Thymic carcinoma is a thymic epithelial tumor that exhibits a definite cytologic

atypia and a set of histologic features no longer specific to the thymus, but r
ather similar to those histologic features observed in carcinomas of other organ
s. In contrast to type A and B thymomas, thymic carcinomas lack immature lymphoc
ytes. Any lymphocytes that are present are mature and usually admixed with plasm
a cells. It has been hypothesized that thymic carcinoma may arise from malignant
transformation of a pre-existing thymoma. This hypothetical evolution could acc
ount for the existence of thymic epithelial lesions that exhibit combined featur
es of thymoma and thymic carcinoma within the same tumor. Thymic carcinomas are
usually advanced when diagnosed and have a higher recurrence rate and worse surv
ival compared with thymoma. The 5-year and 10-year actuarial overall survival ra
tes are typically 38% and 28%, respectively. In contrast to the thymomas, the as
sociation of thymic carcinoma and autoimmune disease is rare.
Histologic subtypes of thymic carcinoma include the following (combinations of t
he following types can occur):
Squamous cell (epidermoid) thymic carcinoma This type of thymic carcinoma ex
hibits clear-cut cytologic atypia. In routinely stained sections, the keratinizi
ng form exhibits equally clear-cut evidence of squamous differentiation in the f
orm of intercellular bridges and/or squamous pearls, while the nonkeratinizing f
orm lacks obvious signs of keratinization. Another subtype, basaloid carcinoma,
is composed of compact lobules of tumor cells that exhibit peripheral palisading
and an overall basophilic staining pattern due to the high nucleocytoplasmic ra
tio and the absence of keratinisation.
Lymphoepithelioma-like thymic carcinoma This type of thymic carcinoma has mo
rphologic features indistinguishable from those of lymphoepithelial carcinoma (l
ymphoelithelioma) of the nasopharyngeal.. The differential diagnosis with germ c
ell tumors, particularly seminomas, can be difficult but important for treatment
. It is considered a type of poorly differentiated squamous cell carcinoma.
Sarcomatoid thymic carcinoma (carcinosarcoma) This is a type of thymic carci
noma in which part or all of the tumor resembles 1 of the types of soft tissue s
arcoma
Clear cell thymic carcinoma This is a type of thymic carcinoma composed pred
ominantly or exclusively of cells with optically clear cytoplasm.
Mucoepidermoid thymic carcinoma This type of thymic carcinoma has an appeara
nce similar to that of mucoepidermoid carcinoma of the major and minor salivary
glands.
Papillary thymic adenocarcinoma This type of thymic carcinoma grows in a pap
illary fashion. This histology may be accompanied by psammoma body formation, re
sulting in a marked similarity with papillary carcinoma of the thyroid gland.
Undifferentiated thymic carcinoma This is a rare type of thymic carcinoma th
at grows in a solid undifferentiated fashion but without exhibiting sarcomatoid
(spindle cell or pleomorphic) features.