Alexander Marx1, Philipp Ströbel, Sunil S Badve, Lara Chalabreysse, John K C Chan, Gang Chen, Laurence de Leval, Frank Detterbeck, Nicolas Girard, Jim Huang, Michael O Kurrer, Libero Lauriola, Mirella Marino, Yoshihiro Matsuno, Thierry Jo Molina, Kiyoshi Mukai, Andrew G Nicholson, Daisuke Nonaka, Ralf Rieker, Juan Rosai, Enrico Ruffini, William D Travis. 1. *Institute of Pathology, University Medical Centre Mannheim, University of Heidelberg, Mannheim, Germany; †Institute of Pathology, University of Göttingen, Göttingen, Germany; ‡Department of Pathology, Indiana University Health Pathology Laboratory, Indianapolis, Indiana; §Department of Pathology, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; ‖Department of Pathology, Queen Elizabeth Hospital, Hong Kong, China; ¶Department of Pathology, Shanghai Pulmonary Hospital and Tongji University School of Medicine, Shanghai, China; #University Institute of Pathology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland; **Department of Thoracic Surgery, Yale University School of Medicine, New Haven, Connecticut; ††Department of Respiratory Medicine, Louis Pradel Hospital, Hospices Civils de Lyon, Lyon, France; ‡‡Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York; §§Division of Pathology, Zurich, Switzerland; ‖‖Department of Pathology, Catholic University, Rome, Italy; ¶¶Department of Pathology, Regina Elena National Cancer Institute, Rome, Italy; ##Department of Diagnostic Pathology, Hokkaido University Hospital, Sapporo, Japan; ***Department of Pathology, AP-HP, Necker, University Paris Descartes, Paris, France; †††Department of Diagnostic Pathology, Saiseikai Central Hospital, Tokyo, Japan; ‡‡‡Diagnostic Thoracic Pathology, Royal Brompton Hospital, and Imperial College London, London, United Kingdom; §§§Department of Histopathology, The Cristie Hospital, and Institute of Cancer Sciences, The University of Manchester, Manchester, United Kingdom; ‖‖‖Institute of Pathology, University of Erlangen, Erlangen, Germany; ¶¶¶Centro Diagnostico Italiano, Milano, Italy; ###Department of Thoracic Surgery, University of Torino, Torino, Italy; and ****Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, New York.
Abstract
INTRODUCTION: The 2004 version of the World Health Organization classification subdivides thymic epithelial tumors into A, AB, B1, B2, and B3 (and rare other) thymomas and thymic carcinomas (TC). Due to a morphological continuum between some thymoma subtypes and some morphological overlap between thymomas and TC, a variable proportion of cases may pose problems in classification, contributing to the poor interobserver reproducibility in some studies. METHODS: To overcome this problem, hematoxylin-eosin-stained and immunohistochemically processed sections of prototypic, "borderland," and "combined" thymomas and TC (n = 72) were studied by 18 pathologists at an international consensus slide workshop supported by the International Thymic Malignancy Interest Group. RESULTS: Consensus was achieved on refined criteria for decision making at the A/AB borderland, the distinction between B1, B2, and B3 thymomas and the separation of B3 thymomas from TCs. "Atypical type A thymoma" is tentatively proposed as a new type A thymoma variant. New reporting strategies for tumors with more than one histological pattern are proposed. CONCLUSION: These guidelines can set the stage for reproducibility studies and the design of a clinically meaningful grading system for thymic epithelial tumors.
INTRODUCTION: The 2004 version of the World Health Organization classification subdivides thymic epithelial tumors into A, AB, B1, B2, and B3 (and rare other) thymomas and thymic carcinomas (TC). Due to a morphological continuum between some thymoma subtypes and some morphological overlap between thymomas and TC, a variable proportion of cases may pose problems in classification, contributing to the poor interobserver reproducibility in some studies. METHODS: To overcome this problem, hematoxylin-eosin-stained and immunohistochemically processed sections of prototypic, "borderland," and "combined" thymomas and TC (n = 72) were studied by 18 pathologists at an international consensus slide workshop supported by the International Thymic Malignancy Interest Group. RESULTS: Consensus was achieved on refined criteria for decision making at the A/AB borderland, the distinction between B1, B2, and B3thymomas and the separation of B3 thymomas from TCs. "Atypical type A thymoma" is tentatively proposed as a new type A thymoma variant. New reporting strategies for tumors with more than one histological pattern are proposed. CONCLUSION: These guidelines can set the stage for reproducibility studies and the design of a clinically meaningful grading system for thymic epithelial tumors.
Authors: Alexander Marx; John K C Chan; Jean-Michel Coindre; Frank Detterbeck; Nicolas Girard; Nancy L Harris; Elaine S Jaffe; Michael O Kurrer; Edith M Marom; Andre L Moreira; Kiyoshi Mukai; Attilio Orazi; Philipp Ströbel Journal: J Thorac Oncol Date: 2015-10 Impact factor: 15.609