Presentation
Thymoma presents with the following signs and symptoms:
- Persistent cough
- Drooping eyelids
- Muscle weakness
- Difficulty in breathing
- Undue fatigue
- Weight loss
- Dizziness
- Anemia
- Difficulty in swallowing food
- Inflammation in the arms and face
- Pain in the chest
- Prone to frequent infections
- Double vision
Respiratoric
- Hemoptysis
Symptoms that do occur are due to pressure on (compression of) local structures and may include: Chest pain Fever and chills Cough Coughing up blood (hemoptysis) Hoarseness Night sweats Shortness of breath Treatment for mediastinal tumors depends on the [nlm.nih.gov]
[…] tumors include the following: Tracheobronchial tree and lungs Esophagus Superior vena cava Pleura Chest wall Adjacent intrathoracic nerves Pathophysiologic changes that can be produced by invasion of specific structures are obstructive pneumonia and hemoptysis [emedicine.com]
A 67-year-old man who presented with chest pain and hemoptysis was referred to The University of Texas M. D. Anderson Cancer Center (Houston, TX). Radiologic studies revealed a large anterior mediastinal mass. [thedoctorsdoctor.com]
- Sputum
The same pathogen was isolated in subsequent blood and sputum cultures. This current report describes the rare association of salmonella infection with thymoma. [ncbi.nlm.nih.gov]
A 40-year-old man presented with sputum-positive PTB and was started on anti-tuberculosis treatment. Subsequently, he developed symptoms and findings consistent with thymoma and other components of Good's syndrome. [cancerindex.org]
- Tachypnea
Symptoms Eye bulging (exophthalmus) Third eye protusion Swelling of the head, neck, or forelimbs Abnormally rapid breathing (tachypnea) Difficult or labored breathing (dyspnea) Widespread scaling of the skin (exfoliative dermatitis) Sebaceous adentitis [wabbitwiki.com]
- Labored Breathing
Symptoms Eye bulging (exophthalmus) Third eye protusion Swelling of the head, neck, or forelimbs Abnormally rapid breathing (tachypnea) Difficult or labored breathing (dyspnea) Widespread scaling of the skin (exfoliative dermatitis) Sebaceous adentitis [wabbitwiki.com]
- Respiratory Distress
The tumor occurred in a 70-year-old woman with respiratory distress but neither myasthenia gravis nor other symptoms. Metastases or another primary tumor were absent. [thedoctorsdoctor.com]
Gastrointestinal
- Loss of Appetite
When symptoms are present, they may include: Shortness of breath Cough, which may contain blood Chest pain Trouble swallowing Loss of appetite Weight loss If the tumor is affecting the main blood vessel between the head and heart, known as superior vena [cedars-sinai.edu]
Symptoms of thymus gland tumours Symptoms might include: chest pain a cough that won’t go shortness of breath difficulty swallowing hoarseness of the voice loss of appetite The thymus is close to the superior vena cava. [cancerresearchuk.org]
Many of these side effects will dissipate after chemotherapy has concluded. [48] However, the common side effects include: Nausea Vomiting Infection Diarrhea Reduced appetite Hair loss Fatigue 7 Ask your doctor about octreotide. [wikihow.com]
Cardiovascular
- Chest Pain
Abstract A 21-year-old boy presented with high grade fever, diffuse chest pain and exertional breathlessness of one month duration. Radiologically he had a large lobulated anterior mediastinal mass with necrotic thick enhancing septaes. [ncbi.nlm.nih.gov]
Thymoma Symptom Chest Pain There are many causes of chest pain. A serious form of chest pain is angina, which is a symptom of heart disease and results from inadequate oxygen supply to the heart muscle. [medicinenet.com]
Musculoskeletal
- Muscle Weakness
With this illness, nerve impulses are not transmitted properly to muscles, which can result in severe muscle weakness. This often affects muscles that control eye and eyelid movement, facial expression, and swallowing. [mskcc.org]
CNS; Neurologic examination revealed masticatory and bulbar muscle weakness,proximal muscle weakness, fatigability of the arms and legs, and distal muscle weakness of the legs. chest; harsh vesicular breathing with good air entry. [slideshare.net]
Persistent cough Shortness of breath Pain or pressure in the chest Muscle weakness Drooping eyelids Double vision Arm or facial swelling Difficulty swallowing Anemia, which is a low red blood cell count Frequent infections Fatigue Dizziness If you are [cancer.net]
Symptoms Persistent cough Shortness of breath Pain or pressure in the chest Muscle weakness Drooping eyelids Double vision Arm or facial swelling Difficulty swallowing Anemia (low red blood cell count) Frequent infections Fatigue Dizziness Diagnosing [providence.org]
Workup
A preliminary physical examination will be done to diagnose thymoma. In addition, the following procedures would be used to arrive at a definitive conclusion:
- Imaging studies such as CT scan is carried out to determine the size and the location of the tumor lesion. MRI scans are also done to measure the size of the tumor. Positron emission tomography (PET) is a method that is employed for studying the internal organs and tissues [4]. In this method, a radioactive sugar substance is inserted into the body which is actively used by the tumor cells. With the help of the scanner, the images of those cells which have absorbed the substance can be detected.
- Biopsy is used for determining the nature of the tumor cells.
X-Ray
- Mediastinal Mass
We report a case of a 57-year-old male who presented an anterior mediastinal mass suspicious of thymoma by chest computed tomography. [ncbi.nlm.nih.gov]
- Anterior Mediastinal Mass
Radiologically he had a large lobulated anterior mediastinal mass with necrotic thick enhancing septaes. Histopathology of the mass was suggestive of thymoma and culture from the necrotic aspirate yielded Salmonella typhi. [ncbi.nlm.nih.gov]
Treatment
A multidisciplinary approach will be employed for treating thymoma [5]. The major goal of treatment would be to remove the malignant tumor and take steps to avoid recurrence of the cancer. The following are the various types of method employed for treating thymoma:
- Surgery is often the first line of treatment employed for removal of the tumor from the organ. When the cancer has spread to the neighboring organs, efforts are made to remove as much tumor as possible. This method is known as debulking surgery [6]. Thoracic surgery may be performed with the use of video guided thoracoscopy for a more precise excision of the thymoma [7].
- Radiation therapy may be employed after surgery or along with chemotherapy. In conditions, when the size of the tumor cells is large, radiation therapy is given prior to surgery to shrink the size. Following this, the tumor can easily be removed [8].
- Chemotherapy [9].
- Coricosteroids have been sparingly used to facilitate tumor regression in some cases [10].
Prognosis
The prognosis of the disease depends on the stage at which the cancer was diagnosed and age of the individual. With appropriate initiation of treatment regime, the patient can live for several years. However, the prognosis is usually bad for patients who have been diagnosed when the disease has reached advanced stage. Multivariate analysis of thymoma survival rate reaches 5 to 10 years on the average in all stages [2].
Complications
The most debilitating complication of thymoma is metastasis of the tumor. When the tumor spreads to other organs of the body it gives rise to various other secondary conditions. Thymoma may spread to the superior vena cava to cause obstructive signs in patients [3]. In addition, individuals affected by thymoma also have to experience the unpleasant side effects of cancer treatment.
Etiology
The exact cause that triggers development of cancerous cells in the thymus is not yet understood. However, various syndromes have been associated with this condition. These include:
- Red cell aplasia
- Systemic lupus erythematosus
- Cushing syndrome
- Dermatomyositis
- Inappropriate secretion of antidiuretic hormone syndrome
- Neuromuscular disorder such as myasthenia gravis [1]
Individuals with thymoma have been found to suffer from the above mentioned conditions. It is therefore thought that thymoma can occur as a secondary complication to these syndromes.
Epidemiology
Thymoma is a rare occurrence and accounts for 1% of tumors that originate in the thymus. Individuals between 40 – 60 years fall easy prey to this disease; however reports document that a cancer of this type can strike individuals at any age. It has been estimated that about 15% of patients with myasthenia gravis develop thymoma.
Pathophysiology
Thymus consists of 2 types of cells, epithelial and lymphocytes. Thymoma occurs when cells originate in the epithelial cells of the organ. When these cells begin to grow in an uncontrollable fashion, a tumor is formed. In rare cases, thymoma may spread to other parts of the body. In case when it does, the pleura is affected. When the tumor develops, it precipitates into the following stages:
- Stage I: The tumor is located in the organ and a capsule covers it.
- Stage II: The tumor invades the capsule and spreads to neighboring fatty tissues.
- Stage III: Cancer begins spreading to other parts of the body.
- Stage IVA: Cancer has affected the lungs.
- Stage IVB: Cancer has spread to the lymph nodes and blood vessels.
Prevention
Thymoma cannot be prevented; however, steps can be taken to prevent the progression of the disease and its recurrence. Once the individuals receive treatment for cancer, they are advised to regularly follow up with their health care provider. Regular scans and tests should be done to determine any fresh tumor growth. This would help timely initiation of treatment and prevent the onset of complications as well.
Summary
Thymoma is a neoplasm of the epithelial cells lining the thymus. The thymus is a small organ that is located beneath the sternum. This organ is a part of the lymphatic system responsible for producing white blood cells and protecting the body against infections.
Tumor originating from the surface of the organ hampers its original functioning paving way for development of serious life threatening complications. The tumor cells of thymoma mimic normal cells and in rare cases spread to other organs.
Patient Information
Definition
Thymoma is a rare form of cancer originating from the surface of the thymus organ. This organ is located beneath the breastbone and plays a vital role in production of white blood cells along with the lymphatic system.
Cause
The exact cause behind the development of thymoma still remains a mystery. Researchers have documented that thymoma can occur as a result of several disease conditions such as myasthenia gravis, red cell aplasia, Cushing syndrome, dermatomyositis and systemic lupus erythematous.
Symptoms
Symptoms of thymoma include persistent cough, difficulty in swallowing, swollen hands and face, pain in chest, shortness of breath, fatigue muscle aches, dizziness and anemia.
Diagnosis
Imaging studies such as CT scan, MRI and PET scan form the preliminary diagnostic procedures. These provide information about the size and location of the tumor. Following this, biopsy of the tumor is carried out to study its nature.
Treatment
Surgical resection of the tumor cells is primary mode of treatment. In addition, radiation therapy and chemotherapy are also employed to arrest and prevent the growth of tumors.
References
- Quddus MA, Rahman MM, Ali ZI, et al. Treatment of myasthenia gravis: a surgical profile. Mymensingh Med J. Jul 2009; 18(2):203-7.
- Blumberg D, Port JL, Weksler B, Delgado R, Rosai J, Bains MS, et al. Thymoma: a multivariate analysis of factors predicting survival. Ann Thorac Surg. Oct 1995; 60(4):908-13; discussion 914.
- Konstantinov IE, Saxena P, Koniuszko M, Ghosh S, Low VH, Khor TS, et al. Superior Vena Cava Obstruction by Tumour Thrombus in Invasive Thymoma: Diagnosis and Surgical Management. Heart Lung Circ. Apr 9 2007.
- Bagga S, Bloch EM. Imaging of an invasive malignant thymoma on PET scan: CT and histopathologic correlation. Clin Nucl Med. Oct 2006; 31(10):614-6.
- Shin DM, Walsh GL, Komaki R, Putnam JB, Nesbitt J, Ro JY, et al. A multidisciplinary approach to therapy for unresectable malignant thymoma. Ann Intern Med. Jul 15 1998; 129(2):100-4.
- Wright CD. Pleuropneumonectomy for the treatment of Masaoka stage IVA thymoma. Ann Thorac Surg. Oct 2006; 82(4):1234-9.
- Kaiser LR. Thymoma. The use of minimally invasive resection techniques. Chest Surg Clin N Am. Feb 1994; 4(1):185-94.
- Wilkins EW Jr, Grillo HC, Scannell JG, Moncure AC, Mathisen DJ. J. Maxwell Chamberlain Memorial Paper. Role of staging in prognosis and management of thymoma. Ann Thorac Surg. Jun 1991; 51(6):888-92.
- Falkson CB, Bezjak A, Darling G, et al. The management of thymoma: a systematic review and practice guideline. J Thorac Oncol. Jul 2009; 4(7):911-9.
- Barratt S, Puthucheary ZA, Plummeridge M. Complete regression of a thymoma to glucocorticoids, commenced for palliation of symptoms. Eur J Cardiothorac Surg. Jun 2007; 31(6):1142-3.