[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-326800-105":3,"detail-sidebar-cat-0-en-105":81,"doc-detail-326800-en":130},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","tnm-staging-system-in-thymoma-a-critical-appraisal-narrative-review","TNM Staging System in Thymoma: A Critical Appraisal - narrative review","","Thymomas are rare anterior mediastinal tumors with distinctive clinical and pathological behavior, long shaped by major pathological classifications and by staging concepts linked to key pioneers such as Masaoka and Koga. With the development of the tumor-node-metastasis (TNM) framework, thymomas were placed in a structure comparable to other solid malignancies. This narrative review traces the evolution of thymic epithelial tumor (TET) staging and critically evaluates the current TNM classification against the historical Masaoka–Koga system, emphasizing the proposed direction for the ninth TNM edition expected in 2024.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/research-report/","Research & Report",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/tnm-staging-system-in-thymoma-a-critical-appraisal-narrative-review/326800/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/tnm-staging-system-in-thymoma-a-critical-appraisal-narrative-review/326800.png","ImageObject",300,407,{"name":42,"@type":43},"Himbo","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-23","2026-09-21",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",6,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"Why was a TNM staging system introduced for thymoma?","Question",{"text":63,"@type":64},"TNM was developed to rationally align thymomas with the staging approach used for other solid tumors, moving beyond older, thymus-specific schemes.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How are thymomas and thymic carcinomas clinically different?",{"text":68,"@type":64},"Thymomas are usually indolent and show a tendency to grow in size with relatively poor infiltrative attitude, whereas thymic carcinomas tend to be more aggressive and invade contiguous structures in many cases.",{"name":70,"@type":61,"acceptedAnswer":71},"Which historical classifications are compared in this review?",{"text":72,"@type":64},"The review compares the actual TNM classification with the historical Masaoka–Koga classification, focusing on how they relate to earlier staging concepts.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},326800,1790196308,{"code":4,"msg":82,"data":83},"success",[84,88,92,96,101,105,110,114,119,122,126],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":89,"show_sort_weight":90,"slug":91},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":93,"show_sort_weight":94,"slug":95},"Exam",70,"exam",{"id":97,"doc_module":4,"doc_module_name":25,"category_name":98,"show_sort_weight":99,"slug":100},5,"Comic",60,"comic",{"id":55,"doc_module":4,"doc_module_name":25,"category_name":102,"show_sort_weight":103,"slug":104},"Technology",50,"technology",{"id":106,"doc_module":4,"doc_module_name":25,"category_name":107,"show_sort_weight":108,"slug":109},7,"Healthcare",40,"healthcare",{"id":111,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":112,"slug":113},8,30,"research-report",{"id":115,"doc_module":4,"doc_module_name":25,"category_name":116,"show_sort_weight":117,"slug":118},9,"Religion & Spirituality",20,"religion-spirituality",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":120,"show_sort_weight":117,"slug":121},"World Cup","world-cup",{"id":123,"doc_module":4,"doc_module_name":25,"category_name":124,"show_sort_weight":123,"slug":125},10,"Lifestyle","lifestyle",{"id":127,"doc_module":4,"doc_module_name":25,"category_name":128,"show_sort_weight":97,"slug":129},19,"General","general",{"code":4,"msg":82,"data":131},{"doc_id":79,"user_id":132,"nickname":42,"user_avatar":133,"doc_module":4,"category_id":111,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":123,"language":139,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":12,"update_tm":143,"read_time":144,"preview_page_count":4},687197100911,"https://ap-avatar.wpscdn.com/avatar/a000239b6f1da00475?x-image-process=image/resize,m_fixed,w_180,h_180&k=1785132997149421697","Review  \nTNM Staging System in Thymoma: A Critical Appraisal?  \nMarcello Carlo Ambrogi 1,2,†, Vittorio Aprile 1,2, *,†, Alessandra Lenzini 1,2, Diana Bacchin 1,2, Maria Giovanna Mastromarino 1, Stylianos Korasidis 1 and Marco Lucchi 1,2  \nCitation: Ambrogi, M.C.; Aprile, V.; Lenzini, A.; Bacchin, D.;  \nMastromarino, M.G.; Korasidis, S.; Lucchi, M. TNM Staging System in Thymoma: A Critical Appraisal? J.  \nClin. Med. 2024, 13, 610. [https://](https://)[ ](https://)[doi.org/10.3390/jcm13020610](doi.org/10.3390/jcm13020610)  \nAcademic Editor: Tawee Tanvetyanon  \nReceived: 23 November 2023  \nRevised: 11 January 2024  \nAccepted: 19 January 2024  \nPublished: 21 January 2024  \nCopyright: © 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ([https://](https://)[ ](https://)[creativecommons.org/licenses/by/](creativecommons.org/licenses/by/)[ ](creativecommons.org/licenses/by/)[4.0/](4.0/)) .  \n1 Division of Thoracic Surgery, Cardiac, Thoracic, and Vascular Department, University of Pisa, 56127 Pisa, Italy;  \n[marcello.ambrogi@unipi.it](marcello.ambrogi@unipi.it) (M.C.A.); [alessandralenzini2@gmail.com](alessandralenzini2@gmail.com) (A.L.); [d.bacchin@hotmail.com](d.bacchin@hotmail.com) (D.B.);  \n[mgmastromarino@gmail.com](mgmastromarino@gmail.com) (M.G.M.); [stylianoskorasidis@gmail.com](stylianoskorasidis@gmail.com) (S.K.); [marco.lucchi@unipi.it](marco.lucchi@unipi.it) (M.L.)  \n2 Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56124 Pisa, Italy  \n* Correspondence: vittorio.aprile@unipi.it  \n† These authors contributed equally to this work.  \nAbstract: Thymomas are rare tumors of the anterior mediastinum with peculiar clinical and pathological features. They have been deeply analyzed by pioneer authors, who strictly linked their name to the main pathological and staging classifications. Before the latest edition of the WHO classification of thymic epithelial tumors, the history of thymoma pathological classification inherited the name of the pathologists who systematically addressed the issue, from Levine-Rosai to Muller-Hermelink. Similarly, the thymoma staging system is intimately related to the name of two surgeons, Masaoka and Koga, who historically dealt with this disease. More recently, the traditional tumor-nodesmetastasis (TNM) system has been developed for the staging of this condition, in a rational attempt to put thymomas in conformity with the other solid tumors. The efforts of the International Thymic Malignancies Interest Group (ITMIG) and the Thymic Domain of the Staging and Prognostic Factors Committee (TD-SPFC) of the International Association for the Study of Lung Cancer (IASLC) resulted in the TNM classification of thymic tumors, which have been included in the eighth edition of the American Joint Committee on Cancer’s (AJCC) Cancer Staging Manual. Herein, we report a narrative review of the evolution of the thymic epithelial tumors (TET) staging system and present a critical appraisal of the actual TNM classification compared with the historical Masaoka-Koga classification, with special focus on the proposal for the ninth edition of the TNM, expected in 2024 .  \nKeywords: thymoma; thymic epithelial tumor; staging; TNM; Masaoka-Koga  \n1. Introduction  \nThymomas and thymic carcinomas (thymic epithelial tumors, TETs) are rare neoplasms accounting for 0.2–1.5% of all malignancies although they represent more than 50% of all anterior mediastinal masses [1] . Both thymomas and thymic carcinomas arise from the epithelial cells of the thymus, but they are characterized by different behavior: Thymomas are usually indolent neoplasms with a tendency to increase in size with a poor infiltrative attitude, while thymic carcinomas tend to be more aggressive; in 80% of cases, there is evidence of invasion of the contiguous structures [2] ","cbCaijV9TOaylPPO","https://ap.wps.com/l/cbCaijV9TOaylPPO","pdf",529217,"English","# Introduction\n## Evolution of thymic tumor classification\n## Development of staging systems\n# TNM classification background","[{\"question\":\"Why was a TNM staging system introduced for thymoma?\",\"answer\":\"TNM was developed to rationally align thymomas with the staging approach used for other solid tumors, moving beyond older, thymus-specific schemes.\"},{\"question\":\"How are thymomas and thymic carcinomas clinically different?\",\"answer\":\"Thymomas are usually indolent and show a tendency to grow in size with relatively poor infiltrative attitude, whereas thymic carcinomas tend to be more aggressive and invade contiguous structures in many cases.\"},{\"question\":\"Which historical classifications are compared in this review?\",\"answer\":\"The review compares the actual TNM classification with the historical Masaoka–Koga classification, focusing on how they relate to earlier staging concepts.\"}]","TNM Staging System in Thymoma: A Critical Appraisal - narrative review | PDF",1789975378,25]