Incidence Structure of Thymus Tumors in the Kharkiv Region and Analysis of Diagnostically Significant Parameters of Immune Response in Patients with Thymomas

The purpose of the study was to determine the structure of the incidence of thymus tumors in the Kharkiv region, taking into account the histological classification of thymus tumors and to analyze diagnostically significant indicators of the immune response of patients with thymomas. Materials and methods. The medical histories of 158 patients aged 16 to 80 years with diseases of the thymus gland were studied during 2006-2019. The indices of phagocytic activity of granulocytic neutrophils in blood heparinization, phagocytic index, phagocytic number, phagocytosis completion index and activity of proteins of the complement system were analyzed. We also analyzed the indices of the number of T- and B-lymphocytes obtained using monoclonal antibodies (CD2+, CD3+, CD4+, CD8+, CD16+, CD19+) (immunofluorescence method). Results and discussion. The structure of the incidence of tumors of the thymus in the Kharkiv region was determined, taking into account the histological classification of tumors of the thymus and indicators of the immune status of patients with thymomas. The relationship was determined between the indicators of the phagocytic activity of granulocytic neutrophils and the activity of proteins of the complement system, as well as changes in the ratio of the subpopulation composition of T-lymphocytes in patients with different types of thymomas. Lymphoepithelial thymoma is most widespread in male population in the age groups 40-59 and 20-39 years, and the lymphoid thymoma – in male population in the age group 20-39 years and female population in the age group 40-59 years. The significant decrease (p <0.05) in the mean value of the phagocytic index was revealed in group of patients with lymphoid thymomas. The subpopulations of T-lymphocytes CD3+ and CD4+ were significantly reduced (p <0.05) in group of patients with lymphoepithelial thymomas. The subpopulations of T-lymphocytes CD4+ and CD8+ were significantly reduced (p <0.05) in group of patients with lymphoid thymomas. The increasing of the mean values of markers CD16+ and CD19+ (p <0.05) in all study groups indicates that the processes of antibody production in patients with thymomas are activated regardless of the type of thymoma. Conclusion. The structure of thymus pathology in the population of the Kharkiv region is characterized by the predominance of tumor pathology in the general structure of thymus pathology, which is 51.3%. The lymphoepithelial and lymphoid thymomas are the most common tumors of the thymus and were recorded in 64.2% and 30.8% of patients with thymomas, respectively

IMPROVING THE SELECTIVE TREATMENT OF THYMUS TUMORS USING INTRA-ARTERIAL CHEMOEMBOLIZATION

Epithelial tumors of the thymus occur in the thymus and include thymomas and carcinomas of the thymus. Thymomas are the most common primary tumor in the anterior mediastinum, but are generally rare (1.5 cases / 1,000,000). Although thymomas can spread locally, they are much less invasive than thymic carcinomas. Patients with thymic carcinomas often have metastases. The 5-year survival of patients with thymoma reaches 90%. At the same time, the 5-year survival rate for thymic carcinoma is approximately 55% (NCCN Guidelines. Version 1.2020).Surgical treatment as an independent method can be used only when there are thymus tumors in encapsulated and minimally invasive tumors in the first degree, rarely in the second degree. In all other cases, patients are subject to combined, complex or conservative treatment. In combined and complex treatment, preference should be given to neoadjuvant methods, which allows to achieve regression of the tumor, reduces its volume, limits the invasion of surrounding tissues, as well as to transform the inoperable process into operability.Endovascular technologies, namely regional chemotherapy, in the preoperative period, as a preparatory stage, will increase the level of ablastics and antiblastics in surgical treatment of thymus and reduce the percentage of cytostatics on the whole body, as in intravenous administration. At patients with a paraneoplastic syndrome it is necessary to increase term of regression of displays of these syndromes.Intra-arterial administration of chemotherapeutics has certain advantages:• cytostatics in the arteries that supply blood to the tumor are injected directly into the affected area, which allows you to significantly increase the concentration of the drug in the tumor itself;• reduces the toxic effects of chemotherapy on the whole body;• longer action of drugs allows long-term contact of the cytostatic with tumor cells at all stages of the cell cycle.Another main detail of treatment is that after the introduction of the cytostatic, it is necessary to introduce special emboli (microspheres) to block the removal of the chemotherapeutic agent.The analysis of treatment is taking into account the stage, anamnestic data, the development of clinical manifestations, the results of laboratory and instrumental methods of examination.According to our evidence, taking into account clinical and anamnestic (complaints), laboratory, instrumental (CT OGK with IV contrast), certain conclusions were made in the treatment of thymic tumors.According to our observations, a method of complex treatment of thymic tumors was developed. In this technique, we used regional chemotherapy (namely intra-arterial administration of chemotherapy-cytostatics) as the main method.Object of study. Epithelial tumors of the thymus gland. Subject of study. Indicators of survival and quality of life of patients with malignant thymoma without surgical treatment. The results of radical surgical treatment after regional chemotherapy. Indicators of ablastic and antiblastic. Indicators of results of patients with paraneoplastic syndrome.The aim of the study. Increase the effectiveness of treatment of patients with epithelial tumors of the thymus by using intra-arterial chemoembolization as a neoadjuvant therapy to create ischemia and high concentrations of cytostatics in tumors for a long period of time to achieve devitalization of tumor tissue and reduce overall toxicity of chemotherapy.Objectives of the study.1. To determine the causes of unsatisfactory results of treatment of patients with epithelial tumors of the thymus using standard methods2. Improve the technique of intra-arterial chemoembolization in epithelial tumors of the thymus gland (technology, choice of cytostatics)3. To study the dynamics of biochemical markers (AFP, HGT) and antibodies to acetylcholine in paraneoplastic syndrome using intra-arterial chemoembolization4. To study pathomorphological changes in tumor tissue using intra-arterial chemoembolization5. To compare the clinical efficacy (increased tumor operability) of intra-arterial chemoembolization in the complex therapy of patients with epithelial tumors of the thymus gland.

Recent advances and conceptual changes in the classification of neuroendocrine tumors of the thymus

Neuroendocrine tumors of the thymus (TNET) are exceedingly rare neoplasms. Their histomorphology is identical to neuroendocrine tumors elsewhere in the body (in particular the lungs) and bears no similarity with thymomas and thymic carcinomas. Recent molecular findings have profoundly changed our perception of these tumors and may impact future histological classification systems.

Robotic thoracic surgery for resection of thymoma and tumors of the thymus: technical development and initial experience

ABSTRACT Objective: To evaluate the results of resection of tumors of the thymus by robotic thoracic surgery, analyzing the extent of resection, postoperative complications, time of surgery, and length of stay. Methods: Retrospective study from a database involving patients diagnosed with a tumor of the thymus and undergoing robotic thoracic surgery at one of seven hospitals in Brazil between October of 2015 and June of 2018. Results: During the study period, there were 18 cases of resection of tumors of the thymus: thymoma, in 12; carcinoma, in 2; and carcinoid tumor, in 1; high-grade sarcoma, in 1; teratoma, in 1; and thymolipoma, in 1. The mean lesion size was 60.1 ± 32.0 mm. Tumors of the thymus were resected with tumor-free margins in 17 cases. The median (interquartile range) for pleural drain time and hospital stay, in days, was 1 (1-3) and 2 (2-4), respectively. There was no need for surgical conversion, and there were no major complications. Conclusions: Robotic thoracic surgery for resection of tumors of the thymus has been shown to be feasible and safe, with a low risk of complications and with postoperative outcomes comparable to those of other techniques.