Abstract
Micronodular thymic carcinoma with lymphoid hyperplasia (MNTCLH) is a rare form of thymic carcinoma. We present the experience of RYTHMIC, the French national network devoted to the treatment of thymic epithelial tumors through multidisciplinary tumor boards with a review of all tumors by pathologists for classification and staging. Six cases of MNTCLH were diagnosed during a review of 1007 thymic epithelial tumors. Histologically, epithelial cells with atypia and mitoses formed micronodules that were surrounded by an abundant lymphoid background with follicles. There was neither obvious fibro-inflammatory stroma nor necrosis. Spindle cells areas were common. Initial diagnosis was micronodular thymoma in two cases, cellular atypia being overlooked, eclipsed by the micronodular pattern. Immunohistochemistry with a panel of five antibodies showed that cytokeratins (AE1-AE3) and p63-positive epithelial cells also expressed CD5 and that there was no TdT-positive cells within the tumors. CD20 highlighted the lymphoid hyperplasia. Additionally epithelial cells also expressed CD117 and diffusely Glut 1. Twenty-seven micronodular thymomas with lymphoid stroma diagnosed during the same period did not show the CD5 and CD117 positivities seen in MNTCLH and contained TdT-positive lymphocytes. Three of the 6 patients with MNTCLH had adjuvant radiotherapy. Three patients with follow-up information were alive without recurrence at 38, 51, and 95 months. Our study shows that immunohistochemistry, such as that used in the RYTHMIC network with a small panel of antibodies, may easily help to confirm the correct diagnosis of MNTCLH, a rare and low-aggressive form of thymic carcinoma, and avoid the misdiagnosis of micronodular thymoma.
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Acknowledgements
The authors thank the patients, the Institut National du Cancer (INCa) and the Institut français de cancérologie thoracique (IFCT) for their support and the referring clinicians and pathologists and the clinicians of RYTHMIC network. The authors also thank Mrs Stéphanie Grandol, Mrs Pascale Missy, and Mrs Edith Bazeli for their secretarial and technical assistances.
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RYTHMIC network is supported by the Institut National du Cancer (INCa) and by the Institut français de cancérologie thoracique (IFCT).
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Vincent Thomas de Montpreville wrote the paper. Audrey Mansuet-Lupo, Cécile Le Naoures, and Lara Chalabreysse contributed to selection of the cases. Anne De Muret, Véronique Hofman, Isabelle Rouquette, Nicolas Piton, and Romain Dubois reviewed histological documents. Jose Carlos Benitez collected clinical data. Vincent Thomas de Montpreville, Nicolas Girard, Benjamin Besse, Alexander Marx, and Thierry Jo Molina designed the research study.
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This work has been presented as an oral abstract at the 10th International Thymic Malignancy Interest Group Annual Meeting. ITMIG 2019, Niagara-on-the-Lake, Canada, October 10–12, 2019.
This article is part of the Topical Collection on Quality in Pathology
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Thomas de Montpreville, V., Mansuet-Lupo, A., Le Naoures, C. et al. Micronodular thymic carcinoma with lymphoid hyperplasia: relevance of immunohistochemistry with a small panel of antibodies for diagnosis—a RYTHMIC study. Virchows Arch 479, 741–746 (2021). https://doi.org/10.1007/s00428-021-03044-2
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DOI: https://doi.org/10.1007/s00428-021-03044-2