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Ann Thorac Surg 2004;78:411-416
© 2004 The Society of Thoracic Surgeons

Original article: general thoracic

Atypical thymoma: A report of seven patients

Johanna L. Baran, BSa, Cynthia M. Magro, MDb, Mark A. King, MDc, Thomas E. Williams, Jr, MD, PhDd, Patrick Ross, Jr, MD, PhDd*

a School of Medicine and Public Health, Columbus, OH, USA
b Department of Pathology, Ohio State University, Columbus, OH, USA
c Division of Diagnostic Radiology, Ohio State University, Columbus, OH, USA
d Division of Cardiothoracic Surgery, Ohio State University, Columbus, Ohio, USA

Accepted for publication December 29, 2003.

* Address reprint requests to Dr Ross, Division of Cardiothoracic Surgery, Ohio State University, N839 Doan Hall, 410 West 10th Ave, Columbus, OH 43210, USA
e-mail: ross-3{at}medctr.osu.edu

BACKGROUND: Most thymic neoplasms fall under the designation of thymoma, consisting of well-differentiated epithelial cells, resembling normal thymus. At the opposite spectrum are thymic carcinomas; the cell of origin while similar is malignant. Recently a third category of thymic neoplasms, atypical thymomas, has been recognized representing thymic neoplasms manifesting atypia although without overt cytomorphologic criteria of malignancy.

METHODS: Seven patients with a diagnosis of atypical thymoma were encountered over a 6-year period from the patient files of the cardiothoracic division of The Ohio State Medical Center.

RESULTS: In all patients there was gross or light microscopic invasive disease with involvement of the capsule, phrenic nerve, diaphragm, chest wall, and lung. Surgical extirpation/de-bulking along with radiation therapy in six and chemotherapy in one led to complete disease regression. Intrathoracic recurrences developed in 4 involving lung, pleura, chest wall and diaphragm. All patients are well.

CONCLUSIONS: Atypical thymomas are locally aggressive tumors with a high incidence of intrathoracic recurrence; extrathoracic spread is not seen. Our study corroborates other reports that death attributable to atypical thymoma is uncommon.






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