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American Society of Clinical Oncology Technology Assessment: Chemotherapy Sensitivity and Resistance Assays

Purpose
To develop a technology assessment of chemotherapy sensitivity and resistance assays in order to
define the role of these tests in routine oncology practice.
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Thymomas and thymic carcinoma are rare neoplasms. Surgical resection is the cornerstone of effective therapy. Stage I disease is effectively treated by complete surgical resection. The role of radiation therapy in completely resected stage II disease remains controversial. Adjuvant radiation therapy is useful for local control and may improve survival in patients with incompletely resected tumours. Cisplatin-based chemotherapy regimens play an important role in the treatment of advanced stage III/IV or recurrent disease thymomas, but have proven less effective for thymic carcinoma. Phase II trials of multimodality therapy incorporating neoadjuvant chemotherapy, surgery and postoperative radiation therapy show promise for unresectable disease. This review discusses recent clinical data and the potential role for agents targeting the epidermal growth factor receptor, angiogenesis and apoptotic pathways.Read More →

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Carcinoma showing thymus-like differentiation (CASTLE) is a rare tumor that occurs in the soft tissue of the neck or in the thyroid gland. We report a case of CASTLE in a 54-year-old man presenting with hoarseness. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a mass enclosing the right carotid artery with the shape of lobulation and invasion to the trachea. The mass was hypointense on T1-weighted imaging and, on T2-weighted imaging, showed a hyperintense periphery with isointense center relative to muscle. In dynamic MRI, the mass revealed gradual but slight heterogeneous enhancement from the periphery. Diagnosis was confirmed by histopathology.Read More →

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Human thymus development and thymoma behavior remain elusive, in spite of many acquisitions in the field in last decades. In the present paper, we analyzed the immunohistochemical expression of D2-40 in the normal human thymus and thymoma. In both fetal and postnatal normal thymus, we found a strong expression of D2-40 in the subcapsular and cortico-medullary epithelial cells, and lack of expression in the thymus of involution. These findings support a role for podoplanin in the proliferation of some subtypes of epithelial cells of the normal thymus stroma. In thymoma, the expression of D2-40 was detected in neoplastic cells in 18 from 26 cases (69.23%). No correlation was found between D2-40 expression and histological types of thymoma, but strong correlation was noticed with tumor stage. Based on these results, it is suggested that D2-40 expression is a good predictor of invasion and can be considered as a potential target for therapy in selected cases.
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A cytologic diagnosis of thymoma is extremely challenging. In part, this is because the tumor is uncommon and aspirates are infrequently encountered, a technically proficient interventional radiolo- gist is needed, epithelial cells may be difficult to recognize in lymphoid rich aspirate smears, and there is inherent sampling error in a tumor that frequently displays heterogeneous histopathology. Critical to the cytologic diagnosis of most WHO Type B thymomas is the recognition of a distinct population of epithelial cells mixed with lymphocytes.Read More →