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Thymic Epithelial Tumors and Benign Thymic Lesions

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Mediastinal Lesions

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Abstract

The initial clinical management of mediastinal masses essentially depends on the assumption whether surgery is indicated or not. Thymic masses that are thought to be operable based on imaging studies may not need to be biopsied, if surgery is deemed to be the treatment of choice. However, if nonsurgical therapies (as is the case in lymphomas) or neoadjuvant strategies are options, core needle biopsies may be an invaluable tool to guide therapeutic decisions. Like small biopsies elsewhere, sampling error is also a key problem in the prevascular and visceral mediastinum where it is, however, aggravated by (i) the high degree of microscopic similarity between normal thymus, thymic hyperplasias, T-cell-rich thymomas, and T-lymphoblastic lymphoma; (ii) the common histological heterogeneity across individual type B thymomas; (iii) the striking morphological overlap between spindle cell lesions with thymic epithelial, neuroendocrine, mesenchymal, and dendritic differentiation; (iv) the occurrence of acquired thymic cysts, the development of which is driven by different inflammatory processes and a broad spectrum of mediastinal tumors that may be dwarfed by the cystic process and escape sampling in small biopsies; and (v) reactive epithelial proliferations that can mimic neoplasias. These challenges encountered in small biopsies imply inevitable diagnostic limitations, suggest cautious reporting of diagnoses and argue not only for the thoughtful use of ancillary immunohistological and molecular studies but also for thorough clinicopathological correlation. The below sections on thymic epithelial tumors, various types of thymic hyperplasias and thymic cysts pinpoint diagnostic pitfalls and suggest strategies to avoid them.

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Authors and Affiliations

  1. Department of Pathology, University Medical Centre Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, Mannheim, 68167, Germany

    Alexander Marx & Cleo-Aron Weis

  2. Institute of Pathology, University Medical Center Göttingen, Robert-Koch-Str. 40, 37075, Göttingen, Germany

    Philipp Ströbel

  3. Institute of Pathology, University Hospital Basel, Basel, Switzerland

    Alexandar Tzankov

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  1. Alexander Marx
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  2. Cleo-Aron Weis
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  3. Alexandar Tzankov
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  4. Philipp Ströbel
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Correspondence to Alexander Marx .

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  1. Department of Pathology, Mayo Clinic School of Medicine, Rochester, Minnesota, USA

    Anja C. Roden

  2. Department of Pathology, New York University Langone Medical Center, New York, New York, USA

    Andre L. Moreira

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Marx, A., Weis, CA., Tzankov, A., Ströbel, P. (2017). Thymic Epithelial Tumors and Benign Thymic Lesions. In: Roden, A., Moreira, A. (eds) Mediastinal Lesions. Springer, Cham. https://doi.org/10.1007/978-3-319-48379-5_5

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