{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T16:41:02Z","timestamp":1773592862587,"version":"3.50.1"},"reference-count":60,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T00:00:00Z","timestamp":1574121600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["acsjournals.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cancer Cytopathology"],"published-print":{"date-parts":[[2020,1]]},"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Fine\u2010needle aspiration (FNA), a minimally invasive and cost\u2010effective procedure, often is used in the initial diagnosis of thymic lesions. However, the diagnosis can be challenging. Knowledge of the diagnostic pitfalls is important to improve diagnostic accuracy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The authors retrospectively searched the pathology database of The University of Texas MD Anderson Cancer Center for FNA cases using the keywords \u201cthymoma\u201d or \u201cthymic\u201d in cytologic diagnoses or in corresponding final histologic diagnoses rendered from January 2002 to June 2018. The authors reviewed the FNA diagnostic accuracy and pitfalls in comparison with the final histologic diagnoses.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 118 FNA cases were identified from 115 patients. The FNA diagnoses were concordant with the final pathologic diagnoses in 110 cases (93.2%), including thymoma (97 cases), atypical thymoma (5 cases), and thymic carcinoma (8 cases). Discrepant FNA and final diagnoses were noted in 8 tumors (6.8%): thymoma versus atypical thymoma\/thymic carcinoma (3 tumors), thymoma versus lymphoma (2 tumors), suspicious for lymphoma versus thymoma (1 tumor), and T\u2010lymphoblastic lymphoma versus thymoma (2 tumors). Factors contributing to misinterpretation included intrinsic limitations of the FNA sample (sampling error and a lack of histologic architecture information) and similarities of the cytologic and immunophenotypic features of lymphocyte\u2010rich thymoma and T\u2010lymphoblastic lymphoma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>An accurate FNA diagnosis of thymic tumors can be rendered in the majority of cases. Diagnostic pitfalls can be encountered in rare cases. It is important to handle each case carefully to avoid erroneous diagnoses that may lead to inappropriate treatment.<\/jats:p><\/jats:sec>","DOI":"10.1002\/cncy.22211","type":"journal-article","created":{"date-parts":[[2019,11,19]],"date-time":"2019-11-19T09:42:23Z","timestamp":1574156543000},"page":"57-67","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["Pitfalls of FNA diagnosis of thymic tumors"],"prefix":"10.1002","volume":"128","author":[{"given":"Minhua","family":"Wang","sequence":"first","affiliation":[{"name":"Department of Pathology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Uma","family":"Kundu","sequence":"additional","affiliation":[{"name":"Department of Pathology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7607-7712","authenticated-orcid":false,"given":"Yun","family":"Gong","sequence":"additional","affiliation":[{"name":"Department of Pathology The University of Texas MD Anderson Cancer Center Houston Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2019,11,19]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000325544"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000294"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000295"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000654"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1309\/CAV8RNU5TKNACKNC"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000482"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1309\/AJCP88FZTWANLRCB"},{"key":"e_1_2_8_9_1","first-page":"1","article-title":"Fine needle aspiration cytology of thymic tumors","volume":"27","author":"Dahlgren S","year":"1983","journal-title":"Acta Cytol"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0339(199603)14:2<165::AID-DC12>3.0.CO;2-K"},{"key":"e_1_2_8_11_1","first-page":"63","article-title":"Diagnosis of thymoma by needle biopsy","volume":"34","author":"Sherman ME","year":"1990","journal-title":"Acta Cytol"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19830101)51:1<127::AID-CNCR2820510126>3.0.CO;2-Y"},{"key":"e_1_2_8_13_1","first-page":"165","article-title":"Cytopathology of thymoma","volume":"28","author":"Tao LC","year":"1984","journal-title":"Acta Cytol"},{"key":"e_1_2_8_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/1746-1596-2-13"},{"key":"e_1_2_8_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0142(20000225)90:1<24::AID-CNCR4>3.0.CO;2-A"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1159\/000331959"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/(SICI)1097-0339(199708)17:2<121::AID-DC7>3.0.CO;2-J"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181f23e19"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1159\/000331958"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/dc.20738"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.semdp.2006.02.005"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.hoc.2008.03.003"},{"key":"e_1_2_8_23_1","first-page":"387","article-title":"Epithelial cytologic atypia in a fine needle aspirate of an invasive thymoma. A case report","volume":"36","author":"Riazmontazer N","year":"1992","journal-title":"Acta Cytol"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0003-4975(03)01392-4"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1038\/modpathol.2009.105"},{"key":"e_1_2_8_26_1","first-page":"200","article-title":"Middle mediastinal thymoma of unusual pathologic type","volume":"12","author":"Kuzdzal J","year":"2006","journal-title":"Ann Thorac Cardiovasc Surg"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAS.0000000000000699"},{"key":"e_1_2_8_28_1","first-page":"543","article-title":"Intrathyroid epithelial thymoma (ITET) and carcinoma showing thymus\u2010like differentiation (CASTLE): CD5\u2010positive neoplasms mimicking squamous cell carcinoma of the thyroid","volume":"28","author":"Kakudo K","year":"2013","journal-title":"Histol Histopathol"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/BF01656263"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1136\/pgmj.65.763.310"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.4081\/monaldi.2005.625"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.11-8-887"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1186\/1757-1626-2-9149"},{"key":"e_1_2_8_34_1","first-page":"508","article-title":"A rare case of middle mediastinal thymoma mimicking left lower lobe lung tumor","volume":"60","author":"Venayaga K","year":"2005","journal-title":"Med J Malaysia"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.5090\/kjtcs.2017.50.1.54"},{"key":"e_1_2_8_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejso.2007.02.033"},{"key":"e_1_2_8_37_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e3181a4b8e0"},{"key":"e_1_2_8_38_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0000000000000378"},{"key":"e_1_2_8_39_1","volume-title":"WHO Classification Of Tumours of the Lung, Pleura, Thymus and Heart","author":"Travis WD","year":"2015"},{"key":"e_1_2_8_40_1","doi-asserted-by":"publisher","DOI":"10.1097\/PAP.0000000000000119"},{"key":"e_1_2_8_41_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00292-016-0199-z"},{"key":"e_1_2_8_42_1","first-page":"170","article-title":"A primary mediastinal Hodgkin's lymphoma with asymptomatic myasthenia gravis: a rare association","volume":"100","author":"Ayadi\u2010Kaddour A","year":"2008","journal-title":"Pathologica"},{"key":"e_1_2_8_43_1","first-page":"999","article-title":"Thymic Hodgkin's disease with cystic variants: a case report","volume":"33","author":"Kamiya N","year":"1995","journal-title":"Nihon Kyobu Shikkan Gakkai Zasshi"},{"key":"e_1_2_8_44_1","doi-asserted-by":"publisher","DOI":"10.1007\/s005950050109"},{"key":"e_1_2_8_45_1","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0b013e318252e01b"},{"key":"e_1_2_8_46_1","doi-asserted-by":"publisher","DOI":"10.3109\/10428194.2011.596968"},{"key":"e_1_2_8_47_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00595-007-3644-z"},{"key":"e_1_2_8_48_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11748-016-0652-1"},{"key":"e_1_2_8_49_1","article-title":"Primary thymic extranodal marginal zone B cell lymphoma as an incidental finding in a Caucasian woman","volume":"2015","author":"Petersen JK","year":"2015","journal-title":"BMJ Case Rep"},{"key":"e_1_2_8_50_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0142(19920315)69:6<1347::AID-CNCR2820690608>3.0.CO;2-C"},{"key":"e_1_2_8_51_1","doi-asserted-by":"publisher","DOI":"10.1097\/00000478-200108000-00015"},{"key":"e_1_2_8_52_1","first-page":"652","article-title":"Thymoma with extensive necrosis: a case report and review of literature","volume":"98","author":"Cui W","year":"2006","journal-title":"Pathologica"},{"key":"e_1_2_8_53_1","first-page":"43","article-title":"A rare case of necrotic thymoma","volume":"35","author":"De Palma A","year":"2014","journal-title":"G Chir"},{"key":"e_1_2_8_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prp.2018.01.009"},{"key":"e_1_2_8_55_1","doi-asserted-by":"publisher","DOI":"10.1136\/jclinpath-2018-205399"},{"key":"e_1_2_8_56_1","doi-asserted-by":"publisher","DOI":"10.1078\/0344-0338-00473"},{"key":"e_1_2_8_57_1","first-page":"20","article-title":"Misdiagnosis of 3 cases lymphoma due to misjudgement of immunohistochemistry","volume":"33","author":"Gu CY","year":"2012","journal-title":"Zhonghua Xue Ye Xue Za Zhi"},{"key":"e_1_2_8_58_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00428-014-1606-6"},{"key":"e_1_2_8_59_1","doi-asserted-by":"publisher","DOI":"10.1309\/K2FY1TED8GEGFLNG"},{"key":"e_1_2_8_60_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncy.21584"},{"key":"e_1_2_8_61_1","doi-asserted-by":"publisher","DOI":"10.1016\/S1569-9293(03)00136-1"}],"container-title":["Cancer Cytopathology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncy.22211","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/cncy.22211","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/cncy.22211","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T17:14:36Z","timestamp":1760289276000},"score":1,"resource":{"primary":{"URL":"https:\/\/acsjournals.onlinelibrary.wiley.com\/doi\/10.1002\/cncy.22211"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,11,19]]},"references-count":60,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2020,1]]}},"alternative-id":["10.1002\/cncy.22211"],"URL":"https:\/\/doi.org\/10.1002\/cncy.22211","archive":["Portico"],"relation":{},"ISSN":["1934-662X","1934-6638"],"issn-type":[{"value":"1934-662X","type":"print"},{"value":"1934-6638","type":"electronic"}],"subject":[],"published":{"date-parts":[[2019,11,19]]},"assertion":[{"value":"2019-07-31","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-10-21","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2019-11-19","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}