Thymoma natural history: Difference between revisions

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Latest revision as of 23:04, 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]

Overview

If left untreated, thymoma may progress to invade the mediastinum and the surrounding structures. Depending on the stage of the tumor at the time of diagnosis, the prognosis may vary. The prognosis is generally regarded as good. Common complications of thymoma include the pressure effect of the mass itself, autoimmune diseases, and rarely, progression to malignancy.

Natural History, Complications, and Prognosis

Natural History

One-third of the tumors are discovered because of an associated autoimmune disorder.
The most common of these autoimmune disorders is myasthenia gravis: 10 - 15% of patients with myasthenia gravis have thymoma. And 30 - 45% of patients with thymoma have myasthenia gravis.
Patients with thymoma demonstrate a tendency for local mediastinal recurrence and pleural ‘‘droplet’’ recurrence presumably caused by mediastinal pleural invasion after resection.^[1]

Complications

Complications associated with thymoma include:

Pressure effect associated with thymoma (sometimes presenting as superior vena cava syndrome)
Autoimmune diseases associated with thymoma (myasthenia gravis and pure red cell aplasia)
Thymic malignancy of unknown etiology
Rarely (approximately 7% of cases), metastasis to pleura, bones, liver, or brain^[2]

Complications of Radiotherapy

The most common complications of radiotherapy are:^[1]

Complications of Surgery

The most common complications of thymectomy are:

Complications of the procedure, such as:
- Bleeding
- Infection
- Damage to other organs
- Nerve injuries (bilateral phrenic nerve injury)
- Respiratory failure
Recurrence has been described 10 to 20 years after removal of the primary lesion, necessitating long-term follow up.
Live attenuated vaccines, such as yellow fever vaccine, may have adverse effects after thymectomy due to an inadequate T-cell response.

Complications of Taking Thymic Biopsy

The complications of taking thymic biopsy include:

Prognosis

The prognosis of thymoma depends on the following:

Location of the tumor
Stage of the tumor

The prognosis is much worse for stage III or IV thymoma as compared to stage I and II tumors
Patients with stage III and IV tumors may nonetheless survive for several years with appropriate oncological management

Resectability of the tumor
Patient's general health
Primary diagnosis vs. recurrence
Histologic type (mixed histologic type is associated with the worst prognosis)^[1]

References

↑ ^1.0 ^1.1 ^1.2 "Results of surgical treatment for t... [J Thorac Cardiovasc Surg. 1984] - PubMed - NCBI".
↑ Thomas CR, Wright CD, Loehrer PJ (1999). "Thymoma: state of the art". Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 17 (7): 2280–9. PMID 10561285. Text "accessdate" ignored (help); Unknown parameter |month= ignored (help)

Template:WikiDoc Sources

[www.ncbi.nlm.nih.gov-1] 1.0 ^1.1 ^1.2 "Results of surgical treatment for t... [J Thorac Cardiovasc Surg. 1984] - PubMed - NCBI".

[pmid10561285-2] Thomas CR, Wright CD, Loehrer PJ (1999). "Thymoma: state of the art". Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology. 17 (7): 2280–9. PMID 10561285. Text "accessdate" ignored (help); Unknown parameter |month= ignored (help)

[1]

[2]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{Thymoma}}
-{{CMG}} {{AE}} {{AM}}
+{{CMG}} {{AE}} {{AM}} {{AAM}}
-Please help WikiDoc by adding more content here.  It's easy!  Click  [[Help:How_to_Edit_a_Page|here]]  to learn about editing.
 ==Overview==
-The main prognostic factors for recurrence and survival are the stage at diagnosis and whether a complete resection has been achieved. Other prognostic factors with less impact on prognosis are the histological subtype, tumour size at diagnosis, age, gender and presence or absence of myasthenia gravis.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = A review of prognostic factors in thymic mali... [J Thorac Oncol. 2011] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/21847050 | publisher =  | date =  | accessdate = }}</ref>
+If left untreated, thymoma may progress to invade the [[mediastinum]] and the surrounding structures. Depending on the [[Cancer staging|stage]] of the [[tumor]] at the time of [[diagnosis]], the [[prognosis]] may vary. The [[prognosis]] is generally regarded as good. Common [[Complication (medicine)|complications]] of thymoma include the [[Mass effect (medicine)|pressure effect]] of the mass itself, [[autoimmune diseases]], and rarely, progression to [[malignancy]].
-The natural history of [[thymoma]] certainly illustrates the tendency for local mediastinal recurrence and pleural ‘‘droplet’’ recurrence presumably caused by mediastinal pleural invasion after resection. Local recurrences have been noted in the surgical incision used to completely remove a thymoma.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Results of surgical treatment for t... [J Thorac Cardiovasc Surg. 1984] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/6690858 | publisher =  | date =  | accessdate = }}</ref>
+==Natural History, Complications, and Prognosis==
+===Natural History===
-==Natural history==
+*One-third of the [[Tumor|tumors]] are discovered because of an associated [[autoimmune disorder]].
-Thymic malignancies are generally considered indolent tumours due to long recurrence intervals (median of 68 months). Overall, for patients diagnosed with a resectable thymic tumor, 16% of them will recur after radical resection, either locally with pleural or ganglionar recurrence or with distant metastases. The most common sites of distant recurrence are lung, liver, bone, kidney, brain and bone marrow.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Recurrence of thymoma: clinicopathological feat... [J Surg Oncol. 2001] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/11745803 | publisher =  | date =  | accessdate = }}</ref>
+*The most common of these [[Autoimmune disorder|autoimmune disorders]] is [[myasthenia gravis]]: 10 - 15% of [[Patient|patients]] with [[myasthenia gravis]] have thymoma. And 30 - 45% of [[Patient|patients]] with thymoma have [[myasthenia gravis]].
+*[[Patient|Patients]] with thymoma demonstrate a tendency for local [[Mediastinum|mediastinal]] recurrence and [[pleural]] ‘‘droplet’’ recurrence presumably caused by [[Mediastinal pleura|mediastinal pleural]] [[Invasive (medical)|invasion]] after [[resection]].<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Results of surgical treatment for t... [J Thorac Cardiovasc Surg. 1984] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/6690858 | publisher =  | date =  | accessdate = }}</ref>
-==Complications==
+===Complications===
-Thymoma doesn't have complications other than the pressure effect that it might cause (sometimes presented as [[superior vena cava syndrome]]). The complications are mostly due to the associated autoimmune diseases (e.g. [[myasthenia gravis]], [[pure red cell aplasia]]) or complications of surgical removal.
+[[Complication (medicine)|Complications]] associated with thymoma include:
+*[[Mass effect (medicine)|Pressure effect]] associated with thymoma (sometimes presenting as [[superior vena cava syndrome]])
+* [[Autoimmune diseases]] associated with thymoma ([[myasthenia gravis]] and [[pure red cell aplasia]])
+*[[Thymic]] [[malignancy]] of unknown [[etiology]]
+*Rarely (approximately 7% of cases), [[metastasis]] to [[pleura]], [[bones]], [[liver]], or [[brain]]<ref name="pmid10561285">{{cite journal |author=Thomas CR, Wright CD, Loehrer PJ |title=Thymoma: state of the art |journal=[[Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology]] |volume=17 |issue=7 |pages=2280–9 |year=1999 |month=July |pmid=10561285 |doi= |url=http://www.jco.org/cgi/pmidlookup?view=long&pmid=10561285 |accessdate}}</ref>
 ====Complications of Radiotherapy====
-The most common complications with radiotherapy are: [[pulmonary fibrosis]], [[pericarditis]] and [[myelitis]]. IMRT, a new technique of radiotherapy will hopefully have less toxicities.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Technical advances of radiation therapy for t... [J Thorac Oncol. 2010] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/20859129 | publisher =  | date =  | accessdate = }}</ref>
+The most common [[complications]] of [[Radiation therapy|radiotherapy]] are:<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = Technical advances of radiation therapy for t... [J Thorac Oncol. 2010] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/20859129 | publisher =  | date =  | accessdate = }}</ref>
+*[[Pulmonary fibrosis]]
+*[[Pericarditis]]
+*[[Myelitis]]
 ====Complications of Surgery====
-The complications of the procedure is rare but they should be considered. Bleeding, infection, damage to other organs, nerve injuries(biateral phrenic nerve injury) and respiratory failure.
+The most common [[Complication (medicine)|complications]] of [[thymectomy]] are:
-Local recurrence is more common than distant especially in advanced stages of the disease. Recurrence was described 10-20 years after removal of the primary lesion, so long term follow up is very important.
+*[[Complication (medicine)|Complications]] of the procedure, such as:
+**[[Bleeding]]
-==Prognosis==
+**[[Infection]]
-Prognosis is much worse for stage III or IV thymomas as compared with stage I and II tumors. Invasive thymomas uncommonly can also metastasize, generally to pleura, bones, liver or brain in approximately 7% of cases.<ref name="pmid10561285">{{cite journal |author=Thomas CR, Wright CD, Loehrer PJ |title=Thymoma: state of the art |journal=[[Journal of Clinical Oncology : Official Journal of the American Society of Clinical Oncology]] |volume=17 |issue=7 |pages=2280–9 |year=1999 |month=July |pmid=10561285 |doi= |url=http://www.jco.org/cgi/pmidlookup?view=long&pmid=10561285 |accessdate}}</ref>
+**Damage to other [[Organ (anatomy)|organs]]
+**[[Nerve injury|Nerve injuries]] ([[bilateral]] [[phrenic nerve]] injury)
-Patients with stage III and IV tumors may nonetheless survive for several years with appropriate oncological management.
+**[[Respiratory failure]]
+*Recurrence has been described 10 to 20 years after removal of the [[Primary tumor|primary lesion]], necessitating long-term follow up.
+*Live attenuated [[vaccines]], such as [[yellow fever]] vaccine, may have [[adverse effects]] after [[thymectomy]] due to an inadequate [[T cell|T-cell]] response.
-Patients who have undergone thymectomy for thymoma should be warned of possible severe side effects after [[yellow fever]] vaccination. This is probably caused by inadequate T-cell response to live attenuated [[yellow fever]] vaccine. Deaths have been reported.
+====Complications of Taking Thymic Biopsy====
+The [[Complication (medicine)|complications]] of taking [[Thymus|thymic]] [[biopsy]] include:
+*[[Pneumothorax]]
+*[[Mediastinitis]]
-The prognosis of thymoma depends on the following:
+===Prognosis===
-*The location of the tumor.
+The [[prognosis]] of thymoma depends on the following:
-*The stage of the tumor.
+*Location of the [[tumor]]
-*Whether the tumor can be removed completely by surgery.
+*[[Cancer staging|Stage]] of the [[tumor]]
-*The patient's general health.
-*Whether the cancer has just been diagnosed or has recurred.
-The prognostic significance of the histologic type is somewhat variable because of the subjectivity of the classification into lymphocyte predominant, epithelial predominant, and mixed. The mixed histologic type was associated with the worst prognosis. The presence of myasthenia gravis at diagnosis is of less prognostic significance today.<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = A review of prognostic factors in thymic mali... [J Thorac Oncol. 2011] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/21847050 | publisher =  | date =  | accessdate = }}</ref>
+:*The [[prognosis]] is much worse for stage III or IV thymoma as compared to stage I and II [[Tumor|tumors]]
-{|
+:*[[Patient|Patients]] with stage III and IV [[Tumor|tumors]] may nonetheless survive for several years with appropriate [[Oncology|oncological]] management
-| [[File:ttt.png|1200px|thumb]]
+*[[Resection|Resectability]] of the [[tumor]]
-|}
+*[[Patient|Patient's]] general [[health]]
+*Primary [[diagnosis]] vs. recurrence
+*[[Histology|Histologic]] type (mixed [[Histology|histologic]] type is associated with the worst [[prognosis]])<ref name="www.ncbi.nlm.nih.gov">{{Cite web  | last =  | first =  | title = A review of prognostic factors in thymic mali... [J Thorac Oncol. 2011] - PubMed - NCBI | url = http://www.ncbi.nlm.nih.gov/pubmed/21847050 | publisher =  | date =  | accessdate = }}</ref>
 ==References==
 {{Reflist|2}}
-[[Category:Needs content]]
-[[Category:Oncology]]
 [[Category:Types of cancer]]
 [[Category:Rare diseases]]
 [[Category:Disease]]
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+ [[Category:Up-To-Date]]
+[[Category:Oncology]]
+[[Category:Medicine]]
+[[Category:Hematology]]
+[[Category:Immunology]]
+[[Category:Surgery]]