Mediastinum (Hong Kong, China)最新文献

{"title":"Histologic features, growth patterns and classification of atypical thymomas.","authors":"David I Suster, Saul Suster","doi":"10.21037/med-25-15","DOIUrl":"10.21037/med-25-15","url":null,"abstract":"<p><p>Atypical thymomas are a rare form of primary thymic epithelial neoplasm that are characterized by conservation of most of the organotypical features of thymic differentiation, but show atypical cytological features. The spectrum of histologic features and growth patterns these tumors can exhibit have not been extensively documented or illustrated in the literature. The basic histologic growth patterns seen in atypical thymomas include the epithelioid or \"Squamoid\" subtype and the spindle cell subtype. The histologic picture may often be confused with thymic carcinomas or metastatic disease, in particular squamous cell carcinoma due to the overlap in histologic features. In addition, these subtypes may be seen in combination with each other or in combination with conventional types of thymoma including type A, type AB, type B1 and type B2. Cases of thymic carcinoma arising from atypical thymoma have also been documented in the literature. The biologic behavior of atypical thymomas is intermediate between conventional thymoma and thymic carcinoma. The tumors tend to present with aggressive behavior and an increased rate of metastasis and thus achieving the correct diagnosis is of utmost importance. We present a review of the various morphologic appearances of these tumors to emphasize the wide spectrum of histologic features that they can display, with a discussion of the current nomenclature and approach to these neoplasms.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"20"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260955/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Surveillance of thymic epithelial tumors (TETs)-a narrative review.","authors":"Giye Choe, Nassrene Elmadhun","doi":"10.21037/med-25-20","DOIUrl":"10.21037/med-25-20","url":null,"abstract":"<p><strong>Background and objective: </strong>Surveillance after thymic epithelial tumors (TETs) is widely recommended yet poorly studied. While this is not a situation unique to TETs, we seek to evaluate the rational of surveillance after treatment of TETs and summarize current available guidelines.</p><p><strong>Methods: </strong>A literature review was conducted in PubMed/MEDLINE and Google Scholar databases. Articles were included if they discussed the following: (I) the epidemiology and natural history of TETs; (II) the diagnosis of recurrent TETs; (III) the treatment and outcomes of recurrent TETs; (IV) current available guidelines for surveillance or follow-up after treatment of TETs.</p><p><strong>Key content and findings: </strong>TETs are rare group of neoplasms that include thymoma, thymic carcinoma and neuroendocrine neoplasms. Thymomas have excellent overall survival but can recur over longer periods of time compared to other malignancies. Thymic carcinoma and neuroendocrine neoplasms have less favorable outcomes but still have prolonged survival even at advanced stages. Moreover, recurrence tends to be asymptomatic and localized to the chest and pleura, making it amenable to local treatments such as surgery and/or radiation. As such, TETs may be positioned to benefit from surveillance but also present unique challenges regarding surveillance. There are no prospective studies addressing surveillance in TETs, but at least 5 guidelines have made recommendations that mostly recommend computed tomography (CT) of the chest in variable frequencies and durations. Most agree that the duration for thymoma surveillance should be 10 years or longer. Thymic malignancies are frequently associated with paraneoplastic syndromes which can be a symptom of recurrence, and knowledge of these disorders should be a component of surveillance.</p><p><strong>Conclusions: </strong>Surveillance after treatment for TETs is felt to be beneficial, but there is a paucity of evidence directly studying this. Currently available guidelines do offer some direction based on expert opinion. Given the rare occurrence of TETs and recurrences after treatment, pooling of data such as the International Thymic Malignancy Interest Group (ITMIG) database to study follow up will be necessary to develop more effective surveillance strategies.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"18"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260953/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644317","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Mediastinal restaging in non-small cell lung cancer: comparing endobronchial ultrasound-guided transbronchial needle aspiration and mediastinal cryobiopsy following neoadjuvant therapy.","authors":"Miguel Ariza-Prota, Javier Pérez-Pallarés, Lucía García Alfonso, Lanza Martínez Angela, Héctor Torres-Rivas, Luis Fernández-Fernández, María de la Paz González Gutiérrez, Mario Berríos-Hernández, Marta García-Clemente, Francisco López-González","doi":"10.21037/med-25-11","DOIUrl":"10.21037/med-25-11","url":null,"abstract":"<p><strong>Background: </strong>Accurate mediastinal restaging in patients with non-small cell lung cancer (NSCLC) following neoadjuvant therapy is crucial for treatment planning. Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA), the standard technique, has limitations such as low diagnostic yield and false negatives, often requiring invasive mediastinoscopy. This study evaluates the performance of endobronchial ultrasound-guided transbronchial mediastinal cryobiopsy (EBUS-TMC) as a potential alternative to EBUS-TBNA in mediastinal restaging following neoadjuvant therapy. This study compares the diagnostic accuracy of EBUS-TBNA and EBUS-TMC, specifically focusing on diagnostic yield, false-negative rates, sample adequacy for molecular and immunohistochemical analyses, as well as the potential need for mediastinoscopy.</p><p><strong>Methods: </strong>This prospective study was conducted on 22 NSCLC patients undergoing mediastinal restaging after neoadjuvant therapy from September 2023 to October 2024. Each patient underwent both EBUS-TBNA and EBUS-TMC in the same procedure. Mediastinoscopy was performed only in cases where both EBUS-TBNA and EBUS-TMC results were negative or non-diagnostic, serving as the reference standard.</p><p><strong>Results: </strong>EBUS-TMC demonstrated superior diagnostic sensitivity (95.45% <i>vs.</i> 63.63%) and achieved sample adequacy for molecular and immunohistochemical analysis in 94.11% of cases compared to 29.41% for EBUS-TBNA. EBUS-TMC identified six additional malignancy cases and had fewer non-diagnostic results (4.5% <i>vs.</i> 22.7%). No complications were reported for any procedure, and mediastinoscopy confirmed all negative EBUS-TMC cases as true negatives.</p><p><strong>Conclusions: </strong>EBUS-TMC significantly improves diagnostic accuracy and sample adequacy for restaging NSCLC following neoadjuvant therapy, reducing the need for mediastinoscopy. Its integration into clinical practice could enhance patient outcomes, lower healthcare costs, and support personalized treatment strategies. This is the first study to demonstrate EBUS-TMC's transformative potential in thoracic oncology.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260948/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644269","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative review of the prognostic significance of primary tumor size in thymic epithelial tumor.","authors":"Asato Hashinokuchi, Shinkichi Takamori, Tomoyoshi Takenaka, Tomoharu Yoshizumi, Takefumi Komiya","doi":"10.21037/med-25-3","DOIUrl":"10.21037/med-25-3","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic epithelial tumors (TETs) are the most common mediastinal neoplasms and include thymomas, thymic carcinomas, and thymic neuroendocrine neoplasms (TNENs). The staging system of TETs has been based on the Masaoka-Koga system or the 8th edition of the TNM classification, which does not consider tumor size as a T descriptor. The 9th edition of the TNM classification was released in January 2025, and tumor size was incorporated, with the T1 category subdivided into T1a (≤5 cm) and T1b (>5 cm). Thus, the clinical importance of tumor size in TETs has attracted increasing attention. This review summarizes previous reports focusing on tumor size as a prognostic factor for TETs and highlights the association between tumor size, prognosis, and clinicopathological features of TETs.</p><p><strong>Methods: </strong>The literature search was performed using PubMed for the narrative review. Eligible articles were published in English between January 1, 2004 and December 1, 2024.</p><p><strong>Key content and findings: </strong>We identified 35 articles investigating the effect of TET tumor size. Tumor size assessed using surgical specimens was a useful predictor for prognosis in all stages of thymomas. A large tumor size was associated with tumor invasion into adjacent tissues, which contributes to advanced-stage disease and incomplete resection. Thus, large tumor size was shown to be related to a high recurrence rate and poor prognosis. In addition, tumor size had a strong prognostic impact in patients with early-stage thymoma. Consistent with the evaluation of surgical specimens, preoperative assessment of tumor size using computed tomography also contributed to the postoperative prognosis. Furthermore, evaluation of tumor size may help determine treatment strategies, such as surgical approaches and adjuvant radiotherapy. However, the prognostic role of tumor size in thymic carcinoma and TNENs was unclear because of their rarity.</p><p><strong>Conclusions: </strong>Primary tumor size was identified as an important prognostic factor in patients with thymoma. However, the significance of thymic carcinoma or TNEN remains unclear. Further prospective large-scale studies are warranted to investigate the clinical significance of tumor size in TETs.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260957/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644270","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Thymic hyperplasia in myasthenia gravis: a narrative review.","authors":"Patricia M Sikorski, Henry J Kaminski, Linda L Kusner","doi":"10.21037/med-25-12","DOIUrl":"10.21037/med-25-12","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic pathology is observed in approximately 80% of patients with acetylcholine receptor antibody-positive myasthenia gravis (AChR-MG). Among these thymic abnormalities, thymic follicular hyperplasia (TFH) is commonly associated with early-onset MG (EOMG). TFH is characterized by the presence of lymphoid follicles and germinal center (GC) formation, which are closely linked with the breakdown of tolerance to the AChR. GCs promote the development of autoreactive plasma cells that secrete autoantibodies against the AChR, contributing to the disease pathology. In this review, we examine current knowledge on thymic pathology in EOMG, immunological and environmental factors contributing to the development of thymic hyperplasia and highlight avenues for future research.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed without restriction on publication date. Articles were included if they discussed the function of the thymus, thymic pathology in MG, thymic hyperplasia in EOMG, or focused on cellular or molecular mechanisms associated with TFH in EOMG.</p><p><strong>Key content and findings: </strong>TFH is a hallmark of EOMG, characterized by GC formation and intrathymic production of AChR autoantibodies. The hyperplastic thymus exhibits heightened interferon (IFN) signaling, toll-like receptor (TLR) activation, altered chemokine expression, accumulation of B and T cells, and expression of AChR by thymic epithelial cells, creating a pro-autoimmune environment. Sex-related differences, particularly estrogen's effects on autoimmune regulator gene (AIRE) expression and immune tolerance, may contribute to the female predominance in EOMG. Emerging technologies such as single-cell and spatial transcriptomics, along with thymic organoid models, offer new avenues to study the mechanisms driving TFH.</p><p><strong>Conclusions: </strong>TFH reflects the convergence of immune dysregulation and structural abnormalities that together promote the loss of tolerance in EOMG. The interindividual variability in thymic pathology and treatment response underscores the need for more personalized therapeutic strategies. Advances in high-resolution profiling and experimental modeling will be essential to uncover the underlying drivers of thymic hyperplasia and to guide the development of targeted therapies for MG.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"17"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260958/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644318","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Intraoperative complications during robotic thymectomy and their management: a narrative review.","authors":"Natacha Wathieu, Hana Ajouz, Abbas E Abbas","doi":"10.21037/med-24-43","DOIUrl":"10.21037/med-24-43","url":null,"abstract":"<p><strong>Background and objective: </strong>Complete thymectomy is the established treatment for thymic epithelial tumors (TET) and often included in the management of myasthenia gravis. Minimally invasive approaches, including robotic-assisted techniques, have gained acceptance for their benefits in reducing postoperative pain and recovery time. Thymectomy poses risks due to the proximity of the thymus to critical mediastinal structures, and intraoperative complications confronted on the robotic platform can be precarious. Current literature on intraoperative complications is fragmented and limited, and lacks emphasis on the nuance brought about by the robotic platform specifically. The aim of this narrative review is to comprehensively explore such possible complications and to discuss their distinct management strategies in a systematic manner.</p><p><strong>Methods: </strong>We review the literature by examining the PubMed database between 2000 and 2024 for relevant studies that report the intraoperative and postoperative complications of robotic thymectomy. The technique of robotic thymectomy is also described.</p><p><strong>Key content and findings: </strong>Robotic thymectomy offers a safe and oncologically effective approach to treatment. It is met with a low complication rate that is not increased compared to the open approach. Common complications include injury to nearby structures such as the internal mammary vessels, brachiocephalic vein (BCV), superior vena cava (SVC), phrenic nerve, and recurrent laryngeal nerve. Each complication requires a distinct management strategy that is concordant with an understanding of the limitations of the robotic platform.</p><p><strong>Conclusions: </strong>This narrative review focuses on the intraoperative complications encountered during robotic thymectomy and provides an in-depth review of strategies for managing these complications, emphasizing the importance of preoperative planning, understanding the robotic platform's limitations, and the need for a well-coordinated surgical team. Reviewing the complexity of such complications and their nuanced management strategies is not only beneficial for surgeons in their clinical practice, but also to develop scientific curiosities surrounding this topic to ultimately improve patient outcomes. As such, studies elaborating on the details of such complications while on the robotic platform are necessary.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"19"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260964/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644268","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Phrenic nerve reconstruction after combined resection in malignant tumors: a narrative review.","authors":"Yosuke Hamada, Sakashi Fujimori, Souichiro Suzuki, Takahiro Karasaki, Shinichiro Kikunaga, Shusei Mihara","doi":"10.21037/med-25-9","DOIUrl":"10.21037/med-25-9","url":null,"abstract":"<p><strong>Background and objective: </strong>Phrenic nerve resection is sometimes necessary during tumor removal when the nerve is infiltrated by malignancies. However, this can result in diaphragmatic paralysis and respiratory insufficiency. While mechanical ventilation and diaphragmatic pacing may temporarily support respiratory function, phrenic nerve reconstruction offers a potential long-term solution. Nevertheless, its use during tumor resection remains underreported. This review assesses current evidence on phrenic nerve reconstruction, focusing on surgical techniques, nerve graft selection, and the feasibility of minimally invasive approaches.</p><p><strong>Methods: </strong>A literature search was conducted in PubMed for phrenic nerve reconstruction studies. English-language studies published between January 1, 1980 and January 30, 2025, that focused on immediate phrenic nerve reconstruction following tumor resection were included in the review.</p><p><strong>Key content and findings: </strong>Phrenic nerve reconstruction can be performed either immediately after nerve resection or as a delayed procedure. Immediate reconstruction, especially when conducted concurrently with tumor resection, has been shown to promote optimal nerve regeneration and functional recovery. In contrast, delayed reconstruction is generally associated with greater technical challenges and less predictable outcomes. Direct anastomosis is preferable when feasible; however, nerve grafting is often required due to insufficient residual nerve length to achieve a tension-free repair. Among graft options, the intercostal nerve is favorable due to its anatomical proximity and minimal additional surgical burden, whereas the use of other nerves, such as the sural nerve, requires an additional incision at a separate site, which may be less desirable. Successful reconstruction can also be achieved using minimally invasive approaches such as video-assisted thoracoscopic surgery (VATS) and robotic-assisted thoracoscopic surgery (RATS). Notably, the additional time required for reconstruction in minimally invasive procedures is manageable and does not significantly affect patient outcomes.</p><p><strong>Conclusions: </strong>Immediate phrenic nerve reconstruction, either by direct suturing or intercostal nerve grafting, is a feasible and effective method for preserving respiratory function. The ability to perform reconstruction using minimally invasive techniques further supports its clinical adoption. Given its advantages in functional recovery and its relatively low additional surgical burden, phrenic nerve resection followed by immediate reconstruction may be considered in most cases involving phrenic nerve invasion.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260954/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644316","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Complete pathologic response after concomitant pembrolizumab and radiotherapy in a patient with pretreated metastatic thymic carcinoma: a case report.","authors":"Paolo Mendogni, Riccardo Orlandi, Gilbert Spizzo, Domenico Damiani, Martin Maffei, Giorgio Alberto Croci, Davide Tosi","doi":"10.21037/med-25-16","DOIUrl":"10.21037/med-25-16","url":null,"abstract":"<p><strong>Background: </strong>Thymic carcinoma (TC) is a rare and aggressive malignancy, accounting for approximately 6% of thymic neoplasms. Due to its frequent late-stage diagnosis and poor prognosis, standard treatment typically involves multimodal therapy, including platinum-based chemotherapy, radiotherapy, and surgery. However, effective treatment options remain limited, with response rates being unsatisfactory. Recent studies have highlighted the potential of immune checkpoint inhibitors (ICIs) in treating thymic epithelial tumors, particularly in tumors with high programmed cell death ligand 1 (PD-L1) expression. Despite this, the role of ICIs in TC is still under investigation, and further research is needed to assess their efficacy and safety in clinical practice.</p><p><strong>Case description: </strong>We present the case of a 31-year-old male diagnosed with stage IVA squamous TC. Following disease progression after first-line chemotherapy with paclitaxel, carboplatin, and ramucirumab as part of the RELEVENT phase II trial, PD-L1 assessment revealed an 85% expression, leading to the initiation of off-label pembrolizumab (200 mg every 3 weeks). The patient subsequently developed oligoprogression with local sternal infiltration, prompting the addition of radiotherapy (10×3 Gy) alongside continued pembrolizumab. Over the following months, imaging demonstrated progressive response to treatment, culminating in a near-complete metabolic response. A residual mediastinal lesion was later surgically resected, revealing no viable tumor cells, indicative of a complete pathological response. Nine months after surgery, the patient is disease-free, with no reported immune-related adverse events.</p><p><strong>Conclusions: </strong>This case highlights the potential of immune checkpoint inhibition combined with radiotherapy and surgery in the management of advanced TC. The patient's complete pathologic remission underscores the importance of a multidisciplinary approach. Further studies are warranted to establish ICIs as a standard treatment and optimize patient selection while mitigating immune-related toxicities.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"21"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260952/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644264","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hyperthermic intrathoracic chemotherapy (HITHOC) in stage IVA thymomas: a narrative review.","authors":"Paolo Mendogni, Riccardo Orlandi, Marcello Ambrogi, Marco Lucchi, Filippo Lococo, Enrico Ruffini, Stefano Margaritora, Dirk Van Raemdonck, Tom Vandaele, Laurens J Ceulemans, Lorenzo Rosso","doi":"10.21037/med-25-8","DOIUrl":"10.21037/med-25-8","url":null,"abstract":"<p><strong>Background and objective: </strong>While surgery remains a cornerstone of thymoma treatment, its role as a standalone therapy is limited in ensuring adequate local disease control, particularly in cases involving serous dissemination or recurrence. For disseminated disease, various multidisciplinary approaches have been explored, including systemic chemotherapy and radiotherapy, either as standalone treatments or in combination with surgery. The efficacy is unsatisfactory, and the management is anything but standardized. However, recently, a promising technique has been introduced within the therapeutic algorithm of advanced stage thymomas: the hyperthermic intrathoracic chemotherapy (HITHOC) as an adjunct to surgery. By combining cytoreductive surgery with localized heated chemotherapy perfusion, HITHOC may help in treating residual disease, providing a targeted approach to pleural dissemination. HITHOC has demonstrated efficacy in managing stage IVA thymomas and thymoma-related pleural recurrences, establishing itself as a potential critical component of modern multimodal treatment strategies. This narrative review aims at providing a detailed examination of the mechanisms, indications, procedural aspects, and outcomes of HITHOC in pleural localization of thymomas, as well as its future potential in thoracic oncology.</p><p><strong>Methods: </strong>A literature search was performed using the MEDLINE and Google Scholar databases, including original full-length articles, meta-analyses, review articles, and case reports published up to January 2025.</p><p><strong>Key content and findings: </strong>HITHOC has been developed as an adjunct to macroscopic radical pleural tumor resection. By enhancing local tumor control and lowering recurrence rates, HITHOC provides a valuable addition to the multimodal treatment of advanced thymomas.</p><p><strong>Conclusions: </strong>HITHOC may represent a promising approach in the treatment of advanced thymomas with pleural dissemination. By combining cytoreductive surgery with localized hyperthermic chemotherapy, it may address the limitations of conventional therapies, potentially offering improved local disease control and survival.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"16"},"PeriodicalIF":0.0,"publicationDate":"2025-06-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260944/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644267","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Narrative review: this or that?-uncommon challenges in mediastinal pathology.","authors":"Jose G Mantilla, Andre L Moreira","doi":"10.21037/med-25-13","DOIUrl":"10.21037/med-25-13","url":null,"abstract":"<p><strong>Background and objective: </strong>Accurate diagnosis of mediastinal tumors is of critical importance to establish appropriate therapy. However, these lesions are relatively uncommon and may be challenging to evaluate, particularly in small biopsy specimens. Thymomas and thymic carcinomas are the most common primary malignant tumors of the mediastinum, but the site can be affected by many other neoplasms that can pose significant difficulty in diagnosis. The objective of this article is to bring awareness to these rarer tumors and offer a diagnostic approach using ancillary techniques guided by clinical and morphological features.</p><p><strong>Methods: </strong>We discuss and review six challenging cases of mediastinal tumors with overlapping morphologic features. We discuss their unique morphologic, immunophenotypic, and relevant molecular characteristics to support their definitive diagnosis, based on current literature. Sources were obtained via PubMed search and include original studies and review articles published in the English language between 1990 and 2025. Search terms include the diagnostic entities discussed in the article.</p><p><strong>Key content and findings: </strong>Judicious use of immunohistochemistry and molecular studies is necessary to accurately diagnose mediastinal neoplasms with overlapping histologic features, such as those seen in the cases discussed.</p><p><strong>Conclusions: </strong>Diagnosis of uncommon mediastinal lesions may be challenging, particularly in small biopsies, as morphological features may be shared among different entities. Awareness of these rare entities, their clinical characteristics and presentation, and differential diagnosis can guide in the selection of appropriate immunohistochemical panels, molecular markers, and molecular diagnostics when appropriate to support the diagnoses.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2025-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12260956/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144644315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}