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Updated: Dec 27 2021

Thymoma / Thymic Cancer

  • 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
    • 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
    • Dependent on stage and resectability
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