oncotomskСибирский онкологический журналSiberian journal of oncology1814-48612312-3168Tomsk National Research Medical Сепtеr of the Russian Academy of Sciences10.21294/1814-4861-2017-16-4-76-83oncotomsk-572Research ArticleОБЗОРЫREVIEWSТИМОМА (ОБЗОР ЛИТЕРАТУРЫ)THYMOMA (REVIEW OF THE LITERATURE)АлександровО. А.AlexandrovO. A.

Александров Олег Александрович - клинический ординатор, Московский научно-исследовательский онкологический институт им. П.А. Герцена – филиал федерального государственного бюджетного учреждения «Национальный медицинский исследовательский радиологический центр» Министерства здравоохранения Российской Федерации.

125284, г. Москва, 2-ой Боткинский проезд, 3.

Alexandrov Oleg A., Clinical Resident, Р.A. Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre.

3, Botkinsky proezd 2-nd, 125284-Moscow, Russia.

alexandrov.oleg.al@gmail.comРябовА. Б.RyabovA. B.

Рябов Андрей Борисович - профессор, доктор медицинских наук, руководитель отдела торако-абдоминальной онкохирургии, Московский научно-исследовательский онкологический институт им. П.А. Герцена – филиал федерального государственного бюджетного учреждения «Национальный медицинский исследовательский радиологический центр» Министерства здравоохранения Российской Федерации.

125284, г. Москва, 2-ой Боткинский проезд, 3.

Ryabov Andrey B., MD, DSc, Professor, Head of Thoracic and Abdominal Surgery, Р.A. Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre.

3, Botkinsky proezd 2-nd, 125284-Moscow, Russia.

ryabovdoc@mail.ruПикинО. В.PikinO. V.

Пикин Олег Валентинович - профессор, доктор медицинских наук, руководитель отделения торакальной хирургии, Московский научно-исследовательский онкологический институт им. П.А. Герцена – филиал федерального государственного бюджетного учреждения «Национальный медицинский исследовательский радиологический центр» Министерства здравоохранения Российской Федерации.

125284, г. Москва, 2-ой Боткинский проезд, 3.

Pikin Oleg V., MD, DSc, Professor, Head of Thoracic Surgery, Р.A. Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre.

3, Botkinsky proezd 2-nd, 125284-Moscow, Russia.

pikin_ov@mail.ruМосковский научно-исследовательский онкологический институт имени П.А. Герцена – филиал федерального государственного бюджетного учреждения «Национальный медицинский исследовательский радиологический центр» Министерства здравоохранения Российской Федерации.РоссияР.A. Herzen Moscow Oncology Research Institute – Branch of the National Medical Research Radiological Centre.Russian Federation2017120920171647683Copyright © Александров О.А., Рябов А.Б., Пикин О.В., 20172017Александров О.А., Рябов А.Б., Пикин О.В.Alexandrov O.A., Ryabov A.B., Pikin O.V.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.siboncoj.ru/jour/article/view/572

Цель исследования – провести систематический обзор данных, имеющихся в современной литературе, об эпидемиологии, современной классификации, клинической картине, особенностях диагностики и лечения тимомы. Материал и методы. Поиск источников производился в системах Medline, Elibrary. Включены данные как ретроспективных, так и проспективных клинических исследований. Обобщен опыт зарубежных и отечественных авторов. Результаты. Изложены концепции систем классификации, факторы прогноза, описаны уникальные для тимомы паранеопластические синдромы, частота их встречаемости. Приведены сведения о диагностической значимости компьютерной, магнитно-резонансной, позитронно-эмиссионной томографии, методах морфологической верификации. Пристальное внимание уделено методам хирургического лечения, принципам интраоперационной тактики, стратегии комбинированного лечения. Заключение. Тимома – редко встречающаяся злокачественная опухоль. По мере накопления результатов отдаленных наблюдений произошли изменения в подходах к диагностике и лечению. Склонность к поздним местным рецидивам даже после радикального хирургического лечения обусловливает стратегию комбинированного лечения. 

Objective. We aimed to systematically review the literature dealing with the epidemiology, classification, clinical course, diagnosis and treatment of thymoma. Material and methods. We reviewed retrospective and prospective randomized trials using Medline and Elibrary databases. Results. The classification system, prognostic factors, paraneoplastic syndromes and their incidence in patients with thyoma were described. The diagnostic value of computed tomography, magnetic resonance imaging and positron emission tomography was evaluated and the methods of morphologic verification were described. The main attention was paid to multimodality treatment of thymoma, including surgery and intraoperative radiotherapy. Conclusion. Thymoma is a rare tumor. The accumulation of long-term follow-up results prompted the changes in clinical management of thymoma. Predisposition to late recurrence even after radical surgery determined multimodality treatment strategies.

тимомаопухоль средостенияопухоль вилочковой железыThymomamediastinal tumorthymic tumorReferences. 1. Engels E.A. Epidemiology of thymoma and associated malignancies. Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer. NIH Public Access; 2010; 5: S260–5. doi: 10.1097/JTO.0b013e3181f1f62d.. 1. Engels E.A. Epidemiology of thymoma and associated malignancies. Journal of thoracic oncology: official publication of the International Association for the Study of Lung Cancer. NIH Public Access; 2010; 5: S260–5. doi: 10.1097/JTO.0b013e3181f1f62d.Detterbeck F.C. Evaluation and Treatment of Stage I and II Thymoma. J Thorac Oncol. 2010 Oct; 5 (10 Suppl 4): S318–22. doi: 10.1097/JTO.0b013e3181f20dab.Detterbeck F.C. Evaluation and Treatment of Stage I and II Thymoma. J Thorac Oncol. 2010 Oct; 5 (10 Suppl 4): S318–22. doi: 10.1097/JTO.0b013e3181f20dab.Bernatz P.E., Harrison E.G., Clagett O.T. Thymoma: a clinicopathologic study. J Thor Cardiovasc Surg. 1961; 42: 424–44.Bernatz P.E., Harrison E.G., Clagett O.T. Thymoma: a clinicopathologic study. J Thor Cardiovasc Surg. 1961; 42: 424–44.Levine G.D., Rosai J., Bearman R.M., Polliack A. The fine structure of thymoma, with emphasis on its differential diagnosis. A study of ten cases. Am J Pathol. 1975; 81: 49–86.Levine G.D., Rosai J., Bearman R.M., Polliack A. The fine structure of thymoma, with emphasis on its differential diagnosis. A study of ten cases. Am J Pathol. 1975; 81: 49–86.Travis W.D., Brambilla E., Muller-Hermelink H.K., Harris C.C. Tumours of the Lung, Pleura, Thymus and Heart. World Health Organization Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. IARC Press Lyon. 2000.Travis W.D., Brambilla E., Muller-Hermelink H.K., Harris C.C. Tumours of the Lung, Pleura, Thymus and Heart. World Health Organization Pathology and Genetics of Tumours of Haematopoietic and Lymphoid Tissues. IARC Press Lyon. 2000.Masaoka A., Monden Y., Nakahara K., Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981; 48: 2485–92.Masaoka A., Monden Y., Nakahara K., Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer. 1981; 48: 2485–92.Koga K., Matsuno Y., Noguchi M., Mukai K., Asamura H., Goya T., Shimosato Y. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Intern. 1994; 44: 359–67.Koga K., Matsuno Y., Noguchi M., Mukai K., Asamura H., Goya T., Shimosato Y. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Intern. 1994; 44: 359–67.Bedini A.V., Andreani S.M., Tavecchio L., Fabbri A., Giardini R., Camerini T., Bufalino R., Morabito A., Rosai J. Proposal of a novel system for the staging of thymic epithelial tumors. Ann Thor Surg. 2005; 80: 1994–2000. doi: 10.1016/j.athoracsur.2005.07.019Bedini A.V., Andreani S.M., Tavecchio L., Fabbri A., Giardini R., Camerini T., Bufalino R., Morabito A., Rosai J. Proposal of a novel system for the staging of thymic epithelial tumors. Ann Thor Surg. 2005; 80: 1994–2000. doi: 10.1016/j.athoracsur.2005.07.019Yagi K., Hirata T., Fukuse T., Yokomise H., Inui K., Ike O., Mizuno H., Aoki M., Hitomi S., Wada H. Surgical treatment for invasive thymoma, especially when the superior vena cava is invaded. Ann Thorac Surg. 1996 Feb; 61 (2): 521–4.Yagi K., Hirata T., Fukuse T., Yokomise H., Inui K., Ike O., Mizuno H., Aoki M., Hitomi S., Wada H. Surgical treatment for invasive thymoma, especially when the superior vena cava is invaded. Ann Thorac Surg. 1996 Feb; 61 (2): 521–4.Regnard J.F., Magdeleinat P., Dromer C., Dulmet E., de Montpreville V., Levi J.F., Levasseur P. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thor Cardiovasc Surg. 1996; 112: 376–84. doi: S0022-5223(96)70265-9Regnard J.F., Magdeleinat P., Dromer C., Dulmet E., de Montpreville V., Levi J.F., Levasseur P. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thor Cardiovasc Surg. 1996; 112: 376–84. doi: S0022-5223(96)70265-9Voltz R.D., Albrich W.C., Nägele A., Schumm F., Wick M., Freiburg A., Gautel M., Thaler H.T., Aarli J., Kirchner T., Hohlfeld R. Paraneoplastic myasthenia gravis: detection of anti-MGT30 (titin) antibodies predicts thymic epithelial tumor. Neurology. 1997; 49: 1454–7.Voltz R.D., Albrich W.C., Nägele A., Schumm F., Wick M., Freiburg A., Gautel M., Thaler H.T., Aarli J., Kirchner T., Hohlfeld R. Paraneoplastic myasthenia gravis: detection of anti-MGT30 (titin) antibodies predicts thymic epithelial tumor. Neurology. 1997; 49: 1454–7.Rosenow E.C., Hurley B.T. Disorders of the thymus. A review. Archives of internal medicine. 1984; 144: 763–70.Rosenow E.C., Hurley B.T. Disorders of the thymus. A review. Archives of internal medicine. 1984; 144: 763–70.Detterbeck F.C., Zeeshan A. Thymoma: current diagnosis and treatment. Chin Med J (Engl). 2013; 126 (11): 2186–91.Detterbeck F.C., Zeeshan A. Thymoma: current diagnosis and treatment. Chin Med J (Engl). 2013; 126 (11): 2186–91.Tomaszek S., Wigle D.A., Keshavjee S., Fischer S. Thymomas: Review of Current Clinical Practice. Ann Thorac Surg. 2009 Jun; 87 (6): 1973–80. doi: 10.1016/j.athoracsur.2008.12.095.Tomaszek S., Wigle D.A., Keshavjee S., Fischer S. Thymomas: Review of Current Clinical Practice. Ann Thorac Surg. 2009 Jun; 87 (6): 1973–80. doi: 10.1016/j.athoracsur.2008.12.095.Marom E.M. Imaging Thymoma. J Thor Oncol. 2010; 5: S296–303. doi: 10.1097/JTO.0b013e3181f209caMarom E.M. Imaging Thymoma. J Thor Oncol. 2010; 5: S296–303. doi: 10.1097/JTO.0b013e3181f209caYanagawa M., Tomiyama N. Prediction of Thymoma Histology and Stage by Radiographic Criteria. Thorac Surg Clin. 2011 Feb; 21 (1): 1–12. doi: 10.1016/j.thorsurg.2010.08.008.Yanagawa M., Tomiyama N. Prediction of Thymoma Histology and Stage by Radiographic Criteria. Thorac Surg Clin. 2011 Feb; 21 (1): 1–12. doi: 10.1016/j.thorsurg.2010.08.008.Ali S.Z., Erozan Y.S. Thymoma. Cytopathologic features and differential diagnosis on fine needle aspiration. Acta Cytol. 42: 845–54.Ali S.Z., Erozan Y.S. Thymoma. Cytopathologic features and differential diagnosis on fine needle aspiration. Acta Cytol. 42: 845–54.Annessi V., Paci M., De Franco S., Cavazza A., Ferrari G., Ricchetti T., Sgarbi G. Diagnosis of anterior mediastinal masses with ultrasonically guided core needle biopsy. Chir Ital. 55: 379–84.Annessi V., Paci M., De Franco S., Cavazza A., Ferrari G., Ricchetti T., Sgarbi G. Diagnosis of anterior mediastinal masses with ultrasonically guided core needle biopsy. Chir Ital. 55: 379–84.Ruffini E., Van Raemdonck D., Detterbeck F., Rocco G., Thomas P., Venuta F.; European Society of Thoracic Surgeons Thymic Questionnaire Working Group. Management of Thymic Tumors: A Survey of Current Practice among Members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2011 Mar; 6 (3): 614–23. doi: 10.1097/JTO.0b013e318207cd74.Ruffini E., Van Raemdonck D., Detterbeck F., Rocco G., Thomas P., Venuta F.; European Society of Thoracic Surgeons Thymic Questionnaire Working Group. Management of Thymic Tumors: A Survey of Current Practice among Members of the European Society of Thoracic Surgeons. J Thorac Oncol. 2011 Mar; 6 (3): 614–23. doi: 10.1097/JTO.0b013e318207cd74.Ackman J.B., Verzosa S., Kovach A.E., Louissaint A.Jr., Lanuti M., Wright C.D., Shepard J.A., Halpern E.F. High rate of unnecessary thymectomy and its cause. Can computed tomography distinguish thymoma, lymphoma, thymic hyperplasia, and thymic cysts? Eur J Radiol. 2015 Mar; 84 (3): 524–33. doi: 10.1016/j.ejrad.2014.11.042.Ackman J.B., Verzosa S., Kovach A.E., Louissaint A.Jr., Lanuti M., Wright C.D., Shepard J.A., Halpern E.F. High rate of unnecessary thymectomy and its cause. Can computed tomography distinguish thymoma, lymphoma, thymic hyperplasia, and thymic cysts? Eur J Radiol. 2015 Mar; 84 (3): 524–33. doi: 10.1016/j.ejrad.2014.11.042.Guerrera F., Rendina E.A., Venuta F., Margaritora S., Ciccone A.M., Novellis P., Novero D., Anile M., Bora G., Rena O., Casadio C., Mussi A., Evangelista A., Ruffini E., Lucchi M., Filosso P.L. Does the World Health Organization histological classification predict outcomes after thymomectomy? Results of a multicentre study on 750 patients. Eur J Cardiothorac Surg. 2015 Jul; 48 (1): 48–54. doi: 10.1093/ejcts/ezu368.Guerrera F., Rendina E.A., Venuta F., Margaritora S., Ciccone A.M., Novellis P., Novero D., Anile M., Bora G., Rena O., Casadio C., Mussi A., Evangelista A., Ruffini E., Lucchi M., Filosso P.L. Does the World Health Organization histological classification predict outcomes after thymomectomy? Results of a multicentre study on 750 patients. Eur J Cardiothorac Surg. 2015 Jul; 48 (1): 48–54. doi: 10.1093/ejcts/ezu368.Kondo K., Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003 Sep; 76 (3): 878–84.Kondo K., Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003 Sep; 76 (3): 878–84.Rea F., Marulli G., Girardi R., Bortolotti L., Favaretto A., Galligioni A., Sartori F. Long-term survival and prognostic factors in thymic epithelial tumours. European journal of cardio-thoracic surgery. Eur J Cardiothorac Surg. 2004 Aug; 26 (2): 412–8.Rea F., Marulli G., Girardi R., Bortolotti L., Favaretto A., Galligioni A., Sartori F. Long-term survival and prognostic factors in thymic epithelial tumours. European journal of cardio-thoracic surgery. Eur J Cardiothorac Surg. 2004 Aug; 26 (2): 412–8.Zhu G., He S., Fu X., Jiang G., Liu T. Radiotherapy and prognostic factors for thymoma: a retrospective study of 175 patients. Int J Radiat Oncol Biol Phys. 2004 Nov 15; 60 (4): 1113–9.Zhu G., He S., Fu X., Jiang G., Liu T. Radiotherapy and prognostic factors for thymoma: a retrospective study of 175 patients. Int J Radiat Oncol Biol Phys. 2004 Nov 15; 60 (4): 1113–9.Nakagawa K., Asamura H., Matsuno Y., Suzuki K., Kondo H., Maeshima A., Miyaoka E., Tsuchiya R. Thymoma: a clinicopathologic study based on the new World Health Organization classification. J Thor Cardiovasc Surg. 2003; 126: 1134–40. doi: 10.1016/S0022Nakagawa K., Asamura H., Matsuno Y., Suzuki K., Kondo H., Maeshima A., Miyaoka E., Tsuchiya R. Thymoma: a clinicopathologic study based on the new World Health Organization classification. J Thor Cardiovasc Surg. 2003; 126: 1134–40. doi: 10.1016/S0022Regnard J.F., Magdeleinat P., Dromer C., Dulmet E., de Montpreville V., Levi J.F., Levasseur P. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thor Cardiovasc Surg. 1996; 112: 376–84. doi: 10.1016/S0022-5223(96)70265-9Regnard J.F., Magdeleinat P., Dromer C., Dulmet E., de Montpreville V., Levi J.F., Levasseur P. Prognostic factors and long-term results after thymoma resection: a series of 307 patients. J Thor Cardiovasc Surg. 1996; 112: 376–84. doi: 10.1016/S0022-5223(96)70265-9Kim D.J., Yang W.I., Choi S.S., Kim K.D., Chung K.Y. Prognostic and clinical relevance of the World Health Organization schema for the classification of thymic epithelial tumors: a clinicopathologic study of 108 patients and literature review. Chest. 2005; 127: 755–61. doi: 10.1378/chest.127.3.755Kim D.J., Yang W.I., Choi S.S., Kim K.D., Chung K.Y. Prognostic and clinical relevance of the World Health Organization schema for the classification of thymic epithelial tumors: a clinicopathologic study of 108 patients and literature review. Chest. 2005; 127: 755–61. doi: 10.1378/chest.127.3.755Okumura M., Ohta M., Tateyama H., Nakagawa K., Matsumura A., Maeda H., Tada H., Eimoto T., Matsuda H., Masaoka A. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer. 2002; 94: 624–32.Okumura M., Ohta M., Tateyama H., Nakagawa K., Matsumura A., Maeda H., Tada H., Eimoto T., Matsuda H., Masaoka A. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer. 2002; 94: 624–32.Venuta F., Rendina E.A., Longo F., De Giacomo T., Anile M., Mercadante E., Ventura L., Osti M.F., Francioni F., Coloni G.F. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thor Surg. 2003; 76: 1866–72.Venuta F., Rendina E.A., Longo F., De Giacomo T., Anile M., Mercadante E., Ventura L., Osti M.F., Francioni F., Coloni G.F. Long-term outcome after multimodality treatment for stage III thymic tumors. Ann Thor Surg. 2003; 76: 1866–72.Forquer J.A., Rong N., Fakiris A.J., Loehrer P.J.Sr., Johnstone P.A. Postoperative radiotherapy after surgical resection of thymoma: differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys. 2010 Feb 1; 76 (2): 440–5. doi: 10.1016/j.ijrobp.2009.02.016.Forquer J.A., Rong N., Fakiris A.J., Loehrer P.J.Sr., Johnstone P.A. Postoperative radiotherapy after surgical resection of thymoma: differing roles in localized and regional disease. Int J Radiat Oncol Biol Phys. 2010 Feb 1; 76 (2): 440–5. doi: 10.1016/j.ijrobp.2009.02.016.Toker A., Sonett J., Zielinski M., Rea F., Tomulescu V., Detterbeck F.C. Standard Terms, Definitions, and Policies for Minimally Invasive Resection of Thymoma. Zhongguo Fei Ai Za Zhi. 2014 Feb; 17 (2): 90–4. doi: 10.3779/j.issn.1009-3419.2014.02.05.Toker A., Sonett J., Zielinski M., Rea F., Tomulescu V., Detterbeck F.C. Standard Terms, Definitions, and Policies for Minimally Invasive Resection of Thymoma. Zhongguo Fei Ai Za Zhi. 2014 Feb; 17 (2): 90–4. doi: 10.3779/j.issn.1009-3419.2014.02.05.Masaoka A., Nagaoka Y., Kotake Y. Distribution of thymic tissue at the anterior mediastinum. Current procedures in thymectomy. J Thorac Cardiovasc Surg. 1975 Oct; 70 (4): 747–54.Masaoka A., Nagaoka Y., Kotake Y. Distribution of thymic tissue at the anterior mediastinum. Current procedures in thymectomy. J Thorac Cardiovasc Surg. 1975 Oct; 70 (4): 747–54.Пикин О.В., Трахтенберг А.Х., Колбанов К.И., Глушко В.А., Казакевич В.И., Амиралиев А.М., Вурсол Д.А., Кирсанова О.Н. Циркулярная резекция верхней полой вены без протезирования у больных с опухолью средостения, осложнённой синдромом медиастинальной компрессии. Онкохирургия. 2013; 5: 60–6.Pikin О.V., Trakhtenberg А.Kh., Kolbanov К.I., Glushko V.А., Kazakevich V.I., Amiraliev А.М., Vursol D.А. Resection of the superior vena cava without reconstruction in patients with mediastinal tumor, complicated by the syndrome of mediastinal compression. Oncosurgery. 2013; 5: 60–6. [in Russian]Kondo K., Monden Y. Lymphogenous and hematogenous metastasis of thymic epithelial tumors. Ann Thorac Surg. 2003 Dec; 76 (6): 1859–64.Kondo K., Monden Y. Lymphogenous and hematogenous metastasis of thymic epithelial tumors. Ann Thorac Surg. 2003 Dec; 76 (6): 1859–64.Detterbeck F.C., Moran C., Huang J., Suster S., Walsh G., Kaiser L., Wick M. Which Way is Up? Policies and Procedures for Surgeons and Pathologists Regarding Resection Specimens of Thymic Malignancy. J Thor Oncol. 2011; 6: S1730–8. doi: 10.1097/JTO.0b013e31821ea567.Detterbeck F.C., Moran C., Huang J., Suster S., Walsh G., Kaiser L., Wick M. Which Way is Up? Policies and Procedures for Surgeons and Pathologists Regarding Resection Specimens of Thymic Malignancy. J Thor Oncol. 2011; 6: S1730–8. doi: 10.1097/JTO.0b013e31821ea567.Yang Y., Dong J., Huang Y. Thoracoscopic thymectomy versus open thymectomy for the treatment of thymoma: a meta-analysis. Eur J Surg Oncol. 2016 Nov; 42 (11): 1720–28. doi: 10.1016/j.ejso.2016.03.029.Yang Y., Dong J., Huang Y. Thoracoscopic thymectomy versus open thymectomy for the treatment of thymoma: a meta-analysis. Eur J Surg Oncol. 2016 Nov; 42 (11): 1720–28. doi: 10.1016/j.ejso.2016.03.029.Wright C.D., Wain J.C., Wong D.R., Donahue D.M., Gaissert H.A., Grillo H.C., Mathisen D.J. Predictors of recurrence in thymic tumors: Importance of invasion, World Health Organization histology, and size. J Thorac Cardiovasc Surg. 2005 Nov; 130 (5): 1413–21.Wright C.D., Wain J.C., Wong D.R., Donahue D.M., Gaissert H.A., Grillo H.C., Mathisen D.J. Predictors of recurrence in thymic tumors: Importance of invasion, World Health Organization histology, and size. J Thorac Cardiovasc Surg. 2005 Nov; 130 (5): 1413–21.Detterbeck F., Youssef S., Ruffini E., Okumura M. A Review of Prognostic Factors in Thymic Malignancies. J Thor Oncol. 2011; 6: S1698–704. doi: 10.1097/JTO.0b013e31821e7b12.Detterbeck F., Youssef S., Ruffini E., Okumura M. A Review of Prognostic Factors in Thymic Malignancies. J Thor Oncol. 2011; 6: S1698–704. doi: 10.1097/JTO.0b013e31821e7b12.Cowen D., Richaud P., Mornex F., Bachelot T., Jung G.M., Mirabel X., Marchal C., Lagrange J.L., Rambert P., Chaplain G. Thymoma: results of a multicentric retrospective series of 149 non-metastatic irradiated patients and review of the literature. FNCLCC trialists. Fédération Nationale des Centres de Lutte Contre le Cancer. Radiother Oncol. 1995 Jan; 34 (1): 9–16.Cowen D., Richaud P., Mornex F., Bachelot T., Jung G.M., Mirabel X., Marchal C., Lagrange J.L., Rambert P., Chaplain G. Thymoma: results of a multicentric retrospective series of 149 non-metastatic irradiated patients and review of the literature. FNCLCC trialists. Fédération Nationale des Centres de Lutte Contre le Cancer. Radiother Oncol. 1995 Jan; 34 (1): 9–16.

The authors declare that there are no conflicts of interest present.