Thymoma staging

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2]

Overview

Staging of thymic epithelial tumors was initially proposed by Bergh and his colleagues in 1978,[1] modified by Wilkins and Castleman in 1979,[2] and advanced by Masaoka et al. in 1981.[3][4] Modified Masaoka staging grouped with TNM classification is the most widely adopted system for thymic epithelial tumors currently in use.

Modified Masaoka Clinical Staging of Thymoma

Modified Masaoka Clinical Staging of Thymoma (1994)[5]
Stage Description
I Macroscopically and microscopically completely encapsulated
II A. Microscopic transcapsular invasion
B. Macroscopic invasion into surrounding fatty tissue or grossly adherent to but not through
mediastinal pleura or pericardium
III Macroscopic invasion into neighboring organs (ie, pericardium, great vessels, lung)
A. Without invasion of great vessels
B. With invasion of great vessels
IV A. Pleural or pericardial dissemination
B. Lymphogenous or hematogenous metastasis


TNM Classification of Thymic Epithelial Tumors

TNM Classification of Thymic Epithelial Tumors by Yamakawa and Masaoka (1991)[6]
T/N/M Stage Description
T factor T1 Macroscopically completely encapsulated and microscopically no capsular invasion
T2 Macroscopically adhesion or invasion into surrounding fatty tissue or mediastinal pleura,
or microscopic invasion into capsule
T3 Invasion into neighboring organs, such as pericardium, great vessels, and lung
T4 Pleural or pericardial dissemination
N factor N0 No lymph node metastasis
N1 Metastasis to anterior mediastinal lymph nodes
N2 Metastasis to intrathoracic lymphnodes except anterior mediastinal lymph nodes
N3 Metastasis to extrathoracic lymphnodes
M factor M0 No hematogenous metastasis
M1 Hematogenous metastasis


Combined Masaoka Staging/TNM Classification (1994)[7]
Masaoka Stage T factor N factor M factor
Stage I T1 N0 M0
Stage II T2 N0 M0
Stage III T3 N0 M0
Stage IVa T4 N0 M0
Stage IVb Any T N1, N2, or N3 M0
Any T Any N M1

Previously Reported Staging System

Masaoka Staging (1981)[3]
Stage Description
I Macroscopically completely encapsulated and microscopically no capsular invasion
II 1. Macroscopic invasion into surrounding fatty tissue or mediastinal pleura
2. Microscopic invasion into capsule
III Macroscopic invasion into neighboring organ (ie, pericardium, great vessels, or lung)
IVa Pleural or pericardial dissemination
IVb Lymphogenous or hematogenous metastasis


Clinical Staging by Bergh (1978) and Wilkins (1979)[1][2]
Author Stage Description
Bergh et al. I Intact capsule or growth within the capsule
II Pericapsular growth into the mediastinal fat tissue
III Invasive growth into the surrounding organs and/or intrathoracic metastases
Wilkins et al. I Intact capsule or growth within the capsule
II Pericapsular growth into the mediastinal fat tissue or adjacent pleura or pericardium
III Invasive growth into the surrounding organs and/or intrathoracic metastases

References

  1. 1.0 1.1 Bergh, NP.; Gatzinsky, P.; Larsson, S.; Lundin, P.; Ridell, B. (1978). "Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas". Ann Thorac Surg. 25 (2): 91–8. PMID 626543. Unknown parameter |month= ignored (help)
  2. 2.0 2.1 Wilkins, EW.; Castleman, B. (1979). "Thymoma: a continuing survey at the Massachusetts General Hospital". Ann Thorac Surg. 28 (3): 252–6. PMID 485626. Unknown parameter |month= ignored (help)
  3. 3.0 3.1 Masaoka, A.; Monden, Y.; Nakahara, K.; Tanioka, T. (1981). "Follow-up study of thymomas with special reference to their clinical stages". Cancer. 48 (11): 2485–92. PMID 7296496. Unknown parameter |month= ignored (help)
  4. Kondo, K. (2005). "Invited commentary". Ann Thorac Surg. 80 (6): 2000–1. doi:10.1016/j.athoracsur.2005.08.053. PMID 16305832. Unknown parameter |month= ignored (help)
  5. Masaoka, A.; Yamakawa, Y.; Niwa, H.; Fukai, I.; Saito, Y.; Tokudome, S.; Nakahara, K.; Fujii, Y. (1994). "Thymectomy and malignancy". Eur J Cardiothorac Surg. 8 (5): 251–3. PMID 8043287.
  6. Yamakawa, Y.; Masaoka, A.; Hashimoto, T.; Niwa, H.; Mizuno, T.; Fujii, Y.; Nakahara, K. (1991). "A tentative tumor-node-metastasis classification of thymoma". Cancer. 68 (9): 1984–7. PMID 1913546. Unknown parameter |month= ignored (help)
  7. Tsuchiya R, Koga K, Matsuno Y, Mukai K, Shimosato Y (1994). "Thymic carcinoma: proposal for pathological TNM and staging". Pathol Int. 44 (7): 505–12. PMID 7921194.