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[Pathology] Atlas of Immunohistochemistry of Thymoma

Immunohistochemistry of Thymoma, [Pathology] Atlas of Immunohistochemistry of Thymoma, Atlas of Mediastinal Pathology


The diagnosis of thymomas is mainly predicated on identifying their characteristic features on routine microscopy using hematoxylin and eosin (H&E)-stained tissue sections. In some instances, however, the use of ancillary techniques can be of help in establishing the diagnosis. Table 2.3 shows some of the most common immunostaining patterns used in thymomas.


Table 2.3 Most common immunohistochemical stains in diagnosis of thymoma  

+++ strong positivity in the majority of the cells, ++ strong positivity in
many of the cells, + focal positivity in some cells, +/- may show focal
positivity or negative, - negative staining in the tumor cells
Fig. 2.95 Immunohistochemical staining in lymphocyte-rich spindle-cell
thymoma (WHO type AB): (a) keratin staining shows diffuse cytoplasmic
positivity (AE1/AE3); (b) p63 testing shows strong nuclear positivity in
the spindle cells in type AB thymoma; notice the negative small lymphocytes 
in the background and the oval shape of the stained nuclei; (c) bcl-2
positivity is seen in the epithelial cells in type AB thymoma. Bcl-2 is often
positive in spindle-cell thymoma but does not stain the B types. This can
be a useful adjunct for separating lymphocyte-rich thymoma (type B1)
from lymphocyte-rich spindle-cell thymoma (WHO type AB)

Fig. 2.96 (a) Keratin staining in lymphocyte-rich thymoma (WHO
type B1); (b) p63 nuclear staining in lymphocyte-rich thymoma (type
B1) shows scattered positive nuclei surrounded by numerous negativestaining 
small lymphocytes; (c) CD1a staining in type B1 thymoma
highlights a dense population of immature thymocytes

Fig. 2.97 Immunohistochemical staining in atypical thymoma (WHO
type B3): (a) p63 nuclear staining labels virtually all the epithelial cells;
(b) CD117 positivity is seen in scattered epithelial cells; (c) Ki-67 
proliferation marker shows scattered nuclear positivity in ~15 % of the
epithelial cells. Atypical thymomas (WHO type B3) always display an
increased proliferation rate compared with other types of thymoma

Suggested Reading

Chalabreysse L, Roy P, Cordier J-F, Loire R, Gamondes JP, ThivoletBejui F. Correlation of the WHO schema for the classification of thymic epithelial neoplasms with prognosis: a retrospective study of 90 tumors. Am J Surg Pathol. 2002;26:1605–11.

Choi WWL, Lui YH, Lau WH, Crowley P, Khan A, Chan JK. Adenocarcinoma of the thymus: report of two cases, including a previously undescribed mucinous subtype. Am J Surg Pathol. 2003;27:124–30.

Hasserjian RP, Klimstra DS, Rosai J. Carcinoma of the thymus with clear cell features: report of eight cases and a review of the literature. Am J Surg Pathol. 1995;19:835–41.

Kalhor N, Suster S, Moran CA. Spindle cell thymoma with prominent papillary and pseudopapillary features: A clinicopathologic study of 10 cases. Am J Surg Pathol. 2011;35:372–7.

Koga K, Matsuno Y, Noguchi M, Mukai K, Asamura H, Goya T, Shimosato Y. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int. 1994;44:359–67.

Matsuno Y, Morozumi N, Hirosashi S, Shimosato Y, Rosai J. Papillary carcinoma of the thymus. Report of four cases of a new microscopic type of thymic carcinoma. Am J Surg Pathol. 1998;22:873–80.

Moran CA, Suster S. Mucoepidermoid carcinomas of the thymus. Clinicopathologic study of 6 cases. Am J Surg Pathol. 1995;19:826–34.

Moran CA, Suster S. Thymoma with prominent cystic and hemorrhagic changes and areas of necrosis and infarction. A clinicopathologic study of 25 cases. Am J Surg Pathol. 2001;25:1086–90.

Moran CA, Suster S. Ancient (sclerosing) thymomas. A clinicopathologic study of 10 cases. Am J Clin Pathol. 2004;121:867–71.

Moran CA, Suster S. Thymic carcinoma: current concepts and histologic features. Hematol Oncol Clin North Am. 2008;22:393–407.

Moran CA, Kalhor N, Suster S. Invasive spindle cell thymomas (WHO type A): a clinicopathologic correlation of 41 cases. Am J Clin Pathol. 2010;134:793–8.

Pan CC, Chen WY, Chiang H. Spindle cell and mixed spindle/lymphocytic thymomas: an integrated clinicopathologic and immunohistochemical study of 81 cases. Am J Surg Pathol. 2001;25:111–20.

Rieker RJ, Hoegel J, Morresi-Hauf A, Hofmann WJ, Blaeker H, Penzel R, Otto HF. Histologic classification of thymic epithelial tumors: comparison of established classifications schemes. Int J Cancer. 2002;98:900–6.

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Suster S, Rosai J. Cystic thymomas: clinicopathologic study of 10 cases. Cancer. 1992;69:92–7.

Suster S, Moran CA. Primary thymic epithelial neoplasms with combined features of thymoma and  thymic carcinoma. A clinicopathologic study of 22 cases. Am J Surg Pathol. 1996;20:1469–80. 

Suster S, Moran CA, Chan JKC. Thymoma with pseudosarcomatous stroma. Report of an unusual histologic variant of thymic epithelial neoplasms that may simulate carcinosarcoma. Am J Surg Pathol. 1997;21:1316–23.

Suster S, Moran CA. Thymic carcinoma: spectrum of differentiation and histologic types. Pathology. 1998;30:111–22. 

Suster S, Moran CA. Thymoma, atypical thymoma and thymic carcinoma. A novel conceptual approach to the classifi cation of neoplasms of thymic epithelium. Am J Clin Pathol. 1999a;111:826–33.

Suster S, Moran CA. Spindle cell carcinoma of the thymus. Clinicopathologic and immunohistochemical study of 15 cases of a novel form of thymic carcinoma. Am J Surg Pathol. 1999b;23:691–700.

Suster S, Moran CA. Micronodular thymoma with lymphoid B-cell hyperplasia. Clinicopathologic and immunohistochemical study of 18 cases of a distinctive morphologic variant of thymic epithelial
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Suster S, Moran CA. Primary thymic epithelial neoplasms: spectrum of differentiation and histologic features. Semin Diagn Pathol. 1999d;16:2–17.

Suster S. Thymic carcinoma: update of current diagnostic criteria and histologic types. Semin Diagn Pathol. 2005;22:198–212. 

Suster S, Moran CA. Thymoma classification: current status and future trends. Am J Clin Pathol. 2006;125:542–54.

Suster S, Moran CA. Classification of thymoma: the WHO and beyond. Hematol Oncol Clin North Am. 2008;22:381–92. 

Suster S, Moran CA. The mediastinum. In: Weidner N, Cote R, Suster S, Weiss LM, editors. Modern surgical pathology. 2nd ed. Philadelphia: W.B. Saunders; 2009. p. 454–516.

Travis WD, Brambilla E, Burke AP, Marx A, Nicholson AG. Pathology and genetics. Tumors of the lung, pleura, thymus, and heart. In: World Health Organization classification of tumors. Lyon: IARC
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Immunohistochemistry of Thymoma, [Pathology] Atlas of Immunohistochemistry of Thymoma, Atlas of Mediastinal Pathology
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