1、Clinic Staging of Thymic Tumors,Thymic Tumors,Rare diseasesRemain localized to the mediastinum in many casesOften indolent progressionMay be locally aggressiveDissemination within the chestDistant metastases unusualLymphatic spread unusual,No official stage classification by UICC(Union for Internati
2、onal Cancer Control) and AJCC(American Joint Committee on Cancer)Various classification (Masaoka, modified Masaoka, NETT,TNM)ITMIG(International Thymic Malignancy Interesting Group) has chosen to use the Masaoka-Koga stage classification system, consistent with what has been adopted most broadly.(20
3、11.02).,Thymoma Staging System,Stage DefinitionI Grossly and microscopically completely encapsulated tumor II a Microscopic transcapsular invasion b Macroscopic invasion into thymic or surrounding fatty tissue, or grossly adherent to but not breaking through mediastinal pleura or pericardiumIII Macr
4、oscopic invasion into neighboring organ (i.e. pericardium, great vessel or lung)IV a Pleural or pericardial metastases b Lymphogenous or hematogenous metastasis,Masaoka-Koga staging system,Grossly and microscopically completely encapsulated tumor This includes tumors with invasion into but not throu
5、gh the capsuleIf capsule is partially absent - should not be interpreted as invasion,Stage I,Microscopic transcapsular invasion If there is limited microscopic extension into tissues surrounding the capsule the tumor should be classified as stage IIa, minimally invasive,Stage IIa,Gross visual tumor
6、extension into normal thymus or perithymic fat surrounding the thymoma (microscopically confirmed),Stage IIb,Adherence to pleura or pericardium making removal of these structures necessary during resection, with microscopic confirmation of perithymic invasion but without microscopic extension into o
7、r through the mediastinal pleura or into the fibrous layer of the pericardium,Stage IIb,This includes extension of the primary tumor to any of the following tissues:Microscopic involvement of mediastinal pleura (either partial or penetrating the elastin layer)Microscopic involvement of the pericardi
8、um (either partial in the fibrous layer or penetrating through to the serosal layer),Stage III,Microscopically confirmed direct penetration into the outer elastin layer of the visceral pleura or into the lungInvasion into the phrenic or vagus nerves (microscopically confirmed, adherence alone is not
9、 sufficient)Invasion into or penetration through major vascular structures (microscopically confirmed),Stage III,Microscopically confirmed nodules, separate from the primary tumor, involving the visceral or parietal pleural surfaces, or the pericardial or epicardial surfaces,Stage IVa,Any nodal invo
10、lvement (e.g. anterior mediastinal, intrathoracic, low/anterior cervical nodes, any other extrathoracic nodes)Distant metastases (i.e. extrathoracic and outside the cervical perithymic region) or pulmonary parenchymal nodules (not a pleural implant),Stage IVb,胸腺瘤的分期,I期 肿瘤局限在胸腺内，肉眼及镜下均无包膜浸润II期 IIa期 肿瘤镜下超出胸膜包膜 IIb期 侵犯邻近脂肪组织，但未侵犯至纵隔胸膜III期 肿瘤侵犯邻近组织或器官，包括心包、肺及大 血管 IIIa期 肿瘤未侵犯大血管 IIIb期 肿瘤侵犯大血管IV期 IVa期 肿瘤广泛侵犯胸膜和（或）心包 IVb期 肿瘤扩散到远处器官,胸腺瘤的分期,胸腺瘤的分期,胸腺瘤的分期,胸腺瘤的分期,Thanks for attention!,
