Mediastinum (Hong Kong, China)最新文献

{"title":"Oncologic strategies and options for the management of metastatic thymic carcinoma.","authors":"Rohan Maniar, Patrick J Loehrer","doi":"10.21037/med-25-38","DOIUrl":"https://doi.org/10.21037/med-25-38","url":null,"abstract":"<p><p>Thymic carcinoma (TC) is a rare, aggressive subset of thymic epithelial tumors (TETs) with a poor prognosis and limited treatment options. Representing approximately 15-20% of TETs, TC is distinct from thymoma in its histopathologic features, lack of paraneoplastic autoimmune syndromes, and more complex genomic landscape. Surgical resection remains the primary modality for early-stage disease, while platinum-based chemotherapy forms the cornerstone of treatment for advanced or unresectable TC. Advancements in targeted therapies have expanded therapeutic options, resulting in improved clinical efficacy, especially in tumors with high angiogenic activity or specific mutations (e.g., Kit). Immune checkpoint blockade (ICB) has shown activity in TC, with response rates around 20%, and is being explored in combination with chemotherapy, anti-angiogenic agents, and CTLA-4 blockade. Combinatorial strategies have demonstrated enhanced response rates but require vigilant management of immune-related adverse events. Novel therapeutic approaches are emerging, including PRMT5 inhibitors in MTAP-deficient tumors, TROP-2-directed antibody-drug conjugates (e.g., sacituzumab govitecan), and chimeric antigen receptor (CAR) T-cell therapies targeting mesothelin. Bispecific agents such as bintrafusp alfa and ivonescimab, which co-target various pathways, offer innovative strategies. Despite these advances, TC remains a challenging malignancy with no standardized treatment algorithm. Collaborative efforts across institutions will be essential to accelerate progress and improve outcomes in this rare disease.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"11"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071655/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694125","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":"Management of liver metastases secondary to thymic epithelial tumors: a narrative review of current management and future directions.","authors":"Alex J Ma, Erica S Alexander","doi":"10.21037/med-2025-1-50","DOIUrl":"https://doi.org/10.21037/med-2025-1-50","url":null,"abstract":"<p><strong>Background and objective: </strong>Hepatic metastases secondary to thymic epithelial tumors (TETs), encompassing thymomas and thymic carcinomas (TCs), are a rare but clinically meaningful phenomenon and are associated with worse overall survival (OS). Management of liver metastases is largely limited to systemic therapy and chemotherapeutic regimens; although, there are smaller-scale studies in the literature reporting use of more novel treatment regimens and liver-directed therapies. The purpose of this article is to explore management options for TET hepatic metastases, including novel therapeutic options.</p><p><strong>Methods: </strong>A review of the available electronic literature was performed through October 10, 2025, using PubMed and Google Scholar. A single author identified the studies, and both authors reviewed the selection to determine which studies to include.</p><p><strong>Key content and findings: </strong>The literature involving systemic therapy options was much more developed, as this is the first-line treatment option for TET hepatic metastases. Smaller series supporting the use of surgical resection, radiation therapy, and interventional radiology therapies suggest benefit in liver-directed resection and/or therapies.</p><p><strong>Conclusions: </strong>Data evaluating therapeutic options for managing liver metastases secondary to TETs is limited. Given the prognostic implications of these metastatic lesions, a broader understanding of available therapies is essential for determining optimal management.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"1"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071623/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694033","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":"Preclinical and human tracheal replacement with aortic grafts: a narrative review.","authors":"Alain Wurtz, Jérémy Tricard, Pierre Fayoux, Marie-Christine Copin, François Bertin","doi":"10.21037/med-2025-1-55","DOIUrl":"https://doi.org/10.21037/med-2025-1-55","url":null,"abstract":"<p><strong>Background and objective: </strong>Numerous reviews have been published in the field of tracheal replacement. However, most did not differentiate between patch tracheal reconstruction (PTR), non-circumferential tracheal replacement (NCTR), and full-circumferential tracheal replacement (FCTR). This distinction is essential in terms of postoperative mortality. So far, the most widely used tracheal substitutes are the cartilage-reinforced forearm free flap (FFF) and the cryopreserved aortic allograft (CAA), respectively. The aim of our study is to identify and report the results of both preclinical and human use of the aortic grafts in tracheal replacement with a focus on the benefit/risk assessment in clinical practice.</p><p><strong>Methods: </strong>We performed an in-depth literature search with no language restriction (PubMed/MEDLINE) in order to identify articles related to the topic up to September 2025. Articles focused on experimental and human use of aortic grafts for tracheal replacement, including the authors' experience, were selected for the present review and reported in a narrative fashion.</p><p><strong>Key content and findings: </strong>In the setting of preclinical studies, we identified 22 articles and one relevant abstract from 1958 to 2025. In the field of human use, we retrieved 20 articles from 1999 to 2025. From a structural viewpoint, our studies of preclinical and human use of aortic grafts implanted into the trachea show that they transform into flaccid tube-shaped scar tissue that contracts over time around the luminal support up to an average of 60%. Occasionally, the graft is subject to endochondral ossification. In the clinical setting, we highlight the usefulness of aortic allograft in the case of tracheal anastomosis dehiscence. In contrast, due to the significant difference between partial and FCTR with a postoperative mortality rate of 0 <i>vs.</i> 18.9%, we have some reservations about the implementation of the latter procedure, mainly in the field of low-grade radiosensitive malignancies such as adenoid cystic carcinomas (ACCs).</p><p><strong>Conclusions: </strong>Physicians must be aware that the ideal tracheal substitute has not yet been discovered before considering a potential FCTR, mainly in oncology.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"2"},"PeriodicalIF":0.0,"publicationDate":"2026-03-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071635/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694161","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":"Atypical type A thymoma: a narrative review of a distinct and progressive variant of low-risk thymoma.","authors":"Mikito Suzuki, Kazuo Nakagawa","doi":"10.21037/med-2025-1-63","DOIUrl":"https://doi.org/10.21037/med-2025-1-63","url":null,"abstract":"<p><strong>Background and objective: </strong>Atypical type A thymoma is a rare subtype of thymoma recently recognized for its more progressive clinical course and biological behavior, in contrast to the conventionally indolent course and favorable prognosis of conventional type A thymoma. Histologically, atypical type A thymoma retains the spindle or oval epithelial cell morphology of the conventional type, but is characterized by atypical features such as increased mitotic counts, hypercellularity, and focal necrosis, which are generally absent in the conventional type. This review integrates the latest knowledge on clinicopathological features, diagnostic criteria, and treatment.</p><p><strong>Methods: </strong>A literature search was performed using PubMed for articles in English published between January 1990 and July 2025. We included case reports, case series, and original studies with comprehensive clinicopathological and survival data for atypical type A thymomas.</p><p><strong>Key content and findings: </strong>We identified 67 cases of atypical type A thymoma in 16 case reports/series and two original reports that specifically mentioned detailed information for each case. Recurrence was observed in 27.3% of patients, predominantly manifesting as distant metastasis to sites such as the lungs, the rib/chest wall, and brain, a rate notably higher than that observed in conventional type A and AB thymomas. In contrast, the 5-year overall survival (OS) rate was 91.9%, indicating a prognosis closer to that of conventional type A and AB thymomas than to type B2-B3 thymomas. Its proliferative capacity, indicated by a median Ki-67 index of 10-14.5%, is closer to that of type B3 thymoma or thymic carcinoma (TC).</p><p><strong>Conclusions: </strong>Since current studies on metastatic type A thymomas often mix conventional and atypical cases, further case accumulation and the establishment of strict, standardized pathological criteria are crucial for a clearer understanding of this rare but potentially progressive tumor and for refining long-term follow-up and treatment strategies. Moreover, the relationship between metastatic and atypical type A thymomas needs to be clarified.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"4"},"PeriodicalIF":0.0,"publicationDate":"2026-03-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071653/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147693940","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":"Thymectomy or partial thymectomy, that is the question: surgical considerations for early-stage thymic epithelial tumors: a narrative review.","authors":"Koichi Fukumoto, Reo Kondo, Madoka Goto, Shoji Okado, Yasuhisa Ichikawa, Mika Uchiyama, Shoichi Mori","doi":"10.21037/med-2025-1-47","DOIUrl":"https://doi.org/10.21037/med-2025-1-47","url":null,"abstract":"<p><strong>Background and objective: </strong>According to the National Comprehensive Cancer Network (NCCN) and other international guidelines, thymectomy is the standard surgical procedure for early-stage thymic epithelial tumors (TETs). However, the optimal extent of resection remains controversial. Recent evidence suggests that partial thymectomy, which preserves part of the thymus, may achieve outcomes comparable to thymectomy in the short- and long-term. This review aims to compare perioperative and long-term oncologic outcomes between complete and partial thymectomy in early-stage TETs.</p><p><strong>Methods: </strong>We conducted a PubMed search for English-language studies published from January 1, 1980, to July 31, 2025 that reported perioperative and long-term outcomes of patients with early-stage TETs who underwent either thymectomy or partial thymectomy.</p><p><strong>Key content and findings: </strong>Initial single-institution retrospective studies with limited cases were followed by larger multicenter investigations, national database analyses, and two meta-analyses. Partial thymectomy was frequently associated with shorter operative time, less blood loss, and, in some studies, lower complication rates. Short-term survival outcomes were generally similar between the two procedures. Recurrence rates, disease-free survival, and overall survival (OS) were broadly comparable, although some studies indicated slightly better OS with thymectomy in certain subgroups.</p><p><strong>Conclusions: </strong>Based on the currently available retrospective evidence, partial thymectomy may be feasible in carefully selected patients with early-stage thymoma; however, the lack of prospective data precludes definitive conclusions regarding oncologic equivalence. Most existing evidence is based on open approaches, particularly median sternotomy. Whether these findings extend to minimally invasive techniques such as video-assisted thoracoscopic surgery or robot-assisted thoracic surgery remains uncertain. Long-term data beyond 5 years are limited, and evidence regarding thymic malignancies other than thymoma is sparse. Further contemporary studies, particularly of minimally invasive approaches, are needed to clarify the relative benefits of partial thymectomy versus thymectomy.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"3"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071621/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694166","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":"Role of radiotherapy in thymoma and thymic carcinoma: a narrative review.","authors":"Atsuto Katano","doi":"10.21037/med-2025-1-64","DOIUrl":"https://doi.org/10.21037/med-2025-1-64","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic epithelial tumors, comprising thymoma and thymic carcinoma, are rare and heterogeneous neoplasms for which high-level evidence is limited. Radiotherapy is integral across the disease continuum-from postoperative settings to definitive therapy for unresectable tumors and oligometastatic/recurrent disease. This narrative review synthesizes contemporary evidence and guidance on indications, technique, dose prescription, outcomes, and toxicity, with focused discussion of hypofractionation and stereotactic body radiotherapy (SBRT).</p><p><strong>Methods: </strong>A comprehensive PubMed search (1 November 2025) combined MeSH and free-text terms for thymic tumors and radiotherapy without date restriction. English-language human studies of any design were eligible. Titles/abstracts and full texts were screened independently by the author; reference lists of key studies and recent reviews were hand-searched to ensure completeness.</p><p><strong>Key content and findings: </strong>For completely resected early-stage thymoma, surgery alone often suffices, whereas postoperative radiotherapy (PORT) is generally favored for positive margins (R1/R2), advanced stages (III-IV) and unfavorable pathological finding. Meta-analyses increasingly suggest overall survival benefit from PORT in stage III-IV thymoma and in thymic carcinoma, with more variable findings for stage II disease. In thymic carcinoma, multi-institutional series demonstrate a clearer association between PORT and improved survival. For unresectable disease, concurrent chemoradiation using modern conformal techniques achieves high response rates and meaningful survival. Dose recommendations across international guidelines converge on 45-50 Gy (R0), 50-54 Gy (R1), and 60-70 Gy (R2), with elective nodal irradiation generally discouraged.</p><p><strong>Conclusions: </strong>Current data support PORT for high-risk features and thymic carcinoma, definitive chemoradiation for unresectable disease, and carefully selected use of hypofractionation/SBRT for limited recurrences. Priorities include randomized evaluation of PORT in borderline settings, harmonized reporting of toxicity and quality of life, and prospective study of modality selection to optimize cure while minimizing late effects.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"5"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071613/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694205","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":"Prognostic and predictive biomarkers in thymic epithelial tumors: beyond traditional staging: a narrative review.","authors":"Luis Cabezón-Gutiérrez, Vilma Pacheco-Barcia, Sara Custodio-Cabello, Magda Palka-Kotlowska, Lucía Sanz-Gómez, David Díaz-Pérez, Beatriz Chacón-Ovejero","doi":"10.21037/med-25-44","DOIUrl":"https://doi.org/10.21037/med-25-44","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic epithelial tumors (TETs), encompassing thymomas (TMs) and thymic carcinomas (TCs), are rare and heterogeneous mediastinal malignancies with variable clinical behaviors and prognoses. Current prognostic assessment primarily relies on histological classification (WHO) and anatomical staging systems (Masaoka-Koga, TNM). However, the rarity and complex biology of TETs necessitate the identification of novel prognostic and predictive biomarkers to improve risk stratification and guide personalized treatment strategies. This narrative review aims to summarize and discuss emerging prognostic and predictive biomarkers in TETs beyond traditional staging systems.</p><p><strong>Methods: </strong>For this narrative review, we searched EMBASE and MEDLINE up to 4 September 2025. The terms used in the search included TM, TC, TETs, prognosis and predictive biomarkers.</p><p><strong>Key content and findings: </strong>Traditional staging systems (Masaoka-Koga, TNM) and histological classification retain strong prognostic value. Clinical factors (including age, resection status, and lymph node involvement) further refine risk stratification. Molecular markers such as programmed death-ligand 1 (PD-L1) expression, tumor mutational burden (TMB), DNA methylation profiles, Hippo pathway components, and Ki-67 show promise as prognostic and/or predictive biomarkers, although prospective validation remains limited. Predictive biomarkers for immunotherapy and targeted agents are under active investigation, with preliminary evidence supporting the role of TMB, PD-L1 expression, and c-kit mutations.</p><p><strong>Conclusions: </strong>Prognosis in TETs relies primarily on histology and staging, whereas molecular and immunological biomarkers represent emerging tools for risk stratification and treatment selection. Multiparametric models integrating clinical, pathological, and molecular data may pave the way for precision oncology in TETs.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"9"},"PeriodicalIF":0.0,"publicationDate":"2026-03-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071634/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694182","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":"Classification of mediastinal compartments: is separation of the superior mediastinum crucial?-a clinical practice review.","authors":"Takao Nakanishi","doi":"10.21037/med-2025-1-56","DOIUrl":"https://doi.org/10.21037/med-2025-1-56","url":null,"abstract":"<p><p>The division of the mediastinum into specific compartments is essential for identifying, characterizing, and managing mediastinal abnormalities. The current international standard is the three-compartment model proposed by the International Thymic Malignancy Interest Group (ITMIG), which divides the mediastinum into prevascular (anterior), visceral (middle), and paravertebral (posterior) compartments. This model has replaced the traditional four-compartment system, which included the superior mediastinum, due to its simplicity, familiarity, and clearly defined boundaries. However, given the superior mediastinum's unique anatomy and distinct pathology, it remains clinically reasonable to consider it separately. Continued clinical use of the term \"superior mediastinum\" has produced numerous conflicting definitions, while the Japanese Association for Research on the Thymus (JART) has recently proposed a computed tomography (CT)-based four-compartment model. Disease distribution in the superior mediastinum is dominated by thyroid goiters and neurogenic tumors, while the incidence of thymic epithelial tumors (TETs) in this region varies among studies. Surgery in the superior mediastinum is challenging due to its narrow space and the presence of major blood vessels and nerves. Operative complications frequently include Horner's syndrome. Furthermore, studies suggest that superior mediastinal thymomas may demonstrate more aggressive behavior and lower survival rates than thymomas in other locations. Establishing a clear, standardized definition of the superior mediastinum would resolve current inconsistencies and facilitate the accumulation of detailed clinical data on superior mediastinal lesions. This article focuses on the superior mediastinum and discusses its classification, clinical features, surgical approaches, treatment outcomes, and future perspectives.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"7"},"PeriodicalIF":0.0,"publicationDate":"2026-03-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071627/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694054","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 parathyroid adenoma: diagnostic and therapeutic challenges.","authors":"Wei Ting Chan, Diluka Pinto, Rajeev Parameswaran","doi":"10.21037/med-2025-1-57","DOIUrl":"https://doi.org/10.21037/med-2025-1-57","url":null,"abstract":"<p><p>Mediastinal parathyroid adenomas (MPAs) represent an uncommon but clinically important cause of persistent or recurrent primary hyperparathyroidism. Though most cases of sporadic primary hyperparathyroidism are due to a parathyroid adenoma in the cervical area; ectopic glands account for a fifth of cases, with only 1-2% situated in the mediastinum. Aberrant embryological descent of the inferior parathyroid glands along the thymic descent pathway gives rise to MPAs, with variable locations within the anterior or posterior mediastinum. The anatomical variability, coupled with limited accessibility is a major contributor to diagnostic uncertainty and surgical failure, especially in reoperative cases. Accurate preoperative localization using multimodal imaging is essential for optimal management of the condition. Whilst the dual modalities of imaging, namely the ultrasound scan and technetium-99m sestamibi scintigraphy are useful in cervical lesions, the sensitivity of picking up adenomas especially the small and cystic lesions in the mediastinum is quite low. Four-dimensional computed tomography (4D-CT) provides high spatial resolution and characteristic enhancement kinetics that are particularly useful in ectopic or reoperative settings, albeit at the cost of higher radiation exposure. Positron emission tomography/computed tomography (PET-CT) using 18F-fluorocholine demonstrates high sensitivity in negative or discordant first-line imaging and is increasingly adopted where available. Where non-invasive modalities fail, invasive techniques like selective venous sampling may localize mediastinal lesions but requires expertise and careful interpretation of variant venous drainage. Intervention with surgical excision via the cervical approach is possible when the MPAs are located above the innominate vein. Historically the deeper locations required access with sternotomy or thoracotomy, but with the advent of minimally invasive thoracic approaches, higher cure rates with minimal morbidity are possible, coupled with adjuncts such as intraoperative parathyroid hormone monitoring (IOPTH) and fluorescence techniques. Ongoing challenges include discordant imaging, multiglandular disease, resource limitations, and reoperative complexity, underscoring the need for stepwise imaging escalation and multidisciplinary approach to optimize outcomes.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"8"},"PeriodicalIF":0.0,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071630/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694093","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":"Immune dysregulation in thymoma: a potential mechanistic link to secondary lung cancer-a case report.","authors":"Sameh Taki-Aldin, Yahya Alwatari, Lauren Pomerantz, Mohamed Shanshal","doi":"10.21037/med-25-43","DOIUrl":"https://doi.org/10.21037/med-25-43","url":null,"abstract":"<p><strong>Background: </strong>Thymoma is a rare mediastinal neoplasm derived from thymic epithelial cells and is frequently associated with paraneoplastic autoimmune syndromes. Beyond these classical manifestations, thymomas can induce chronic systemic inflammation through impaired central tolerance, cytokine release, and immune dysregulation. This inflammatory microenvironment has been increasingly recognized as a potential contributor to secondary malignancies, although reports remain scarce.</p><p><strong>Case description: </strong>We report a 71-year-old male with a significant smoking history who was diagnosed with non-small cell lung carcinoma (NSCLC), adenocarcinoma subtype, harboring an ERBB2 mutation and programmed death ligand 1 (PD-L1) expression of 0%. Staging studies revealed a small anterior mediastinal mass initially interpreted as a metastatic lesion from NSCLC. However, biopsy performed for staging purposes demonstrated type A thymoma. Histology demonstrated spindle-shaped epithelial cells (AE1/AE3⁺, p40⁺) within a background rich in CD3⁺ T-cells, terminal deoxynucleotidyl transferase (TdT)⁺ and CD1a⁺ immature thymocytes, and CD20⁺ B-cell aggregates. The patient developed spontaneous acute pericarditis with elevated inflammatory markers, while infectious and autoimmune causes were excluded. Flow cytometry and T-cell receptor (TCR) gene rearrangement studies were negative, indicating unexplained inflammation in the context of thymoma. We hypothesize that thymoma-associated immune dysregulation contributed to lung carcinogenesis through cytokine-driven inflammation and impaired autoimmune regulator (AIRE)-mediated central tolerance, leading to reduced tumor immunosurveillance. Prior reports describing elevated pro-inflammatory cytokines in thymic lesions and lung cancer support the concept of a paracrine inflammatory niche.</p><p><strong>Conclusions: </strong>This case highlights a potential mechanistic link between thymic-associated immune dysregulation, chronic inflammation, and secondary malignancies. Recognition of this relationship is important for clinical management, long-term surveillance, and therapeutic decision-making in patients with thymoma. Future studies are warranted to further define the oncogenic consequences of thymic dysfunction and its implications for cancer development.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"15"},"PeriodicalIF":0.0,"publicationDate":"2026-03-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071622/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694081","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}