{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,11]],"date-time":"2026-02-11T15:31:25Z","timestamp":1770823885069,"version":"3.50.1"},"reference-count":17,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2014,11,10]],"date-time":"2014-11-10T00:00:00Z","timestamp":1415577600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Histopathology"],"published-print":{"date-parts":[[2015,5]]},"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>The current <jats:styled-content style=\"fixed-case\">WHO<\/jats:styled-content> classification of thymic epithelial neoplasms describes type A and type <jats:styled-content style=\"fixed-case\">AB<\/jats:styled-content> thymomas as behaving \u2018like benign neoplasms\u2019. However, recent published data suggest that rare cases may show more aggressive behaviour. The aim of this study was to assess the frequency of atypical cases, and to determine whether atypia is associated with more advanced disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>One hundred and twenty\u2010one thymomas (type A, <jats:italic>n<\/jats:italic>\u00a0=\u00a068; type <jats:styled-content style=\"fixed-case\">AB<\/jats:styled-content>,<jats:italic> n<\/jats:italic>\u00a0=\u00a053) were retrospectively reviewed for \u2018atypical\u2019 features (nuclear pleomorphism, mitotic activity, and necrosis). Logistic regression was used to ascertain the association with increasing Masaoka\u2013Koga stage. Where available, follow\u2010up data were also reviewed. There were 72 stage I, 42 stage <jats:styled-content style=\"fixed-case\">II<\/jats:styled-content>, five stage <jats:styled-content style=\"fixed-case\">III<\/jats:styled-content> and two stage <jats:styled-content style=\"fixed-case\">IV<\/jats:styled-content> tumours. Only the presence of necrosis showed a significant association with increased stage in univariate and multivariate analysis. Nuclear atypia and increased mitotic activity were not associated with increasing stage of disease.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Our data support the concept of there being more aggressive atypical variants of both type A and type <jats:styled-content style=\"fixed-case\">AB<\/jats:styled-content> thymoma, and suggest that the presence of necrosis could be used to predict aggressive behaviour.<\/jats:p><\/jats:sec>","DOI":"10.1111\/his.12512","type":"journal-article","created":{"date-parts":[[2014,8,11]],"date-time":"2014-08-11T11:41:29Z","timestamp":1407757289000},"page":"884-891","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":22,"title":["Type A and <scp>AB<\/scp> thymomas: histological features associated with increased stage"],"prefix":"10.1111","volume":"66","author":[{"given":"Anna C","family":"Green","sequence":"first","affiliation":[{"name":"Department of Histopathology Royal Brompton and Harefield Hospitals NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexander","family":"Marx","sequence":"additional","affiliation":[{"name":"Institute of Pathology University Medical Centre Mannheim Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Philipp","family":"Str\u00f6bel","sequence":"additional","affiliation":[{"name":"Institute of Pathology University Medical Centre Mannheim Germany"},{"name":"Institute of Pathology University Medical Centre G\u00f6ttingen Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marianne","family":"Mason","sequence":"additional","affiliation":[{"name":"Department of Histopathology Royal Brompton and Harefield Hospitals NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric","family":"Lim","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Brompton Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simon","family":"Jordan","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Brompton Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"George","family":"Ladas","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Brompton Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Dusmet","sequence":"additional","affiliation":[{"name":"Department of Thoracic Surgery Brompton Hospital London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alexandra","family":"Rice","sequence":"additional","affiliation":[{"name":"Department of Histopathology Royal Brompton and Harefield Hospitals NHS Foundation Trust London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew G","family":"Nicholson","sequence":"additional","affiliation":[{"name":"Department of Histopathology Royal Brompton and Harefield Hospitals NHS Foundation Trust London UK"},{"name":"National Heart and Lung Institute Imperial College London UK"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2014,11,10]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/JTO.0b013e31821e8cff"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10665"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/cncr.10226"},{"key":"e_1_2_8_5_1","volume-title":"Tumours of the lung, pleura, thymus and heart","author":"World Health 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