-brick mucousa, tachycardia and cardiac and pulmonar hypofonese. Chest radiographs revealed an area of increased radiopacity in the cranial mediastinum without a plane of separation to the heart. The eccodopplercardiogram exam identified a poorly delimited mass adjacent to the base of the heart, measuring 9.5x6.8cm. Computed tomography demonstrated it as an expansive neoformation (9.5x6.5x7.8cm). Mass was removed through intercostal thoracotomy and the removed tissue was submitted to histopathology with a diagnosis compatible with type AB thymoma (mixed). Immunohistochemistry was positive for AE1/AE3 citokeratin in 90% of epithelial cells, confirming tumour origin. Tumour infiltrating lymphocytes were positive for CD79a (70%) and CD3 (20%). The proliferation index (Ki-67 imunolabeling) was 60%. About 45 days after surgery the patient was presented with generalized muscle weakness and regurgitation, with confirmed megaesophagus on chest X-ray. Treatment with pyridostigmine was initiated because of suspected myasthenia gravis, and complete remission of the neurological signs occurred within a month. A chemotherapeutic protocol with carboplatin was then instituted. After four sessions, a new thoracic radiograph revealed tumour recurrence in the cranial mediastinum.[...]
Assuntos
Masculino , Animais , Cães , Miastenia Gravis/complicações , Miastenia Gravis/tratamento farmacológico , Miastenia Gravis/veterinária , Timoma/cirurgia , Timoma/diagnóstico , Timoma/tratamento farmacológico , Timoma/veterinária , Quimioterapia Adjuvante/veterinária , Síndromes Paraneoplásicas/veterináriaRESUMO
Background: Thymomas are epithelial neoplasms of the thymus, although lymphocyte infiltration is common. Histological features are not sufficient to define its biological behaviour, which is dependent of clinical criteria of invasiveness and resectability. Myasthenia gravis may happen as a paraneoplastic syndrome in up to 47% of canine thymomas. This article aims at reporting a case of thymoma associated with myasthenia gravis in a dog, emphasizing the morphological, phenotypical and therapeutical aspects.Case: A 7-year-old, male Labrador, was presented with a history of acute dyspnea and exercise intolerance. The physical examination revealed a red-brick mucousa, tachycardia and cardiac and pulmonar hypofonese. Chest radiographs revealed an area of increased radiopacity in the cranial mediastinum without a plane of separation to the heart. The eccodopplercardiogram exam identified a poorly delimited mass adjacent to the base of the heart, measuring 9.5x6.8cm. Computed tomography demonstrated it as an expansive neoformation (9.5x6.5x7.8cm). Mass was removed through intercostal thoracotomy and the removed tissue was submitted to histopathology with a diagnosis compatible with type AB thymoma (mixed). Immunohistochemistry was positive for AE1/AE3 citokeratin in 90% of epithelial cells, confirming tumour origin. Tumour infiltrating lymphocytes were positive for CD79a (70%) and CD3 (20%). The proliferation index (Ki-67 imunolabeling) was 60%. About 45 days after surgery the patient was presented with generalized muscle weakness and regurgitation, with confirmed megaesophagus on chest X-ray. Treatment with pyridostigmine was initiated because of suspected myasthenia gravis, and complete remission of the neurological signs occurred within a month. A chemotherapeutic protocol with carboplatin was then instituted. After four sessions, a new thoracic radiograph revealed tumour recurrence in the cranial mediastinum.[...](AU)
Assuntos
Animais , Masculino , Cães , Timoma/diagnóstico , Timoma/tratamento farmacológico , Timoma/cirurgia , Timoma/veterinária , Miastenia Gravis/complicações , Miastenia Gravis/veterinária , Miastenia Gravis/tratamento farmacológico , Síndromes Paraneoplásicas/veterinária , Quimioterapia Adjuvante/veterináriaAssuntos
Autoanticorpos/sangue , Proteínas de Membrana/imunologia , Proteínas do Tecido Nervoso/imunologia , Síndromes Paraneoplásicas do Sistema Nervoso/diagnóstico , Síndromes Paraneoplásicas do Sistema Nervoso/imunologia , Siringomielia/diagnóstico , Siringomielia/imunologia , Timoma/complicações , Neoplasias do Timo/complicações , Idoso , Humanos , Masculino , Síndromes Paraneoplásicas do Sistema Nervoso/tratamento farmacológico , Síndrome , Siringomielia/tratamento farmacológico , Timoma/cirurgia , Neoplasias do Timo/cirurgiaRESUMO
BACKGROUND: Mediastinal tumours in children are rare. Around 25% of them can be malignant. The thymoma is an uncommon neoplasm, and during adulthood it corresponds to 30% of anterior mediastinum tumours. The peak incidence is between 55-65 years. CLINICAL CASE: A case of lymphocytic thymoma case is reported in a 4 year old patient with no previous or associated symptomatology. There was only a volume increase on the anterior neck region. The neck radiography and neck and chest tomography confirmed an anterior mediastinal mass surrounding the aorta and vena cava, as well as multiple mediastinal lymph nodes CONCLUSIONS: Early diagnosis and complete resection are the basis for management and prognosis.