Molecular Classification of Neuroendocrine Tumors of the Thymus

Helen Dinter, Hanibal Bohnenberger, Julia Beck, Kirsten Bornemann-Kolatzki, Ekkehard Schütz, Stefan Küffer, Lukas Klein, Teri J. Franks, Anja Roden, Alexander Emmert, Marc Hinterthaner, Mirella Marino, Luka Brcic, Helmut Popper, Cleo Aron Weis, Giuseppe Pelosi, Alexander Marx, Philipp Ströbel

Research output: Contribution to journalArticlepeer-review

19 Scopus citations


Introduction: The WHO classification of pulmonary neuroendocrine tumors (PNETs) is also used to classify thymic NETs (TNETs) into typical and atypical carcinoid (TC and AC), large cell neuroendocrine carcinoma (LCNEC), and small cell carcinoma (SCC), but little is known about the usability of alternative classification systems. Methods: One hundred seven TNET (22 TC, 51 AC, 28 LCNEC, and 6 SCC) from 103 patients were classified according to the WHO, the European Neuroendocrine Tumor Society, and a grading-related PNET classification. Low coverage whole-genome sequencing and immunohistochemical studies were performed in 63 cases. A copy number instability (CNI) score was applied to compare tumors. Eleven LCNEC were further analyzed using targeted next-generation sequencing. Morphologic classifications were tested against molecular features. Results: Whole-genome sequencing data fell into three clusters: CNIlow, CNIint, and CNIhigh. CNIlow and CNIint comprised not only TC and AC, but also six LCNECs. CNIhigh contained all SCC and nine LCNEC, but also three AC. No morphologic classification was able to predict the CNI cluster. Cases where primary tumors and metastases were available showed progression from low-grade to higher-grade histologies. Analysis of LCNEC revealed a subgroup of intermediate NET G3 tumors that differed from LCNEC by carcinoid morphology, expression of chromogranin, and negativity for enhancer of zeste 2 polycomb repressive complex 2 subunit (EZH2). Conclusions: TNETs fall into three molecular subgroups that are not reflected by the current WHO classification. Given the large overlap between TC and AC on the one hand, and AC and LCNEC on the other, we propose a morphomolecular grading system, Thy-NET G1-G3, instead of histologic classification for patient stratification and prognostication.

Original languageEnglish (US)
Pages (from-to)1472-1483
Number of pages12
JournalJournal of Thoracic Oncology
Issue number8
StatePublished - Aug 2019


  • Carcinoid
  • Classification
  • Genetic
  • Molecular
  • Neuroendocrine
  • Thymus

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine


Dive into the research topics of 'Molecular Classification of Neuroendocrine Tumors of the Thymus'. Together they form a unique fingerprint.

Cite this