Skip to main content

Advertisement

SpringerLink
Log in

Computed tomography and thymoma: distinctive findings in invasive and noninvasive thymoma and predictive features of recurrence

Tomografia computerizzata e timoma: caratteristiche distintive tra forme invasive e non-invasive ed aspetti predittivi di recidiva

  • Chest Radiology / Radiologia Toracica
  • Published:
La radiologia medica Aims and scope Submit manuscript

Abstract

Purpose

Our goal was to assess the computed tomo graphy (CT) imaging findings of thymoma and to correlate these features with Masaoka staging system and prognosis.

Materials and methods

CT findings of thymoma were analysed in 58 patients who had undergone surgery between January 2002 and September 2007. All cases were classified according to the Masaoka staging system. The presence of various CT findings was correlated with tumour invasiveness and recurrence. In statistical analysis, a p value <0.05 was interpreted as significant.

Results

The study found 26 noninvasive thymomas and 32 invasive thymomas. Invasive thymomas were more likely to be greater in size (p<0.01), with lobulated or irregular contours (p<0.02), a necrotic or cystic component (p<0.04), foci of calcification (p<0.05) and heterogeneous contrast enhancement (p<0.01) than were noninvasive thymomas. Disease progression developed in nine of 58 patients. Tumour recurrence and metastasis correlated with greater size (p<0.04), lobulated or irregular contours (p<0.01), complete mediastinal fat obliteration (p<0.01), great vessel invasion (p<0.01) and pleural implants (p<0.02).

Conclusions

CT is useful in differentiating invasive from noninvasive thymomas and plays an important role in evaluating and treating these patients for multimodal therapy with neoadjuvant approaches. Moreover, CT findings may serve as predictors of postoperative recurrence or metastasis.

Riassunto

Obiettivo

Scopo di questo lavoro è stato valutare le caratteristiche alla tomografia computerizzata (TC) dei timomi e correlarle alla classificazione anatomo-chirurgica di Masaoka ed alla prognosi dei pazienti.

Materiali e metodi

Sono state analizzate le caratteristiche TC del timoma in 58 pazienti sottoposti a resezione chirurgica nel periodo gennaio 2002/settembre 2007. Tutti i casi sono stati classificati secondo il sistema di stadiazione di Masaoka. Molteplici aspetti TC della lesione sono stati correlati all’invasività ed alla ripresa di malattia a distanza. I dati ottenuti sono stati considerati significativi con p<0,05.

Risultati

La casistica ha incluso 26 timomi non-invasivi e 32 timomi invasivi. Nel gruppo invasivo si sono riscontrati, con maggior frequenza, dimensioni maggiori (p<0,01), margini lobulati o irregolari (p<0,02), componente cistica o necrotica (p<0,04), calcificazioni (p<0,05) ed enhancement disomogeneo (p<0,01). La ripresa di malattia a distanza, intra- od extra-toracica, si è evidenziata in 9/58 pazienti. Questa si è riscontrata, con maggior frequenza, nelle neoplasie alla diagnosi di dimensioni maggiori (p<0,04) e caratterizzate da contorni lobulati o irregolari (p<0,01), completa obliterazione dei piani di clivaggio adiposo (p<0,01), invasione dei grossi vasi (p<0,01) ed insemenzamento pleurico (p<0,02).

Conclusioni

La TC è utile nel differenziare i timomi invasivi dalle forme non-invasive e riveste ruolo fondamentale nella corretta gestione terapeutica dei pazienti da indirizzare ai trattamenti neoadiuvanti l’escissione chirurgica. Inoltre la TC fornisce elementi predittivi di recidiva a distanza.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References/Bibliografia

  1. Priola AM, Priola SM, Cardinale L et al (2006) The anterior mediastinum: diseases. Radiol Med 111:312–342

    Article  CAS  PubMed  Google Scholar 

  2. Nishino M, Ashiku SK, Kocher ON et al (2006) The thymus: a comprehensive review. Radiographics 26:335–348

    Article  PubMed  Google Scholar 

  3. Zerhouni EA, Scott WW Jr, Baker RR et al (1982) Invasive thymomas: Diagnosis and evaluation by computed tomography. J Comput Assist Tomogr 6:92–100

    CAS  PubMed  Google Scholar 

  4. Lewis JE, Wick MR, Scheithauer BW et al (1987) Thymoma. A clinicopathologic review. Cancer 60:2727–2743

    Article  CAS  PubMed  Google Scholar 

  5. Maggi G, Casadio C, Cavallo A et al (1991) Thymoma: results of 241 operated cases. Ann Thorac Surg 51:152–156

    Article  CAS  PubMed  Google Scholar 

  6. Masaoka A, Monden Y, Nakahara K, Tanioka T (1981) Follow-up study of thymomas with special reference to their clinical stages. Cancer 48:2485–2492

    Article  CAS  PubMed  Google Scholar 

  7. Cowen D, Hannoun-Levi JM, Resbeut M, Alzieu C (1998) Natural history and treatment of malignant thymoma. Oncology 12:1001–1005

    CAS  PubMed  Google Scholar 

  8. Johnson SB, Eng TY, Giaccone G, Thomas CR Jr (2001) Thymoma: Update for the new millennium. Oncologist 6:239–246

    Article  CAS  PubMed  Google Scholar 

  9. Detterbeck FC, Parsons AM (2004) Thymic tumors. Ann Thorac Surg 77:1860–1869

    Article  PubMed  Google Scholar 

  10. Bretti S, Berruti A, Loddo C et al (2004) Multimodal management of stages III–IVa malignant thymoma. Lung Cancer 44:69–77

    Article  CAS  PubMed  Google Scholar 

  11. Kim ES, Putnam JB, Komaki R et al (2004) 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. Lung Cancer 44:369–379

    Article  PubMed  Google Scholar 

  12. Lucchi M, Ambrogi MC, Duranti L et al (2005) Advanced stage thymomas and thymic carcinomas: results of multimodality treatments. Ann Thorac Surg 79:1840–1844

    Article  PubMed  Google Scholar 

  13. Yokoi K, Matsuguma H, Nakahara R et al (2007) Multidisciplinary treatment for advanced invasive thymoma with cisplatin, doxorubicin, and methylprednisolone. J Thorac Oncol 2:73–78

    Article  PubMed  Google Scholar 

  14. Shin DM, Walsh GL, Komaki R et al (1998) A multidisciplinary approach to therapy for unresectable malignant thymoma. Ann Intern Med 129:100–104

    CAS  PubMed  Google Scholar 

  15. Yamakawa Y, Masaoka A, Hashimoto T et al (1991) A tentative tumor-node-metastasis classification of thymoma. Cancer 68:1984–1987

    Article  CAS  PubMed  Google Scholar 

  16. Bernatz PE, Harrison EG, Clagett OT (1961) Thymoma: a clinicopathologic study. J Thorac Cardiovasc Surg 42:424–444

    CAS  PubMed  Google Scholar 

  17. Verley JM, Hollmann KH (1985) Thymoma: a comparative study of clinical stages, histologic features, and survival in 200 cases. Cancer 55:1074–1086

    Article  CAS  PubMed  Google Scholar 

  18. Müller-Hermelink HK, Marino M, Palestro G et al (1985) Immunohistological evidences of cortical and medullary differentiation in thymoma. Virchows Arch A Pathol Anat Histopathol 408:143–161

    Article  PubMed  Google Scholar 

  19. Rosai J, Sobin L (1999) Histologic typing of tumours of the thymus. In: Rosai J, Sobin L (eds) World Health Organization, international histological classification of tumours. Springer-Verlag, Berlin, New York, pp 9–14

    Google Scholar 

  20. Müller-Hermelink HK, Ströbel P, Zettl A et al (2004) Combined thymic epithelial tumours. In: Travis WD, Brambilla E, Müller-Hermelink HK, Harris CC (eds) Pathology and genetics of tumours of the lung, pleura, thymus and heart (WHO classification of tumours series). IARC Press, Lyon, pp 196–198

    Google Scholar 

  21. Jeong YJ, Lee KS, Kim J et al (2004) Does CT of thymic epithelial tumors enable us to differentiate histologic subtypes and predict prognosis. AJR Am J Roentgenol 183:283–289

    PubMed  Google Scholar 

  22. Kondo K, Yoshizawa K, Tsuyuguchi M et al (2004) WHO histologic classification is a prognostic indicator in thymoma. Ann Thorac Surg 77:1183–1188

    Article  PubMed  Google Scholar 

  23. Park MS, Chung KY, Kim KD et al (2004) Prognosis of thymic epithelial tumors according to the New World Health Organization histologic classification. Ann Thorac Surg 78:992–998

    Article  PubMed  Google Scholar 

  24. Detterbeck FC (2006) Clinical value of the WHO classification system of thymoma. Ann Thorac Surg 81:2328–2334

    Article  PubMed  Google Scholar 

  25. Tomiyama N, Johkoh T, Mihara N et al (2002) Using the World Healt Organization classification of thymic epithelial neoplasms to describe CT findings. AJR Am J Roentgenol 179:881–886

    PubMed  Google Scholar 

  26. Han J, Lee KS, Yi CA et al (2003) Thymic epithelial tumors classified according to a newly established WHO scheme: CT and MR findings. Korean J Radiol 4:46–53

    Article  PubMed  Google Scholar 

  27. Sadohara J, Fujimoto K, Müller NL et al (2006) Thymic epithelial tumors: comparison of CT and MR imaging findings of low-risk thymomas, high-risk thymomas, and thymic carcinomas. Eur J Radiol 60:70–79

    Article  PubMed  Google Scholar 

  28. Tomiyama N, Müller NL, Ellis SJ et al (2001) Invasive and noninvasive thymoma: distinctive CT features. J Comput Assist Tomogr 25:388–393

    Article  CAS  PubMed  Google Scholar 

  29. Priola SM, Priola AM, Cardinale L et al (2006) The anterior mediastinum: anatomy and imaging procedures. Radiol Med 111:295–311

    Article  CAS  PubMed  Google Scholar 

  30. Priola AM, Priola SM, Cataldi A et al (2008) CT-guided percutaneous transthoracic biopsy in the diagnosis of mediastinal masses: evaluation of 73 procedures. Radiol Med 113:3–15

    Article  CAS  PubMed  Google Scholar 

  31. Blumberg D, Burt ME, Bains MS et al (1998) Thymic carcinoma. Current staging does not predict prognosis. J Thorac Cardiovasc Surg 115:303–309

    Article  CAS  PubMed  Google Scholar 

  32. Jung KJ, Lee KS, Han J et al (2001) Malignant thymic epithelial tumors: CT-pathologic correlation. AJR Am J Roentgenol 176:433–439

    CAS  PubMed  Google Scholar 

  33. Rosado-de-Christenson ML, Galobardes J, Moran CA (1992) Thymoma: radiologic-pathologic correlation. Radiographics 12:151–168

    CAS  PubMed  Google Scholar 

  34. Okumura M, Miyoshi S, Fujii Y et al (2001) Clinical and functional significance of WHO classification on human thymic epithelial neoplasms: a study of consecutive 146 tumors. Am J Surg Pathol 25:103–110

    Article  CAS  PubMed  Google Scholar 

  35. Chalabreysse L, Roy P, Cordier JF et al (2002) Correlation of the WHO schema for the classification of thymic epithelial neoplasms with prognosis: a retrospective study of 90 tumors. Am J Surg Pathol 26:1605–1611

    Article  PubMed  Google Scholar 

  36. Wright CD, Wain JC, Wong DR et al (2005) Predictors of recurrence in thymic tumors: importance of invasion, World Health Organization histology, and size. J Thorac Cardiovasc Surg 130:1413–1421

    Article  PubMed  Google Scholar 

  37. Suster S, Rosai J (1991) Thymic carcinoma: a clinico-pathologic study of 60 cases. Cancer 67:1025–1032

    Article  CAS  PubMed  Google Scholar 

  38. Wilkins EJ, Edmunds LH, Castleman B (1966) Cases of thymoma at the Massachusetts General Hospital. J Thorac Cardiovasc Surg 52:322–330

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, University of Turin, S. Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano Turin, Italy

    A. M. Priola, S. M. Priola, A. Cataldi, S. Durando & C. Fava

  2. Department of Pharmacy, University of Turin, S. Luigi Gonzaga Hospital, Regione Gonzole 10, 10043, Orbassano Turin, Italy

    M. Di Franco

Authors
  1. A. M. Priola
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. S. M. Priola
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. M. Di Franco
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. Cataldi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. S. Durando
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. C. Fava
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. M. Priola.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Priola, A.M., Priola, S.M., Di Franco, M. et al. Computed tomography and thymoma: distinctive findings in invasive and noninvasive thymoma and predictive features of recurrence. Radiol med 115, 1–21 (2010). https://doi.org/10.1007/s11547-009-0478-3

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11547-009-0478-3

Keywords

Parole chiave

Search

Navigation