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Type B3 thymoma is the most aggressive thymoma, a thymus gland tumour made mostly of epithelial cells with few lymphocytes, sitting at the border with thymic carcinoma. More than a third have already grown into the chest structures when found, so it is treated with surgery plus radiotherapy, and chemotherapy before surgery when it is too large to remove at once.
Type B3 thymoma is the epithelial-rich thymoma of the WHO classification, once called well-differentiated thymic carcinoma; the ITMIG consensus set criteria separating B3 from B2 and from thymic carcinoma, the latter distinguished by frank cytological atypia, loss of thymus-like features and expression of CD5 and CD117 (Marx 2014). In the worldwide database, 38 percent of type B3 thymomas were stage III at diagnosis, the highest of any type, and the B1 to B3 group recurred in 2 to 7 percent after resection against 1 to 2 percent for A and AB (Weis 2015).
How it differs from its parent: it is the thymoma most likely to invade the pericardium, great vessels and lung and to recur, so it is the one where preoperative chemotherapy, radical surgery with vascular reconstruction and postoperative radiotherapy are most often combined, and the one that must be separated from thymic carcinoma, which has its own page and its own drugs.
How common: the ITMIG database gives its stage distribution but not its share in the abstract read; it is less common than B2 (Weis 2015).
Treatment: complete resection when feasible with postoperative radiotherapy for stage II to III disease or incomplete resection; induction platinum-based chemotherapy (cisplatin, doxorubicin, cyclophosphamide) for tumours not resectable at presentation, then surgery or radiotherapy; systemic therapy for recurrence as on the parent page.
A minority of thymomas but the one most often advanced: 38 percent of type B3 in the ITMIG worldwide database presented at stage III (Weis 2015).
Central tumours arise in the large airways, peripheral ones in the alveoli; both drain to hilar then mediastinal nodes, and the pleural lining is a separate cancer site.
Same organ: Mediastinal germ cell tumour, Pleuropulmonary blastoma (types I, Ir, II and III), Type A and type AB thymoma, Type B1 and type B2 thymoma, Micronodular thymoma with lymphoid stroma, Adenocarcinoma of the lung, Squamous cell carcinoma of the lung, Large cell carcinoma of the lung, Sarcomatoid carcinoma of the lung, Adenosquamous carcinoma of the lung, Invasive mucinous adenocarcinoma of the lung, Adenocarcinoma in situ and minimally invasive adenocarcinoma of the lung, Basaloid squamous cell carcinoma of the lung, Lymphoepithelial carcinoma of the lung, Pulmonary blastoma (adult), Non-small-cell lung cancer, Lung cancer (all types), Small-cell lung cancer, Mesothelioma, Pleural mesothelioma, Thymoma and thymic carcinoma, Childhood lung and airway tumours (pleuropulmonary blastoma, tracheobronchial tumours), Inflammatory myofibroblastic tumour (IMT), EGFR-mutated non-small-cell lung cancer, ALK-positive non-small-cell lung cancer, KRAS G12C-mutant non-small-cell lung cancer, ROS1-positive non-small-cell lung cancer, MET exon 14 and MET-amplified non-small-cell lung cancer, RET fusion-positive non-small-cell lung cancer, BRAF V600E-mutant non-small-cell lung cancer, HER2-mutant non-small-cell lung cancer, NTRK fusion-positive non-small-cell lung cancer, PD-L1-high non-small-cell lung cancer without a driver mutation, Resectable stage I to III non-small-cell lung cancer, Unresectable stage III non-small-cell lung cancer, Limited-stage small-cell lung cancer, Extensive-stage small-cell lung cancer, Lung neuroendocrine tumours (typical and atypical carcinoid), Thymoma (WHO types A, AB, B1, B2 and B3), Thymic carcinoma
Resection with postoperative radiotherapy for stage II to III or incomplete resection; induction platinum-based chemotherapy for unresectable tumours; recurrence as on the parent page.
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Query for this cancer: (TITLE:"Type B3 thymoma" OR ABSTRACT:"Type B3 thymoma" OR TITLE:"Type B3 thymoma epithelial-rich, the most aggressive thymoma" OR ABSTRACT:"Type B3 thymoma epithelial-rich, the most aggressive thymoma" OR TITLE:"Well-differentiated thymic carcinoma historical term" OR ABSTRACT:"Well-differentiated thymic carcinoma historical term" OR TITLE:"Epithelial thymoma" OR ABSTRACT:"Epithelial thymoma" OR TITLE:"Atypical thymoma" OR ABSTRACT:"Atypical thymoma") AND (treatment OR therapy OR trial OR survival OR diagnosis). Results are unfiltered search hits about Type B3 thymoma, not a curated reading list.
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Bleeding that will not stop, black or bloody stools, or unexplained bruising when platelets are expected to be low.
Cumulative dose: risk rises steeply above 400-550 mg/m² (see the anthracycline calculator).
Dose reduce or avoid for CrCl below 60 (carboplatin is the alternative).
Reduce by 50% for bilirubin 20-50 µmol/L and 75% for 50-85 µmol/L.
Heart damage from cancer treatment: anthracyclines weaken the heart muscle permanently in a dose-related way, trastuzumab does so reversibly, and some kinase inhibitors raise blood pressure or disturb rhythm. Heart function (LVEF) is monitored by ultrasound during treatment.
See all on the product pages:CisplatinCyclophosphamideDoxorubicin·Printable cards in the navigator
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