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==Overview==
==Overview==
*There is no universally accepted system; no AJCC staging exists.
* The thymic epithelial tumor staging system was initially proposed by Bergh and his colleagues in 1978,<ref name="Bergh-1978">{{Cite journal  | last1 = Bergh | first1 = NP. | last2 = Gatzinsky | first2 = P. | last3 = Larsson | first3 = S. | last4 = Lundin | first4 = P. | last5 = Ridell | first5 = B. | title = Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas. | journal = Ann Thorac Surg | volume = 25 | issue = 2 | pages = 91-8 | month = Feb | year = 1978 | doi =  | PMID = 626543 }}</ref> modified by Wilkins and Castleman in 1979,<ref name="Wilkins-1979">{{Cite journal  | last1 = Wilkins | first1 = EW. | last2 = Castleman | first2 = B. | title = Thymoma: a continuing survey at the Massachusetts General Hospital. | journal = Ann Thorac Surg | volume = 28 | issue = 3 | pages = 252-6 | month = Sep | year = 1979 | doi =  | PMID = 485626 }}</ref> and further developed by Masaoka et al. in 1981.<ref name="Masaoka-1981">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Monden | first2 = Y. | last3 = Nakahara | first3 = K. | last4 = Tanioka | first4 = T. | title = Follow-up study of thymomas with special reference to their clinical stages. | journal = Cancer | volume = 48 | issue = 11 | pages = 2485-92 | month = Dec | year = 1981 | doi =  | PMID = 7296496 }}</ref><ref name="Kondo-2005">{{Cite journal  | last1 = Kondo | first1 = K. | title = Invited commentary. | journal = Ann Thorac Surg | volume = 80 | issue = 6 | pages = 2000-1 | month = Dec | year = 2005 | doi = 10.1016/j.athoracsur.2005.08.053 | PMID = 16305832 }}</ref>
*Historically, a classifiaction system used both histological features and clinical behavior.
* Modified Masaoka staging grouped with TNM classification is the most widely adopted system for thymic epithelial tumors currently in use.
*Masaoka staging is the clinically used staging system, although it may not be predictive for thymic carcinoma.
*GETT staging is the surgical staging system, and may have better correlation with outcome.
*A meta-analysis from UCLA suggests that evaluation of transcapsular extension (Stage I vs. Stage IIa) is of no clinical value, as they have same DFS and OS outcomes.


==Historical Classification==
==Modified Masaoka Clinical Staging of Thymoma==
*Benign Thymoma (histologically and behaviorally benign)
*Malignant Thymoma (invasive)
:*Type I - histologically benign, but behaving aggressively with local invasion
:*Type II ("thymic carcinoma") - histologically malignant, aggresive behavior


==Masaoka TNM Staging (1999)==
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
{|
|+ <SMALL>''Modified Masaoka Clinical Staging of Thymoma (1994)''<ref name="Masaoka-1994">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Yamakawa | first2 = Y. | last3 = Niwa | first3 = H. | last4 = Fukai | first4 = I. | last5 = Saito | first5 = Y. | last6 = Tokudome | first6 = S. | last7 = Nakahara | first7 = K. | last8 = Fujii | first8 = Y. | title = Thymectomy and malignancy. | journal = Eur J Cardiothorac Surg | volume = 8 | issue = 5 | pages = 251-3 | month =  | year = 1994 | doi =  | PMID = 8043287 }}</ref></SMALL>
| [[File:ttt1.png|800px|thumb]]
! style="background: #4479BA; color:#FFF;" | '''Stage'''
|}.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last = | first = | title = Thymectomy and malignancy. [Eur J Cardiothorac Surg. 1994] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/8043287 | publisher = | date = | accessdate = }}</ref>
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| style="background: #F0F0F0;" align="center" | '''I'''
| style="background: #F0F0F0;" | Macroscopically and microscopically completely encapsulated
|-
| style="background: #F0F0F0;" align="center" | '''II'''
| style="background: #F0F0F0;" | A. Microscopic transcapsular invasion <BR> B. Macroscopic invasion into surrounding fatty tissue or grossly adherent to but not through <BR> mediastinal pleura or pericardium
|-
| style="background: #F0F0F0;" align="center" | '''III'''
| style="background: #F0F0F0;" | Macroscopic invasion into neighboring organs (ie, pericardium, great vessels, lung) <BR> A. Without invasion of great vessels <BR> B. With invasion of great vessels
|-
| style="background: #F0F0F0;" align="center" | '''IV'''
| style="background: #F0F0F0;" | A. Pleural or pericardial dissemination <BR> B. Lymphogenous or hematogenous metastasis
|-
|}


==TNM Classification of Thymic Epithelial Tumors==


==Original Masaoka Staging (1991)==
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
*Stage I - Macroscopically and microscopically completely encapsulated
|+ <SMALL>''TNM Classification of Thymic Epithelial Tumors by Yamakawa and Masaoka (1991)''<ref name="pmid3621939">{{cite journal| author=Sinha Hikim AP, Hoffer AP| title=Quantitative analysis of germ cells and Leydig cells in rat made infertile with gossypol. | journal=Contraception | year= 1987 | volume= 35 | issue= 4 | pages= 395-408 | pmid=3621939 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3621939  }} </ref></SMALL>
*Stage II - Macroscopic invasion into surrounding fatty tissues or mediastinal pleura or microscopic invasion into the capsule
! colspan="2" style="background: #4479BA; color:#FFF;" | '''T/N/M Stage'''
*Stage III - Macroscopic invasion into adjacent organs or intrathoracic metastases
! style="background: #4479BA; color:#FFF;" | '''Description'''
*Stage IVA - Pleural or pericardial implants/dissemination
|-
*Stage IVB - Nodal or hematogenous metastases
| rowspan="4" style="background: #F0F0F0; width:75px;" align="center" | '''T factor''' || style="background: #F0F0F0; width: 50px;" align="center" | '''T1'''
| style="background: #F0F0F0;" | Macroscopically completely encapsulated and microscopically no capsular invasion
|-
| style="background: #F0F0F0;" align="center" | '''T2'''
| style="background: #F0F0F0;" | Macroscopically adhesion or invasion into surrounding fatty tissue or mediastinal pleura, <BR> or microscopic invasion into capsule
|-
| style="background: #F0F0F0;" align="center" | '''T3'''
| style="background: #F0F0F0;" | Invasion into neighboring organs, such as pericardium, great vessels, and lung
|-
| style="background: #F0F0F0;" align="center" | '''T4'''
| style="background: #F0F0F0;" | Pleural or pericardial dissemination
|-
| rowspan="4" style="background: #F0F0F0;" align="center" | '''N factor''' || style="background: #F0F0F0;" align="center" | '''N0'''
| style="background: #F0F0F0;" | No lymph node metastasis
|-
| style="background: #F0F0F0;" align="center" | '''N1'''
| style="background: #F0F0F0;" | Metastasis to anterior mediastinal lymph nodes
|-
| style="background: #F0F0F0;" align="center" | '''N2'''
| style="background: #F0F0F0;" | Metastasis to intrathoracic lymphnodes except anterior mediastinal lymph nodes
|-
| style="background: #F0F0F0;" align="center" | '''N3'''
| style="background: #F0F0F0;" | Metastasis to extrathoracic lymphnodes
|-
| rowspan="4" style="background: #F0F0F0;" align="center" | '''M factor''' || style="background: #F0F0F0;" align="center" | '''M0'''
| style="background: #F0F0F0;" | No hematogenous metastasis
|-
| style="background: #F0F0F0;" align="center" | '''M1'''
| style="background: #F0F0F0;" | Hematogenous metastasis
|-
|}


==GETT Staging==
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
*Stage IA - Encapsulated, completely resected.
|+ <SMALL>''Combined Masaoka Staging/TNM Classification (1994)''<ref name="pmid7921194">{{cite journal| author=Tsuchiya R, Koga K, Matsuno Y, Mukai K, Shimosato Y| title=Thymic carcinoma: proposal for pathological TNM and staging. | journal=Pathol Int | year= 1994 | volume= 44 | issue= 7 | pages= 505-12 | pmid=7921194 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7921194  }} </ref></SMALL>
*Stage IB - Macroscopically completely resected but suspicion of mediastinal adhesions or potential capsular invasion at surgery.
! style="background: #4479BA; color:#FFF;" | '''Masaoka Stage'''
*Stage II - Invasive tumor, completely resected.
! style="background: #4479BA; color:#FFF;" | '''T factor'''
*Stage IIIA - Invasive tumor, subtotal resection.
! style="background: #4479BA; color:#FFF;" | '''N factor'''
*Stage IIIB - Invasive tumor, biopsy alone.
! style="background: #4479BA; color:#FFF;" | '''M factor'''
*Stage IVa - Supraclav or pleural met.
|-
*Stage IVb - Distant metastases.<ref name="www.ncbi.nlm.nih.gov">{{Cite web | last = | first = | title = Seventeen years of surgical treatmen... [Eur J Cardiothorac Surg. 1991] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/2025438 | publisher = | date =  | accessdate = }}</ref>
| style="background: #F0F0F0;" align="center" | '''Stage I'''
| style="background: #F0F0F0;" align="center" | T1
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage II'''
| style="background: #F0F0F0;" align="center" | T2
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage III'''
| style="background: #F0F0F0;" align="center" | T3
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | '''Stage IVa'''
| style="background: #F0F0F0;" align="center" | T4
| style="background: #F0F0F0;" align="center" | N0
| style="background: #F0F0F0;" align="center" | M0
|-
| rowspan="2" style="background: #F0F0F0;" align="center" | '''Stage IVb'''
| style="background: #F0F0F0;" align="center" | Any T
| style="background: #F0F0F0;" align="center" | N1, N2, or N3
| style="background: #F0F0F0;" align="center" | M0
|-
| style="background: #F0F0F0;" align="center" | Any T
| style="background: #F0F0F0;" align="center" | Any N
| style="background: #F0F0F0;" align="center" | M1
|-
|}
 
==Previously Reported Staging System==
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>''Masaoka Staging (1981)''<ref name="Masaoka-1981">{{Cite journal  | last1 = Masaoka | first1 = A. | last2 = Monden | first2 = Y. | last3 = Nakahara | first3 = K. | last4 = Tanioka | first4 = T. | title = Follow-up study of thymomas with special reference to their clinical stages. | journal = Cancer | volume = 48 | issue = 11 | pages = 2485-92 | month = Dec | year = 1981 | doi =  | PMID = 7296496 }}</ref></SMALL>
! style="background: #4479BA; color:#FFF;" | '''Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| style="background: #F0F0F0;" align="center" | '''I'''
| style="background: #F0F0F0;" | Macroscopically completely encapsulated and microscopically no capsular invasion
|-
| style="background: #F0F0F0;" align="center" | '''II'''
| style="background: #F0F0F0;" | 1. Macroscopic invasion into surrounding fatty tissue or mediastinal pleura <BR> 2. Microscopic invasion into capsule
|-
| style="background: #F0F0F0;" align="center" | '''III'''
| style="background: #F0F0F0;" | Macroscopic invasion into neighboring organ (ie, pericardium, great vessels, or lung)
|-
| style="background: #F0F0F0;" align="center" | '''IVa'''
| style="background: #F0F0F0;" | Pleural or pericardial dissemination
|-
| style="background: #F0F0F0;" align="center" | '''IVb'''
| style="background: #F0F0F0;" | Lymphogenous or hematogenous metastasis
|-
|}
 
{| style="border: 0px; font-size: 90%; margin: 3px;" align="center"
|+ <SMALL>''Clinical Staging by Bergh (1978) and Wilkins (1979)''<ref name="Bergh-1978">{{Cite journal | last1 = Bergh | first1 = NP. | last2 = Gatzinsky | first2 = P. | last3 = Larsson | first3 = S. | last4 = Lundin | first4 = P. | last5 = Ridell | first5 = B. | title = Tumors of the thymus and thymic region: I. Clinicopathological studies on thymomas. | journal = Ann Thorac Surg | volume = 25 | issue = 2 | pages = 91-8 | month = Feb | year = 1978 | doi =  | PMID = 626543 }}</ref><ref name="Wilkins-1979">{{Cite journal  | last1 = Wilkins | first1 = EW. | last2 = Castleman | first2 = B. | title = Thymoma: a continuing survey at the Massachusetts General Hospital. | journal = Ann Thorac Surg | volume = 28 | issue = 3 | pages = 252-6 | month = Sep | year = 1979 | doi =  | PMID = 485626 }}</ref></SMALL>
! style="background: #4479BA; color:#FFF;" | '''Author'''
! style="background: #4479BA; color:#FFF;" | '''Stage'''
! style="background: #4479BA; color:#FFF;" | '''Description'''
|-
| rowspan="3" style="background: #F0F0F0;" align="center" | Bergh et al. || style="background: #F0F0F0;" align="center" | '''I''' || Intact capsule or growth within the capsule
|-
| style="background: #F0F0F0;" align="center" | '''II''' || Pericapsular growth into the mediastinal fat tissue
|-
| style="background: #F0F0F0;" align="center" | '''III''' || Invasive growth into the surrounding organs and/or intrathoracic metastases
|-
| rowspan="3" style="background: #F0F0F0;" align="center" | Wilkins et al. || style="background: #F0F0F0;" align="center" | '''I''' || Intact capsule or growth within the capsule
|-
| style="background: #F0F0F0;" align="center" | '''II''' || Pericapsular growth into the mediastinal fat tissue or adjacent pleura or pericardium
|-
| style="background: #F0F0F0;" align="center" | '''III''' || Invasive growth into the surrounding organs and/or intrathoracic metastases
|-
|}


==References==
==References==
{{Reflist|2}}
{{reflist|2}}


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Latest revision as of 20:52, 20 November 2018

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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

  • The thymic epithelial tumor staging system was initially proposed by Bergh and his colleagues in 1978,[1] modified by Wilkins and Castleman in 1979,[2] and further developed 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. ↑ Sinha Hikim AP, Hoffer AP (1987). "Quantitative analysis of germ cells and Leydig cells in rat made infertile with gossypol". Contraception. 35 (4): 395–408. PMID 3621939.
  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.
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