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Article Abstract

Metaplastic thymoma is a rare biphasic thymic tumor with indolent behavior and recurrent gene rearrangement. Although the diagnosis of this tumor is usually straightforward based on hematoxylin and eosin (H&E) findings alone, cases with scant spindle-cell ("pseudosarcomatous stroma") components can be easily confused with more commonly occurring type A thymoma. We present a case of metaplastic thymoma with a sparse stroma-like spindle-cell component, discussing its histological and immunohistochemical hints and drawing attention to the visual similarity to type A thymoma. This is also the first published case of metaplastic thymoma with associated psoriasis.

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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC11165440PMC
http://dx.doi.org/10.7759/cureus.60136DOI Listing

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Metaplastic thymoma: A rare and indolent subtype.

Indian J Pathol Microbiol

August 2025

Department of Histopathology, Lilavati Hospital and Research Centre, Mumbai, Maharashtra, India.

Though thymomas are the commonest neoplasms of the anterior mediastinum, metaplastic thymoma is an extremely rare subtype, with only a few reported cases. It was included in the 2004 WHO classification of thymic epithelial tumors and exhibits a biphasic morphology distinct from the conventional thymomas. It has a benign clinical course with extremely rare cases showing recurrence and malignant transformation.

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Background And Purpose: We report the incidence, characteristics, and comorbidities of the complete unselected Danish cohort of patients with thymic epitheliums (TETs), which may serve as evidence for guiding treatment, surveillance, and counselling of TET patients.

Patients And Methods: All patients diagnosed with TETs from January 1st, 2015, to December 31st, 2020, were identified using the Danish Pathology Data Registry. Data on patient characteristics, comorbidities, and tumor histology were collected from electronic medical records available for all patients.

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Article Synopsis
  • Metaplastic thymoma (MT) is a rare type of thymic tumor that has a specific genetic fusion (YAP1::MAML2), similar to skin tumors called poromas.
  • Recent studies revealed that MT lacks YAP1 C-terminus expression, but the expression of YAP1 N-terminus in MT and other thymic epithelial tumors (TETs) needed further exploration.
  • In an examination of 14 MT cases, it was found that MT consistently showed a distinct staining pattern (YAP1[N]-positive, YAP1[C]-negative), while other TETs like type B3 thymoma exhibited variable staining, highlighting the need for more research on YAP1's role
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Article Synopsis
  • Metaplastic thymoma (MT) is a rare tumor characterized by a biphasic structure of solid epithelial and spindle cells, which can be confused with other thymoma types; thus, accurate diagnosis is essential for treatment.
  • A case of a 32-year-old woman with a mediastinal nodule revealed a biphasic architecture after surgical excision, and positive markers were noted through immunohistochemical analysis, confirming MT diagnosis.
  • The study emphasizes the importance of combining histopathological, immunohistochemical, and genetic analyses in diagnosing MT, with gene fusion detection via FISH analysis providing a valuable diagnostic tool.
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