Thymoma differential diagnosis: Difference between revisions

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__NOTOC__
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{{Thymoma}}
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Thymoma]]
{{CMG}}; {{AE}} {{AM}}
{{CMG}} {{AE}} {{AM}} {{AAM}}  [[User:K.Nouman|Khuram Nouman, M.D. [4]]]
==Overview==
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==
Differential diagnosis of thymomas types A, AB, B and [[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]]
|+
|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
! rowspan="2" |Diseases
!Site
! 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
|-
! 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]])
 
*[[Reed-Sternberg cells]] and variants ([[Hodgkin's lymphoma]])
| style="background: #F5F5F5; padding: 5px;" |
*Immature([[Non-Hodgkin lymphoma]])
*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: 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]]
 
*[[Antibodies]] against [[thyroglobulin]]
|}
 
 
=== Thymoma Vs Thymic Carcinoma ===
* The following table highlights the difference between thymoma and thymic carcinoma:
{|
| [[File:diff.png|800px|thumb|Differential diagnosis of thymoma types A, AB, B, and [[Thymic cancer|thymic carcinomas]].]]
|}
|}


===Anterior Mediastinal Masses===
==Other Differential Diagnoses==
It's very difficult to differentiate radiologically.
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]].
*'''Thymic masses'''
:-[[Thymoma]] Benign tumor that arise from the thymus and is associated with more than 15% of patients with [[myasthenia gravis]].
:-Thymic Cyst: It is incidental mass that may be congenital or acquired. It might contain [[parathyroid]] or salivary tissue, as they has a common embryological origin.
:-Thymic Hyperplasia: Resected only if associated [[paraneoplastic syndrome]].
:-[[Thymolipoma]]: Increased thymic size with mixed [[adipose tissue]].
:-[[Thymic Carcinoma]]: Rare thymic tumor, poor survival rate, high rate of recurrence. Sometimes called [[type C thymoma]].
:-Thymic [[Carcinoid]]: Also called [[thymic neuroendocrine tumors]], uncommon and present as mass in the anterior mediastinum.
:-Ectopic [[parathyroid]] tissue
*'''Germ cell tumors'''
Most common site for extragonadal [[germ cell tumors]] is the mediastinum.
:-[[Teratomas]]: Represents two thirds of mediastinal GCTs. Usually benign, but when malignant it's very aggressive and very poor prognosis.
:-[[Dermoid cysts]]: 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>
:-Malignant GCTs: 90% of malignant mediastinal GCTs occur in males. Full physical examination and scrotal U/S is required.
::-Seminomas: Slightly more common, grow slowly but might reach large sizes.
::-Non-seminomatous GCTs: Consists of [[yolk sac carcinoma]], [[embryonal cell carcinoma]], and/or [[choriocarcinoma]]. Commonly between 20-40 years of age.
Tumor markers are very helpful in diagnosing GCTs. [[AFP]] is normal in [[teratoma]] and “pure” [[seminomas]]. [[Beta-HCG]] is mildly elevated in 10 percent of patients with seminomas. Ninety percent of non-seminomatous GCTs have elevated AFP and/or beta-HCG.
*'''Lymphoma''' (terrible, could be middle or posterior mediastinal too)
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 as fever weight loss and night sweats and may also have other symptoms as [[chest pain]], [[wheezes]], [[dyspnea]] or [[superior vena cava syndrome}}.
*'''Thyroid''' (intrathyroid goitre)
Presents with [[shortness of breath]] or [[dysphagia]].


{| 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;" + |Type 1 Diabetes Mellitus
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Hypothyroidism
! align="center" style="background:#4479BA; color: #FFFFFF;" + |Other Disorders Present
|-
!APS  type 1
|<nowiki>+</nowiki>
|
* Less common
|
* Less common
|
* [[Hypoparathyroidism]]
* [[Candidiasis]]
* [[Hypogonadism]]
|-
!APS  type 2
| +
| +
| +
|
* [[Hypogonadism]]
* [[Malabsorption]]
|-
!APS  type 3
|<nowiki>-</nowiki>
| +
|<nowiki>+</nowiki>
|
* [[Malabsorption]]
|-
![[Thymoma]]
| +
|<nowiki>-</nowiki>
| +
|
* [[Myasthenia gravis]]
* [[Cushing syndrome]]
|-
![[Chromosomal abnormalities]]<br>([[Turner syndrome]],<br>[[Down's syndrome]])
| -
| +
| +
|
* [[Cardiac dysfunction]]
|-
![[Kearns–Sayre syndrome]]
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|
* [[Myopathy]]
* [[Hypoparathyroidism]]
* [[Hypogonadism]]
|-
![[Wolfram syndrome]]
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|
* [[Diabetes insipidus]]
* [[Optic atrophy]]
* [[Deafness]]<br>
|-
![[POEMS syndrome]]
|<nowiki>-</nowiki>
| +
|<nowiki>-</nowiki>
|
* [[Polyneuropathy]]
* [[Hypogonadism]]
* [[Plasma cell dyscrasia|Plasma cell dyscrasias]]
|}
==References==
==References==
{{Reflist|2}}
<references />
 
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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 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
  • Non-adhesive
  • Mature looking
  • Small
Thymic masses
  • Thymoma
  • Cyst
  • Thymic carcinoma
  • Thymolipoma
  • Parathyroid hyperplasia)
  • Varies
  • Varies with type
  • Varies with type
Lymphoma
  • Non-adhesive
Sub-sternal goiter & thyroid lymphoma
  • Varies


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
APS type 2 + + +
APS type 3 - + +
Thymoma + - +
Chromosomal abnormalities
(Turner syndrome,
Down's syndrome) 		- + +
Kearns–Sayre syndrome - + -
Wolfram syndrome - + -
POEMS syndrome - + -

References


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