Clinicopathological features and research progress of atypical type A thymoma_West China Medical Journal

Authors：

WANG Yuxuan ,  WANG Weiya

Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Weiya, Email: 151422303@qq.com

Keywords：

Thymoma; atypical type A thymoma; pathology; diagnosis

DOI：

10.7507/1002-0179.202211132

Video：

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Abstract Full text Figures/Tables Video References Cited by

Thymic epithelial tumors represent the most common neoplasms of the anterior mediastinum, while atypical type A thymoma is a rare subtype of thymoma. On the morphological basis of type A thymoma, this tumor exhibits some atypical histological features, such as abundant cells, increased mitotic counts, tumor necrosis, and increased Ki67 index. At present, the clinical and pathological data of this tumor is still available. Since it was formally named, 16 cases have been reported around the world. In order to improve the understanding of the disease, this article reviews the related literature and tries to elaborate the atypical type A thymoma from the aspects of pathological features, clinical manifestations, epidemiology and differential diagnosis.

Citation： WANG Yuxuan, WANG Weiya. Clinicopathological features and research progress of atypical type A thymoma. West China Medical Journal, 2023, 38(6): 943-946. doi: 10.7507/1002-0179.202211132 Copy

1.	Marx A, Ströbel P, Badve SS, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol, 2014, 9(5): 596-611.
2.	Travis WD, Brambilla E, Burke AP, et al. WHO classification of tumors of the lung, pleura, thymus and heart. 4th. Lyon: IARC Press, 2015: 183-242.
3.	Yanagiya M, Horiuchi H, Hiyama N, et al. Histopathological heterogeneity in an atypical type A thymoma variant with pulmonary metastases. Pathol Int, 2021, 71(6): 438-440.
4.	Jimbo N, Tateyama H, Komatsu M, et al. A case of type AB thymoma with atypical histological features: is atypical type AB thymoma an acceptable variant of thymoma?. Pathol Int 2021, 71(4): 272-274.
5.	苏文敬, 宗园媛, 崔风云. 混合性不典型 A 型胸腺瘤合并伴有淋巴样间质的微结节型胸腺瘤一例. 中华病理学杂志, 2020, 49(12): 1333-1335.
6.	Yanagiya M, Hamaya H, Matsuzaki H, et al. Atypical type A thymoma variant manifesting polymyalgia rheumatic. Ann Thorac Surg, 2020, 110(4): E253-E255.
7.	Chiappetta M, Marino M, Facciolo F. Unique case of atypical type A thymoma with vertebral metastasis and high 18-fluorodeoxyglucose avidity. ANZ J Surg, 2019, 89(10): E450-E451.
8.	Shen X, Jin Y, Shen L, et al. Thymoma and thymic carcinoma associated with multilocular thymic cyst: a clinicopathologic analysis of 18 cases. Diagn Pathol, 2018, 13(1): 41.
9.	Kawakita N, Kondo K, Toba H, et al. A case of atypical type A thymoma with vascular invasion and lung metastasis. Gen Thorac Cardiovas, 2018, 66(4): 239-242.
10.	Bürger T, Schaefer IM, Küffer S, et al. Metastatic type A thymoma: morphological and genetic correlation. Histopathology, 2017, 70(5): 704-710.
11.	苏运超, 底锦熙, 笪冀平. 不典型A型胸腺瘤临床病理分析. 中华病理学杂志, 2017, 46(5): 314-317.
12.	Hashimoto M, Tsukamoto Y, Matsuo S, et al. Lung metastases in an atypical type A thymoma variant. J Thorac Dis, 2017, 9(9): E805-E807.
13.	Grajkowska W, Matyja E, Kunicki J, et al. AB thymoma with atypical type A component with delayed multiple lung and brain metastases. J Thorac Dis, 2017, 9(9): E808-E814.
14.	Hashimoto M, Shimizu S, Takuwa T, et al. A case of atypical type A thymoma variant. Surg Case Rep, 2016, 2(1): 116.
15.	Petrini I, Meltzer PS, Kim IK, et al. A specific missense mutation in GTF2I occurs at high frequency in thymic epithelial tumors. Nat Genet, 2014, 46(8): 844-849.
16.	Nonaka D, Rosai J. Is there a spectrum of cytologic atypia in type a thymomas analogous to that seen in type B thymomas? A pilot study of 13 cases. Am J Surg Pathol, 2012, 36(6): 889-894.
17.	Vladislav IT, Gökmen-Polar Y, Kesler KA, et al. The role of histology in predicting recurrence of type A thymomas: a clinicopathologic correlation of 23 cases. Mod Pathol, 2013, 26(8): 1059-1064.
18.	Moran CA, Kalhor N, Suster S. Invasive spindle cell thymomas (WHO Type A): a clinicopathologic correlation of 41 cases. Am J Clin Pathol, 2010, 134(5): 793-798.
19.	Marx A, Belharazem D, Lee DH, et al. Molecular pathology of thymomas: implications for diagnosis and therapy. Virchows Arch, 2021, 478(1): 101-110.
20.	Vivero M, Davineni P, Nardi V, et al. Metaplastic thymoma: a distinctive thymic neoplasm characterized by YAP1-MAML2 gene fusions. Mod Pathol, 2020, 33(4): 560-565.

1. Marx A, Ströbel P, Badve SS, et al. ITMIG consensus statement on the use of the WHO histological classification of thymoma and thymic carcinoma: refined definitions, histological criteria, and reporting. J Thorac Oncol, 2014, 9(5): 596-611.
2. Travis WD, Brambilla E, Burke AP, et al. WHO classification of tumors of the lung, pleura, thymus and heart. 4th. Lyon: IARC Press, 2015: 183-242.
3. Yanagiya M, Horiuchi H, Hiyama N, et al. Histopathological heterogeneity in an atypical type A thymoma variant with pulmonary metastases. Pathol Int, 2021, 71(6): 438-440.
4. Jimbo N, Tateyama H, Komatsu M, et al. A case of type AB thymoma with atypical histological features: is atypical type AB thymoma an acceptable variant of thymoma?. Pathol Int 2021, 71(4): 272-274.
5. 苏文敬, 宗园媛, 崔风云. 混合性不典型 A 型胸腺瘤合并伴有淋巴样间质的微结节型胸腺瘤一例. 中华病理学杂志, 2020, 49(12): 1333-1335.
6. Yanagiya M, Hamaya H, Matsuzaki H, et al. Atypical type A thymoma variant manifesting polymyalgia rheumatic. Ann Thorac Surg, 2020, 110(4): E253-E255.
7. Chiappetta M, Marino M, Facciolo F. Unique case of atypical type A thymoma with vertebral metastasis and high 18-fluorodeoxyglucose avidity. ANZ J Surg, 2019, 89(10): E450-E451.
8. Shen X, Jin Y, Shen L, et al. Thymoma and thymic carcinoma associated with multilocular thymic cyst: a clinicopathologic analysis of 18 cases. Diagn Pathol, 2018, 13(1): 41.
9. Kawakita N, Kondo K, Toba H, et al. A case of atypical type A thymoma with vascular invasion and lung metastasis. Gen Thorac Cardiovas, 2018, 66(4): 239-242.
10. Bürger T, Schaefer IM, Küffer S, et al. Metastatic type A thymoma: morphological and genetic correlation. Histopathology, 2017, 70(5): 704-710.
11. 苏运超, 底锦熙, 笪冀平. 不典型A型胸腺瘤临床病理分析. 中华病理学杂志, 2017, 46(5): 314-317.
12. Hashimoto M, Tsukamoto Y, Matsuo S, et al. Lung metastases in an atypical type A thymoma variant. J Thorac Dis, 2017, 9(9): E805-E807.
13. Grajkowska W, Matyja E, Kunicki J, et al. AB thymoma with atypical type A component with delayed multiple lung and brain metastases. J Thorac Dis, 2017, 9(9): E808-E814.
14. Hashimoto M, Shimizu S, Takuwa T, et al. A case of atypical type A thymoma variant. Surg Case Rep, 2016, 2(1): 116.
15. Petrini I, Meltzer PS, Kim IK, et al. A specific missense mutation in GTF2I occurs at high frequency in thymic epithelial tumors. Nat Genet, 2014, 46(8): 844-849.
16. Nonaka D, Rosai J. Is there a spectrum of cytologic atypia in type a thymomas analogous to that seen in type B thymomas? A pilot study of 13 cases. Am J Surg Pathol, 2012, 36(6): 889-894.
17. Vladislav IT, Gökmen-Polar Y, Kesler KA, et al. The role of histology in predicting recurrence of type A thymomas: a clinicopathologic correlation of 23 cases. Mod Pathol, 2013, 26(8): 1059-1064.
18. Moran CA, Kalhor N, Suster S. Invasive spindle cell thymomas (WHO Type A): a clinicopathologic correlation of 41 cases. Am J Clin Pathol, 2010, 134(5): 793-798.
19. Marx A, Belharazem D, Lee DH, et al. Molecular pathology of thymomas: implications for diagnosis and therapy. Virchows Arch, 2021, 478(1): 101-110.
20. Vivero M, Davineni P, Nardi V, et al. Metaplastic thymoma: a distinctive thymic neoplasm characterized by YAP1-MAML2 gene fusions. Mod Pathol, 2020, 33(4): 560-565.

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