Thymoma differential diagnosis: Difference between revisions

Latest revision as of 22:28, 8 August 2019

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2] Ahmad Al Maradni, M.D. [3] Khuram Nouman, M.D. [4]

Overview

Thymoma must be differentiated from thymic carcinoma, mediastinal germ cell tumor, thymic masses, lymphoma, and sub-sternal thyroid.

Differentiating Thymoma from other Diseases


Diseases	Mediastinal Part	Systemic Symptoms	Obstructive Symptoms	Additional Features	Cell Organization	Tumor Cells	Lymphoid Cells	Additional Tests
Diseases	Site	Clinical Features			Pathology			Labs
Mediastinal Germ Cell Tumor	Anterior	Chest pain, Cough Difficulty breathing Weight loss	Superior vena cava syndrome	Post-obstructive pneumonia	Non-adhesive	Cells with large nuclei and prominent nucleoli	Mature looking Small	PLAP+ Serum AFP
Thymic masses Thymoma Cyst Thymic carcinoma Thymolipoma Parathyroid hyperplasia)	Anterior	Fever Night sweats Weight loss (depending on the type of mass)	Stridor Superior vena cava syndrome Facial swelling Painful swallowing	Horner syndrome due to mass effect	Varies	Varies with type	Varies with type	Varies with type Serum PTH CBC TSH, T3, T4 beta-HCG Serum AFP Gamma Globulins
Lymphoma Non-Hodgkin lymphoma Hodgkin's lymphoma	Anterior Middle	Fever Weight loss Night sweats Shortness of breath	Phrenic nerve palsy Hoarseness Superior vena cava syndrome	Pleural effusion Pericardial effusion	Non-adhesive	Immature lymphoid cells (Non-Hodgkin lymphoma) Reed-Sternberg cells and variants (Hodgkin's lymphoma)	Immature(Non-Hodgkin lymphoma) Mature, small (Hodgkin's lymphoma)	LCA+ Light chain restriction in B-NHL CD15+, CD30+ in Hodgkin's lymphoma
Sub-sternal goiter & thyroid lymphoma	Anterior	Symptoms of hypothyroidism(cold intolerance, weight gain, andconstipation) Hyperthyroidism (heat intolerance, weight loss, and diarrhea)	Positional dyspnea Choking sensation Wheezing Superior vena cava syndrome	Vocal cord palsy Horner's syndrome	Varies	Hurthle cells Prominent nucleoli Abundant cytoplasm	Non-Hodgkin type is more common in thyroid lymphoma	Antibodies against thyroid peroxidase Antibodies against thyroglobulin

Thymoma Vs Thymic Carcinoma

The following table highlights the difference between thymoma and thymic carcinoma:

Differential diagnosis of thymoma types A, AB, B, and thymic carcinomas.

Other Differential Diagnoses

Thymoma must be differentiated from other similar conditions which lead to multiple endocrine disorders, such as autoimmune polyendocrine syndrome, POEMS syndrome, Hirata's syndrome, Kearns–Sayre syndrome, and Wolfram syndromes.

Disease	Addison's Disease	Type 1 Diabetes Mellitus	Hypothyroidism	Other Disorders Present
APS type 1	+	Less common	Less common	Hypoparathyroidism Candidiasis Hypogonadism
APS type 2	+	+	+	Hypogonadism Malabsorption
APS type 3	-	+	+	Malabsorption
Thymoma	+	-	+	Myasthenia gravis Cushing syndrome
Chromosomal abnormalities (Turner syndrome, Down's syndrome)	-	+	+	Cardiac dysfunction
Kearns–Sayre syndrome	-	+	-	Myopathy Hypoparathyroidism Hypogonadism
Wolfram syndrome	-	+	-	Diabetes insipidus Optic atrophy Deafness
POEMS syndrome	-	+	-	Polyneuropathy Hypogonadism Plasma cell dyscrasias

References

Template:WikiDoc Sources

@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Thymoma}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Thymoma]]
-{{CMG}} {{AE}} {{AM}} {{AAM}}
+{{CMG}} {{AE}} {{AM}} {{AAM}}  [[User:K.Nouman|Khuram Nouman, M.D. [4]]]
 ==Overview==
-Thymoma must be differentiated from other diseases such as [[thymic carcinoma]], thymic [[cyst]], thymic [[hyperplasia]] and [[germ cell tumors]].
+Thymoma must be differentiated from [[thymic carcinoma]], [[mediastinal germ cell tumor]], [[Thymus|thymic]] masses, [[lymphoma]], and sub-[[Sternum|sternal]] [[Thyroid disease|thyroid]].
-==Differential Diagnosis==
+==Differentiating Thymoma from other Diseases==
-Thymoma must be differentiated from other diseases such as:
+{|
-* '''Thymic masses'''
+|+
-:* ''[[Cyst|Thymic cyst]]'': It is an incidental mass that may be congenital or acquired. It might contain [[parathyroid]] or salivary tissue, as they have a common embryological origin.
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-:* ''Thymic [[hyperplasia]]'': Resected only if associated [[paraneoplastic syndrome]].
+! rowspan="2" |Diseases
-:* ''Thymolipoma'': Increased thymic size with mixed [[adipose tissue]].
+!Site
-:* ''[[Thymic cancer|Thymic carcinoma]]'': Rare thymic tumor, poor survival rate, high rate of recurrence. Sometimes called type C thymoma.
+! colspan="3" |Clinical Features
-:* ''Thymic [[carcinoid]]'': Also called thymic neuroendocrine tumor, uncommon and presents as a mass in the anterior mediastinum.
+| colspan="3" |'''Pathology'''
-:* ''Ectopic [[parathyroid]] tissue''
+|'''Labs'''
+|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
+!Mediastinal Part
+!Systemic Symptoms
+!Obstructive Symptoms
+!Additional Features
+!Cell Organization
+!Tumor Cells
+!Lymphoid Cells
+!Additional Tests
+|-
+! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Mediastinal germ cell tumor|Mediastinal Germ Cell Tumor]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Anatomical terms of location|Anterior]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Chest pain, cough and dyspnea|Chest pain]],
+*[[Cough]]
+*[[Dyspnea|Difficulty breathing]]
+*[[Weight loss]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Superior vena cava syndrome]]
+| style="background: #F5F5F5; padding: 5px;" |
+*Post-obstructive [[pneumonia]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Non-adhesive
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Cell (biology)|Cells]] with large [[Cell nucleus|nuclei]] and prominent [[Nucleolus|nucleoli]]
+| style="background: #F5F5F5; padding: 5px;" |
+*Mature looking
+*Small
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Placental alkaline phosphatase|PLAP]]+
+*[[Serum]] [[Alpha-fetoprotein|AFP]]
+|-
+! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Thymus|Thymic]] masses
+* Thymoma
+* Cyst
+* Thymic carcinoma
+* Thymolipoma
+* Parathyroid hyperplasia)
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Anatomical terms of location|Anterior]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Fever and cough|Fever]]
+*[[Night sweats]]
+*[[Weight loss]] (depending on the type of mass)
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Stridor]]
+*[[Superior vena cava syndrome]]
+*[[Face|Facial]] [[swelling]]
+*[[Odynophagia|Painful swallowing]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Horner syndrome]] due to [[Mass effect (medicine)|mass effect]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Varies
+| style="background: #F5F5F5; padding: 5px;" |
+*Varies with type
+| style="background: #F5F5F5; padding: 5px;" |
+*Varies with type
+| style="background: #F5F5F5; padding: 5px;" |
+*Varies with type
+*[[Serum]] [[Parathyroid hormone|PTH]]
+*[[Complete blood count|CBC]]
+*[[Thyroid-stimulating hormone|TSH]], [[Triiodothyronine|T3]], [[Thyroxine|T4]]
+*[[Human chorionic gonadotropin|beta-HCG]]
+*[[Serum]] [[Alpha-fetoprotein|AFP]]
+*Gamma [[Globulin|Globulins]]
+|-
+! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Lymphoma]]
+* [[Non-Hodgkin Lymphoma|Non-Hodgkin lymphoma]]
+* [[Hodgkin's lymphoma]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Anterior mediastinum|Anterior]]
+* [[Middle mediastinum|Middle]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Fever and cough|Fever]]
+*[[Weight loss]]
+*[[Night sweats]]
+*[[Shortness of breath while lying down|Shortness of breath]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Phrenic nerve]] [[palsy]]
+*[[Hoarseness]]
+*[[Superior vena cava syndrome]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Pleural effusion]]
+*[[Pericardial effusion]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Non-adhesive
+| style="background: #F5F5F5; padding: 5px;" |
+*Immature [[Lymphoid cell|lymphoid cells]] ([[Non-Hodgkin lymphoma]])
-* '''Germ cell tumors'''
+*[[Reed-Sternberg cells]] and variants ([[Hodgkin's lymphoma]])
-:*The most common site of extragonadal [[germ cell tumors]] is the mediastinum.
+| style="background: #F5F5F5; padding: 5px;" |
-:* Germ cell tumors include:
+*Immature([[Non-Hodgkin lymphoma]])
-::* ''[[Teratoma]]s'': Represents two thirds of mediastinal germ cell tumors. Usually benign, but when malignant, it's very aggressive and has a very poor prognosis.
+*Mature, small ([[Hodgkin's lymphoma]])
-::* ''[[Dermoid cyst]]s'': Very rare tumor, only 118 cases have been reported.<ref name="Ripa-1992">{{Cite journal | last1 = Ripa | first1 = LW. | title = Rinses for the control of dental caries. | journal = Int Dent J | volume = 42 | issue = 4 Suppl 1 | pages = 263-9 | month = Aug | year = 1992 | doi = | PMID = 1399044 }}</ref>
+| style="background: #F5F5F5; padding: 5px;" |
-::* ''Malignant germ cell tumor'': 90% of malignant mediastinal germ cell tumors occur in males. A full physical examination and scrotal ultrasound is required.
+*LCA+
-::* ''Seminomas'': Slightly more common, grows slowly but might reach large sizes.
+*[[Light chain]] restriction in B-[[Non-Hodgkin lymphoma|NHL]]
-::* ''Non-seminomatous germ cell tumor'': Consists of [[yolk sac tumor]]s, embryonal cell carcinoma, and/or [[choriocarcinoma]]. Commonly occurs between 20 and 40 years of age.
+*[[CD15]]+, [[CD30]]+ in [[Hodgkin's lymphoma]]
+|-
+! style="background: #DCDCDC; padding: 5px; text-align: left;" |Sub-[[Sternum|sternal]] [[goiter]] & [[thyroid]] [[lymphoma]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Anterior mediastinum|Anterior]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Symptom|Symptoms]] of [[hypothyroidism]](cold intolerance, [[weight gain]], and[[constipation]])
+*[[Hyperthyroidism]] (heat intolerance, [[weight loss]], and [[diarrhea]])
+| style="background: #F5F5F5; padding: 5px;" |
+*Positional [[dyspnea]]
+*[[Choking]] sensation
+*[[Wheezing]]
+*[[Superior vena cava syndrome]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Vocal cord]] [[palsy]]
+*[[Horner's syndrome]]
+| style="background: #F5F5F5; padding: 5px;" |
+* Varies
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Hurthle cells]]
+*Prominent [[Nucleolus|nucleoli]]
+*Abundant [[cytoplasm]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Non-Hodgkin Lymphoma|Non-Hodgkin]] type is more common in [[thyroid]] [[lymphoma]]
+| style="background: #F5F5F5; padding: 5px;" |
+*[[Antibodies]] against [[thyroid peroxidase]]
-* '''Lymphoma''' (anterior mediatinal lymphoma, also known as terrible lymphoma, may be middle or posterior mediastinal)
+*[[Antibodies]] against [[thyroglobulin]]
-:*''Nodular sclerosing [[Hodgkin’s lymphoma]]'' and ''primary mediastinal [[B-cell lymphoma]]'' are the two common types that present in the mediastinum.
+|}
-:*Usually has systemic symptoms such as fever, weight loss, and night sweats and may also have other symptoms as [[chest pain]], [[wheezing]], [[dyspnea]] or [[superior vena cava syndrome]].
-* '''Thyroid''' (intrathyroid [[goiter]])
-:*''[[Grave's disease]]'' and ''[[Hashimoto's thyroiditis]]'' are usually associated with [[goiter]].
-:*Presents with [[shortness of breath]] or [[dysphagia]].
+=== Thymoma Vs Thymic Carcinoma ===
+* The following table highlights the difference between thymoma and thymic carcinoma:
 {|
-| [[File:diff.png|800px|thumb|Differential diagnosis of thymomas types A, AB, B and [[Thymic cancer|thymic carcinomas]].<ref>{{Cite web  | last =  | first =  | title = http://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb10/BB10.pdf | url = http://www.iarc.fr/en/publications/pdfs-online/pat-gen/bb10/BB10.pdf | publisher =  | date =  | accessdate = }}</ref>]]
+| [[File:diff.png|800px|thumb|Differential diagnosis of thymoma types A, AB, B, and [[Thymic cancer|thymic carcinomas]].]]
 |}
-==Other differentials==
+==Other Differential Diagnoses==
-Thymoma must be differentiated from other similar conditions which lead to multiple endocrine disorders such as [[autoimmune polyendocrine syndrome]], [[POEMS syndrome]], Hirata syndrome, [[Kearns–Sayre syndrome]] and [[Wolfram syndrome|Wolfram syndromes]].<ref name="pmid21533467">{{cite journal |vauthors=Sherer Y, Bardayan Y, Shoenfeld Y |title=Thymoma, thymic hyperplasia, thymectomy and autoimmune diseases (Review) |journal=Int. J. Oncol. |volume=10 |issue=5 |pages=939–43 |year=1997 |pmid=21533467 |doi= |url=}}</ref><ref name="Nozza2017">{{cite journal|last1=Nozza|first1=Andrea|title=POEMS SYNDROME: AN UPDATE|journal=Mediterranean Journal of Hematology and Infectious Diseases|volume=9|issue=1|year=2017|pages=e2017051|issn=2035-3006|doi=10.4084/mjhid.2017.051}}</ref><ref name="pmid17342029">{{cite journal |vauthors=Maceluch JA, Niedziela M |title=The clinical diagnosis and molecular genetics of kearns-sayre syndrome: a complex mitochondrial encephalomyopathy |journal=Pediatr Endocrinol Rev |volume=4 |issue=2 |pages=117–37 |year=2006 |pmid=17342029 |doi= |url=}}</ref><ref name="pmid22790102">{{cite journal |vauthors=Rigoli L, Di Bella C |title=Wolfram syndrome 1 and Wolfram syndrome 2 |journal=Curr. Opin. Pediatr. |volume=24 |issue=4 |pages=512–7 |year=2012 |pmid=22790102 |doi=10.1097/MOP.0b013e328354ccdf |url=}}</ref><ref name="HusebyeAnderson2010">{{cite journal|last1=Husebye|first1=Eystein S.|last2=Anderson|first2=Mark S.|title=Autoimmune Polyendocrine Syndromes: Clues to Type 1 Diabetes Pathogenesis|journal=Immunity|volume=32|issue=4|year=2010|pages=479–487|issn=10747613|doi=10.1016/j.immuni.2010.03.016}}</ref>
+Thymoma must be differentiated from other similar conditions which lead to multiple [[Endocrine diseases|endocrine disorders]], such as [[autoimmune polyendocrine syndrome]], [[POEMS syndrome]], Hirata's syndrome, [[Kearns–Sayre syndrome]], and [[Wolfram syndrome|Wolfram syndromes]].
 {| class="wikitable"
 ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease
-! align="center" style="background:#4479BA; color: #FFFFFF;" + |Addison's disease
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Addison's Disease
-! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type 1 diabetes mellitus
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type 1 Diabetes Mellitus
 ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hypothyroidism
-! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other disorders present
+! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other Disorders Present
 |-
-|APS  type 1
+!APS  type 1
 |<nowiki>+</nowiki>
-|Less common
+|
-|Less common
+* Less common
-|[[Hypoparathyroidism]]<br>[[Candidiasis]]<br>[[Hypogonadism]]
+|
+* Less common
+|
+* [[Hypoparathyroidism]]
+* [[Candidiasis]]
+* [[Hypogonadism]]
 |-
-|APS  type 2
+!APS  type 2
 | +
 | +
 | +
-|[[Hypogonadism]]<br>[[Malabsorption]]
+|
+* [[Hypogonadism]]
+* [[Malabsorption]]
 |-
-|APS  type 3
+!APS  type 3
 |<nowiki>-</nowiki>
 | +
 |<nowiki>+</nowiki>
-|[[Malabsorption]]
+|
+* [[Malabsorption]]
 |-
-|[[Thymoma]]
+![[Thymoma]]
 | +
 |<nowiki>-</nowiki>
 | +
-|[[Myasthenia gravis]]<br>[[Cushing syndrome]]
+|
+* [[Myasthenia gravis]]
+* [[Cushing syndrome]]
 |-
-|[[Chromosomal abnormalities]]<br>([[Turner syndrome]],<br>[[Down's syndrome]])
+![[Chromosomal abnormalities]]<br>([[Turner syndrome]],<br>[[Down's syndrome]])
 | -
 | +
 | +
-|[[Cardiac dysfunction ]]
+|
+* [[Cardiac dysfunction]]
 |-
-|[[Kearns–Sayre syndrome]]
+![[Kearns–Sayre syndrome]]
 |<nowiki>-</nowiki>
 | +
 |<nowiki>-</nowiki>
-|[[Myopathy]]<br>[[Hypoparathyroidism]]<br>[[Hypogonadism]]
+|
+* [[Myopathy]]
+* [[Hypoparathyroidism]]
+* [[Hypogonadism]]
 |-
-|[[Wolfram syndrome]]
+![[Wolfram syndrome]]
 |<nowiki>-</nowiki>
 | +
 |<nowiki>-</nowiki>
-|[[Diabetes insipidus]]<br>[[Optic atrophy]]<br>[[Deafness]]<br>
+|
+* [[Diabetes insipidus]]
+* [[Optic atrophy]]
+* [[Deafness]]<br>
 |-
-|[[POEMS syndrome]]
+![[POEMS syndrome]]
 |<nowiki>-</nowiki>
 | +
 |<nowiki>-</nowiki>
-|[[Polyneuropathy]]<br>[[Hypogonadism]]<br>[[Plasma cell dyscrasia|Plasma cell dyscrasias]]
+|
+* [[Polyneuropathy]]
+* [[Hypogonadism]]
+* [[Plasma cell dyscrasia|Plasma cell dyscrasias]]
 |}
 ==References==
-{{Reflist|2}}
+<references />
 [[Category:Types of cancer]]
 [[Category:Rare diseases]]