Thymoma natural history
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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
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. However, 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 patients have their thymomas discovered because of an associated autoimmune disorder. The most common of those conditions is myasthenia gravis: 10–15% of patients with myasthenia gravis have thymoma. Conversely, 30–45% of patients with thymomas have myasthenia gravis.
- Patients with thymoma demonstrate a tendency for local mediastinal recurrence and plural ‘‘droplet’’ recurrence presumably caused by mediastinal plural invasion after resection.[1]
Complications
Complications associated with thymoma may include:
- Pressure effect associated with thymoma (sometimes presented as superior vena cava syndrome)
- Autoimmune diseases associated with thymoma (e.g. myasthenia gravis, 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), and respiratory failure.
- Recurrence has been described 10 to 20 years after removal of the primary lesion, so long-term follow up is very important.
- Live attenuated vaccines such as yellow fever vaccine may have adverse effects after thymectomy due to an inadequate T-cell response.
Complications of Thymic Biopsy
The complications of 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 thymomas as compared with 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
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