Mediastinum (Hong Kong, China)最新文献

{"title":"Is it time to complete the transition from Masaoka-Koga to TNM in thymic tumors?-the con perspective.","authors":"Annemarie Shepherd","doi":"10.21037/med-2026-1-0010","DOIUrl":"10.21037/med-2026-1-0010","url":null,"abstract":"","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"45"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589325/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009440","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 tracheostomy: techniques, outcomes and quality of life-a systematic review.","authors":"Jonas Peter Ehrsam, Ana-Maria Petrone, Marko Aleksic, Paul Christian Fuchs, Steffen Maune, Theresa Stork, Stéphane Collaud","doi":"10.21037/med-2026-0022","DOIUrl":"10.21037/med-2026-0022","url":null,"abstract":"<p><strong>Background: </strong>Mediastinal tracheostomy (MT) is a rare, technically demanding salvage procedure in which the distal trachea is redirected into the upper mediastinum. It is indicated when extensive resection of the proximal trachea precludes conventional tracheal reconstruction or cervical tracheostomy. It is performed for a variety of underlying diseases. The aim of this systematic review was to summarize the available evidence on operative techniques, perioperative outcomes, disease-specific outcomes, and quality of life.</p><p><strong>Methods: </strong>A systematic review was conducted. PubMed was searched for case reports and case series. Data on surgical techniques, indications, perioperative outcomes, complications, and quality of life were descriptively analyzed.</p><p><strong>Results: </strong>Seventy publications reporting 437 mediastinal tracheostomies over 85 years were identified. Of these, 429 were permanent anterior mediastinal tracheostomies, the predominant type. Several techniques have evolved for this procedure over time. Extended manubrial resection was performed in most cases, whereas hemi-manubrial resection (2.8%) has gained popularity in recent years. Although a tracheal stump length of ≥5 cm is generally recommended, 12.6% of tracheostomies were created with a stump measuring 0-4 cm. Tracheal transposition was performed in 52.9% of cases to increase tracheal length and avoid contact with the brachiocephalic artery. Initially, direct collar skin (20.3%) or bipedicled upper thoracic skin flaps (13.8%) were used for reconstruction; more recently, the pectoralis major myocutaneous flap (32.9%) has become the predominant technique. Postoperative mortality was 7.0% and decreased over time. Major complications included great vessel rupture (6.8%), tracheal necrosis (8.4%), and tracheal stenosis (9.6%). Patients with a tracheal stump length of 0-3cm had a failure rate of 33.3%. Available data did not permit reliable conclusions on outcomes for specific malignancy types. Quality-of-life data were scarce, although individual reports described independent daily living and return to strenuous work for more than 10 years.</p><p><strong>Conclusions: </strong>Permanent anterior MT remains the standard form of MT and can provide acceptable outcomes when meticulous surgical technique is applied. Tracheal transposition and well-vascularized muscle flap reconstruction appear to reduce procedure-related complications, particularly in patients with short tracheal remnants. Prospective multicenter studies are needed to define optimal surgical strategies, long-term oncological outcomes, and patient-reported quality of life.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"39"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589320/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009523","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":"Nodal dissection in thymic surgery: a narrative review of the evolution of practice and evidence in the era of the 9th edition TNM classification (2000-2025).","authors":"Harleen Kaur, Ritu R Gill, Joshua Sonett","doi":"10.21037/med-2026-1-0007","DOIUrl":"10.21037/med-2026-1-0007","url":null,"abstract":"<p><strong>Background and objective: </strong>Lymph node dissection (LND) for thymic epithelial tumors (TETs) has been performed inconsistently due to guidance from heterogeneous definitions of \"intentional\" versus \"incidental\" nodal dissection. Persistent variability in the recommendations of the International Thymic Malignancy Interest Group (ITMIG) and the International Association for the Study of Lung Cancer (IASLC), there remains equipoise among surgical teams on nodal dissection during thymic resection. The objective of this narrative review is to synthesize the contemporary evidence on the indications, optimal extent, technical conduct, and oncologic implications of LND in TETs, and to translate that evidence into a pragmatic, risk-adapted protocol to guide clinical practice.</p><p><strong>Methods: </strong>We performed a focused narrative review covering January 2000 to March 2025. PubMed/MEDLINE, the Cochrane Library, Embase, Scopus, and Web of Science were searched using a Boolean string combining \"thymoma OR thymic carcinoma OR thymic neuroendocrine tumor OR thymic epithelial tumor\" with \"lymphadenectomy OR lymph node dissection OR nodal metastasis\". The search was supplemented by the Japanese Association for Research in the Thymus (JART), European Society of Thoracic Surgeons (ESTS), and Chinese Alliance for Research in Thymoma (ChART) database publications. Inclusion criteria: adult human studies; English; ≥20 patients with TET reporting nodal yield, incidence, or outcomes. Thirty-two studies were retained.</p><p><strong>Key content and findings: </strong>Nodal incidence varied predictably with histology and stage: <2% in World Health Organization (WHO) type A/AB/B1; 5-15% in B2/B3; 25-32% in thymic carcinoma; 40-50% in thymic neuroendocrine tumor (NET). Tumor size >5 cm, T3-T4 disease, and high-grade histology were independent predictors. Skip metastasis to N2 occurred in 8-10% of thymic carcinomas, most commonly the right paratracheal (4R). LND improved staging accuracy but did not independently improve survival in propensity-matched analyses, reflecting confounding by adjuvant therapy and the role of nodal status as a marker of disease biology.</p><p><strong>Conclusions: </strong>A risk-adapted, approach is recommended: omit LND for clinical T1a thymomas; perform N1 sampling for B2/B3 or T1b-T2 disease; perform systematic N1 + N2 dissection targeted by nodal stations for thymic carcinoma and thymic NET, including the right paratracheal station regardless of laterality. Persistent gaps include the absence of prospective randomized data, heterogeneous definitions of LND, and lack of validated preoperative radiologic predictors. A multinational prospective registry-based trial is warranted.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589318/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009491","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: locally advanced thymoma-do we really need induction therapy before extended resection?","authors":"Luigi Ventura","doi":"10.21037/med-2026-0021","DOIUrl":"10.21037/med-2026-0021","url":null,"abstract":"<p><strong>Background and objective: </strong>Locally advanced thymoma remains a challenging condition in which complete tumour clearance may require extended surgical resection. Induction therapy, including chemotherapy or chemoradiotherapy, is used in selected patients to improve resectability; however, the evidence supporting its routine use remains limited. This narrative review evaluates the role of induction therapy before extended resection, with particular attention to patient selection, resectability assessment, and multidisciplinary decision-making.</p><p><strong>Methods: </strong>A structured narrative review was conducted using PubMed/MEDLINE, supplemented by manual screening of reference lists from relevant articles, reviews, registry analyses, and guideline documents. The original search covered the period from January 1990 to April 2026 and was updated on 21 June 2026 during revision. Search terms included combinations of \"thymoma\", \"thymic epithelial tumours\", \"locally advanced\", \"induction therapy\", \"neoadjuvant treatment\", \"preoperative chemotherapy\", \"chemoradiotherapy\", \"resectability\", \"borderline resectable\", and \"extended resection\". English-language clinical studies, systematic and narrative reviews, registry analyses, and international guidelines were considered.</p><p><strong>Key content and findings: </strong>The available evidence is largely derived from retrospective, heterogeneous studies, often including mixed populations of thymoma and thymic carcinoma. Platinum-based regimens can achieve radiologic response rates of approximately 50-70%, but no prospective or randomised data demonstrate a clear survival advantage over upfront surgery in clearly resectable thymoma. Induction therapy may provide practical advantages in selected anatomically complex or borderline-resectable cases, including tumour bulk reduction, improved operative planning, and potential facilitation of margin-negative resection. However, radiologic response does not necessarily indicate true pathologic downstaging or reduced need for <i>en bloc</i> resection. Current evidence therefore supports a selective, rather than routine, use of induction therapy following multidisciplinary assessment.</p><p><strong>Conclusions: </strong>Extended surgical resection remains the standard of care when complete resection appears achievable upfront. Current evidence is insufficient to support routine induction therapy in clearly resectable locally advanced thymoma, although induction treatment remains appropriate in selected borderline-resectable cases in which preoperative therapy may improve the likelihood or quality of complete resection. Further prospective and collaborative studies are needed to refine patient selection and clarify its role.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"38"},"PeriodicalIF":0.0,"publicationDate":"2026-09-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589314/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009518","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":"Anti-angiogenic therapy in thymic carcinoma: a narrative review of current evidence and emerging combinations.","authors":"Hye Sung Kim, Sukhmani K Padda","doi":"10.21037/med-2026-0019","DOIUrl":"10.21037/med-2026-0019","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic carcinoma (TC) is a rare and aggressive malignancy with limited systemic treatment options. Although platinum-based chemotherapy has historically been the first-line standard, anti-angiogenic therapy has emerged as an important therapeutic strategy across treatment settings. This review synthesizes current evidence on anti-angiogenic therapies, as monotherapy and in combination with chemotherapy or immunotherapy, and defines their evolving role in TC management.</p><p><strong>Methods: </strong>A targeted narrative review was conducted using PubMed/MEDLINE, Embase, Google Scholar, ClinicalTrials.gov, conference proceedings, and reference list screening to identify clinical studies of anti-angiogenic therapy in TC published from January 2000 to January 2026.</p><p><strong>Key content and findings: </strong>Anti-angiogenic therapy demonstrates clinical activity across treatment settings in TC. Yet the magnitude and durability of benefit vary by agent, treatment line, and prior vascular endothelial growth factor (VEGF) exposure. In the first-line setting, VEGFR-2 inhibition with ramucirumab combined with platinum-based chemotherapy has achieved encouraging response rates and prolonged progression-free survival (PFS), though findings require cautious interpretation given small sample sizes and early termination of the trials without phase III confirmation. Multikinase inhibitors, such as sunitinib and lenvatinib, provide durable disease control in previously treated patients, with benefit closely linked to maintaining adequate dose intensity. Anti-angiogenic agents combined with immunotherapy have further expanded therapeutic options, particularly in anti-angiogenic-naïve patients; however, superiority over sequential use of these agents is unproven and additive toxicity is substantial. No validated predictive biomarkers currently guide treatment selection or sequencing.</p><p><strong>Conclusions: </strong>Anti-angiogenic therapy has emerged as a clinically active component of TC management across treatment lines and in rational combinations. The evidence base nevertheless rests on small phase II studies without confirmatory phase III data or broad regulatory approval. Future progress will depend on optimizing treatment sequencing, improving toxicity management, and advancing biomarker-driven patient selection through collaborative, multi-institutional efforts.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2026-09-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589324/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009528","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":"Advanced thymic epithelial tumours after neoadjuvant therapy: a narrative review of surgical challenges and strategies.","authors":"Nabih Berjaoui, Micayla Pather, Eleni Karapanagiotou, Gianluca Lucchese, Akshay Patel, Andrea Billè","doi":"10.21037/med-2026-1-0012","DOIUrl":"10.21037/med-2026-1-0012","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Background and objective: &lt;/strong&gt;Thymic epithelial tumours, including thymoma and thymic carcinoma, are rare anterior mediastinal neoplasms. Complete surgical resection remains the strongest prognostic determinant, yet locally advanced disease frequently involves critical mediastinal structures and requires multimodality treatment. Neoadjuvant therapy is commonly used to improve resectability, although it alters operative anatomy in ways that can complicate subsequent surgery. This narrative review offers an updated appraisal of the surgical challenges that arise after neoadjuvant therapy, and of contemporary strategies for complex post-induction resection.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methods: &lt;/strong&gt;A targeted literature search was carried out in PubMed, MEDLINE, Embase, Scopus, Web of Science and Google Scholar for English-language publications from January 1990 through January 2026. Search terms combined thymic malignancies, induction and chemoradiotherapy strategies, surgical resection, vascular reconstruction, pleural disease and survival. Emphasis was placed on contemporary literature (2010 to 2026) to reflect advances in imaging, multimodality therapy and surgical reconstruction.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Key content and findings: &lt;/strong&gt;Neoadjuvant therapy produces dense fibrosis and obscures tissue planes, which complicates the dissection of critical structures. Imaging often underestimates stromal remodelling and residual viable tumour, so unexpected intraoperative difficulty is common. Vascular involvement is a major driver of operative complexity and frequently calls for resection and reconstruction, with contemporary graft patency of roughly 85% to 90% at five years in specialised series. In stage III disease, reported five-year survival after complete resection is approximately 70% to 90% for thymoma and 30% to 50% for thymic carcinoma. In stage IVa disease, cytoreductive surgery remains a treatment option when macroscopic complete resection is feasible, but the balance between aggressive procedures such as extrapleural pneumonectomy and more conservative pleurectomy/decortication must be weighed very carefully, since high-quality comparative evidence is lacking. Emerging data suggest that neoadjuvant chemoradiotherapy may yield higher R0 rates than chemotherapy alone, albeit at the cost of more pronounced fibrosis, although a matching survival benefit has not yet been proven. Molecular profiling (including GTF2I and TP53/KIT alterations) and AI-assisted imaging biomarkers are increasingly informing patient selection and surgical planning.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;Surgery after neoadjuvant therapy is feasible and safe in experienced centres, and in selected patients the oncologic outcomes appear to approach those of upfront resection with acceptable postoperative morbidity. Given the rarity of these tumours and the retrospective nature of most of the evidence, however, any comparison with upfront surgery should be interpreted with","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"34"},"PeriodicalIF":0.0,"publicationDate":"2026-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589326/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009486","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":"Novel strategies in radiation therapy: high-dose radiotherapy for oligometastatic/oligo-progressive thymic tumors.","authors":"Tinatin Alaverdashvili, Andreas Rimner","doi":"10.21037/med-25-33","DOIUrl":"10.21037/med-25-33","url":null,"abstract":"<p><p>Oligometastatic and oligoprogressive thymic tumors are unique clinical presentations that are generally rare, yet occur with some regularity, especially in large volume centers. Close observation is often a viable option at first. Surgical resection is usually the primary local therapy approach whenever possible based on technical resectability and patient's medical operability. High-dose radiation therapy has opened more opportunities for patients who may need adjuvant radiation therapy to further optimize local tumor control in addition to surgery or definitive therapy, or in place of surgical resection when surgery may be difficult or impossible due to tumor- or patient-related factors, with high local control rates in appropriately selected patients. Especially in the metastatic setting, long-term effects of therapy and quality of life need to be balanced against local tumor control and survival endpoints. The excellent ratio of high efficacy and low risk of adverse events with high-dose stereotactic body radiation therapy and intensity-modulated radiation therapy make this radiation technique a particularly attractive treatment approach for optimizing local control and quality of life. A deep understanding of the strengths and weaknesses of each treatment modality are critical to allow for optimal use and integration of local and systemic treatment options. Here, we review the newest data for the role of local therapies in oligometastatic, oligoresidual and oligoprogressive thymic tumors with a focus on the development of high-dose radiation therapy techniques.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"40"},"PeriodicalIF":0.0,"publicationDate":"2026-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589321/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009516","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":"A rare giant large cell neuroendocrine carcinoma: an ITMIG Tumor Board case report from a Turkish multidisciplinary team.","authors":"Ayten Kayi Cangir, Serpil Dizbay Sak, Gökalp Güneş, Ayşegül Gürsoy Çoruh, Şebnem Dursun, Serap Akyürek, Elif Berna Köksoy, Dirk Van Raemdonck, Chad Strange, Andrea Arrossi, Anja C Roden, Arun Rajan, Ritsuko Komaki, Annemarie Shepherd","doi":"10.21037/med-2026-0018","DOIUrl":"10.21037/med-2026-0018","url":null,"abstract":"<p><strong>Background: </strong>Large cell neuroendocrine carcinomas (LCNECs) of the thymus are rare, high-grade neuroendocrine neoplasms characterized by a high mitotic index and classified separately from thymomas, with markedly more aggressive behavior in terms of treatment response and prognosis. This study describes the treatment management of a patient who underwent surgery and received multimodal therapy for LCNEC.</p><p><strong>Case description: </strong>A contrast-enhanced thoracic computed tomography (CT) scan of a 52-year-old male patient revealed an anterior mediastinal mass measuring approximately 14 cm × 16 cm, with areas of calcification and cystic components. Following transthoracic fine-needle aspiration biopsy, which was consistent with LCNEC, the patient received three cycles of neoadjuvant chemotherapy and subsequently underwent thymectomy via median sternotomy. Histopathological examination confirmed the diagnosis of LCNEC, after which adjuvant therapy was administered. The patient has remained disease-free during follow-up for 40 months.</p><p><strong>Conclusions: </strong>LCNEC is an exceptionally rare subtype, accounting for only a very small proportion of all thymic epithelial tumors. Given the aggressive course of LCNEC and its potential for both local invasion and distant metastasis, a multimodal treatment approach is required. This treatment sequence represents a rational strategy consistent with previous studies advocating combined-modality management for advanced or recurrent thymic malignancies.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"42"},"PeriodicalIF":0.0,"publicationDate":"2026-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589319/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009533","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":"Very late recurrence of thymoma after 14 years: an International Thymic Malignancy Interest Group Tumor Board case report from a Turkish multidisciplinary team.","authors":"Ayten Kayi Cangir, Serpil Dizbay Sak, Gökalp Güneş, Ayşegül Gürsoy Çoruh, Şebnem Dursun, Serap Akyürek, Elif Berna Köksoy, Dirk Van Raemdonck, Chad Strange, Andrea Arrossi, Anja C Roden, Arun Rajan, Ritsuko Komaki, Annemarie Shepherd","doi":"10.21037/med-2026-0017","DOIUrl":"10.21037/med-2026-0017","url":null,"abstract":"<p><strong>Background: </strong>Thymomas are generally slow-growing tumors with a favorable prognosis; however, late recurrences have been well documented in the literature and may occur many years after complete (R0) resection. In this report, the multimodal management of a patient who experienced recurrence 14 years after surgery is presented as discussed during the multidisciplinary International Thymic Malignancy Interest Group (ITMIG) Tumor Board meeting on 17 October 2025.</p><p><strong>Case description: </strong>An 18-year-old female patient underwent median sternotomy in 2006 for resection of a 15.5-cm type B1 thymoma. Histopathological examination revealed microscopic transcapsular invasion with negative surgical margins, and adjuvant therapy was not recommended at that time. In 2020, progressive myasthenic symptoms led to re-evaluation, and imaging demonstrated multifocal right pleural recurrence with suspected involvement of the inferior vena cava and hepatic interface. Fine-needle aspiration biopsy confirmed recurrent World Health Organization (WHO) type B1 thymoma. Because complete resection was considered unlikely, the patient received cisplatin/etoposide chemotherapy followed by definitive chemoradiotherapy, achieving major radiologic response and disease stability. In 2024, after progression of a paravertebral recurrent lesion, salvage surgery was performed via right thoracotomy, including wedge resection, pleurectomy, mediastinal lymph node dissection, and intraoperative hyperthermic intrathoracic chemotherapy. The patient has since remained disease-free on continued surveillance.</p><p><strong>Conclusions: </strong>In thymic epithelial tumors with increased risk of recurrence, multimodal treatment strategies may improve long-term outcomes. This case highlights that very late recurrence may occur even after R0 resection and supports lifelong surveillance. Long-term follow-up should include periodic contrast-enhanced thoracic computed tomography, with magnetic resonance imaging considered in younger patients to reduce cumulative radiation exposure.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"41"},"PeriodicalIF":0.0,"publicationDate":"2026-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589316/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009513","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":"Recurrence and primary TETs: is it the same disease?-a narrative review.","authors":"Francesco Givigliano, Teresa Ferrazzo, Filippo Lococo, Paolo Mendogni, Ottorino Perrone, Salvatore Merola, Valeria Manfredi, Mary Jo Filice, Massimiliano Tisba, Giancarlo Pino, Marco Chiappetta","doi":"10.21037/med-2026-1-0014","DOIUrl":"10.21037/med-2026-1-0014","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic epithelial tumors (TETs) present peculiar characteristics, with indolent behavior and excellent prognosis when treated. Based on these characteristics, also recurrence may present similar characteristics, but some aspects of their management should be interpreted and are still not well defined. The objective of this narrative review is to discuss peculiar aspects of primary and recurrent TETs showing how should be managed.</p><p><strong>Methods: </strong>A literature search was conducted using PubMed and Google Scholar to inform the narrative review. Eligible articles had to be published in English between January 1, 1991 to September 30, 2025.</p><p><strong>Key content and findings: </strong>The presentation of recurrent disease may show some differences compared with primary tumors. Many features are shared by primary TETs and their recurrences, with only limited changes in histology and genetic profiles that do not seem to significantly affect prognosis. Recurrences generally retain the characteristics of the original tumor, although they may exhibit greater clinical aggressiveness. Due to their clinically indolent behavior, these tumors are managed quite peculiarly. Indeed, surgery represents the cornerstone of treatment for these tumors and is often considered, even in cases of recurrence.</p><p><strong>Conclusions: </strong>Primary TETs and recurrences present similar characteristics that may be considered during treatment, even if in case of recurrence the more aggressive behavior should be taken into account.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2026-08-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13589315/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149009510","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}