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Query: UMLS:C0027627 (metastases)
 103,950 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary epithelial neoplasms of the anterior mediastinum in children are very rare. We have studied 10 cases of thymic epithelial neoplasms in children aged 16 years or less and correlated their histologic features with the clinical outcome. The patients' ages ranged from one to 16 years (mean: 10.2); with a male:female ratio of 1.5:1. Nine patients had symptoms attributable to their tumors; one was asymptomatic. Four patients presented in clinical stage I, one in stage IIb, and five in stage IVb. Histologically, the tumors comprised a heterogenous group displaying a range of morphologic appearances: one tumor had the classic features of lymphocyte-rich thymoma of the adult; four were of the lymphocyte-rich type with associated unusual stromal features; two were spindle cell thymomas with cytologic and architectural atypia; and three displayed obvious cytologic features of malignancy (i.e., thymic carcinoma); two in the last group showed features of small cell carcinoma, and the other was an undifferentiated/anaplastic carcinoma. The epithelial nature of the tumors was supported in six cases by positive staining of the tumor cells with keratin antibodies and in two cases by electron microscopic demonstration of desmosomes and intracytoplasmic bundles of tonofilaments within the tumor cells. The prognosis for these patients correlated well with the degree of atypicality exhibited by the epithelial components; it was very poor in patients with small cell and undifferentiated/anaplastic carcinoma (8 months average survival), better for those with atypical spindle cell thymomas (multiple recurrences and metastases but no fatalities over a 15- to 72-month period), and best in those with lymphocyte-rich thymomas without cytologic atypia (no recurrences or metastases over an 8-month to 3-year follow-up).
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PMID:Primary thymic epithelial neoplasms in children. 203 41

Malignant thymomas are extremely rare in children, with only 27 cases reported thus far in the pediatric surgical literature. We report four additional cases diagnosed at this institution over the past 20 years (ages 3 to 14 years). Clinical presentations included superior vena cava syndrome, cough, dyspnea, cyanosis, enlarging mediastinal mass, spontaneous pneumothorax, and pleuropericardial effusion. Three patients underwent incomplete resection of the mass or biopsy because of "unresectability" and were treated with radiotherapy and adjunctive chemotherapy. One patient underwent near complete macroscopic resection as well as radiotherapy and chemotherapy. All patients died at intervals ranging from 6 months to 2 1/2 years after diagnosis. Three patients were found to have metastatic disease prior to death or at autopsy. In one case, the initial pathological diagnosis was lymphocytic thymoma. After ultrastructural studies were performed, the diagnosis was changed to thymic T-cell lymphoma. This patient subsequently developed acute lymphoblastic leukemia 3 months after surgical resection followed by radiotherapy. Malignant thymomas are highly aggressive tumors in children. A radical surgical approach with complete excision of the tumor and contiguous structures in continuity, with adjunctive radiotherapy and chemotherapy remains the only hope for survival in children with these rare lesions.
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PMID:Malignant thymoma in children: a 20-year review. 227 28

Two hundred thymomas, surgically treated between 1955 and 1982 at the Marie Lannelongue Surgical Center, were subjected to statistical analysis, comparing clinical stages and histologic types and relating them to survival. Clinical stages were defined as follows. Stage I: no invasiveness, total excision; Stage II: localized invasiveness (no more than two mediastinal structures); Stage III: largely invasive, with or without distant tumorous grafts, lymph node deposits, or metastases. Four histologic types were retained: (1) spindle or oval cell type thymoma, (2) lymphocyte-rich thymoma, (3) differentiated epithelial thymoma, and (4) undifferentiated epithelial thymoma. Invasiveness remained a major prognostic factor, but the degree of invasion did not affect the survival rate or always justify radical surgery. Thus, the survival rate dropped from 85% at 5 years and 80% at 10 years in noninvasive tumors to 50% and 35%, respectively, in invasive tumors, but without significant difference between moderately invasive Stage II and largely invasive Stage III tumors. Histologic typing indicated a good correlation between the degree of differentiation of the tumors and prognosis. The survival rates were 80% at 5 years and 75% at 10 years for spindle cell type 1 and lymphocyte-rich type 2 thymomas, 75% at 5 years and 50% at 10 years for differentiated epithelial type 3, and nil at 5 years for undifferentiated type 4 thymomas. Although invasiveness often paralleled histologic typing, they appeared as two distinct parameters with separate prognostic significance, particularly in differentiated and undifferentiated epithelial tumors. One hundred five patients had myasthenia gravis and 14 had another autoimmune disease. The associated syndromes were no longer an adverse factor in the prognosis of thymoma.
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PMID:Thymoma. A comparative study of clinical stages, histologic features, and survival in 200 cases. 396 92

Histologic features of an invasive mediastinal tumor found in a 25-year-old woman fulfilled the accepted criteria for diagnosis of predominantly lymphocytic thymoma. Histochemical and cell marker studies indicated that the neoplasm contained a preponderance of T lymphocytes. After surgical debulking of the mass, aggressive radiotherapy and chemotherapy eradicated all evidence of thoracic disease. However, six months after the initial diagnosis, rapid development of cranial nerve and brainstem metastases--without detectable recurrent disease elsewhere--resulted in the patient's death. Autopsy examination revealed the presence of peripheral nerve metastases as well. A review of the literature disclosed fewer than 10 cases of central nervous system metastasis from thymoma. In only two of these were there clinicopathologic features similar to those seen in this case.
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PMID:Malignant, predominantly lymphocytic thymoma with central and peripheral nervous system metastases. 697 6

We report transdiaphragmatic pleural and retroperitoneal metastasis developing two and half years after resection of invasive thymoma (Masaoka stage III; WHO type B1, lymphocyte-rich) in a 34-year-old man. Post-surgery, he received radiotherapy and chemotherapy. Follow-up computed tomography (CT) one year post-surgery did not reveal any local recurrence or metastasis. He remained asymptomatic throughout. A follow-up CT done two and half years later revealed an enhancing retrocrural-retroperitoneal (posterior pararenal space) soft tissue mass measuring 12 cm x 10 cm x 6 cm. Another enhancing deposit was found in the left pleural space. This lesion was found infiltrating into the subjacent lung. Both these deposits were resected along with wedge resection of the affected subsegment of the lung. Histopathology confirmed these lesions to be metastases from the lymphocyte-rich thymoma.
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PMID:Pleural and transdiaphragmatic retroperitoneal metastasis developing two and half years after resection of invasive thymoma. 1836 88