Mediastinum (Hong Kong, China)最新文献

{"title":"HER2 expression and <i>HER2</i> gene amplification in thymic epithelial tumors: a narrative review.","authors":"Apostolos C Agrafiotis, Dieter Peeters, Maite De Roeck, Jeroen M H Hendriks, Karen Zwaenepoel, Koen De Winne, Senada Koljenović, Paul E Van Schil","doi":"10.21037/med-2025-1-48","DOIUrl":"https://doi.org/10.21037/med-2025-1-48","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic epithelial tumors (TETs) are a rare group of neoplasms situated in the prevascular mediastinum. Due to their rarity and histological diversity, understanding their development is quite challenging, and their molecular profile is not well defined. Although advances in molecular profiling have improved our understanding of many solid cancers, TET remains poorly characterized. The human epidermal growth factor receptor 2 (HER2/ERBB2) has gained interest as a molecular target due to its role in oncogenesis and its therapeutic significance in various malignancies; however, its potential role in treating TET remains unclear. This review examines the expression patterns, gene amplification status, and clinical implications of HER2 in thymomas and thymic carcinomas, especially in the era of antibody-drug conjugates which target tumors with low HER2 expression.</p><p><strong>Methods: </strong>PubMed, Embase and Web of Science research was conducted using the terms [HER2] OR [ERBB2] OR [ErbB2] OR [HER2/neu] OR [c-erB2] AND [thymic epithelial tumors], [HER2] OR [ERBB2] OR [ErbB2] OR [HER2/neu] OR [c-erB2] AND [thymoma], and [HER2] OR [ERBB2] OR [ErbB2] OR [HER2/neu] OR [c-erB2] AND [thymic carcinoma]. There were no restrictions on publication date. After analysis, nine articles met the research criteria.</p><p><strong>Key content and findings: </strong>In one study, thymic carcinomas expressed HER2 frequently, with focal to strong membranous positivity in 8 of the 17 cases. In another, HER2 was expressed in 58.3% of cases with other members of the receptor family and signaling pathway ligands also demonstrating frequent expression. The immunohistochemical analysis revealed that the receptors epidermal growth factor receptor (EGFR) (33.3%), phosphorylated epidermal growth factor receptor (pEGFR) (33.3%), and human epidermal growth factor receptor 3 (HER3) (45.8%), along with the ligands transforming growth factor-α (TGF-α) (54.2%), amphiregulin (25.0%), and epiregulin (91.7%), were expressed in the tumor cells. Only one case showed <i>HER2</i> gene amplification. In another study, HER2 expression was positive in only one case of thymic carcinoma (1/22), whereas there was no expression observed in any of the thymoma cases (0/22). In the other series, there were scarce or no cases with HER2 expression or gene amplification.</p><p><strong>Conclusions: </strong>HER2 plays a still undefined role in TET, especially in thymic carcinoma. Although gene amplification is rare, protein expression is more frequent, suggesting potential for targeted therapy. Detailed molecular profiling and innovative research methods are essential to further explore the therapeutic potential of HER2 in these rare cancers.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"13"},"PeriodicalIF":0.0,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071657/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694070","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":"Does needle size affect the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration for malignant lymphoma?-a narrative review.","authors":"Atsushi Torii, Masahide Oki","doi":"10.21037/med-2025-1-53","DOIUrl":"https://doi.org/10.21037/med-2025-1-53","url":null,"abstract":"<p><strong>Background and objective: </strong>Bronchoscopic diagnosis of malignant lymphoma is challenging, because bronchoscopic tissues are often relatively small. Recently, a 19-gauge needle (19G) was developed to obtain larger tissue cores; however, its effectiveness in improving the diagnostic yields remains controversial. Therefore, in this narrative review, we aimed to summarize recent findings and evaluate the usefulness of different needle sizes for diagnosing malignant lymphoma.</p><p><strong>Methods: </strong>A comprehensive and systematic online literature search of PubMed was conducted using the keywords (\"malignant lymphoma\" OR \"lymphoma\") and (\"endobronchial ultrasound\" OR \"endobronchial ultrasound guided\" OR \"endobronchial ultrasound guided transbronchial needle aspiration\" OR \"EBUS\" OR \"EBUS-TBNA\" OR \"needle size\").</p><p><strong>Key content and findings: </strong>Three prospective and 13 retrospective studies were included. Approximately 50% of the procedures were performed under moderate sedation, and the remainder under general anesthesia. Regarding subtype determination, the diagnostic yield of endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) ranged from 50% to 65% with a 19G, and from 19% to 88% with a 21G and 22G. Supportive methods such as rapid on-site cytological evaluation (ROSE) and flow cytometry were performed variably, depending on the bronchoscopist's preference or institutional resources.</p><p><strong>Conclusions: </strong>When ROSE and flow cytometry are available, there seems to be no significant difference in diagnostic yield for lymphoma subtype determination between 19G and 21/22G during EBUS-TBNA.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"10"},"PeriodicalIF":0.0,"publicationDate":"2026-02-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071659/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694052","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":"The evolving role of interventional pulmonology with endobronchial ultrasonography in the diagnosis of lymphoma: a narrative review.","authors":"Saad Farooq, Anthony Rowe, Horiana B Grosu","doi":"10.21037/med-2025-1-51","DOIUrl":"https://doi.org/10.21037/med-2025-1-51","url":null,"abstract":"<p><strong>Background and objective: </strong>For patients undergoing evaluation for mediastinal/hilar adenopathy or masses suspicious for lymphoma, endobronchial ultrasonography (EBUS)-transbronchial needle aspiration (TBNA) offers a lower-risk alternative to surgical or percutaneous biopsy. While the utility of EBUS-TBNA is well established in lung cancer diagnosis, including biomarker analysis, its role in lymphoma is more limited. This is because for accurate subtyping of lymphoma, larger intact tissue specimens are needed and EBUS-TBNA can only provide cytology specimens. To address this limit, various needle sizes and/or sampling techniques such as cryobiopsy have been investigated to improve diagnostic sensitivity for lymphoma. In this review, we discuss the current evidence for these various techniques in the diagnosis of lymphoma.</p><p><strong>Methods: </strong>We conducted a narrative review by searching PubMed/MEDLINE, Embase and Google Scholar for articles published during 1980-2025 using search terms including \"EBUS\", \"EBUS-TBNA\", \"endobronchial ultrasound\", \"bronchoscopy\", \"lymphoma diagnosis\", \"mediastinal lymphadenopathy\" and \"interventional pulmonology\". Only articles written in English that focused on evaluation of diagnostic sensitivity, specimen adequacy, and interventional techniques for suspected lymphoma were included in our review.</p><p><strong>Key content and findings: </strong>Several studies suggested that EBUS-TBNA combined with appropriate immunohistochemical, flow cytometry, cytogenetic, and molecular studies can achieve an accurate lymphoma diagnosis. However, its sensitivity for <i>de novo</i> lymphoma remains modest. Various techniques such as cryobiopsy, bigger needles, and forceps via EBUS may improve tissue acquisition but whether this translates into improved diagnostic yield is uncertain.</p><p><strong>Conclusions: </strong>For patients undergoing evaluation for mediastinal/hilar adenopathy or masses suspicious for lymphoma, EBUS with TBNA, or with other techniques such as cryobiopsy, may be a reasonable first diagnostic step, as it is less invasive with a better safety profile than surgical excision of these lymph nodes. Prospective studies are needed to establish best practices for the use of EBUS to diagnose lymphoma.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"6"},"PeriodicalIF":0.0,"publicationDate":"2026-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071652/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694213","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":"Imaging-based criteria for minimally invasive versus open surgery in thymic tumors: a narrative review.","authors":"Takashi Kanou, Yasushi Shintani","doi":"10.21037/med-2025-1-49","DOIUrl":"https://doi.org/10.21037/med-2025-1-49","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic epithelial tumors (TETs) require precise preoperative assessment to achieve complete resection and optimal long-term outcomes. With the expanding use of minimally invasive surgery, imaging has become central not only for diagnosis but also for surgical decision-making. This narrative review aims to summarize current evidence on how metabolic, morphologic, and computed tomography (CT)-based imaging parameters can be integrated to guide surgical strategies for TETs.</p><p><strong>Methods: </strong>A comprehensive literature search was conducted using PubMed and Web of Science for studies published between January 2001 and August 2025. Original clinical studies, multicenter analyses, systematic reviews, and major guidelines published in English were reviewed, with an emphasis on imaging-based surgical decision-making.</p><p><strong>Key content and findings: </strong>Tumor size (TS) consistently predicts invasiveness and surgical complexity, with thresholds of approximately 5-6 cm influencing the choice between minimally invasive and open approaches. Positron emission tomography-derived parameters, particularly maximum standardized uptake value (SUVmax) and the SUVmax-to-TS ratio, correlate with histological aggressiveness and prognosis. CT features, including capsular disruption, calcification, and vascular abutment, further refine risk stratification. Emerging modalities such as volumetry, novel positron-emission tomography (PET) tracers, and artificial intelligence (AI)-based radiomics show promise in enhancing individualized surgical planning.</p><p><strong>Conclusions: </strong>Integrating PET metrics, TS, and CT features provides a comprehensive framework for tailoring surgical strategies in TETs. Future incorporation of volumetric and AI-driven imaging analyses into clinical guidelines may further optimize surgical outcomes and personalized care.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"12"},"PeriodicalIF":0.0,"publicationDate":"2026-02-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071618/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694085","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":"Reframing thymic epithelial tumors through single-cell transcriptomics: a narrative review.","authors":"Minoru Matsumoto, Yasuyo Saijo, Koichi Tsuneyama, Takeshi Oya","doi":"10.21037/med-2025-1-45","DOIUrl":"https://doi.org/10.21037/med-2025-1-45","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic epithelial tumors (TETs) are rare neoplasms originating from thymic epithelial cells (TECs). They exhibit histological, molecular, and immunological diversity shaped by aberrant interactions between neoplastic TECs and immune cells. World Health Organization (WHO) histological classification effectively captures their clinicopathological features, whereas inter- and intra-subtype heterogeneity persists. In this point, single-cell transcriptomics is well-suited to resolve cellular heterogeneity in TETs. This narrative review synthesizes findings from recent single-cell studies that illuminate epithelial subpopulations, intra-tumoral immune landscape, and disease-specific aberrations such as myasthenia gravis (MG)-associated phenotypes in TETs.</p><p><strong>Methods: </strong>We conducted a focused narrative review on three key studies that applied single-cell RNA sequencing (scRNA-seq) to primary human TETs.</p><p><strong>Key content and findings: </strong>Single-cell analyses identified a distinct TEC subpopulation ectopically expressing neuromuscular antigens, termed neuromuscular medullary TECs (nmTECs), in MG-associated thymomas, implicating aberrant antigen presentation and immune cell recruitment in autoantibody production. Other studies delineated tumor epithelial programs that shape the immune microenvironment, linking TEC transcriptional identities to the persistence of immature T-cells or dominance of mature T-cells. Bioinformatic approaches of ligand-receptor networks supported pathogenic crosstalk between neoplastic TECs and immune cells. Notably, independent groups converged on functionally oriented classifications that align across studies, stratifying TETs by epithelial lineage programs and immune composition with correspondence to biological behavior and prognosis.</p><p><strong>Conclusions: </strong>Single-cell approaches have revealed TET heterogeneity encompassing abnormal epithelial cell states, immune development trajectories, and autoimmune-associated molecular programs with high resolution. The ongoing accumulation of single-cell transcriptomics datasets would refine a cell-centric framework for TET classification and pathogenesis, while also deepening insight into normal TEC biology.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"10 ","pages":"14"},"PeriodicalIF":0.0,"publicationDate":"2026-02-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13071626/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147694197","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":"Molecular reprogramming in thymic neuroendocrine tumors: a narrative review.","authors":"Jing Di, Yijia Zhou, Jingjing Hu","doi":"10.21037/med-25-40","DOIUrl":"10.21037/med-25-40","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic neuroendocrine tumors (tNETs) are rare and heterogeneous neoplasms with limited evidence to guide diagnosis and management. Traditional classifications rely heavily on morphology, but recent advances in molecular profiling have begun to reshape understanding of their biology and clinical behavior. This narrative review synthesizes recent molecular findings in tNETs and proposes an integrated framework that combines traditional morphology with molecular stratification to guide precision oncology.</p><p><strong>Methods: </strong>We performed a narrative review of the current literature on tNETs, focusing on histologic classification, molecular taxonomy, diagnostic algorithms, and therapeutic strategies. Special emphasis was placed on integrating emerging evidence from genomic, epigenetic, and clinical studies published between 2010 and 2025.</p><p><strong>Key content and findings: </strong>Molecular frameworks such as copy number instability (CNI)-based classification, together with recurrent alterations in <i>MEN1</i>, <i>TP53</i>, and <i>RB1</i>, are refining risk stratification and linking tNETs to neuroendocrine neoplasms in other organ systems. Therapeutic advances include the use of everolimus and temozolomide, while PRRT appears less effective in this subgroup. Epigenetic dysregulation and novel trial designs, including basket and adaptive studies, represent promising avenues for future research.</p><p><strong>Conclusions: </strong>This review integrates current knowledge of tNETs with recent advances in molecular diagnostics and therapeutic strategies. By highlighting key genetic and epigenetic alterations, as well as future directions such as liquid biopsy, artificial intelligence, and novel trial designs, we emphasize the need for biomarker-driven approaches to improve outcomes in this ultra-rare disease.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"32"},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12771139/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919387","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":"Impact of postoperative surveillance via computed tomography after radical resection for thymoma.","authors":"Natsumi Maru, Haruaki Hino, Takahiro Utsumi, Aki Kobayashi, Kento Fukumoto, Hiroshi Matsui, Yohei Taniguchi, Tomohito Saito, Tomohiro Murakawa","doi":"10.21037/med-25-41","DOIUrl":"10.21037/med-25-41","url":null,"abstract":"<p><strong>Background: </strong>Outpatient follow-up using computed tomography (CT) after thymoma resection is recommended to evaluate tumor recurrence and detect second malignancies. However, the optimal interval for CT surveillance remains unclear. We aimed to investigate the association between CT surveillance intervals and postoperative survival after thymoma resection.</p><p><strong>Methods: </strong>This retrospective study analyzed 143 patients who underwent periodic CT scans after complete thymoma resection at a single institution between 2006 and 2022. Patients were stratified into three groups based on CT interval: half-, 1-, and 2-year groups. CT intervals were stratified according to the attending physician's clinical judgment. Overall survival (OS), recurrence-free survival (RFS), tumor recurrence rates, and post-recurrence treatments were compared among the three interval groups. A multivariate analysis was performed to evaluate the independent prognostic impact of CT intervals.</p><p><strong>Results: </strong>Among the 143 patients included, 82 were assigned to the half-year group, 33 to the 1-year group, and 28 to the 2-year group. The 7-year OS rates were 96.1% in the half-year group, 100% in the 1-year group, and 100% in the 2-year group (P=0.34). The 7-year RFS rates were 85.2%, 92.3%, and 88.1% in the half-, 1-, and 2-year groups, respectively (P=0.37). No significant differences were found in overall and RFS among the three groups. Tumor recurrence rates were 11.0% in the half-year group, 3.0% in the 1-year group, and 7.1% in the 2-year group (P=0.38). No significant differences were noted in recurrence detection modalities and treatment approaches among the three groups (P>0.99, 0.99). In the multivariate analysis, CT follow-up interval was not significantly associated with OS.</p><p><strong>Conclusions: </strong>Postoperative CT follow-up at intervals longer than 1 year may be acceptable and feasible for patients after thymoma resection.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"31"},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12771141/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919406","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":"Spleen metastasis as rare systemic manifestation of thymoma: a case report.","authors":"Tom Decaluwé, Dirk Van Raemdonck, Paul M Clement, Inge Derdelinckx, Christophe M Deroose, Didier Bielen, Thomas Tousseyn, An-Lies Provoost, Joris Jaekers","doi":"10.21037/med-25-17","DOIUrl":"10.21037/med-25-17","url":null,"abstract":"<p><strong>Background: </strong>Thymomas are thymic epithelial tumors (TETs) and the most common tumors of the anterior mediastinum. In the natural course of this malignancy, there is no tendency towards extrathoracic metastasis. This report describes an extremely rare case of splenic metastatic disease from a thymoma. Additionally, the patient developed Good's syndrome, a thymoma-associated immunological disorder which makes the patient vulnerable for opportunistic infections. This syndrome is generally treated with intravenous immunoglobulins.</p><p><strong>Case description: </strong>The patient is an asymptomatic 73-year-old man of Caucasian origin without significant past medical history. He was diagnosed with an anterior mediastinal mass on computed tomography (CT) of the chest in the work-up of his newly diagnosed prostate carcinoma, which turned out to be a thymoma after surgical resection. During follow-up the patient developed a splenic lesion which was difficult to characterize. After laparoscopic splenectomy the diagnosis of metastatic thymoma was confirmed. Additionally, the patient developed Good's syndrome. Unfortunately, the patient died of associated infectious complications after thorough intensive care treatment.</p><p><strong>Conclusions: </strong>Metastatic splenic disease from a thymoma, further complicated by development of Good's syndrome is extremely rare and hitherto never described before. To anticipate possible infectious complications in patients with newly diagnosed thymoma, we advise to routinely check immunoglobulin levels in these patients.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"36"},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12771140/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919412","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":"Distant recurrence from thymoma biopsy seeding: a case report.","authors":"Anita Paiva, Carlos S Pinto, Susana Guimarães, Andrea V Arrossi, Ritsuko Komaki, Paolo Mendogni, Pedro Fernandes","doi":"10.21037/med-25-27","DOIUrl":"10.21037/med-25-27","url":null,"abstract":"<p><strong>Background: </strong>Although some evidence shows an increase in its incidence, epithelial thymic tumors that comprise thymomas, thymic neuroendocrine tumors and thymic carcinomas, are rare (ranging from 2.5-2.8 per million). Thymomas, as presented in this paper, although slow growing lesions are malignant tumors, as the potential to invade surrounding structures and metastasize has been proven. In this case report, we present another feature of these neoplasms, recurrence. Although local and regional are far more frequent, distant can also occur. We present a case of late extra-thoracic recurrence associated with seeding from a preoperative biopsy, a very rare, but real scenario, that needs to be taken into account when deciding the need for invasive staging.</p><p><strong>Case description: </strong>We present a case of a 75-year-old woman who was sent for evaluation of painful palpable extra-thoracic nodules, 8 years after a type A thymoma excision. After image reconstruction, surgical exploration and detailed clinical history and record examination, it was considered as recurrence associated with seeding from preoperative biopsy. She had been followed with regular computed thoracic tomography imaging, with no signs of recurrence during the 5-year period, at the moment of oncological follow-up discharge.</p><p><strong>Conclusions: </strong>This case is a statement for the changes that have been made in diagnosis, treatment and follow-up of epithelial thymic tumors in the last years. Nowadays, the biopsy is not proposed when a resectable epithelial tumor of the mediastinum is the probable diagnosis, as the case presented. We believe that a longer follow-up for these patients is needed as they can recur later than the initially considered 5-year period, and the absence of surgical excision of the biopsy tract or in the presence of a complex biopsy (involving, for example, pleural puncture), should possibly be considered a pseudo-R0.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"35"},"PeriodicalIF":0.0,"publicationDate":"2025-12-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12771136/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919423","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":"Managing stage IV thymic carcinoma-a narrative review of radiation therapy strategies and options.","authors":"Annemarie F Shepherd","doi":"10.21037/med-25-14","DOIUrl":"10.21037/med-25-14","url":null,"abstract":"<p><strong>Background and objective: </strong>Thymic carcinoma is a type of thymic epithelial tumor that is rare and aggressive. Compared to patients with thymoma, patients with thymic carcinoma experience worse overall survival, progression-free survival and earlier relapses. Patients with stage IV thymic carcinoma most commonly have disease involving the pleural or pericardium, but distant spread outside the thorax is also possible. The purpose of this review is to describe radiation therapy strategies and options for patients with stage IV thymic carcinoma.</p><p><strong>Methods: </strong>Due to the rare nature of thymic tumors, the literature on stage IV thymic carcinoma is limited. As a result, most of the data on stage IV thymic carcinoma is based on retrospective reviews and heterogenous populations.</p><p><strong>Key content and findings: </strong>The management of stage IV thymic carcinoma is multidisciplinary and depends on many factors including the patient's performance status, extent of disease, biology of the disease and intent of treatment. Systemic therapy, surgical resection, observation, and radiation therapy are often considered. Radiation can be used for palliation of symptoms, prevention of impending symptoms, and potentially for prolongation of disease control particularly in patients with oligometastatic or oligoprogressive disease. The type of radiation used in patients with stage IV thymic carcinoma depends on the intent of treatment, location of the disease, size of the target, and proximity to organs that are sensitive to radiation. Various techniques such as 3D conformal radiation therapy (3DCRT), stereotactic body radiation therapy (SBRT), intensity modulated radiation therapy (IMRT), proton beam therapy, and hemi-thoracic intensity-modulated pleural radiation therapy (IMPRINT) may be considered depending on these factors.</p><p><strong>Conclusions: </strong>In patients with stage IV thymic carcinoma, radiation therapy is an effective modality for palliation of symptoms, prevention of impending symptoms, and potentially for prolongation of disease control. Due to the rare nature of the disease, additional data and research are required to better understand the impact and appropriateness of various treatment approaches in patients with thymic carcinoma. Because the management of stage IV thymic carcinoma can involve multiple different modalities depending on the patient's individual case, a multidisciplinary approach is critical for optimal patient care.</p>","PeriodicalId":74139,"journal":{"name":"Mediastinum (Hong Kong, China)","volume":"9 ","pages":"33"},"PeriodicalIF":0.0,"publicationDate":"2025-12-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12771142/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145919351","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}