Thymomas are rare tumors, with an annual incidence of 0.13 to 0.15 cases per 100,000 person-years, based on data from the National Cancer Institute Surveillance, Epidemiology and End Results Program.[1]Hsu CH, Chan JK, Yin CH, et al. Trends in the incidence of thymoma, thymic carcinoma, and thymic neuroendocrine tumor in the United States. PLoS One. 2019;14(12):e0227197.
https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0227197
http://www.ncbi.nlm.nih.gov/pubmed/31891634?tool=bestpractice.com
Men and women are affected equally.[8]Detterbeck FC, Parsons AM. Thymic tumors. Ann Thorac Surg. 2004 May;77(5):1860-9.
https://www.annalsthoracicsurgery.org/article/S0003-4975(03)02005-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/15111216?tool=bestpractice.com
[11]Cugell DW, Kamp DW. Asbestos and the pleura: a review. Chest. 2004;125:1103-1117.
http://www.ncbi.nlm.nih.gov/pubmed/15006974?tool=bestpractice.com
[12]Okumura M, Ohta M, Tateyama H, et al. The World Health Organization histologic classification system reflects the oncologic behavior of thymoma: a clinical study of 273 patients. Cancer. 2002 Feb 1;94(3):624-32.
https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.10226
http://www.ncbi.nlm.nih.gov/pubmed/11857293?tool=bestpractice.com
[13]Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;75:878-885.
http://www.ncbi.nlm.nih.gov/pubmed/12963221?tool=bestpractice.com
Thymomas have been reported in infants and also in older adults. The mean age at diagnosis is about 50 years, with a peak broad range between 35 and 70 years. The prevalence of myasthenia gravis in patients with thymoma is about 40%; in comparison, 10% to 15% of patients with myasthenia gravis have an associated thymoma.[8]Detterbeck FC, Parsons AM. Thymic tumors. Ann Thorac Surg. 2004 May;77(5):1860-9.
https://www.annalsthoracicsurgery.org/article/S0003-4975(03)02005-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/15111216?tool=bestpractice.com
[9]Bolodár A, Török O, Szabó M, et al. Ruling out fetal Sanfilippo's syndrome (mucopolysaccharidosis IIIA) in the first trimester of pregnancy [in Hungarian]. Orv Hetil. 1989 Jan 29;130(5):233-4.
http://www.ncbi.nlm.nih.gov/pubmed/2492654?tool=bestpractice.com
These patients tend to present at a slightly younger age.
Thymic carcinomas occur less frequently than thymomas, with an incidence of 0.2 to 0.5 per million.[2]Girard N, Ruffini E, Marx A, et al. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(suppl 5):v40-v55.
https://www.sciencedirect.com/science/article/pii/S0923753419471779
http://www.ncbi.nlm.nih.gov/pubmed/26314779?tool=bestpractice.com
The age distribution is broad, ranging from early childhood to adulthood, with a mean age at diagnosis of 50 to 60 years.[2]Girard N, Ruffini E, Marx A, et al. Thymic epithelial tumours: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2015;26(suppl 5):v40-v55.
https://www.sciencedirect.com/science/article/pii/S0923753419471779
http://www.ncbi.nlm.nih.gov/pubmed/26314779?tool=bestpractice.com
These tumors are slightly more common in men than in women (male-to-female ratio is 1.5:1.0). Most patients present with advanced-stage thymic carcinoma. Myasthenia gravis and other parathymic syndromes are only rarely associated with thymic carcinoma.
The relative prevalence of the WHO histologic types of thymic tumor are: A: 8%; AB: 26%; B1: 6%; B2: 19%; B3: 10%; C: 13%.[3]Detterbeck FC. Clinical value of the WHO classification system of thymoma. Ann Thorac Surg. 2006;81:2328-34.
https://www.annalsthoracicsurgery.org/article/S0003-4975(05)02367-2/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/16731193?tool=bestpractice.com
[6]Marx A, Chan JKC, Chalabreysse L, et al. The 2021 WHO classification of tumors of the thymus and mediastinum: what Is new in thymic epithelial, germ cell, and mesenchymal tumors? J Thorac Oncol. 2022 Feb;17(2):200-13.
https://www.jto.org/article/S1556-0864(21)03258-5/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/34695605?tool=bestpractice.com
Most patients present with early-stage tumors that are either fully encapsulated or invade only the capsule (Masaoka-Koga stage I: 49%; stage II: 22%). About one third present with advanced thymomas that invade other organs (Masaoka-Koga stage III: 19%; stage IVA [pleural or pericardial dissemination]: 7%; stage IVB [hematogenous or lymphatic dissemination]: 3%).[3]Detterbeck FC. Clinical value of the WHO classification system of thymoma. Ann Thorac Surg. 2006;81:2328-34.
https://www.annalsthoracicsurgery.org/article/S0003-4975(05)02367-2/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/16731193?tool=bestpractice.com
[8]Detterbeck FC, Parsons AM. Thymic tumors. Ann Thorac Surg. 2004 May;77(5):1860-9.
https://www.annalsthoracicsurgery.org/article/S0003-4975(03)02005-8/fulltext
http://www.ncbi.nlm.nih.gov/pubmed/15111216?tool=bestpractice.com
Neuroendocrine tumors of the thymus (NETT) are an extremely rare histologic subtype, with only about 200 cases reported.[13]Kondo K, Monden Y. Therapy for thymic epithelial tumors: a clinical study of 1,320 patients from Japan. Ann Thorac Surg. 2003;75:878-885.
http://www.ncbi.nlm.nih.gov/pubmed/12963221?tool=bestpractice.com
[14]Filosso PL, Actis Dato GM, Ruffini E, et al. Multidisciplinary treatment of advanced thymic neuroendocrine carcinoma (carcinoid): report of a successful case and review of the literature. J Thorac Cardiovasc Surg. 2004;127:1215-1219.
http://www.ncbi.nlm.nih.gov/pubmed/15052231?tool=bestpractice.com
Again, all age groups may be affected. The male-to-female ratio is 3:1. About 30% of patients with thymic carcinoid tumors have associated Cushing syndrome. Myasthenia gravis and other parathymic syndromes are not associated with carcinoid tumors. The carcinoid syndrome has only rarely been reported in relation to thymic carcinoid tumors.