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Pathology of Primary Intrapulmonary Thymomas

Dr Sampurna Roy MD 

 

                                                                                                                      

 

 

Primary intrapulmonary thymomas are defined as primary thymomas arising in an intrapulmonary location without an associated mediastinal component, and they are very rare.

Clinical examination reveals a parenchymatous intrapulmonary mass without evidence of mediastinal involvement either radiologically or at surgery.

Intrapulmonary thymomas are not associated with myasthenia gravis, unlike those of mediastinal thymoma.

Site:  Close to the hilum ; Deep within the lung and in subpleural locations; May arise endobronchially and infiltrate the surrounding parenchyma.

Gross:  Lesions vary from 0.5 to 10 cm in greatest diameter.

Systematic mediastinal lymph node dissection according to the lymph node map for primary lung cancer should be recommended for malignant cases.

Microscopic features: Histologically the tumour is composed of biphasic population of lymphocytes admixed with epithelial cells, with prominent lobulation and fibrosis.

Focal areas of spindling of the cells are noted in some cases.

In some cases there are prominent perivascular spaces.

A prominent granulomatous reaction has also been reported.

Immunohistochemical stains for keratin and epithelial membrane antigen highlight the epithelial cells scattered against the lymphoid cell background.

Immunohistochemical studies using lymphocyte markers may be an useful tool for the diagnosis of the thymoma of ectopic site or unusual presentation.

Treatment:  Intrapulmonary thymomas are slow-growing tumors that may respond well to surgical resection when confined to the lung.

As with their mediastinal counterparts, invasive tumors will require additional treatment for the possibility of recurrence of metastasis.

Further reading:

Primary intrapulmonary thymoma.

Primary intrapulmonary thymoma associated with myasthenia gravis.

Primary intrapulmonary thymoma mimicking lung cancer.

Primary intrapulmonary thymoma: a systematic review.

Primary intrapulmonary thymoma. A clinicopathologic and immunohistochemical study of eight cases.

Synchronous primary intrapulmonary and mediastinal thymoma--a case report.

Primary intrapulmonary thymomas: case report and review of the literature.

Primary intrapulmonary thymoma associated with congenital hyperhomocysteinemia.

Intrapulmonary thymoma.

Intrapulmonary thymoma.

Pulmonary and pleural thymoma. Diagnostic application of lymphocyte markers to the thymoma of unusual site.

Primary intrapulmonary spindle cell thymoma with marked granulomatous reaction: report of a case with review of literature.

 

                                                                                    

Dr Sampurna Roy  MD

Consultant  Histopathologist (Kolkata - India)


 

 

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