Thymoma differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Thymoma]] | |||
{{CMG}} {{AE}} {{AM}} {{AAM}} [[User:K.Nouman|Khuram Nouman, M.D. [4]]] | {{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 | |||
{| | {| | ||
|+ | |+ | ||
Line 19: | Line 17: | ||
!Mediastinal Part | !Mediastinal Part | ||
!Systemic Symptoms | !Systemic Symptoms | ||
!Obstructive | !Obstructive Symptoms | ||
!Additional Features | !Additional Features | ||
!Cell Organization | !Cell Organization | ||
Line 26: | Line 24: | ||
!Additional Tests | !Additional Tests | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: left;" |[[Mediastinal germ cell tumor|Mediastinal Germ Cell Tumor]] | |||
|Anterior | | 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]], | *[[Chest pain, cough and dyspnea|Chest pain]], | ||
Line 36: | Line 35: | ||
*[[Superior vena cava syndrome]] | *[[Superior vena cava syndrome]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*Post obstructive pneumonia | *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;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*PLAP+ | *Mature looking | ||
*Serum AFP | *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 | |||
|Anterior | |||
* Thymoma | |||
* Cyst | |||
* Thymic carcinoma | |||
* Thymolipoma | |||
* Parathyroid hyperplasia) | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* [[Anatomical terms of location|Anterior]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*[[Fever and cough|Fever]] | *[[Fever and cough|Fever]] | ||
*[[Night sweats]] | *[[Night sweats]] | ||
*Weight loss( | *[[Weight loss]] (depending on the type of mass) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*Stridor | *[[Stridor]] | ||
*Superior vena cava syndrome | *[[Superior vena cava syndrome]] | ||
*Facial | *[[Face|Facial]] [[swelling]] | ||
*[[Odynophagia]] | *[[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 | *Varies with type | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
* | *Varies with type | ||
*Serum PTH | | style="background: #F5F5F5; padding: 5px;" | | ||
*CBC | *Varies with type | ||
*TSH,T3,T4 | *[[Serum]] [[Parathyroid hormone|PTH]] | ||
*beta-HCG | *[[Complete blood count|CBC]] | ||
*Serum AFP | *[[Thyroid-stimulating hormone|TSH]], [[Triiodothyronine|T3]], [[Thyroxine|T4]] | ||
*Gamma Globulins | *[[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]] | ||
* [[Hodgkin's lymphoma]] | |||
| style="background: #F5F5F5; padding: 5px;" | | |||
* [[Anterior mediastinum|Anterior]] | |||
* [[Middle mediastinum|Middle]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*[[Fever and cough|Fever]] | *[[Fever and cough|Fever]] | ||
Line 81: | Line 94: | ||
*[[Shortness of breath while lying down|Shortness of breath]] | *[[Shortness of breath while lying down|Shortness of breath]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*Phrenic nerve palsy | *[[Phrenic nerve]] [[palsy]] | ||
*[[Hoarseness]] | *[[Hoarseness]] | ||
*Superior vena cava syndrome | *[[Superior vena cava syndrome]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*Pleural | *[[Pleural effusion]] | ||
*[[Pericardial effusion]] | *[[Pericardial effusion]] | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*Immature lymphoid cells([[Non-Hodgkin lymphoma | * Non-adhesive | ||
| 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]]) | *Immature([[Non-Hodgkin lymphoma]]) | ||
*Mature,small(Hodgkin lymphoma) | *Mature, small ([[Hodgkin's lymphoma]]) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*LCA+ | *LCA+ | ||
*Light chain restriction in B-NHL | *[[Light chain]] restriction in B-[[Non-Hodgkin lymphoma|NHL]] | ||
*CD15+,CD30+ in Hodgkin | *[[CD15]]+, [[CD30]]+ in [[Hodgkin's lymphoma]] | ||
|- | |- | ||
! style="background: #DCDCDC; padding: 5px; text-align: left;" |Sub-[[Sternum|sternal]] [[goiter]] & [[thyroid]] [[lymphoma]] | |||
|Anterior | | style="background: #F5F5F5; padding: 5px;" | | ||
* [[Anterior mediastinum|Anterior]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*Symptoms of [[hypothyroidism]](cold intolerance,weight gain,constipation | *[[Symptom|Symptoms]] of [[hypothyroidism]](cold intolerance, [[weight gain]], and[[constipation]]) | ||
*[[Hyperthyroidism]] (heat intolerance,weight loss,diarrhea | *[[Hyperthyroidism]] (heat intolerance, [[weight loss]], and [[diarrhea]]) | ||
| style="background: #F5F5F5; padding: 5px;" | | | style="background: #F5F5F5; padding: 5px;" | | ||
*Positional dyspnea | *Positional [[dyspnea]] | ||
*Choking sensation | *[[Choking]] sensation | ||
*[[Wheezing]] | *[[Wheezing]] | ||
*Superior vena cava syndrome | *[[Superior vena cava syndrome]] | ||
| style="background: #F5F5F5; padding: 5px;" | | |||
*[[Vocal cord]] [[palsy]] | |||
*[[Horner's syndrome]] | |||
| style="background: #F5F5F5; padding: 5px;" | | | 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 | *[[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]] | ||
|} | |} | ||
=== | === Thymoma Vs Thymic Carcinoma === | ||
* The following table | * 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== |
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 | - | + | - |