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THYMOMA: Histological Variants (Bernatz Scheme)

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THYMOMA: Histological Variants (Bernatz Scheme)

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    8. INVASIVE THYMOMA

    9. THYMOMA: Histological Variants (Bernatz Scheme) Lymphocyte-predominant (>66% lymphocytes) Mixed lymphoepithelial (>33 and < 66% lymphocytes) Epithelial-predominant (<33% lymphocytes) Spindle-cell (subtype of epithelial-predominant)

    14. DIFFERENTIAL DIAGNOSIS OF THYMOMA BASED ON THE BERNATZ (AMERICAN) CLASSIFICATION SYSTEM Lymphocyte-predominant: Small lymphocytic, small cleaved-cell, and lymphoblastic lymphomas; small cell neuroendocrine carcinoma; PNET; embryonal rhabdomyosarcoma Mixed lymphoepithelial: Mixed non-Hodgkins and Hodgkins lymphomas; seminoma Epithelial-predominant: Large cell NHL; syncitial NS Hodgkins disease; germ cell tumors; neuroendocrine tumors; follicular thyroid neoplasms Spindle-cell: Fibrohistiocytic tumors; hemangiopericytoma; spindle-cell hemangioendothelioma

    15. STAGING OF THYMOMA: Still the Best Prognostic Procedure Scheme of Masaoka et al. (Cancer 1981) is most widely used and shows good predictive value: Stage I: Tumor confined by its capsule Stage II: Tumor invades through capsule and involves adjacent tissue microscopically Stage III: Macroscopic or microscopic involvement of lung, great vessels, or pericardium, by direct extension Stage IV: Extensive seeding of pleura or pericardium, or extrathoracic metastasis (<10% of cases overall)

    16. THERAPY AND PROGNOSIS OF THYMOMA Complete surgical removal, if at all possible Uniform posteroperative irradiation for Masaoka stage II tumors and higher Chemotherapy for stage IV lesions Survival of stage I & II tumors is >90% at 5 yrs; approximately 50% for stage III lesions and 15% for stage IV

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