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Malignant Thymic Epithelial Tumors

CT-Pathologic Correlation

¹ Department of Radiology, Samsung Medical Center, Sungkyunkwan University, School of Medicine, 50, Ilwon-Dong, Kangnam-Ku, Seoul 135-710, Korea.
² Present address: Department of Radiology, Taegu Catholic Medical Center, Catholic University of Taegu-Hyosung School of Medicine, Taegu 705-718, Korea.
³ Department of Diagnostic Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.
⁴ Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 135-710, Korea.

OBJECTIVE. The purpose of our study was to describe and compare the CT and pathologic findings of atypical thymoma and thymic carcinoma.

MATERIALS AND METHODS. Twenty-seven consecutive patients (14 men, 13 women ranging in age from 22 to 77 years [mean age, 52 years]) with pathologically proven atypical thymoma (n = 9) and thymic carcinoma (n = 18) constituted the study population. The chest CT findings in each of the 27 patients were reviewed retrospectively in consensus by two chest radiologists. These findings were correlated with pathologic findings.

RESULTS. The tumors were located in the anterior mediastinum, and most tumors had a lobulated margin (24/27, 89%). Atypical thymomas were significantly smaller (mean, 4.7 cm) than thymic carcinomas (mean, 7.2 cm) (p = 0.041) on CT. The findings of invasion of the great vessels, lymph node enlargement, extrathymic metastases, and phrenic nerve palsy were seen only in patients with thymic carcinoma. The frequencies of necrosis, intratumoral calcification, pleural effusion, pleural implants, pericardial effusion, and obliteration of the mediastinal fat plane were not significantly different between atypical thymomas and thymic carcinomas (p > 0.05). Various histologic subtypes were included in thymic carcinoma. The tumor necrosis and calcification seen on CT were confirmed at pathologic examination.

CONCLUSION. When a large thymic tumor appears with invasion of the great vessels, lymph node enlargement, phrenic nerve palsy, or extrathymic metastases on CT, thymic carcinoma rather than atypical thymoma should be considered.

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