WHO classification of thymic tumours

Last revised by Francis Deng on 30 Apr 2022

The World Health Organisation (WHO) classification of tumours of the thymus is a component of the WHO classification of thoracic tumours, which was published in its 5th edition in 2021 1. It is a pathological classification of thymic epithelial tumours, including thymomas, thymic carcinomas, and neuroendocrine tumours 2.

Classification

  • thymoma
    • type A thymoma
    • type AB thymoma
    • type B1 thymoma
    • type B2 thymoma
    • type B3 thymoma
    • micronodular thymoma with lymphoid stroma
    • metaplastic thymoma
    • lipofibroadenoma
  • thymic carcinoma
    • squamous cell carcinomas
      • squamous cell carcinoma, NOS
      • basaloid carcinoma
      • lymphoepithelial carcinoma (previously lymphoepithelial-like carcinoma)
    • NUT carcinoma of the thorax
    • salivary gland-like carcinomas
      • mucoepidermoid carcinoma
      • clear cell carcinoma
        • hyalinizing clear cell carcinoma
      • sarcomatoid carcinoma
        • carcinosarcoma
    • adenocarcinomas
      • adenocarcinoma, NOS
      • low-grade papillary adenocarcinoma (previously papillary adenocarcinoma)
      • thymic carcinoma with adenoid cystic carcinoma-like features
      • enteric-type adenocarcinoma
    • adenosquamous carcinoma
    • undifferentiated carcinoma
    • thymic carcinoma, NOS
      • hepatoid carcinoma
      • rhabdoid carcinoma
      • undifferentiated large cell carcinoma associated with Castleman disease-like reaction
      • sebaceous carcinoma
  • thymic neuroendocrine neoplasms
    • carcinoid tumour/neuroendocrine tumour
      • NOS
      • typical, grade 1
      • atypical, grade 2
    • small cell carcinoma
    • large cell neuroendocrine carcinoma
    • combined small cell carcinoma and large cell neuroendocrine carcinoma

Most of the above are considered malignant under the International Classification of Diseases for Oncology (behaviour code 3) 2. The exceptions are that micronodular thymoma with lymphoid stroma is considered unspecified, borderline, or uncertain (behaviour code 1) and lipofibroadenoma is considered benign (behaviour code 0).

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