Thymoma differential diagnosis: Difference between revisions
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(I have edited and rearranged the differential diagnosis of thymoma in table form.) |
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Thymoma]] | |||
{{CMG}} {{AE}} {{AM}} {{AAM}} Nouman | {{CMG}} {{AE}} {{AM}} {{AAM}} [[User:K.Nouman|Khuram Nouman, M.D. [4]]] | ||
==Overview== | ==Overview== | ||
Thymoma must be differentiated from | Thymoma must be differentiated from [[thymic carcinoma]], [[mediastinal germ cell tumor]], [[Thymus|thymic]] masses, [[lymphoma]], and sub-[[Sternum|sternal]] [[Thyroid disease|thyroid]]. | ||
== | ==Differentiating Thymoma from other Diseases== | ||
Thymoma | |||
{| | {| | ||
|+ | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
! rowspan="2" |Diseases | ! rowspan="2" |Diseases | ||
!Site | !Site | ||
! colspan="3" |Clinical Features | ! colspan="3" |Clinical Features | ||
| colspan="3" |'''Pathology''' | |||
|'''Labs''' | |||
|- style="background: #4479BA; color: #FFFFFF; text-align: center;" | |- style="background: #4479BA; color: #FFFFFF; text-align: center;" | ||
!Mediastinal Part | !Mediastinal Part | ||
!Systemic Symptoms | |||
!Obstructive Symptoms | |||
!Additional Features | |||
!Cell Organization | !Cell Organization | ||
!Tumor Cells | !Tumor Cells | ||
!Lymphoid Cells | !Lymphoid Cells | ||
!Additional Tests | !Additional Tests | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Mediastinal germ cell tumor|Mediastinal Germ Cell Tumor]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * [[Anatomical terms of location|Anterior]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *[[Chest pain, cough and dyspnea|Chest pain]], | ||
*[[Cough]] | |||
*[[Dyspnea|Difficulty breathing]] | |||
*[[Weight loss]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *[[Superior vena cava syndrome]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[ | *Post-obstructive [[pneumonia]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Non-adhesive | ||
| style="background: #F5F5F5; padding: 5px;" | | | 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * [[Anatomical terms of location|Anterior]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *[[Fever and cough|Fever]] | ||
*[[Night sweats]] | |||
*[[Weight loss]] (depending on the type of mass) | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *[[Stridor]] | ||
*[[Superior vena cava syndrome]] | |||
*[[Face|Facial]] [[swelling]] | |||
*[[Odynophagia|Painful swallowing]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[ | *[[Horner syndrome]] due to [[Mass effect (medicine)|mass effect]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Varies | ||
| style="background: #F5F5F5; padding: 5px;" | | | 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]] | |||
|Anterior | * [[Non-Hodgkin Lymphoma|Non-Hodgkin lymphoma]] | ||
| style="background: #F5F5F5; padding: 5px;" | | * [[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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *[[Phrenic nerve]] [[palsy]] | ||
*[[Hoarseness]] | |||
* | *[[Superior vena cava syndrome]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *[[Pleural effusion]] | ||
* | *[[Pericardial effusion]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * Non-adhesive | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[ | *Immature [[Lymphoid cell|lymphoid cells]] ([[Non-Hodgkin lymphoma]]) | ||
* [[ | *[[Reed-Sternberg cells]] and variants ([[Hodgkin's lymphoma]]) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *Immature([[Non-Hodgkin lymphoma]]) | ||
* [[ | *Mature, small ([[Hodgkin's lymphoma]]) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *LCA+ | ||
* [[ | *[[Light chain]] restriction in B-[[Non-Hodgkin lymphoma|NHL]] | ||
*[[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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | * [[Anterior mediastinum|Anterior]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | 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;" | | | 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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *[[Hurthle cells]] | ||
* [[ | *Prominent [[Nucleolus|nucleoli]] | ||
*Abundant [[cytoplasm]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*[[Non-Hodgkin Lymphoma|Non-Hodgkin]] type is more common in [[thyroid]] [[lymphoma]] | |||
* [[ | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *[[Antibodies]] against [[thyroid peroxidase]] | ||
* | |||
*[[Antibodies]] against [[thyroglobulin]] | |||
|} | |} | ||
* The following table | |||
=== Thymoma Vs Thymic Carcinoma === | |||
* The following table highlights the difference between thymoma and thymic carcinoma: | |||
{| | {| | ||
| [[File:diff.png|800px|thumb|Differential diagnosis of | | [[File:diff.png|800px|thumb|Differential diagnosis of thymoma types A, AB, B, and [[Thymic cancer|thymic carcinomas]].]] | ||
|} | |} | ||
==Other | ==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]]. | 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" | {| class="wikitable" | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Disease | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Addison's | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Addison's Disease | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Type 1 | ! 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;" + |Hypothyroidism | ||
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other | ! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other Disorders Present | ||
|- | |- | ||
!APS type 1 | |||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|Less common | | | ||
|Less common | * Less common | ||
|[[Hypoparathyroidism]] | | | ||
* Less common | |||
| | |||
* [[Hypoparathyroidism]] | |||
* [[Candidiasis]] | |||
* [[Hypogonadism]] | |||
|- | |- | ||
!APS type 2 | |||
| + | | + | ||
| + | | + | ||
| + | | + | ||
|[[Hypogonadism]] | | | ||
* [[Hypogonadism]] | |||
* [[Malabsorption]] | |||
|- | |- | ||
!APS type 3 | |||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| + | | + | ||
|<nowiki>+</nowiki> | |<nowiki>+</nowiki> | ||
|[[Malabsorption]] | | | ||
* [[Malabsorption]] | |||
|- | |- | ||
![[Thymoma]] | |||
| + | | + | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| + | | + | ||
|[[Myasthenia gravis]] | | | ||
* [[Myasthenia gravis]] | |||
* [[Cushing syndrome]] | |||
|- | |- | ||
![[Chromosomal abnormalities]]<br>([[Turner syndrome]],<br>[[Down's syndrome]]) | |||
| - | | - | ||
| + | | + | ||
| + | | + | ||
|[[Cardiac dysfunction ]] | | | ||
* [[Cardiac dysfunction]] | |||
|- | |- | ||
![[Kearns–Sayre syndrome]] | |||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| + | | + | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|[[Myopathy]] | | | ||
* [[Myopathy]] | |||
* [[Hypoparathyroidism]] | |||
* [[Hypogonadism]] | |||
|- | |- | ||
![[Wolfram syndrome]] | |||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| + | | + | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|[[Diabetes insipidus]] | | | ||
* [[Diabetes insipidus]] | |||
* [[Optic atrophy]] | |||
* [[Deafness]]<br> | |||
|- | |- | ||
![[POEMS syndrome]] | |||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
| + | | + | ||
|<nowiki>-</nowiki> | |<nowiki>-</nowiki> | ||
|[[Polyneuropathy]] | | | ||
* [[Polyneuropathy]] | |||
* [[Hypogonadism]] | |||
* [[Plasma cell dyscrasia|Plasma cell dyscrasias]] | |||
|} | |} | ||
==References== | ==References== | ||
<references /> | <references /> |
Latest revision as of 22:28, 8 August 2019
![](/images/1/16/Home_logo1.png)
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 | Site | Clinical Features | Pathology | Labs | ||||
---|---|---|---|---|---|---|---|---|
Mediastinal Part | Systemic Symptoms | Obstructive Symptoms | Additional Features | Cell Organization | Tumor Cells | Lymphoid Cells | Additional Tests | |
Mediastinal Germ Cell Tumor |
|
|
|
|||||
Thymic masses
|
|
|
|
|
|
|||
Lymphoma |
|
|
|
| ||||
Sub-sternal goiter & thyroid lymphoma |
|
|
|
|
|
|
Thymoma Vs Thymic Carcinoma
- The following table highlights the difference between thymoma and thymic carcinoma:
![]() |
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 | + |
|
|
|
APS type 2 | + | + | + | |
APS type 3 | - | + | + | |
Thymoma | + | - | + | |
Chromosomal abnormalities (Turner syndrome, Down's syndrome) |
- | + | + | |
Kearns–Sayre syndrome | - | + | - | |
Wolfram syndrome | - | + | - | |
POEMS syndrome | - | + | - |