10.1515/chilat-2016-0010
ACTA CHIRURGICA LATVIENSIS • 2016 (16/1)
ORIGINAL ARTICLE
Inside the Mediastinum: the Morphological Spectrum
and Stages of Thymic Tumours
Agita Jukna, Marta Jasa, Mara Mezvevere, Andrejs Vanags, Ilze Strumfa
Riga Stradins University, Riga, Latvia
Summary
Introduction. The diversity of mediastinal anatomy can give rise to wide scope of different pathologies, including thymomas: the
most common cause of anterior mediastinal masses in adults, accounting for 20 – 40% of all mediastinal tumours. However,
thymoma remains a rare disease, characterised by the incidence of 0.10 – 0.26 cases per 100’000 inhabitants. Despite the wellknown association with such diseases as myasthenia gravis, hypogammaglobulinemia, erythroid hypoplasia and others, greater
awareness of this entity is necessary for correct diagnostics. In addition, the small amount of published systematized data interferes
with the research of these tumours.
Aim of the study. The goal of the study was to determine the morphological spectrum and stages of thymic tumours in order to
increase awareness of this mediastinal pathology and to highlight diagnostic key points in local population.
Material and methods. The study was carried out by retrospective design, enrolling all consecutive patients with morphologically
confirmed and surgically removed thymic tumours during 12-year period in a single university hospital. The patients were identified
by archive search. Pathology reports and diagnostic microscopy slides were retrieved to re-evaluate the morphological features.
The histological type was detected according to the World Health Organization (WHO) classification, 2015. The staging by MasaokaKoga system was carried out. The tumour volume was calculated using ellipsoid formula. Descriptive statistical analysis was applied,
including detection of 95% confidence interval (CI).
Results. The identified group comprised 34 patients with tumours of the thymus. There were 20 females (58.82%; 95% CI = 37.25 –
80.39) and 14 males (41.18%; CI = 19.61 – 62.75) in the study group. The mean age of patients was 56.91 years (CI = 52.59 –
61.23). According to WHO classification, type AB thymoma was predominant: 12 cases (35.30%; CI = 19.23 – 51.36), followed by
type B3 tumour: 6 (17.66%; CI = 4.83 – 30.46). Types A, B1 and B2 as well as undifferentiated thymic carcinoma comprised 3 cases
in each group (8.82%; CI = 0 – 18.36). By Masaoka-Koga staging, most tumours were identified in stage IIb: 12 cases (37.50%; CI =
20.73 – 54.27), or IIa: 10 cases (31.25%; CI =15.19 – 47.31) while 7 cases (21.87%; CI = 7.55 – 36.20) were classified as stage I.
The mean tumour volume was 109.24 cm3 (CI = 59.30 – 159.18). There was a trend to higher tumour volume in type A (107.98 cm3;
CI = 76.44 – 139.52), AB (130.90 cm3; CI = 65.61 – 196.18) and B1 (210.03 cm3; CI = 141.80 – 278.26) thymomas in comparison
with B3 (52.90 cm3; CI = 33.37 – 72.43) thymomas.
Conclusions. To the best of our knowledge, this is the first systematic study on thymic tumours in Latvia. The tumours of the
thymus are diagnosed at the mean age of 57 years and are slightly more common in women. The morphological spectrum shows
predominance of AB type thymoma, followed by B3 thymoma. According to Masaoka-Koga staging, by the time of operation the
tumour most frequently has reached stage IIb characterised by gross invasion beyond the capsule. Therefore, increased attention
must be paid towards complete resection of thymic tumour.
Key words: thymic tumours, thymoma, Masaoka-Koga staging
INTRODUCTION
Mediastinum has been compared to a Pandora's box as
many different structures and organs are located in this
anatomical unit giving rise to highly diverse pathologies.
Furthermore, approximately half of the patients may
initially experience no clinical symptoms. Thus, a
fraction of the mediastinal tumours is diagnosed only
when the patient already suffers from the symptoms
due to compression of or invasion into the nearby
anatomical structures. In a better scenario, the lesions
are found incidentally on a routine chest examination (10).
Mediastinal masses include thymic abnormalities that
are rare. Thymoma is the most common cause of anterior
mediastinal mass lesions in adults, accounting for 20 –
40% of all mediastinal masses. However, the incidence
of thymoma is only 0.10 – 0.26 cases per 100’000
inhabitants. The small amount of systematized data
interferes with the characteristics and research of these
tumours (4,6,10,13). The other major types of thymic
neoplasms are thymic carcinoma which constitutes 10 –
22% of all thymic tumours, as well as less frequently
encountered thymolipoma and others (13).
The first-line treatment of thymic neoplasms includes
surgical removal of the tumour. Usually, no additional
therapy is necessary if the tumour can be excised totally
and is well-encapsulated (10). A recurrence rate after
complete surgical resection is from 5 up to 50% (7).
Patients’ prognosis depends on morphological type and
stage of the tumour. In the age of personalized medicine,
histological evaluation of thymic tumours also becomes
more significant (12).
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Table 1. Masaoka-Koga staging system of thymic
tumours
The tumour volume was calculated using ellipsoid
formula: π/6 x length x width x height, using threedimensional gross measurements (2). Descriptive
statistical analysis was applied and 95% confidence
interval (CI) was detected (1).
The study was carried out in accordance with the
Declaration of Helsinki. During surgery, all tissues have
been removed in diagnostic and curative purposes
only; the patients were not subjected to any additional
investigations that would be attributable to the present
study.
RESULTS
The identified group comprised 34 patients diagnosed
with tumours of the thymus. There were 20 females
(58.82%; 95% CI = 37.25 – 80.39) and 14 males
(41.18%; CI = 19.61 – 62.75) within the study group.
The mean age of patients was 56.91 years (CI = 52.59 –
61.23); however, the age ranged widely from 30 to 81
years. The mean age among females was 57.90 (CI =
52.59 – 61.23; range 31 – 81) and in males: 55.50 (CI =
52.59 – 61.23; range 30 – 72) years.
A
AB
B1
B2
B3
Type of the tumour
TC
female
Others
male
Fig. 2. Histological spectrum of thymic tumours
by gender. Abbreviation in the Figure: TC, thymic
carcinoma
Additionally, 32 tumours were classified by MasaokaKoga stage criteria, but 2 cases were excluded from
staging because of the lack of surrounding tissues.
According to Masaoka-Koga classification, most
tumours were identified in stage IIb: 12 cases (37.50%;
CI = 20.73 – 54.27) or stage IIa: 10 cases (31.25%; CI =
15.19 – 47.31). Stage I included 7 cases (21.87%; CI =
7.55 – 36.20). There were 3 (9.37%; CI = 0 – 19.47)
patients diagnosed in stage III. The stage distribution by
patient’s gender, age and morphological type of tumour
is revealed in Figures 3 and 4.
Amount (n)
Stage
Criteria
I
Grossly and microscopically completely
encapsulated tumour
IIa Microscopic transcapsular invasion
IIb Macroscopic invasion into thymic or
surrounding fatty tissue, or grossly adherent to
(but not breaking through) mediastinal pleura
or pericardium
III Macroscopic invasion into neighbouring
organs (pericardium, great vessels, or lung)
IVa Pleural or pericardial metastases
IVb Lymphogenous or haematogenous metastasis
8
7
6
5
4
3
2
1
0
10
9
8
7
6
5
4
3
2
1
0
70
60
50
40
30
20
Age (years)
MATERIAL AND METHODS
A retrospective design was selected for the study. All
consecutive patients, diagnosed with morphologically
confirmed and surgically removed tumour of the thymus
in the time frame between January 2004 and February
2016 in a single university hospital, were identified by
archive search. The pathology reports and diagnostic
microscopy slides were retrieved and re-evaluated by
three authors to ensure data consistency. The histological
type was detected according to the 2015 World Health
Organization (WHO) classification of epithelial thymic
tumours, including thymomas, thymic carcinomas and
thymic neuroendocrine tumours, among other entities
(13). Masaoka-Koga system and criteria (Table 1) based
on invasion into surrounding tissues were applied for
staging (13). In addition, demographic data (gender,
age) were analysed.
According to WHO classification, the following
morphological types (Figure 1) were identified: type
A thymoma: 3 (8.82%; CI = 0 – 18.36); type AB: 12
(35.30%; CI = 19.23 – 51.36); type B1: 3 (8.82%; CI =
0 – 18.36); type B2: 3 (8.82%; CI = 0 – 18.36); type B3:
6 (17.66%; CI = 4.83 – 30.46); undifferentiated thymic
carcinoma: 3 (8.82%; CI = 0 – 18.36) cases. Other specific
tumours found in thymus which could not be included
in any of the previously mentioned histological groups
were micronodular thymoma, thymic neuroendocrine
carcinoma, thymolipoma and thymic solitary fibrous
tumour, one case of each entity (2.94%; CI = 0 – 8.62).
The morphological distribution by histological type and
gender is shown in the Figure 2.
Amount (n)
AIM OF THE STUDY
The aim of this study was to determine the morphological
spectrum and stages of thymic tumours in order to
increase awareness of this mediastinal pathology and to
highlight diagnostic key points in local patients.
10
0
female
male
I
female
male
female
II A
II B
Stage
male
female
male
III
Mean age
Fig. 3. Distribution of the stages by gender and age
among patients with thymic tumours
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A
B
C
D
E
F
Fig. 1. Epithelial tumours of the thymus. A, Type A thymoma with an area featuring fascicular spindle
cell pattern with few admixed lymphocytes. B, Type AB thymoma with biphasic morphology showing
separated type A and B-like areas. C, Type B1 thymoma with a light medullary island and dark cortical
area. D, Type B2 thymoma with epithelial cell clusters admixed with lymphoid cells. E, Type B3
thymoma with atypical epithelial polygonal cells showing a sheet-like pattern. F, Thymic carcinoma
lacking normal thymic architecture and showing invasion (haematoxylin-eosin, original magnification
200x)
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Table 3. The mean thymoma size by MasaokaKoga stages
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
III
IIb
IIa
I
A
AB
B1
B2
Type of the tumour
B3
TC
Fig. 4. Stage distribution of thymic tumours by
histological type. Abbreviation in the Figure: TC,
thymic carcinoma
The mean tumour volume was 109.24 cm3 (CI =
59.30 – 159.18; range 1.15 – 582.47). According to
morphological types by WHO classification, the largest
mean tumour volumes were observed in type B1 (210.03
cm3) and type AB thymomas (130.90 cm3), followed by
type A thymoma (107.98 cm3). The types B2 and B3
possessed smaller mean volume: 76.99 cm3 and 52.90
cm3, respectively. The confidence interval analysis,
shown in Table 2, confirmed the statistical significance
of differences between type B3 and A as well as B3 and
B1 thymomas. In both cases, type B3 was characterised
by smaller mean volume. The differences between
types A and B1 as well as type B2 and B1 thymoma
also were statistically significant. Notably, there were no
significant differences between the thymoma types by
the largest diameter.
Table 2. The mean size of thymomas by WHO
morphological types
Morpho- Largest diameter,
logical
cm
type
Mean 95% CI
A
6.57 1.79 – 11.35
AB
6.68 5.28 – 8.08
B1
7.23 6.46 – 8.00
B2
5.37 4.19 – 6.55
B3
5.50 3.49 – 7.51
Volume, cm3
Mean
107.98
130.90
210.03
76.99
52.90
95% CI
76.44 – 139.52
65.61 – 196.18
141.80 – 278.26
33.02 – 120.95
33.37 – 72.43
Abbreviations in the Table: WHO, World Health
Organisation; CI, confidence interval
The mean tumour volumes by Masaoka-Koga stages
were following: stage I tumours, 119.06 cm3 (CI = 5.45 –
232.66); stage IIa: 129.58 cm3 (CI = 23.72 – 235.44),
stage IIb: 91.85 cm3 (CI = 20.00 – 163.69) and stage
III: 68.83 cm3 (CI = 6.79 – 130.86). The mean largest
diameter by tumour stage is also disclosed in Table 3.
Stage by
MasaokaKoga
system
I
IIA
IIB
III
Largest
diameter, cm
Mean 95% CI
6.10
6.83
6.01
6.40
3.90 – 8.30
5.20 – 8.46
4.26 – 7.76
3.26 – 9.54
Volume, cm3
Mean
95% CI
119.06
129.58
91.85
68.83
5.45 – 232.66
23.72 – 235.44
20.00 – 163.69
6.79 – 130.86
Abbreviation in the Table: CI, confidence interval
DISCUSSION
Thymomas are rare tumours, characterised by the
incidence of 0.10 – 0.26 cases / 100’000 within year.
Nevertheless, thymoma is the most common tumour
found in the thymus followed by thymic carcinomas
that occur in 0.03 – 0.06 patients / 100’000 per year.
Thymomas, mostly located in the anterior mediastinum,
are also the most common mediastinal tumours in adults.
The risk factors of thymomas are largely unknown,
contrasting with the well-known association between
thymoma and certain diseases such as myasthenia
gravis (10,13). Paraneoplastic mechanism has been
proposed to explain this association.
By global data, thymomas frequently present at the age
between 40 and 60 years. Our data, showing the mean
age of 56.9 years, are consistent with this observation.
The incidence between males and females is reported
to be equal, although in some studies a slight female
predominance is observed (13). Similarly, we observed
slightly higher proportion of females although the
difference was not statistically significant.
Thymomas are epithelial neoplasms, classified by WHO
system into types A, AB, B1, B2 and B3. In addition,
rare types as micronodular thymoma with lymphoid
stroma or metaplastic thymoma have been reported.
The morphological classification is of utmost importance
due to its prognostic value. The 5-year and 10-year
survival of patients with type A thymoma is 90 – 100%
and 80 – 100%, respectively, if the resection has been
complete. Regarding type AB thymoma, both 5- and 10year survival is 80 – 100%. In B1 thymoma the 5-year
survival ranges 96 – 100%, but 10- and 20-year survival
reaches 85 – 100%. Type B2 thymoma is associated
with 10- and 20-year survival of 70 – 90% and 59 –
78%, respectively. Type B3 thymoma is contrasting, as
the reported 10- and 20-year survival is 50 – 70% and
25 – 36%. In the global statistics, types AB and B2 are
the most common, representing 27.5% and 26% of all
thymomas, respectively. Types B1 and B3 account for
17.5% and 16.0% of thymomas while type A thymoma
comprises only 11.5% of all thymomas. Other thymic
tumours as well as thymic carcinoma are detected less
frequently. It should be emphasized that controversies
still exist regarding the prognostic parameters of
thymomas (4,13).
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were diagnosed in stages IIb and IIa, characterised
by gross or microscopic transcapsular invasion,
respectively. Thus, attention must be paid to ensure
complete resection.
The limitations of our study include the low number
of cases as could be expected in the research devoted
to rare tumours in relatively small population.
However, considering the global incidence of
thymomas and the size of the population of Latvia
(Table 4; data by Central Statistical Bureau of Latvia,
available at http://data.csb.gov.lv/pxweb/en/Sociala/
Sociala__ikgad__iedz__iedzskaits/IS0022.px/table/
tableViewLayout1/?rxid=c0c89723-38f1-49ef-87eed7c42809edd2; accessed 14th May, 2016), the expected
total number of thymomas in whole Latvia within the
study period could range between 25.5 and 66.5 cases.
Thus, the identified group of 34 patients represents
a significant fraction of thymoma cases in Latvia and
therefore can be considered a representative source of
the morphological scope and stage. The strength of the
present study would include the systematic application
of up-to-dated (2015) histological typing and MasaokaKoga staging by consensus of three researchers.
In conclusion, here we present a systematic evaluation
of thymomas in local population. To the best of our
knowledge, based on PubMed search, such analysis of
thymic tumours has not previously been carried out in
Latvia or Baltic countries although an attempt to detect
risk factors of rare tumours, including thymomas, has
been undertaken. However, no data on stage or WHO
histological type have been provided then (8). Here,
we present a “morphological portrait” of thymomas
showing predominance of an indolent type AB thymoma
followed by aggressive type B3 thymoma. Thus, dual
behaviour of thymomas can be predicted: either indolent
or aggressive histological types dominate. Surgery is the
preferred treatment option and should be recommended
even for small thymomas as the largest volumes were
observed in less aggressive tumour types. As tumour
volume is not the limiting factor, local thymoma patients
theoretically might benefit from minimally invasive or
robotic surgery (5,14,17). However, regardless of the
surgical approach and technology, attention must be
paid to completeness of resection, known to influence
the outcome. This issue can be problematic considering
the high proportion of invasive cases (stage II – III).
Our study expressed some similarities to the data
mentioned above, showing a trend to higher proportion
of type AB thymomas. The more aggressive type B3
thymomas that usually presented in higher stage as well
as brought less favourable prognosis (13) represented
the 2nd most frequent type. Although the differences
can be attributable to deviations seen in small study
group as can be expected regarding rare tumours in
small country, the local morphological spectrum of
thymomas is dual, warning about possible aggressive
course of B3 thymoma contrasting with more frequent
and indolent type AB thymomas in other patients.
In up-to-date medical science, tumour volume has been
explored as a prognostic parameter (9,15,16). Regarding
tumours of the thymus, metabolic and morphological
tumour volume is found of utmost significance in the
identification of thymic carcinomas and predicting
prognosis (11). The physical volume can also have role
in the planning of surgical treatment and approach.
In addition, the tumour size and volume can be
associated with the biological potential of the tumour,
paralleling the prognostic role of tumour volume in
other locations. Slightly larger mean tumour diameter
has been reported in type A and AB thymomas, namely,
5.9 – 7.4 and 7.3 – 7.9 cm, respectively, compared to the
types B1, B2 and B3 with mean values from 4 up to 7.9
cm (13). Our study showed tendency to smaller tumour
volume in B3 thymoma, reaching statistical significance
in comparison with type A and B1 thymoma. There was
also a statistically insignificant trend to smaller tumour
volumes in stages IIb and III at the time of the tumour
surgical removal. These differences and trends can be
attributed to the reported more frequent occurrence
of myasthenia gravis in B thymomas, or more rapid
growth with higher invasive properties leading to
extensive tissue damage as B3 type is known to have
higher biological potential. The trend to lower volume
in higher stage points to the role of biological potential.
Thus, in contrast with many other tumours, small
tumour size cannot be interpreted as an evidence of
more indolent thymoma.
The prognosis of the patient is worldwide based
upon Masaoka-Koga staging system showing reliable
association with overall survival (3). Type A and AB
thymomas usually present at the stage I or II, while the
other types B1, B2 and B3 tend to have more advanced
stages as III and IV (13). In our study, most of the cases
Table 4. Size of the population of Latvia, 2004 – 20151
Year
Population
Year
Population
2004
2005
2006
2007
2008
2009
2276520
2249724
2227874
2208840
2191810
2162834
2010
2011
2012
2013
2014
2015
2120504
2074605
2044813
2023825
2001468
1986096
1
Data by Central Statistical Bureau of Latvia, available at http://data.csb.gov.lv/pxweb/en/Sociala/Sociala__ikgad__
iedz__iedzskaits/IS0022.px/table/tableViewLayout1/?rxid=c0c89723-38f1-49ef-87ee-d7c42809edd2; accessed
14th May, 2016
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CONCLUSIONS
Thymomas in Latvia are characterised by predominance
of type AB and B3 tumours. The relatively frequent
occurrence of B3 tumours and thymomas in MasaokaKoga stage II – III underscores the necessity for careful
surgical technique in order to achieve complete
resection. However, most of local thymoma cases
theoretically could be subjected to minimally invasive or
robotic surgery. Small tumour size in case of thymoma is
not indicative of indolent histological type or low stage.
9.
10.
11.
ACKNOWLEDGEMENT
The research was carried out within the scientific project
ZP08/ Riga Stradins University.
Conflict of interest: None
12.
REFERENCES
1. Altman D, Machin D, Bryant T, Gardner M. Statistics
with Confidence: Confidence Interval and Statistical
Guidelines. 2nd ed. Bristol: Wiley-Blackwell; 2000;
1 – 254
2. Buckle T, van Berg NS, Kuil J, Bunschoten A,
Oldenburg J, Borowsky AD, Wesseling J, Masada
R, Oishi S, Fujii N, van Leeuwen FW. Non-invasive
longitudinal imaging of tumour progression using an
(111)indium labelled CXCR4 peptide antagonist //
Am J Nucl Med Mol Imaging, 2012; 2(1):99 – 109
3. Filosso PL, Venuta F, Oliaro A, Ruffini E, Rendina EA,
Margaritora S, Casadio C, Trezi A, Rena O, Lococo
F, Guerrera F. Thymoma and inter-relationships
between clinical variables: a multicentre study
in 537 patients // Eur J Cardiothorac Surg, 2014;
45(6):1020 – 1027
4. Guerrera F, Rendina EA, Venuta F, Margaritora S,
Ciccone AM, Novellis P, Novero D, Anile M, Bora
G, Rena O, Casadio C, Mussi A, Evangelista A,
Ruffini E, Lucchi M, Filosso PL. Does the World
Health Organization histological classification
predict outcomes after thymomectomy? Results
of a multicentre study on 750 patients // Eur J
Cardiothorac Surg, 2015; 48(1):48 – 54
5. Jurado J, Javidfar J, Newmark A, Lavelle M,
Bacchetta M, Gorenstein L, D’Ovidio F, Ginsburg
ME, Sonett JR. Minimally invasive thymectomy
and open thymectomy: outcome analysis of 263
patients // Ann Thorac Surg, 2012; 94(3):974 – 981
6. Longo DL. Thymoma // In: Kasper DL, Fauci AS,
Hauser SL, Longo DL, Jameson JL, Loscalzo J.
Harrison's Principles of Internal Medicine. 19th ed.
New York: McGraw-Hill; 2015; 619
7. Lucchi M, Mussi A. Surgical treatment of recurrent
thymomas // J Thorac Oncol, 2010; 5 (10 Suppl 4):
348 – 351
8. Lynge E, Afonso N, Kaerlev L, Olsen J, Sabroe S,
Ahrens W, Eriksson M, Guenel P, Merletti F,
Stengrevics A, Suarez-Varela M, Costa-Pererra A,
Vyberg M. European multi-centre case-control
study on risk factors for rare cancers of unknown
aetiology // Eur J Cancer, 2005; 41(4):601 – 612
13.
14.
15.
16.
17.
Qin L, Wu F, Lu H, Wei B, Li G, Wang R. Tumor
volume predicts survival rate of advanced
nasopharyngeal carcinoma treated with concurrent
chemoradiotherapy // Otolaryngol Head Neck Surg,
2016; pii:0194599816644408
Rosai J. Mediastinum // In: Rosai J. Rosai and
Ackerman’s Surgical Pathology. 10th ed. Edinburgh
(international edition): Mosby Elsevier Inc.; 2011;
437– 486
Scagliori E, Evangelista L, Panunzio A, Calabrese F,
Nannini N, Polverosi R, Pomerri F. Conflicting or
complementary role of computed tomography (CT)
and positron emission tomography (PET)/CT in the
assessment of thymic cancer and thymoma: our
experience and literature review // Thorac Cancer,
2015; 6(4):433 – 442
Ströbel P, Hohenberger P, Marx A. Thymoma
and thymic carcinoma: molecular pathology and
targeted therapy // J Thorac Oncol, 2010; 5(10
Suppl 4):286 – 290
Ströbel P, Marx A, Badve S, Chan JKC, Detterbeck
F, Girard N, Kurrer MO, Marchevsky AM, Marom
EM, Matsuno Y, Nicholson AG, Nonaka D, Rieker
RJ. Tumours of the Thymus // In: Travis WD,
Brambilla E, Burke AP, Marx A, Nicholson AG.
WHO Classification of Tumours of the Lung, Pleura,
Thymus and Heart. 4th ed. Lyon: IARC; 2015; 183 –
298
Suda T, Kaneda S, Hachimaru A, Tochii D, Maeda
R, Tochii S, Takagi Y. Thymectomy via a subxiphoid
approach: single-port and robot-assisted // J Thorac
Dis, 2016; 8(Suppl 3):S265 – S271
Takenaka T, Yamazaki K, Miura N, Mori R, Takeo S.
The prognostic impact of tumor volume in patients
with clinical stage IA non-small cell lung cancer // J
Thorac Oncol, 2016; doi:10.1016/j.jtho.2016.02.005
Tullie LG, Sohn HM, Zylstra J, Mattsson F, Griffin N,
Sharma N, Porte F, Ramage L, Cook GJ, Gossage
JA, Mason RC, Lagergren J, Davies AR. A role for
tumor volume assessment in resectable esophageal
cancer // Ann Surg Oncol, 2016; (Epub ahead of
print)
Zhao J, Wang J, Zhao Z, Han Y, Huang L, Li X,
Lu Q, Zhou Y. Subxiphoid and subcostal arch
thoracoscopic extended thymectomy: a safe and
feasible minimally invasive procedure for selective
stage III thymomas // J Thorac Dis, 2016; 8(Suppl
3):S258 – S264
Address:
Agita Jukna
Department of Pathology, Riga Stradins University
Dzirciema Street 16, Riga, LV-1007, Latvia
E-mail: [email protected]
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