Thymic Tumors
7th Cancer Research Workshop, Grenoble, October 15-17, 1987 Thymic Tumors Editors R. Sarrazin, C. Vrousos, F. Vincent, Grenoble 52 figures and 39 tables, 1989 KARGER Basel München Paris London New York New Delhi Singapore Tokyo Sydney
Library of Congress Cataloging-in-Publication Data Cancer Research Workshop (7th: 1987: Grenoble, France) Thymic tumors / 7th Cancer Research Workshop, Grenoble, October 15-17, 1987; editors, Roger Sarrazin... [et al.]. Includes bibliographies and index. 1. Thymus - Tumors - Congresses. I. Sarrazin, R. (Roger) II. Vrousos, C. III. Vincent, François. IV. Title. [DILl: 1. Thymus Neoplasms - diagnosis - congresses. 2. Thymus Neoplasms - therapy - congresses. WK 400 C215t 1987] RC280.T55C36 1987 616.99'243 89-26651 ISBN 3-8055-4800-1 Drug Dosage The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Copyright 1989 by S. Karger AG, P.O. Box, CH-4009 Basel (Switzerland) Printed in Switzerland by Friedrich Reinhardt AG, Basel ISBN 3-8055-4800-1
Contents Preface VII From the Symptom to the Pathological Diagnosis Sarrazin, R.; Gabelle, P.; Dyon, J.-F. (Grenoble): Anatomical Background of the Thymus 1 Bryon, P. A. ; Gentilhomme, O. (Lyon): Microarchitecture and Principal Cell Types of the Normal Human Thymus 9 Exbrayat, C.; Colonnat, M.; Ménégoz, F. (Grenoble): Descriptive Epidemiology of Thymoma. Some Results of a Population-Based Cancer Registry 14 Paramelle, B.; Le Marc'hadour, F.; Pin, L; Schaerer, R.; André-Poyaud, P.; Lévy, P (Grenoble): Some New Features in Clinical Manifestations of Malignant Thymic Tumors 20 Sarrazin, R. (Grenoble): Surgical Approach of Thymic Tumors 25 Couderc, P.; Le Marc'hadour, F.; Panh, M. H. (Grenoble): Introduction to the Pathologic Study of Thymic Tumors 34 Müller-Hermelink, H.K.; Kirchner, T. (Würzburg): The Diagnosis of Thymic Epithelial Tumors 37 Isaacson, P. G. (London); Addis, B. J. (Salisbury): Lymphoma of the Thymus 45 Chantelot, J.M.; Grívaux, M. (Meaux); Kemeny, J.L. (Bobigny); Terrioux, P.; Blanchon, F. (Meaux): Carcinoid Tumor of the Thymus 56 Jarry, J.M.; Labadie, M.; Lefant, D.; Mounios, F.; Bouquet, M. (La Rochelle): Thymic Carcinoid Tumor as Part of a Case of Multiple Endocrine Neoplasia Type I 59 Wurtz, A. ; Chambon, J.P.; Fenaux, P.; Bauters, F.; Gosselin, B. (Lille): Mediastinal Diffuse Large Cell Lymphoma with Sclerosis 62 Fournel, P.; Boucheron, S.; Pommier, G.; Vasselon, C.; Jaubert, J. (Saint-Etienne): B Cell Lymphoma of Thymic Origin. An Analysis of Two Cases with Immunological Support 65 Pasquier, B.; Le Marc'hadour, F.; Pasquier, D.; Couderc, P. (Grenoble): Other Tumors 69
Contents VI Therapeutic Retrospects of Invasive Thymomas Coulomb, M.; Dalsoglio, S.; Rose-Pittet, L.; Lebas, J.F.; Paillasson, F.; Gros, C. (Grenoble): Presurgical Evaluation of Thymomas with Imaging Technique. 79 Ribet, M. (Lille): Retrospective Study of Primary Resections for Invasive Thymomas 92 Dahan, M.; Berjaud, J.; Renella Coll, J.; Haidar, H.; Lauque, D.; Gaillard, J (Toulouse): Long-Term Survival of the Operated on Lymphoepithelial Thymomas 96 Martigne, C. (Pessac); De Mascarel, A. (Bordeaux); Nelly, J. F.; Couraud, L. (Pessac): Invasive Thymomas. A Retrospective Study of 42 Cases with Emphasis on Survival according to Surgery and Clinical Staging 101 Levasseur, P.; Khalil, A.; Menestrier, M.; Gaud, C.; Regnard, J.F.; Rojas-Miranda, A. (Le Plessis Robinson): Therapeutic Strategy for Unresectable Thymomas. 110 Daugaard, G. (Copenhagen): The Effect of Chemotherapy in the Treatment of Malignant Thymoma 1 12 Simpson, W. J. (Toronto, Ont.): The Role of Radiotherapy in the Treatment of Invasive Thymomas 120 Therapeutic Strategies in Inoperable Thymomas Arriagada, R.; Bernal, P.; Le Chevalier, T.; Baldeyrou, P.; Bretel, J.J. (Villejuif): Therapeutic Strategies in Advanced Epithelial Thymic Tumors: Stages III and IV 125 Couraud, L.; Martigne, C. (Pessac): Management of Nonresectable Thymomas. 134 Mousseau, M. ; Schaerer, R. (Grenoble): A Critical Study of the Role of Chemotherapy in the Treatment of Malignant Thymomas: The Grenoble Experience 137 Ribet, M. (Lille): Therapeutic Strategies in Inoperable Thymomas: Secondary Resection after Preoperative X-Ray Therapy 144 Levasseur, P.; Khalil, A.; Menestrier, M.; Gaud, C.; Regnard, J.F.; Rojas-Miranda, A. (Le Plessis Robinson): First Intension Radical Exeresis Surgery in Invasive Thymomas. Results from a Series of 284 Operated Thymomas 147 Simpson, W. J. (Toronto, Ont.): `Unresectable' Thymomas 152 Bretel, J.-J. (Argenteuil): Staging and Preliminary Results of the Thymic Tumour Study Group 156 Conclusions 165 Subject Index 169
Preface Every year, the `Unité de Concertation et de Recherche pour le Traitement des Affections cancéreuses' (Discussion and Research Unit for the Treatment of Cancer Diseases) of Grenoble organizes a state-of-the-art meeting on a particular theme of cancer research. Our 1987 meeting centered on tumors of the thymus, which constitute a group of disparate and rare tumors. Several teams have contributed to the clarification of the problems: we wished to gather them in order to ask them a number of questions; the fruits of their experience and thoughts are published in this volume. After a few generalities, the four thymic tumor types, i.e. lymphomas, cancer of the thymus, thymoma and miscellaneous thymic tumors, were examined from an anatomo-clinical point of view. While the malignant Hodgkin and non-hodgkin tumors, which had been treated in detail during a colloquium in 1984, were not considered, we dwelled on the problems relating to thymomas and thymic neoplasms. It seems necessary to come to an agreement on their anatomical and anatomo-clinical classifications, which, combined with clinical and X-ray findings, will enable one to establish a prognosis and the optimal treatment schedule. At the first two therapeutical stages, surgery remains the method of choice, but pre- and postoperative radiotherapy is found to be an indispensable complementary measure already at the first stage, and becomes the main treatment at the third and fourth stages. The role of chemotherapy is gaining in importance: it can both slow down a detrimental course and constitute a preliminary step prior to resorting to other treatments. This work mirrors the evolution of the thoughts of the various contributing teams and informs on what they consider to be the best strategy for the
Preface VIII time being. Although no spectacular progress has been accomplished, no one has lost courage. The patients must be followed up over long periods of time, as their condition deteriorates over 10 years, 15 years and probably more. Everyone makes his suggestions, but there is general agreement over the fact that in the present state of knowledge, multicenter studies become a necessity. This meeting will perhaps enable the participants to become acquainted to new colleagues and to set up collaborative studies including large series of patients, which would broaden their experience. We hope that this book, in addition to the information it provides, will encourage scientific collaboration between the readers on this fascinating but still worrying theme. R. Sarrazin