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Thymoma

Thymomas


Presentation

Thymoma presents with the following signs and symptoms:

Hyperthermia
  • The purpose of this study was to assess the feasibility and the results in terms of morbidity, mortality and survival rates, of Intra-Thoracic Chemo-Hyperthermia (ITCH) for the treatment of pleural recurrences of thymomas.[ncbi.nlm.nih.gov]
  • , Masahiko Higashiyama, Jiro Okami, Toshiteru Tokunaga, Ayako Fujiwara, Fumio Imamura and Tomio Nakayama, Cytoreductive surgery and post-operative heated pleural chemotherapy for the management of pleural surface malignancy, International Journal of Hyperthermia[doi.org]
Amyloidosis
  • Primary localized amyloidosis presenting as an isolated mediastinal mass is extremely rare, especially in the thymus.[ncbi.nlm.nih.gov]
Rigor
  • A multiinstitutional database is required to more rigorously evaluate both risks and to confirm our results. KEYWORDS: Incidence; Myasthenia gravis; Neoplasm recurrence; Neoplasms; Thymectomy; Thymoma; local; second primary[ncbi.nlm.nih.gov]
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]
Right Upper Quadrant Pain
  • He experienced sudden-onset right upper quadrant pain and was again admitted to our hospital. We noted large hemoperitoneum with a 10-cm encapsulated mass in S5/8 and a 2.3-cm nodular lesion in the right upper quadrant of the abdomen.[ncbi.nlm.nih.gov]
Abdominal Pain
  • A 43-year-old man complained of postprandial abdominal pain, nausea and vomiting.[ncbi.nlm.nih.gov]
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]
  • The present study report a case of a 65-year-old man who was incidentally found to have an anterior mediastinal nodule, without clinical symptoms including fever, chest pain, and myasthenia gravis.[ncbi.nlm.nih.gov]
  • CASE PRESENTATION: Here, we present an unusual case of combined thymic carcinoma of the thymus in a 44-year-old male who had suffered from fever, chest pain, chest tightness and shortness of breath.[ncbi.nlm.nih.gov]
  • Symptoms of thymoma and thymic carcinoma Symptoms of a thymus gland tumour include: chest pain a persistent cough shortness of breath difficulty swallowing hoarseness of the voice swelling of the neck due to the tumour pressing on blood vessels in the[christie.nhs.uk]
  • pain Superior vena caval syndrome Dysphagia Hoarseness About 1/3 are found during workup for myasthenia gravis Imaging Findings Oval round or lobulated soft tissue mass, sharply demarcated, usually smaller than teratomas Usually occur in upper third[learningradiology.com]
Skin Lesion
  • The final diagnosis of her skin lesions was thymoma-associated graft-versus-host-like disease. The skin lesions improved gradually during the 1-month period after resection with only a topical steroid, and further improvement was seen at 3 months.[ncbi.nlm.nih.gov]
  • The patient had developed toxic epidermal necrolysis-like erosive skin lesions over the whole body. Although systemic corticosteroids were effective up to a point, we were unable to begin the steroid taper.[ncbi.nlm.nih.gov]
Eruptions
  • Abstract A 69-year-old woman with refractory skin eruptions, which had first appeared 3 years previously, was examined, and an anterior mediastinal tumor was detected.[ncbi.nlm.nih.gov]
Truncal Ataxia
  • Marked sensory loss can lead to truncal ataxia, although motor strength is normal.[emedicine.com]
Choreoathetoid Movements
  • Her choreoathetoid movements disappeared and her other neurologic symptoms improved. Her cerebrospinal fluid proved to be negative for paraneoplastic limbic encephalitis antibodies.[ncbi.nlm.nih.gov]
Altered Mental Status
  • In this case illustrating the new diagnostic criteria, we report a 70-year-old woman who was brought to the emergency room after the acute onset of cognitive impairment, altered mental status, and choreoathetoid movements.[ncbi.nlm.nih.gov]

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. 
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]
  • 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]
  • An 8.0 7.0 3.0 cm calcified anterior mediastinal mass was found in a 57-year-old man during a regular health checkup. The tumor had invaded the pericardium and phrenic nerve. The Masaoka-Koga classification was stage III.[ncbi.nlm.nih.gov]
  • Surgery removal and histopathological examination determined that the mediastinal mass corresponded to a thymoma and the cervical lesion to a parathyroid adenoma.[ncbi.nlm.nih.gov]
  • At the first hospital admission, the patient had a 45-mm anterior mediastinal mass that was eventually diagnosed as a type A thymoma. The mass was excised, and the patient was disease-free for 6 years.[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]
  • An 8.0 7.0 3.0 cm calcified anterior mediastinal mass was found in a 57-year-old man during a regular health checkup. The tumor had invaded the pericardium and phrenic nerve. The Masaoka-Koga classification was stage III.[ncbi.nlm.nih.gov]
  • 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]
  • At the first hospital admission, the patient had a 45-mm anterior mediastinal mass that was eventually diagnosed as a type A thymoma. The mass was excised, and the patient was disease-free for 6 years.[ncbi.nlm.nih.gov]
  • Herein, we present a case of a 62-year-old woman incidentally found to have an anterior mediastinal mass, 31 24 17 mm in size, without an associated autoimmune disease such as myasthenia gravis.[ncbi.nlm.nih.gov]
Right Pleural Effusion
  • Chest radiography and computed tomography scans revealed right pleural effusion and a mass in the right middle lung field, which were confirmed by a percutaneous lung biopsy as metastatic invasive thymoma.[ncbi.nlm.nih.gov]
Hyponatremia
  • Severe hypoalbuminemia, heavy proteinuria, hyponatremia, and hypercholesterolemia were features of the nephrotic syndrome. A kidney needle biopsy suggested focal segmental glomerulosclerosis.[ncbi.nlm.nih.gov]
Salmonella Typhi
  • Histopathology of the mass was suggestive of thymoma and culture from the necrotic aspirate yielded Salmonella typhi. The same pathogen was isolated in subsequent blood and sputum cultures.[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:

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.

Sex distribution
Age distribution

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

Article

  1. Quddus MA, Rahman MM, Ali ZI, et al. Treatment of myasthenia gravis: a surgical profile. Mymensingh Med J. Jul 2009; 18(2):203-7.
  2. 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.
  3. 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.
  4. 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.
  5. 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.
  6. Wright CD. Pleuropneumonectomy for the treatment of Masaoka stage IVA thymoma. Ann Thorac Surg. Oct 2006; 82(4):1234-9.
  7. Kaiser LR. Thymoma. The use of minimally invasive resection techniques. Chest Surg Clin N Am. Feb 1994; 4(1):185-94.
  8. 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.
  9. 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.
  10. 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.

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Last updated: 2019-07-11 22:50