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__
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Thymoma]]
-{{CMG}} {{AE}} {{AM}} {{AAM}} Nouman M.K, M.D.[4]
+{{CMG}} {{AE}} {{AM}} {{AAM}}  [[User:K.Nouman|Khuram Nouman, M.D. [4]]]
 ==Overview==
-Thymoma must be differentiated from other diseases such as [[thymic carcinoma]], [[mediastinal germ cell tumor]],thymic masses,[[lymphoma]] and substernal [[Thyroid disease|thyroid]].
+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 as:<ref name="Dey2010">{{cite journal|last1=Dey|first1=Pranab|title=Diagnostic dilemma: Diagnostic algorithm in fine needle aspiration cytology of mediastinal tumors|journal=Indian Journal of Pathology and Microbiology|volume=53|issue=3|year=2010|pages=395|issn=0377-4929|doi=10.4103/0377-4929.68241}}</ref>
 {|
+|+
 |- style="background: #4479BA; color: #FFFFFF; text-align: center;"
 ! rowspan="2" |Diseases
 !Site
-! colspan="4" |Histology Findings and Lab Tests
 ! colspan="3" |Clinical Features
+| colspan="3" |'''Pathology'''
+|'''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
-!General Symptoms
-!Obstructive symptoms
-!Additional Features
 |-
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |[[Mediastinal germ cell tumor|Mediastinal Germ Cell Tumor]]
+! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Mediastinal germ cell tumor|Mediastinal Germ Cell Tumor]]
-|Anterior
-| style="background: #F5F5F5; padding: 5px;" |Non-adhesive
 | style="background: #F5F5F5; padding: 5px;" |
-* Cell with large nuclei and prominent nucleoli
+* [[Anatomical terms of location|Anterior]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Mature looking,small
+*[[Chest pain, cough and dyspnea|Chest pain]],
+*[[Cough]]
+*[[Dyspnea|Difficulty breathing]]
+*[[Weight loss]]
 | style="background: #F5F5F5; padding: 5px;" |
-* PLAP+
+*[[Superior vena cava syndrome]]
-* Serum AFP
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Chest pain, cough and dyspnea|Chest pain]],
+*Post-obstructive [[pneumonia]]
-* [[Cough]]
-* [[Dyspnea|Difficulty breathing]]
-* [[Weight loss]]
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Superior vena cava syndrome]]
+* Non-adhesive
 | style="background: #F5F5F5; padding: 5px;" |
-* Post obstructive pneumonia
+*[[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: center;" |[[Thymic masses]]
+! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Thymus|Thymic]] masses
-|Anterior
-| style="background: #F5F5F5; padding: 5px;" |Varies
+* 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;" |
-* Depend on mass type
+*[[Stridor]]
+*[[Superior vena cava syndrome]]
+*[[Face|Facial]] [[swelling]]
+*[[Odynophagia|Painful swallowing]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Varies with type
+*[[Horner syndrome]] due to [[Mass effect (medicine)|mass effect]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Depend on type
+* Varies
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Fever and cough|Fever]]
+*Varies with type
-* [[Night sweats]]
-* Weight loss(depend on mass type)
 | style="background: #F5F5F5; padding: 5px;" |
-* Stridor
+*Varies with type
-* Superior vena cava syndrome
-* Facial Swelling
-* [[Odynophagia]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Obstructive effect can cause [[Horner syndrome]]
+*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: center;" |[[Lymphoma]]
+! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Lymphoma]]
-|Anterior,middle
+* [[Non-Hodgkin Lymphoma|Non-Hodgkin lymphoma]]
-| style="background: #F5F5F5; padding: 5px;" |Non-adhesive
+* [[Hodgkin's lymphoma]]
+| style="background: #F5F5F5; padding: 5px;" |
+* [[Anterior mediastinum|Anterior]]
+* [[Middle mediastinum|Middle]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Immature lymphoid cells([[Non-Hodgkin lymphoma|Non-Hodgkin Lymphoma]]),
+*[[Fever and cough|Fever]]
+*[[Weight loss]]
-* Classical Reed Sternberg Cell and its variant(Hodgkin Lymphoma)
+*[[Night sweats]]
+*[[Shortness of breath while lying down|Shortness of breath]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Immature([[Non-Hodgkin lymphoma]])
+*[[Phrenic nerve]] [[palsy]]
-* Mature,small(Hodgkin lymphoma)
+*[[Hoarseness]]
+*[[Superior vena cava syndrome]]
 | style="background: #F5F5F5; padding: 5px;" |
-* LCA+,
+*[[Pleural effusion]]
-* Light chain restriction in B-NHL,
+*[[Pericardial effusion]]
-* CD15+,CD30+ in Hodgkin Lymphoma
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Fever and cough|Fever]]
+* Non-adhesive
-* [[Weight loss]]
-* [[Night sweats]]
-* [[Shortness of breath while lying down|Shortness of breath]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Phrenic nerve palsy
+*Immature [[Lymphoid cell|lymphoid cells]] ([[Non-Hodgkin lymphoma]])
-* [[Hoarseness]]
-* Superior vena cava syndrome
+*[[Reed-Sternberg cells]] and variants ([[Hodgkin's lymphoma]])
 | style="background: #F5F5F5; padding: 5px;" |
-* Pleural Effusion
+*Immature([[Non-Hodgkin lymphoma]])
-* [[Pericardial effusion]]
+*Mature, small ([[Hodgkin's lymphoma]])
+| 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: center;" |[[Thyroid]]
+! style="background: #DCDCDC; padding: 5px; text-align: left;" |Sub-[[Sternum|sternal]] [[goiter]] & [[thyroid]] [[lymphoma]]
-|Anterior
-| style="background: #F5F5F5; padding: 5px;" |Varies
 | style="background: #F5F5F5; padding: 5px;" |
-* Hurtle cells,prominent nucleoli,abundant cytoplasm
+* [[Anterior mediastinum|Anterior]]
 | style="background: #F5F5F5; padding: 5px;" |
-* [[Non-Hodgkin Lymphoma|Non-Hodgkin]] type is more common in Thyroid lymphoma
+*[[Symptom|Symptoms]] of [[hypothyroidism]](cold intolerance, [[weight gain]], and[[constipation]])
+*[[Hyperthyroidism]] (heat intolerance, [[weight loss]], and [[diarrhea]])
 | style="background: #F5F5F5; padding: 5px;" |
-* Antithyroid peroxidase antibodies,
+*Positional [[dyspnea]]
+*[[Choking]] sensation
-* Antithyroglobulin antibodies
+*[[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;" |
-* Symptoms of [[hypothyroidism]](cold intolerance,weight gain,constipation etc) or
+*[[Hurthle cells]]
-* [[Hyperthyroidism]] (heat intolerance,weight loss,diarrhea etc)
+*Prominent [[Nucleolus|nucleoli]]
+*Abundant [[cytoplasm]]
 | style="background: #F5F5F5; padding: 5px;" |
-* Positional dyspnea
+*[[Non-Hodgkin Lymphoma|Non-Hodgkin]] type is more common in [[thyroid]] [[lymphoma]]
-* Choking sensation
-* [[Wheezing]]
-* Superior vena cava syndrome
 | style="background: #F5F5F5; padding: 5px;" |
-* Vocal cord palsy
+*[[Antibodies]] against [[thyroid peroxidase]]
-* Horner Syndrome
+*[[Antibodies]] against [[thyroglobulin]]
 |}
-=== Thymomas Vs Thymic Carcinomas: ===
-* The following table shows the important differences between thymomas and thymic carcinomas:
+=== 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]].]]
+| [[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]].
+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==
 <references />