Histopathology report

• tumour type - metastatic carcinoma, malignant lymphoma, germ cell tumour, neurogenic tumour, thymoma, sarcoma.

• tumour differentiation:

- metastatic carcinoma: well/moderate/poor.

- malignant lymphoma: low-grade (MALToma/follicular lymphoma)/high-grade (diffuse large cell lymphoma, lymphoblastic lymphoma).

- germ cell tumour: seminoma/non-seminomatous: mature, immature, malignant -embryonal carcinoma, yolk sac tumour, choriocarcinoma, MTI.

- neurogenic tumours: small round blue cell/neuroblastoma component.

- sarcoma - low-grade/high-grade.

- thymoma - classify according to morphology (see above)

• tumour edge - pushing/infiltrative.

• extent of local tumour spread

All tumours:

• confined to mediastinal nodes.

• confined to the thymus.

• into mediastinal connective tissues.

• into other organs:pleura, lung, pericardium, main vessels. Thymoma(WHO):

• encapsulated - thymoma completely surrounded by a fibrous capsule of varying thickness which is not infiltrated by tumour; it may infiltrate into but not through.

• minimally invasive - thymoma surrounded by a capsule which is focally infiltrated by tumour growth or which invades mediastinal fat.

• widely invasive - thymoma spreading by direct extension into adjacent structures such as pericardium, large vessels and lung (may appear invasive to the surgeon - excision may be incomplete).

• with implants - thymoma in which tumour nodules separate from the main mass are found on the pericardial or pleural surface.

• with lymph node metastasis - a tumour that involves one or more lymph nodes anatomically separate from the main mass (most commonly mediastinal and supraclavicular).

• with distant metastases - tumour accompanied by embolic metastases to a distant site (lung, liver, skeletal system).

Encapsulated thymomas with no implants, no lymph node metastases or distant metastases are benign. All other combinations are malignant.

• lymphovascular invasion - present/not present. Note perineural invasion.

• regional lymph nodes - intrathoracic, scalene, supraclavicular nodes.

Thymoma:

- pT0 no regional lymph nodes involved.

- pT1 metastasis to anterior mediastinal lymph nodes.

- pN2 metastasis to intrathoracic lymph nodes other than the anterior mediastinal lymph nodes.

- pN3 metastasis to extrathoracic lymph nodes.

• excision margins - comment on adequacy of excision.

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