Clinical staging of thymic epithelial tumors

Masaoka's clinical stage^[1]
Stage I: Macroscopically completely encapsulated and microscopically no capsular invasion
Stage II: Macroscopic invasion into surrounding fatty tissue or mediastinal pleura, or microscopic invasion into capsule
Stage III: Macroscopic invasion into neighboring organs (ie, pericardium, great vessels, or lung)
Stage IVa: Pleural or pericardial dissemination
Stage IVb: Lymphogenous or hematogenous metastasis
Koga's proposed pathologic tumor extent of thymic epithelial tumors^[2]
Stage I: Grossly and microscopically completely encapsulated
Stage II: Microscopic transcapsular invasion or macroscopic invasion into thymic or surrounding fatty tissue, or grossly adherent to but not breaking through mediastinal pleura or pericardium
Stage III: Macroscopic invasion of neighboring organ (eg, pericardium, great vessels, or lung)
Stage IVa: Pleural or pericardial dissemination
Stage IVb: Lymphogenous or hematogenous metastasis
Yamakawa-Masaoka TNM classification and staging^[3]
T factor:
T1: Macroscopically completely encapsulated and microscopically no capsular invasion
T2: Macroscopically adhesion or invasion into surrounding fatty tissue or mediastinal pleura, or microscopic invasion into capsule
T3: Invasion into neighboring organs, such as pericardium, great vessels, and lung
T4: Pleural or pericardial dissemination
N factor:
N0: No lymph node metastasis
N1: Metastasis to anterior mediastinal lymph nodes
N2: Metastasis to intrathoracic lymph nodes except anterior mediastinal lymph nodes
N3: Metastasis to extrathoracic lymph nodes
M factor:
M0: No hematogenous metastasis
M1: Hematogenous metastasis
Stage:
Stage I	T1	N0	M0
Stage II	T2	N0	M0
Stage III	T3	N0	M0
Stage IVa	T4	N0	M0
Stage IVb	Any T	N1, 2, 3	M0
	Any T	Any N	M1

References:

Masaoka A, Monden Y, Nakahara K, Tanioka T. Follow-up study of thymomas with special reference to their clinical stages. Cancer 1981; 48:2485.
Koga K, Matsuno Y, Noguchi M, et al. A review of 79 thymomas: modification of staging system and reappraisal of conventional division into invasive and non-invasive thymoma. Pathol Int 1994; 44:359.
Yamakawa Y, Masaoka A, Hashimoto T, et al. A tentative tumor-node-metastasis classification of thymoma. Cancer 1991; 68:1984.

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Clinical staging of thymic epithelial tumors