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)

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.

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
  • 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
  • 3 Wilkins E W. Thymoma. In: Pearson FG, Deslauriers J, Ginsberg RJ, et al Thoracic Surgery. New York; Churchill Livingstone Publishers 1995: 1419-1427
  • 4 Morgenthaler T I, Brown L R, Colby T V et al.. Thymoma.  Mayo Clin Proc. 1993;  68 1110-1123
  • 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
  • 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
  • 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
  • 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
  • 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
  • 10 Cumming W JK, Hudgeson P. The role of plasmapheresis in preparing patients with myasthenia for thymectomy.  Muscle Nerve. 1986;  9 S155-S158
  • 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
  • 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
  • 13 Kubota K, Yamada S, Kondo T et al.. PET imaging of primary mediastinal tumours.  Br J Cancer. 1996;  73 882-886
  • 14 Maggi G, Casadio C, Cavallo A et al.. Thymoma: results of 241 operated cases.  Ann Thorac Surg. 1991;  51 152-156
  • 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
  • 16 Bernatz P E, Harrison E G, Clagett O T. Thymoma: a clinicopathologic study.  J West Soc Periodontol Periodontal Abstr. 1961;  42 424-444
  • 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
  • 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
  • 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
  • 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
  • 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
  • 22 Masaoka A, Yamakawa Y, Niwa H et al.. Thymectomy and malignancy.  Eur J Cardiothorac Surg. 1994;  8 251-253
  • 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
  • 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
  • 25 Port J L, Ginsberg R J. Surgery for thymoma.  Chest Surg Clin N Am. 2001;  11 421-437
  • 26 Kaiser L R. Thymoma. The use of minimally invasive resection techniques.  Chest Surg Clin N Am. 1994;  4 185-194
  • 27 Roviaro G, Rebuffat C, Varonli F et al.. Videothoracoscopic excision of mediastinal masses: indications and techniques.  Ann Thorac Surg. 1994;  58 1679-1684
  • 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
  • 29 Acuff T E, Mack M J, Ryan W H et al.. Thoracoscopic thymoma resection.  Ann Thorac Surg. 1993;  55 562-563
  • 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
  • 31 Pollack A, Komaki R, Cox J D et al.. Thymoma: treatment and prognosis.  Int J Radiat Oncol Biol Physiol. 1992;  23 1037-1043
  • 32 Ogawa K, Uno T, Toita T et al.. Postoperative radiotherapy for patients with completely resected thymoma.  Cancer. 2002;  94 1405-1413
  • 33 Haniuda M, Morimoto M, Nishimura H et al.. Adjuvant radiotherapy after complete resection of thymoma.  Ann Thorac Surg. 1992;  54 311-315
  • 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
  • 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
  • 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
  • 37 Thomas C R, Wright C D, Loehrer P J. Thymoma: state of the art.  J Clin Oncol. 1999;  17 2280-2289
  • 38 Macchiarini P, Chella A, Ducci F et al.. Neoadjuvant chemotherapy, surgery and postoperative radiation therapy for invasive thymoma.  Cancer. 1991;  68 706-713
  • 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
  • 40 Rea F, Sartori F, Loy M et al.. Chemotherapy and operation for invasive thymoma.  J Thorac Cardiovasc Surg. 1993;  106 543-549
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 49 Kohman L J. Controversies in the management of malignant thymoma.  Chest. 1997;  112 296S-300S
  • 50 Regnard J F, Zinzindohoue F, Magdeleinat P et al.. Results of re-resection for recurrent thymomas.  Ann Thorac Surg. 1997;  64 1593-1598
  • 51 Kirschner P A. Reoperation for thymoma: report of 23 cases.  Ann Thorac Surg. 1990;  49 550-555
  • 52 Park H S, Shin D M, Lee J S et al.. Thymoma. A retrospective study of 87 cases.  Cancer. 1994;  73 2491-2498
  • 53 Fornasiero A, Daniele O, Ghiotto C et al.. Chemotherapy for invasive thymoma. A 13-year experience.  Cancer. 1991;  68 30-33
  • 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
  • 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
  • 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
  • 57 Park H S, Shin D M, Lee J S et al.. Thymoma: a retrospective study of 87 cases.  Cancer. 1994;  73 2491-2498
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 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
  • 66 Welsh J S, Wilkins K B, Green R et al.. Association between thymoma and second neoplasms.  JAMA. 2000;  283 1142-1143

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