Current Therapy for Thymoma

doi:10.1378/chest.103.4_Supplement.334S

Chest

Volume 103, Issue 4, Supplement, April 1993, Pages 334S-336S

https://doi.org/10.1378/chest.103.4_Supplement.334S Get rights and content

Thymoma is distinguished from other thoracic malignancies by its nonmalignant appearance cytologically. Diagnosis of malignancy is made on the basis of gross or microscopic invasion of the capsule or surrounding tissues. Recent advances may permit diagnosis with fine-needle aspiration of the tumor and immunohistochemical staining techniques, but the skill of the cyopathologist is critical. Thymoma exhibits an indolent course, and this fact may give surgeons an opportunity for a successful resection even late in the course of the disease, after radiotherapy or chemotherapy has reduced the tumor bulk.

Section snippets

Diagnosis

Patients with thymoma are generally between 40 and 60 years of age. The sex distribution of the disease is approximately equal. Patients are usually asymptomatic, but they may complain of vague nonspecific symptoms like pressure in the chest or aches and pains. Radiographic findings of thymoma may be subtle, and computed tomography is helpful in delineating the extent of the tumor. A variety of associated abnormalities have been reported; myasthenia gravis is the most common of these, being

Treatment

The most important therapeutic modality for thymoma is surgical excision, which is ordinarily reserved for those tumors that can be completely excised. Treatment of thymomas that cannot be completely excised is controversial. Although radiotherapy is advocated widely for tumors that extend beyond the capsule, whether it should be administered preoperatively, postoperatively, or both has not been conclusively established.

References (6)

BernatzPE et al.
Thymoma: factors influencing prognosis.
Surg Clin North Am
(1973)
ShamjiF et al.
Results of surgical treatment for thymoma.
J Thorac Cardiovasc Surg
(1984)
NakaharaK et al.
Thymoma: results with complete resection and adjuvant postoperative irradiation in 141 consecutive patients.
J Thorac Cardiovasc Surg
(1988)

There are more references available in the full text version of this article.

Cited by (23)

Immunodeficiency and thymoma in Good syndrome: Two sides of the same coin
2021, Immunology Letters
Citation Excerpt :
It is therefore essential to further investigate the pathogenesis and the mechanisms involved in the immunodeficiency, as well as those associated with thymoma [4,13]. A number of treatments have been proposed, however none has shown a significant impact on the prognosis of these patients [7,39]. Only thymoma resection can prevent local and metastatic invasion, while treatment with gammaglobulins act on infectious complications improving the quality of life of these patients [2,4,7,8,15].
Good Syndrome is a rare clinical entity first described as the conjunction of thymoma and hypogammaglobulinemia, and more recently depicted as a complex disease integrating a medical history of thymoma with humoral immunodeficiency (more accurately stated: hypogammaglobulinemia) with or without cellular immunodeficiency, recurrent infections, autoimmunity, paraneoplastic syndromes and diverse aberrations in the immunological profile. This condition has an ominous prognosis with a high mortality rate secondary to recalcitrant infectious diseases. Understanding the possible discordances in clinical presentation and the temporal relationship between manifestations and immunological alterations is key to prevent misdiagnosis and complications. To this end, here we provide two illustrative patients with Good Syndrome that share common clinical manifestations and yet show unique and opposed immunological profiles, thereby highlighting the pivotal interest of a comprehensive immunological profiling in these patients. We conducted a thorough review of existing literature on the elusive molecular mechanisms underlying the syndrome and provide a clinical assessment algorithm to facilitate the management of these challenging patients.
Pediatric Chest II. Benign Tumors and Cysts
2012, Surgical Clinics of North America
Citation Excerpt :
If diagnostic tests are inconclusive, nodal biopsy may be required; this can be accomplished by ultrasound- or CT-guided percutaneous needle biopsy, biopsy using the thoracoscopic technique or, rarely, open thoracotomy. Thymomas are the most common neoplasms of the anterior mediastinum in adults, but they are rare in children,56–59 and comprise only 1% to 4% of pediatric mediastinal tumors.5,60 Thymomas are commonly associated with myasthenia gravis in adults, but this association is very rare in children.61
Good's syndrome remains a mystery after 55 years: A systematic review of the scientific evidence
2010, Clinical Immunology
Citation Excerpt :
Finally, we also found significant overall mortality (46%) in our review of 152 cases of GS. The treatment of thymoma is surgical removal or debulking of the tumor, [216,219,220] and the most important indicator of long term prognosis is completeness of tumor resection [219,221]. Patients with advanced stage 3 or stage 4 disease tumors often require radiotherapy and combination chemotherapy.
Good syndrome (GS) is a rare association of thymoma and immunodeficiency first described more than 50 years ago. However, this syndrome still remains a mystery to clinicians. We systematically reviewed all the clinical, laboratory and immunologic findings from 152 patients with Good syndrome. The syndrome has a worldwide distribution and approximately half of the cases (47%) have been described in Europe. The diagnosis of thymoma preceded the diagnosis of hypogammaglobulinemia, infection, or diarrhea in 42% of patients whereas in 38% of patients the diagnoses were made almost simultaneously within 2 months of each other. We found significant mortality in patients with this syndrome (44.5%). Astute clinical acumen and increased awareness about the clinical and immunological profile of this syndrome may increase early recognition of this syndrome and prevent mortality. Further studies are needed to elucidate this clinical entity.
Pleural dissemination of thymoma showing tumor regression after combined corticosteroid and tacrolimus therapy
2006, European Journal of Internal Medicine
We present the case of an elderly woman with myasthenia gravis who had pleural dissemination of thymoma reduced by treatments with a moderate dose of corticosteroids and a conventional dose of tacrolimus. A maintenance dose of prednisolone for myasthenia gravis could not shrink the size of the disseminated thymoma, but prednisolone (> 30 mg daily) succeeded in reducing the size of the tumor. Moreover, a combination with tacrolimus enabled the daily dose of prednisolone to be tapered off without recurrence of myasthenia gravis, and the disseminated thymoma almost disappeared. A moderate or higher dosage of corticosteroids with tacrolimus may, in some cases, be an effective procedure for pleural dissemination of thymoma. Treatment should be undertaken on a trial basis for patients not indicated for surgery, radiotherapy, or chemotherapy.
Tumors of the Chest
2006, Kendig's Disorders of the Respiratory Tract in Children
Three-color flow cytometric study on lymphocytes derived from thymic diseases
2001, Journal of Surgical Research
Background. Anterior mediastinal masses derive from a variety of diseases. Thymomas have been shown to commonly hold CD4⁺CD8⁺ double-positive (DP) lymphocytes, and identification of this subset by two-color flow cytometric study was suggested to help diagnosis of thymoma. Several other thymic diseases, however, possibly hold CD4⁺CD8⁺ DP lymphocytes. In this study, we utilized the three-color flow cytometric method for further examination of the phenotypes of lymphocytes in the thymic diseases.
Materials and methods. One hundred eight specimens (77 primary and 10 metastatic thymomas, 10 thymic carcinomas, 2 thymic carcinoids, 4 malignant lymphomas, 2 seminomas, an inflammatory pseudotumor, and 2 nonneoplastic thymic hyperplasias) were subjected to the study. The expressions of CD3, CD4, and CD8 on tumor-associated lymphocytes were evaluated by three-color flow cytometric study.
Results. The proportion of the CD4⁺CD8⁺ DP subset was more than 30% in all 78 lymphocyte-rich thymomas, in 2 malignant lymphomas, and in both thymic hyperplasias. CD3 expression of the CD4⁺CD8⁺ DP subset ranged from a negative to a high level in thymomas and thymic hyperplasias, while it was restricted to a particular level in CD4⁺CD8⁺ DP-type malignant lymphomas. The proportion of CD3⁺ cells in the CD4⁺CD8⁻ single-positive subset was consistently less than 90% in the lymphocyte-rich thymomas, while it was more than 90% in the thymic hyperplasias.
Conclusion. Although identification of the CD4⁺CD8⁺ DP subset in the tumor-associated lymphocytes does not necessarily indicate thymoma, a further characterization of thymic neoplasms possessing the CD4⁺CD8⁺ DP subset was enabled by three-color flow cytometric study, suggesting the utility of this method as an ancillary tool for differential diagnosis of these diseases.

View all citing articles on Scopus

View full text

Chest

ArticleCurrent Therapy for Thymoma

Section snippets

Diagnosis

Treatment

Surg Clin North Am

J Thorac Cardiovasc Surg

J Thorac Cardiovasc Surg

Article
Current Therapy for Thymoma