Thymoma differential diagnosis: Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
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> | 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> | ||
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===Anterior Mediastinal Masses=== | ===Anterior Mediastinal Masses=== | ||
It's very difficult to differentiate radiologically | It's very difficult to differentiate radiologically. | ||
*'''Thymic masses''' | *'''Thymic masses''' | ||
:-[[Thymoma]] Benign tumor that arise from the thymus and is associated with more than 15% of patients with [[myasthenia gravis]]. | :-[[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 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]]. | :-Thymic Hyperplasia: Resected only if associated [[paraneoplastic syndrome]]. | ||
:-[[Thymolipoma]]: Increased thymic size with mixed adipose tissue. | :-[[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 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. | :-Thymic [[Carcinoid]]: Also called [[thymic neuroendocrine tumors]], uncommon and present as mass in the anterior mediastinum. | ||
:-Ectopic [[parathyroid]] tissue | :-Ectopic [[parathyroid]] tissue | ||
*'''Germ cell tumors''' | *'''Germ cell tumors''' | ||
Most common site for extragonadal germ cell tumors is the mediastinum. | 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. | :-[[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> | :-[[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> | ||
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::-Seminomas: Slightly more common, grow slowly but might reach large sizes. | ::-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. | ::-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. | 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) | *'''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}}. | 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}}. | ||
Revision as of 20:14, 26 February 2014
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Amr Marawan, M.D. [2]
Differential Diagnosis
Differential diagnosis of thymomas types A, AB, B and thymic carcinomas.[1]
 |
Anterior Mediastinal Masses
It's very difficult to differentiate radiologically.
- 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.[2]
- -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.