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Histologic features, growth patterns and classification of atypical thymomas.

David I Suster1, Saul Suster2

  • 1Department of Pathology, Rutgers University, New Jersey Medical School, Newark, NJ, USA.

Mediastinum (Hong Kong, China)
|July 16, 2025
PubMed
Summary

Atypical thymomas, rare primary thymic neoplasms, exhibit unusual cell features and diverse growth patterns. Accurate diagnosis is crucial due to their aggressive behavior and metastatic potential.

Keywords:
A3 thymomaB3 thymomaThymomaatypical thymomaclassification

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Area of Science:

  • Pathology
  • Oncology
  • Histology

Background:

  • Atypical thymomas are rare primary thymic epithelial neoplasms.
  • They show conserved organotypical features but possess atypical cytological characteristics.
  • The full spectrum of their histologic features and growth patterns is not well-documented.

Purpose of the Study:

  • To review the diverse morphologic appearances of atypical thymomas.
  • To emphasize the wide spectrum of histologic features displayed by these neoplasms.
  • To discuss current nomenclature and diagnostic approaches.

Main Methods:

  • Review of literature on atypical thymomas.
  • Analysis of histologic features and growth patterns.
  • Discussion of differential diagnoses and biologic behavior.

Main Results:

  • Atypical thymomas present with epithelioid/squamoid and spindle cell subtypes.
  • Histologic features can mimic thymic carcinomas or metastatic disease, particularly squamous cell carcinoma.
  • These subtypes can occur alone, in combination, or with conventional thymoma types.

Conclusions:

  • Atypical thymomas have an intermediate biologic behavior between conventional thymoma and thymic carcinoma.
  • These tumors exhibit aggressive behavior with increased metastasis risk.
  • Correct and timely diagnosis is of utmost importance for patient management.