Thymoma differential diagnosis
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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] Ahmad Al Maradni, M.D. [3]
Overview
Thymoma must be differentiated from other diseases such as thymic carcinoma, thymic cyst, thymic hyperplasia and germ cell tumors.
Differential Diagnosis
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Thymoma must be differentiated from other diseases such as:
- Thymic masses
- 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 a mass in the anterior mediastinum.
- Ectopic parathyroid tissue.
- Germ cell tumors
- The most common site of extragonadal germ cell tumors is the mediastinum.
- Teratomas: Represents two thirds of mediastinal germ cell tumor. 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 germ cell tumor: 90% of malignant mediastinal germ cell tumor occur in males. Full physical examination and scrotal ultrasound is required.
- Seminomas: Slightly more common, grow slowly but might reach large sizes.
- Non-seminomatous germ cell tumor: Consists of yolk sac tumor, embryonal cell carcinoma, and/or choriocarcinoma. Commonly between 20-40 years of age.
- 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 such as fever, weight loss, and night sweats and may also have other symptoms as chest pain, wheezing, dyspnea or superior vena cava syndrome.
- Thyroid (intrathyroid goitre)
- Grave's disease and Hashimoto's thyroiditis are usually associated with goitre.
- Presents with shortness of breath or dysphagia.