Updated: 2/13/2018

Thymoma / Thymic Cancer

0%
Topic
Review Topic
0
0
N/A
N/A
Questions
1
0
0
Topic
Snapshot
  • A 38-year-old female presents with fatigable chewing and "seeing double" when reading a book. She has also noted a "head drop" when she was bathing her dog. On physical exam, pupils are equal, round, and reactive. Ptosis is elicited with prolonged staring towards the ceiling. A glove of ice is applied to the eyelids, and ptosis is improved. She is seropositive for antibodies against acetylcholine receptors. A chest CT is performed, showing an anterior mediastinal mass. (Myasthenia gravis)
Introduction
  • Arises in the anterior mediastinum
    • thymus is involved in T-cell maturation
    • active during infancy and childhood
      • visible on chest radiograph 
        • i.e., thymic "sail sign" at superior, right border of the heart
    • at puberty, will be replaced by fatty tissue
  • Epidemiology
    • most patients with thymoma are between 40-60 years of age
    • no sexual predilection
    • thymoma are associated with paraneoplastic syndromes (e.g., myasthenia gravis, immunodeficiency, pure red cell aplasia, good syndrome)
Presentation
  • Symptoms
    • thyomoma
      • dependent on size
        • horseness
          • recurrent larygneal nerve involvement
        • dysphagia
        • chest pain
        • cough
        • superior vena cava syndrome
    • thymic carcinoma
      • similar to thymoma, but more aggressive (e.g., medistainal structure invasion)
        • extrathoracic metastasis
          • e.g., kidneys, extrathoracic lymphnodes, brain
Evaluation
  • Thoracic CT or MRI
  • Histological evaluation
    • thymic neoplasm classification
Differential
  • Retrosternal thyroid
  • Mediastinal germ cell tumor
    • check an hCG and AFP
  • Lymphoma
Treatment
  • Surgical
    • first-line in most cases
    • when complete resection is feasible
    • allows histological evaluation of specimen
  • Neoadjuvant chemotherapy or chemoradiation
    • in those who are not surgical candidates
    • may be used prior to surgery
      • may improve likelihood of complete resection
  • Radiation therapy and/or chemotherapy
    • in non-operative candidates
    • may prolong survival
Prognosis, Prevention and Complications
  • Prognosis
    • dependent on stage and resectability

Please rate topic.

Average 5.0 of 3 Ratings

Questions (1)
Question locked
Sorry, this question is for
PEAK Premium Subscribers only
Upgrade to PEAK
EXPERT COMMENTS (2)
Private Note