Cytokeratins in normal thymus and thymic epithelial tumors

Background . Thymus consists of some distinct epithelial cells that contain different sets of cytokeratins (CK). Epithelium‐derived tumors maintain the expression of some of the CK of the specific nontransformed cells. Therefore, it seems reasonable to hypothesize that thymic epithelial tumors may differentiate toward distinct subsets of intrathymic epithelial cells in terms of CK expression. Methods . Eighty‐one thymomas and 14 thymic carcinomas were studied immunohistologically using monoclonal antibodies specific for a single CK or a CK pair. Results . Thymic epithelial neoplasms could not be distinguished from each other on the basis of the profile of CK expression because the degree of overlap was extensive. However, polygonal cell thymomas differentiate toward a CK13‐positive cortical subset that is rare in normal thymus. Spindle cell thymomas differentiate toward a CK13‐positive medullary subset. Mixed cell thymomas are comprised of a CK13‐positive medullary subset and a CK13‐negative medullary subset, both of which are typical in normal thymus. CK18 was expressed to a greater extent on the epithelium of thymic carcinomas than on that of thymomas. Polygonal cell thymomas more frequently were invasive than spindle and mixed cell thymomas. Conclusions . There is a possibility that the epithelium of polygonal cell thymomas is immature because it is a phenotypically unusual subset in normal thymus. A thymic carcinoma arising in a thymoma has been reported, although the relationship between the thymoma and the thymic carcinoma was not clear. Nevertheless, given the similar cellular differentiation of thymoma and thymic carcinoma, CK18‐positive epithelium in thymomas may be transformed into thymic carcinoma cells in certain conditions. Cancer 1993; 71:99‐105.